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April 10, 2011

Understanding the science and debates over lethal injection protocols

The New York Times has this helpful new piece in its "Week in Review" section about the controversies surrounding lethal injection drugs.  The piece quotes from various medical authorities and is headlined "What’s in a Lethal Injection ‘Cocktail’?".   Here are excerpts:

The latest controversy over the always controversial subject of capital punishment: the drugs used to execute people on death row....

[Recent] challenges have been prompted by a shortage of one of the drugs, sodium thiopental, an anesthetic.  The American manufacturer of sodium thiopental, Hospira, recently announced that it would no longer produce the drug, and manufacturers in Europe do not want to supply the drug if it will be used in executions.  Some executions have been postponed while states try to sort out the drug situation.

In Texas, which carries out more executions than any other state, the controversy is focused on the proposed switch from sodium thiopental to pentobarbital in a three-drug cocktail.

What is the difference?  The two drugs come from the same family: barbiturates, drugs that depress the central nervous system.  So, in general, said Dr. John Dombrowski, director of the Washington Pain Center and a board member of the American Society of Anesthesiologists, “it’s like if you ask me what’s the difference between Johnnie Walker Blue, Black and Red — they’re all scotch.”

But sodium thiopental has been commonly used as an anesthetic in hospitals. Pentobarbital has a few medical uses in humans, but is often used by veterinarians to anesthetize or euthanize animals.  It has also been used in physician-assisted suicide in Oregon and in Europe....

Sodium thiopental is used in hospitals because it “has a relatively fast onset and it doesn’t last long,” Dr. [Mark A.] Warner [president of the American Society of Anesthesiologists] said.  “You want a patient to go sleep and wake up pretty quickly.”

Pentobarbital is a long-acting drug.... used in hospitals in certain circumstances, like inducing a coma in brain-damaged patients because “that allows the brain to use more energy and oxygen to repair itself,” Dr. Warner said.   He said it can also be used to stop seizures in patients for whom other drugs are ineffective.

Opponents of the death penalty object to either drug.  Some say thiopental can wear off too quickly, allowing inmates to feel pain.  Others object to using pentobarbital, because it is so infrequently used in humans.

In the three-step cocktail common in executions, a barbiturate is given with pancuronium bromide, a paralyzing drug, and potassium chloride, which induces cardiac arrest.  Dr. [Scott] Segal said all three drugs can have lethal effects.  “I’m not sure anyone knows which drug actually kills someone,” he said. 

In fact, one can do the job.  Ohio has used both barbiturates by themselves in executions.

April 10, 2011 at 01:10 PM | Permalink


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Because pentobarbital is rarely used in humans (but is), it's illegitimate to use in lethal injection? That's just nonsense. But what else can one expect from that crowd. What's appalling is that judges have actually swallowed some of this lethal injection nonsense. Remember that Lancet Study . . . .

Posted by: federalist | Apr 10, 2011 1:20:45 PM

This is another pretextual and false use of the law. Experts in pain, in anesthesiology, in veterinary medicine are completely irrelevant. They treat disease, and will go to extremes to save patients. For example, a drug induced coma to reduce energy requirement of damaged brain tissue is extreme medicine. Almost none of those folks will ever go home.

We are doing the opposite, taking healthy people and making them dead. If medical experts know nothing about those methods, lawyers know even less. That they get to decide anything is not appropriate.

Over 90% of us will suffer, for a long time, in humiliating decline of function, then we will die. Only 10% of us will have a nice death. The lawyer demands a perfect death for the butcher that cut a little girl's throat to enhance his sexual pleasure, devoid of anesthesia, heartless, unmoved by begging by an innocent human being.

How does one explain their advocacy for pure evil? They are a criminal enterprise themselves, and they are collecting the rent. I understand arguing that the client is innocent. That is proper and socially beneficial. But they are not, arguing over expiration dates, unauthorized importation, and a host of lawyer gotchas. They are almost as heartless and unmoved by begging as the client.

Morally reprehensible. Disgusting.

Posted by: Supremacy Claus | Apr 10, 2011 2:54:35 PM

I'm waiting for the NYT to run a series on some of the gruesome sorts of murders that result in juries' bringing in the death penalty. Somehow, I think I'll be waiting a long time.

All this minute examination of lethal injection chemicals is undertaken to shift focus onto the result (execution) while shoving the CAUSE (murder) down the memory hole.

And there's this too: It doesn't matter what mix of chemicals is settled upon, because it's not really about that. That's the same kind of dodge the moratorium is. Both the argument about the moratorium and about the chemical mix are designed, not to reach a solution, but to keep the ball rolling and thus to eliminate executions as a de facto matter without ever having to win the main debate in the court of public opinion.

Abolitionism in disguise is the only kind of abolitionism that even half-way sells, because peddled straight up and own its own merits, abolitionism is one of the bigger public policy flops around.

Posted by: Bill Otis | Apr 10, 2011 5:31:12 PM

Bill, I disagree. Abolitionists' main goal isn't convincing the public, but rather the judiciary. And they are winning that battle. The Supreme Court's recent stays of execution show a deep reticence on the part of the Court to let executions go through. That the Supreme Court is willing to debase itself by bending over backwards for capital murderers shows just how far the abolitionist cause has succeeded. And this is not the first time either. In the face of its own precedent, the Supreme Court granted blanket stays when Baze was being litigated. No matter, of course, that many of the murderers waited until the last minute to file their lethal injection claims, and no matter that the murderers could have raised the claims earlier.

This squeamishness about a punishment that has specific sanction in the constitution is ridiculous. That it comes from the Supreme Court is an embarrassment to the idea that we have the rule of law here.

Posted by: federalist | Apr 10, 2011 6:11:45 PM

federalist --

I think you paint with too broad a brush, and are (justifiably) ticked off by some momentary setbacks.

First, the way it actually works is that an institution with such historical and precedential weight behind it, not to mention 2-1 public support, is not about to be overturned.

Second, abbies are not winning with the judiciary. They're winning in a very few state legislatures that have temporarily bloated (and now, post-Novermber 2010, almost entirely disappeared) Democratic majorities, see, e.g., New Mexico, New Jersey and Illinois.

Third and relatedly, it's easy to mistake Anthony Kennedy for the judiciary since he is, in fact, the most important judicial vote in the country. He has proven more than capable of liberal blather about the DP (Kennedy v. Louisiana being the worst although hardly the only example), but he is not an abolitionist. If he were, there is no way he joins the main opinion by CJ Roberts in Baze. In addition, he has not dissented from the denial of a whole host of stays.

I agree that the quite recent stays in the Arizona and Texas cases are troubling to say the least, but I'm pretty sure they'll turn out to be more annoying than portentious.

The overall problem at the Supreme Court, where my wife used to clerk, is that it has inside-the-beltway tendencies, aggravated by inside-the-profession tendencies. There is always the danger that, when you get invited to too many Georgetown parties and too many fancy ABA conventions, you get sucked into that trailer-park-trash way of thinking so prevalent among Those Who Know Better Than You.

But be of good cheer. Reality has a way of striking back. If it's not Timmy McVeigh, it will by KSM, or the Petit murders, or something equally stomach-churning. With the public already overwhelmingly in favor of the DP, and with the only outright abolitionist (Stevens) off the Court, abbies will have a victory here and a victory there, but they hold a losing hand.

Posted by: Bill Otis | Apr 10, 2011 8:02:49 PM

Thank you for sharing,it is very helpful and I really like it!

Posted by: Big pony | Apr 11, 2011 6:08:34 AM

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