Execution Drugs:
Is Lethal Injection Humane?

When José Martinez High was executed by lethal injection in Georgia, the first steps were:

• being strapped to a gurney,
• having a heart monitor fastened to his chest, and
• waiting on the gurney while technicians found one or more usable veins in which to insert a catheter -- the IV needle and tubing into which the lethal chemicals would be fed.

From the time Martinez High was strapped to the gurney, it took him one hour and nine minutes to die. Advocates and prison officials would say that lethal injection takes ten minutes or less to kill, once the needle is inserted. They would say that the condemned person could be considered unconscious after the first few minutes. Death was so slow in coming to José Martinez High because for nearly an hour medical technicians, then a specially summoned physician, tried one after another of Martinez High's veins in an effort to find one that was not collapsed or buried in fat and would allow insertion of a needle.

Martinez High ended up with one needle in his hand, one in his neck, and a "central venous catheter" into the vein near the collarbone. One witness, a reporter for the Atlanta-Journal Constitution, could see that Martinez High "grimaced, appeared to cry, blinked rapidly and stared at a clock on the wall. At one point, he cried out but his words were unintelligible because the microphone in the room was off."

Manufacturing the equipment and chemicals used in both saving and ending life is big business. As one maker of central venous catheters notes in its advertising, "Your patient's needs may change by the minute, but their central venous access shouldn't." Martinez High finally received, minute to minute, a barbiturate intended to make him unconscious, a paralyzing agent to arrest all movement including breathing, and a third chemical to stop his heartbeat.

The chemicals most often used are sodium thiopental (the barbiturate), pancuronium bromide (the paralytic agent), and potassium chloride (the heart-stopping agent). Some of the condemned seem to react "atypically" to the chemicals. A witness to one Oklahoma execution counted 24 convulsions. In a Texas execution, the condemned man's prolonged writhing, gasping, and gagging caused a male witness to faint. Some slow deaths have been blamed on too-rapid administration of the drugs, placing the catheter so that its contents flowed away from the heart, or prisoner restraints that were too tight to let the death chemicals flow through the veins at all. John Wayne Gacy and his audience of witnesses had to wait, after the flow of chemicals had started and then unexpectedly stopped, while executioners replaced a clogged IV tube.

Is lethal injection humane? Based on experience, you could say, "Sometimes." Or you could say, "No one knows." The truth is that lethal injection is pretty much a do-it-yourself project, carried out by prison employees and contract labor at the execution site in each state. Each prison warden is guided by his or her budget priorities and available personnel, and by the state's often-vague legislation on administering death.

One of the strongest trends I uncovered while researching The Hangman's Knot is that a debate over humaneness, and a change in execution method, has accompanied every major era of capital punishment "reform." Lethal injection was debated as early as 1888, but physicians successfully opposed it as potentially associating medical practice with death. Today, doctors skirt the issue by supervising the execution and pronouncement of death without actually touching the condemned. Avoiding hands-on participation was also a reason given by church officials during the Inquisition for burning, rather than hanging or beheading, the condemned. After all, neither tying the condemned to a stake nor setting the wood on fire was a direct cause of death.

In the United States, at some point we came to feel that we must not appear "cruel" when taking the life of a convicted felon. Electrocution, gas, lethal injection -- each has been hailed in its time as "humane," "scientific," a "final solution" to the problem of disposing of those judged unworthy to live. In 1889, forward-looking New York legislator Elbridge Gerry recommended electrocution as a substitute for hanging. Gerry declared that mental suffering before execution was punishment enough, and the method of execution should be "as rapid and painless as possible."

The rest of Gerry's comment was less noticed. He said that any replacement for hanging should not expose onlookers to the violence and blood-letting of other methods, such as the guillotine, even if these methods produced instantaneous death. Gerry was a politician and he knew his constituents. To support capital punishment, the public needed an apparently painless execution. But they also needed an orderly, antiseptic scene of death.

Electrocution, as written about in Scientific American and other prestigious journals, had the right combination of fascinating technology and reassuring efficiency that we now hope we have found in lethal injection. When Elbridge Gerry and others enthused about voltage meters and other apparatus, barely mentioning that this was machinery designed to kill, the execution stopped being a spectacle or even an event. It was reborn as a "procedure."

Ronald Reagan advocated lethal injection in 1973, comparing it to "putting a horse to sleep." In 1977 Oklahoma became the first state to adopt lethal injection. When legislators learned it would cost $62,000 to repair their electric chair and $300,000 to construct a gas chamber, they took the advice of the head of Oklahoma Medical School's Anesthesiology Department and chose lethal injection using a short-acting barbiturate followed by a paralytic agent.

Now that numerous executions have been carried out by lethal injection, of course, the questions and the tinkering have begun, just as they did with previous methods. Is using pancuronium bromide (Pavulon) wantonly cruel, given that the drug has been banned in 19 states as a method for euthanizing non-human animals? Is the Pavulon necessary when potassium chloride is also given? And, on another issue, should the governor of Kentucky, a licensed physician, sign a death warrant?

When executions were public spectacles, the terror and pain of the condemned individuals, weeping, pleading, trussed into immobility like livestock and having lost control over their bodily functions, drove home one obvious point -- the nation or state that executes has ultimate mastery, body and soul, over its subjects. It is not a state that governs by consent of the governed. But after Americans declared ourselves citizens, not subjects, open public debate made capital punishment the political problem it is today. Reformers charged that execution was a barbaric holdover from our colonial subjugation. Conservatives supported, even demanded, capital punishment as a show of domination by the government of which they themselves were often the leaders. Some American states abolished the death penalty -- for a total of 12 non-executing states today. But for most states, a technical fix or other innovation in procedure was instrumental in buying off death-penalty opponents.

This time around, I suspect that in states where the death penalty is popular, officials will stick with lethal injection for awhile and work instead on reducing the amount of information available to witnesses. Prison wardens have an extraordinary amount of arbitrary power, and execution teams now routinely pull the curtains or blinds between witnesses and the death chamber whenever there is a hitch in the dying. Different reasons may be given -- such as "protecting the identity of the execution team" -- or no reason at all.

Will this development put paid to the American ideal of open, and fully informed, public debate? The differences in degree of suffering we are debating now are, frankly, small -- very small compared to crucifixion, stoning, or burning alive. Perhaps our time would be better spent asking ourselves why we execute. No credible study has shown that execution deters others from murder. All we've done is pair statistics on the untested theory that number of murders versus number of executions have a causal relationship. We really haven't studied the mental process of a large sample of killers in any methodical way.

And if our purpose in executing is to exact revenge, to bring satisfaction to the victim's loved ones, why do we concern ourselves with humane procedure at all? Our model of execution over the past 100 years or so seems to be "exterminating a pest" without leaving any mess to clean up.

Execution procedure is driven by a political reality: lawmakers will respond to public demand for the death penalty until said lawmakers find there are political costs to them for support -- costs such as discovering that the means of death is messy or that a number of the condemned didn't commit the crime. The perfect death penalty statute could well be the statute that remains on the books forever, but has so many qualifying factors that no one can actually be executed. That might solve the political equation. But it wouldn't do us much credit as ethical beings. At the end of the day, we-the-people still have to know the purpose of our acts and take responsibility for their outcomes.

©2003-2005, Eliza Steelwater. Web site design by T2Designs.com.