Lethal Choice


Tennessee , which had previously offered inmates a choice between lethal injection and the electric chair , passed a law in May which gave the state the option to use the electric chair if lethal injection drugs are either unavailable or made unconstitutional. In , Pfizer joined over 20 American and European pharmaceutical manufacturers that had previously blocked the sale of their drugs for use in lethal injections, effectively closing the open market for FDA-approved manufacturers for any potential lethal execution drug. The condemned person is strapped onto a gurney ; two intravenous cannulas "IVs" are inserted, one in each arm.

Only one is necessary to carry out the execution; the other is reserved as a backup in the event the primary line fails. A line leading from the IV line in an adjacent room is attached to the prisoner's IV and secured so that the line does not snap during the injections. The arm of the condemned person is swabbed with alcohol before the cannula is inserted. Questions have been raised about why these precautions against infection are performed despite the purpose of the injection being death.

The several explanations include: Following connection of the lines, saline drips are started in both arms. This, too, is standard medical procedure: A heart monitor is attached to the inmate. The execution of the condemned in most states involves three separate injections in sequential order:. The drugs are not mixed externally because that can cause them to precipitate.

Also, a sequential injection is key to achieve the desired effects in the appropriate order: If the person being executed were not already completely unconscious, the injection of a highly concentrated solution of potassium chloride could cause severe pain at the site of the IV line, as well as along the punctured vein, but it interrupts the electrical activity of the heart muscle and causes it to stop beating, bringing about the death of the person being executed. The intravenous tubing leads to a room next to the execution chamber, usually separated from the condemned by a curtain or wall.

Typically, a prison employee trained in venipuncture inserts the needle, while a second prison employee orders, prepares, and loads the drugs into the lethal injection syringes. Two other staff members take each of the three syringes and secure them into the IVs. After the curtain is opened to allow the witnesses to see inside the chamber, the condemned person is then permitted to make a final statement. Following this, the warden signals that the execution may commence, and the executioner s either prison staff or private citizens depending on the jurisdiction then manually inject the three drugs in sequence.

During the execution, the condemned's cardiac rhythm is monitored. Death is pronounced after cardiac activity stops. Death usually occurs within seven minutes, although, due to complications in finding a suitable vein, the whole procedure can take up to two hours, as was the case with the execution of Christopher Newton on May 24, According to state law, if a physician 's participation in the execution is prohibited for reasons of medical ethics , then the death ruling can be made by the state medical examiner 's office.

After confirmation that death has occurred, a coroner signs the condemned's death certificate. Delaware and Missouri use a lethal injection machine designed by Massachusetts -based Fred A. Leuchter consisting of two components: Two staff members each have a station in which the key on the machine and depress two stations' buttons to be ready in case of mechanical failure. Each person presses one station button on the console which travels to a computer which starts all three injections electronically.

The computer then deletes who actually started the syringes, so the participants are not aware if their syringe contained saline or one of the drugs necessary for execution to assuage guilt in a manner similar to the blank cartridge in execution by firing squad. The delivery module has eight syringes.

The end syringes i. The system was used in New Jersey before the abolition of the death penalty in Illinois previously used the computer, and Missouri and Delaware use the manual injection switch on the delivery panel. Eleven states have switched, or have stated their intention to switch, to a one-drug lethal injection protocol. A one-drug method is using the single drug sodium thiopental to execute someone.

The first state to switch to this method was Ohio, on December 8, In , after pressure by activist organizations, the manufacturers of sodium thiopental and pentobarbital halted the supply of the drugs to U.

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In the past, the People's Republic of China executed prisoners primarily by means of shooting. In recent years, lethal injection has become more popular. The specific lethal injection procedures, including the drug or drugs used, are a state secret and not publicly known. Lethal injection in China was legalized in The number of shooting executions slowly decreased; and, in February , the Supreme People's Court ordered the discontinuation of firing squads by the following year under the conclusion that injections were more humane to the prisoner.

It has been suggested that the switch is also in response to executions being horrifying to the public. Lethal injections are less expensive than firing squads, with a single dose costing yuan compared to yuan for a shooting execution. Just like China, executions in Vietnam were also mainly by means of shooting.

The use of lethal injection method was approved by the government in June , adopted in and only executed in The drugs used consist of sodium thiopental anesthetic , pancuronium bromide paralyzing substance and potassium chloride stops cardiac activity. This led to drug shortages, use of domestic poisons and shooting execution to be considered to be adopted back.

The first prisoner in Vietnam to be executed by lethal injection, on August 6, , was the year-old man Nguyen Anh Tuan, arrested for murder and robbery. Typically, three drugs are used in lethal injection. Sodium thiopental is used to induce unconsciousness, pancuronium bromide Pavulon to cause muscle paralysis and respiratory arrest, and potassium chloride to stop the heart. Sodium thiopental US trade name: Sodium Pentothal is an ultra-short acting barbiturate, often used for anesthesia induction and for medically induced coma.

The typical anesthesia induction dose is 0. A full medical dose of thiopental reaches the brain in about 30 seconds. This induces an unconscious state. The half-life of this drug is about When a 'mega-dose' is administered, as in state-sanctioned lethal injection, the concentration in the brain during the tail phase of the distribution remains higher than the peak concentration found in the induction dose for anesthesia, because repeated doses—or a single very high dose as in lethal injection—accumulate in high concentrations in body fat, from which the thiopental is gradually released.

Historically, thiopental has been one of the most commonly used and studied drugs for the induction of coma. It is likely that this data was used to develop the initial protocols for state-sanctioned lethal injection, according to which one gram of thiopental was used to induce the coma. Pentobarbital was introduced at the end of due to a shortage of sodium thiopental, [37] and has since become the primary sedative in lethal injections in the United States.

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This finding that ROS1 inhibition, either genetically or with small-molecule inhibitors, affects E-cadherin—deficient cells was subsequently validated in in vitro experiments, as well as in ex vivo and in vivo models. Texas Department of Criminal Justice. Lethal injection is the practice of injecting one or more drugs into a person typically a barbiturate , paralytic , and potassium solution for the express purpose of causing immediate death. In reference to this problem, Jay Chapman , the creator of the American method, said, "It never occurred to me when we set this up that we'd have complete idiots administering the drugs. Eleven states have switched, or have stated their intention to switch, to a one-drug lethal injection protocol. The story of an imaginary word that managed to sneak past our editors and enter the dictionary.

Barbiturates are the same class of drug used in medically assisted suicide. In euthanasia protocols, the typical dose of thiopental is 1. Pancuronium bromide Trade name: The related drug curare , like pancuronium, is a non-depolarizing muscle relaxant a paralytic agent that blocks the action of acetylcholine at the motor end-plate of the neuromuscular junction. Binding of acetylcholine to receptors on the end-plate causes depolarization and contraction of the muscle fiber; non-depolarizing neuromuscular blocking agents like pancuronium stop this binding from taking place.

The typical dose for pancuronium bromide in capital punishment by lethal injection is 0. Paralysis of respiratory muscles will lead to death in a considerably shorter time. Other drugs in use are tubocurarine chloride and succinylcholine chloride. Pancuronium bromide is a derivative of the alkaloid malouetine from the plant Malouetia bequaertiana. Doctors prescribe potassium for patients when potassium levels are insufficient, called hypokalemia , in the blood. The potassium can be given orally, which is the safest route; or it can be given intravenously, in which case strict rules and hospital protocols govern the rate at which it is given.

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The usual intravenous dose is 10—20 mEq per hour and it is given slowly since it takes time for the electrolyte to equilibrate into the cells. When used in state-sanctioned lethal injection, bolus potassium injection affects the electrical conduction of heart muscle. Elevated potassium, or hyperkalemia , causes the resting electrical potential of the heart muscle cells to be lower than normal less negative. Without this negative resting potential, cardiac cells cannot repolarize prepare for their next contraction.

Depolarizing the muscle cell inhibits its ability to fire by reducing the available number of sodium channels they are placed in an inactivated state. Cases of patients dying from hyperkalemia usually secondary to renal failure are well known in the medical community, where patients have been known to die very rapidly, having previously seemed to be normal. The Ohio protocol, developed after the incomplete execution of Romell Broom , ensures the rapid and painless onset of anesthesia by only using sodium thiopental and eliminating the use of Pavulon and potassium as the second and third drugs, respectively.

It also provides for a secondary fail-safe measure using intramuscular injection of midazolam and hydromorphone in the event intravenous administration of the sodium thiopental proves problematic. In the brief for the U. On December 8, , Kenneth Biros became the first person executed using Ohio's new single-drug execution protocol.

He was pronounced dead at On September 10, , Washington became the second state to use the single-drug Ohio protocol with the execution of Cal Coburn Brown , who was proclaimed dead within two minutes after receiving the single-drug injection of sodium thiopental. Five additional states Arkansas , Kentucky , Louisiana , North Carolina , and Tennessee have announced that they are switching to a single-drug protocol but, as of April , have not executed anyone since switching protocols.

After sodium thiopental began being used in executions, Hospira , the only American company that made the drug, stopped manufacturing it due to its use in executions. Pentobarbital, often used for animal euthanasia , [44] was used as part of a three-drug cocktail for the first time on December 16, , when John David Duty was executed in Oklahoma. Lethal injection has also been used in cases of euthanasia to facilitate voluntary death in patients with terminal or chronically painful conditions. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred.

The following is a Dutch protocol for parenteral intravenous administration to obtain euthanasia, with the old protocol listed first and the new protocol listed second:. A euthanasia machine may allow an individual to perform the process alone. In , the Supreme Court ruled in Hill v. McDonough that death-row inmates in the United States could challenge the constitutionality of states' lethal injection procedures through a federal civil rights lawsuit. Since then, numerous death-row inmates have brought such challenges in the lower courts, claiming that lethal injection as currently practiced violates the ban on "cruel and unusual punishment" found in the Eighth Amendment to the United States Constitution.

For example, courts have found that lethal injection as practiced in California, [48] Florida, [49] and Tennessee [50] is unconstitutional. Other courts have found that lethal injection as practiced in Missouri, [51] Arizona, [52] and Oklahoma [53] is constitutionally acceptable. As of , California has nearly prisoners condemned to death by lethal injection despite the moratorium imposed when in a federal court found California's lethal injection procedures to be unconstitutional.

On April 16, , the Supreme Court rejected Baze v. Rees , thereby upholding Kentucky's method of lethal injection in a majority 7—2 decision. Supreme Court also upheld lethal injection in the case Glossip v. The American Medical Association AMA believes that a physician's opinion on capital punishment is a personal decision. Since the AMA is founded on preserving life, they argue that a doctor "should not be a participant" in executions in any professional capacity with the exception of "certifying death, provided that the condemned has been declared dead by another person" and "relieving the acute suffering of a condemned person while awaiting execution.

Typically, most states do not require that physicians administer the drugs for lethal injection, but most states do require doctors, nurses or paramedics to prepare the substances before their application and to attest the inmate's death after it. Some states specifically detail that participation in a lethal injection is not to be considered practicing medicine. Opponents of lethal injection have voiced concerns that abuse, misuse and even criminal conduct is possible when there is not a proper chain of command and authority for the acquisition of death-inducing drugs.

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Opponents of lethal injection believe that it is not actually painless as practiced in the United States. Opponents argue that the thiopental is an ultrashort-acting barbiturate that may wear off anesthesia awareness and lead to consciousness and an uncomfortable death wherein the inmates are unable to express discomfort because they have been rendered paralyzed by the paralytic agent. Opponents point to the fact that sodium thiopental is typically used as an induction agent and not used in the maintenance phase of surgery because of its short-acting nature.

Following the administration of thiopental, pancuronium bromide is given. Opponents argue that pancuronium bromide not only dilutes the thiopental, but since the inmate is paralyzed also prevents the inmate from expressing pain. Additional concerns have been raised over whether inmates are administered an appropriate level of thiopental owing to the rapid redistribution of the drug out of the brain to other parts of the body.

Additionally, opponents argue that the method of administration is also flawed.

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They state that since the personnel administering the lethal injection lack expertise in anesthesia, the risk of failing to induce unconsciousness is greatly increased. In reference to this problem, Jay Chapman , the creator of the American method, said, "It never occurred to me when we set this up that we'd have complete idiots administering the drugs.

Finally, the remote administration results in an increased risk that insufficient amounts of the lethal injection drugs enter the bloodstream. In total, opponents argue that the effect of dilution or improper administration of thiopental is that the inmate dies an agonizing death through suffocation due to the paralytic effects of pancuronium bromide and the intense burning sensation caused by potassium chloride.

Opponents of lethal injection, as currently practiced, argue that the procedure employed is designed to create the appearance of serenity and a painless death, rather than actually providing it. More specifically, opponents object to the use of pancuronium bromide, arguing that its use in lethal injection serves no useful purpose since the inmate is physically restrained. Therefore, the default function of pancuronium bromide would be to suppress the autonomic nervous system, specifically to stop breathing.

In , University of Miami researchers, in cooperation with the attorney representing death-row inmates from Virginia , published a research letter in the medical journal The Lancet. The article presented protocol information from Texas, Virginia, and North and South Carolina, which showed that executioners had no anesthesia training, drugs were administered remotely with no monitoring for anesthesia, data were not recorded, and no peer review was done.

The authors attributed the risk of consciousness among inmates to the lack of training and monitoring in the process, but carefully make no recommendations on how to alter the protocol or how to improve the process. Indeed, the authors conclude, "because participation of doctors in protocol design or execution is ethically prohibited, adequate anesthesia cannot be certain. Therefore, to prevent unnecessary cruelty and suffering, cessation and public review of lethal injections is warranted. Paid expert consultants on both sides of the lethal-injection debate have found opportunity to criticize the Lancet article.

Subsequent to the initial publication in the Lancet , three letters to the editor and a response from the authors extended the analysis. The issue of contention is whether thiopental, like many lipid-soluble drugs, may be redistributed from blood into tissues after death, effectively lowering thiopental concentrations over time, or whether thiopental may distribute from tissues into the blood, effectively increasing post mortem blood concentrations over time.

Given the near absence of scientific, peer-reviewed data on the topic of thiopental post mortem pharmacokinetics , the controversy continues in the lethal injection community and in consequence, many legal challenges to lethal injection have not used the Lancet article. In , the same group that authored the Lancet study extended its study of the lethal-injection process through a critical examination of the pharmacology of the barbiturate thiopental. This study — published in the online journal PloS Medicine [68] — confirmed and extended the conclusions made in the article and goes further to disprove the assertion that the lethal-injection process is painless.

To date, these two studies by the University of Miami team serve as the only critical peer-reviewed examination of the pharmacology of the lethal injection process. According to the new lethal injection protocols section above, single-drug lethal injection is already in use, or intended, in 11 states. The execution can be painlessly accomplished, without risk of consciousness, by the injection of a single large dose of a barbiturate.

Another possibility would be I. V administration of a powerful and fast-acting opioid , such as sufentanyl , which would ensure comfort while killing via respiratory depression. When sodium pentobarbital, a barbiturate used often in single drug animal euthanasia, is administered in an overdose, it causes rapid unconsciousness followed by paralysis of the diaphragm. This drug may also kill via cardiac arrhythmia. On occasion, difficulties inserting the intravenous needles have also occurred, sometimes taking over half an hour to find a suitable vein.

In addition, opponents point to instances where the intravenous line has failed, or when adverse reactions to drugs or unnecessary delays happen during the process of execution. On December 13, , Angel Nieves Diaz was not executed successfully in Florida using a standard lethal-injection dose. Diaz was 55 years old, and had been sentenced to death for murder. Diaz did not succumb to the lethal dose even after 35 minutes, necessitating a second dose of drugs to complete the execution. At first, a prison spokesman denied Diaz had suffered pain, and claimed the second dose was needed because Diaz had some sort of liver disease.

William Hamilton, stated that Diaz's liver appeared normal, but that the needle had been pierced through Diaz's vein into his flesh. The deadly chemicals had subsequently been injected into soft tissue, rather than into the vein. A study published in in the peer-reviewed journal PLoS Medicine suggested that "the conventional view of lethal injection leading to an invariably peaceful and painless death is questionable". The execution of Romell Broom was abandoned in Ohio on September 15, , after prison officials failed to find a vein after 2 hours of trying on his arms, legs, hands, and ankle.

This has stirred up intense debate in the United States about lethal injection. According to reporters, the execution of McGuire took more than 20 minutes and McGuire was gasping for air for 10 to 13 minutes. It was the first use of a new drug combination which was introduced in Ohio after the European Union banned sodium thiopental exports. Lockett was administered an untested mixture of drugs that had not previously been used for executions in the U.

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Lockett convulsed and spoke during the process, and attempted to rise from the execution table 14 minutes into the procedure, despite having been declared unconscious. Due to its use for executions in the US, the UK introduced a ban on the export of sodium thiopental in December , [80] after it was established that no European supplies to the US were being used for any other purpose. The combination of a barbiturate induction agent and a nondepolarizing paralytic agent is used in thousands of anesthetics every day.

Supporters of the death penalty argue that unless anesthesiologists have been wrong for the last 40 years, the use of pentothal and pancuronium is safe and effective. In fact, potassium is given in heart bypass surgery to induce cardioplegia. Therefore, the combination of these three drugs is still in use today. Supporters of the death penalty speculate that the designers of the lethal-injection protocols intentionally used the same drugs as used in everyday surgery to avoid controversy.

The only modification is that a massive coma-inducing dose of barbiturates is given.

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In addition, similar protocols have been used in countries that support euthanasia or physician-assisted suicide. Thiopental is a rapid and effective drug for inducing unconsciousness, since it causes loss of consciousness upon a single circulation through the brain due to its high lipophilicity. Only a few other drugs, such as methohexital , etomidate , or propofol , have the capability to induce anesthesia so rapidly. Narcotics such as fentanyl are inadequate as induction agents for anesthesia. Supporters argue that since the thiopental is given at a much higher dose than for medically induced coma protocols, it is effectively impossible for the condemned to wake up.

Anesthesia awareness occurs when general anesthesia is inadequately maintained, for a number of reasons.

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Typically, anesthesia is 'induced' with an intravenous drug, but 'maintained' with an inhaled anesthetic given by the anesthesiologist note that there are several other methods for safely and effectively maintaining anesthesia. Barbiturates are used only for induction of anesthesia and these drugs rapidly and reliably induce anesthesia, but wear off quickly.

See the full definition for lethal in the English Language Learners Dictionary. Translation of lethal for Spanish Speakers. Translation of lethal for Arabic Speakers. What made you want to look up lethal? Please tell us where you read or heard it including the quote, if possible. Test Your Knowledge - and learn some interesting things along the way. Subscribe to America's largest dictionary and get thousands more definitions and advanced search—ad free! How a folk song became a term of derision. The participle made famous by Elvis. And is one way more correct than the others?

The story of an imaginary word that managed to sneak past our editors and enter the dictionary. How to use a word that literally drives some people nuts. The awkward case of 'his or her'. Test your visual vocabulary with our question challenge! Adjective baleful , deadly , deathly , fatal , fell , killer , mortal , murderous , pestilent , terminal , vital Antonyms: Adjective healthful , healthy , nonfatal , nonlethal , wholesome Visit the Thesaurus for More. Choose the Right Synonym for lethal Adjective deadly , mortal , fatal , lethal mean causing or capable of causing death.

Lethal injection

Examples of lethal in a Sentence Adjective a potentially lethal dose of a drug He was sentenced to death by lethal injection. Recent Examples on the Web: Adjective The Reno Gazette-Journal reached out to two medical experts to help explain how each of Nevada's lethal injection drugs fentanyl, diazepam and cisatracurium work and how they're used in medicine. First Known Use of lethal Adjective circa , in the meaning defined at sense 1a Noun , in the meaning defined at sense 1. History and Etymology for lethal Adjective Latin letalis, lethalis , from letum death Noun see lethal entry 1.