The following is an opinion dated December 10, 2016 in edition.cnn.com by a US physician on this torture modality.
We can no longer mask
the barbarity of the death penalty
By Ford Vox
Updated 0151 GMT (0951
HKT) December 10, 2016
Witness: Inmate struggled during execution 02:28
Story highlights
·
Ford Vox: United
States is bumbling its way towards the bitter end of the death penalty
·
It's time for America
to take a cue from the rest of the world, Vox writes
Ford Vox is a
physician specializing in rehabilitation medicine and a journalist. He is a
medical analyst for NPR station WABE-FM 90.1 in Atlanta. He writes frequently
for CNN Opinion. Follow him on Twitter @FordVox. The opinions expressed in this
commentary are his.
(CNN)The United States is
bumbling its way toward the bitter end of the death penalty. As the numbers of
executions fall every year, the state-ordered deaths that we do commit become
that much more unusual, freakish and unfair applications of the law. As states
scramble to implement arbitrary new lethal injection protocols, the cruelty of
the procedure only worsens. The way Alabama killed the
convicted murderer Ronald B. Smith on Thursday is only the
latest example.
According to Birmingham News reporter Kent
Faulk, Smith moved his lips after receiving an injection of midazolam, the third-choice
sedative that most death penalty states are using in the absence of stronger
barbiturate drugs. Besides moving his lips, Faulk reported the man was gasping
for breath, heaving and coughing, for 13 minutes, stating that Smith
"clenched his left fist after apparently being administered the first drug
in the three-drug combination."
Faulk also said Smith's left eye appeared
slightly open at times during the procedure and said Smith moved his right arm
and hand after a prison official poked and prodded him a second time to check
whether he was still conscious.
After the midazolam, which is the same
twilight-inducing benzodiazepine that many people experience in lower doses for
common procedures like a colonoscopy, prison staff next injected Smith with the
paralytic pancuronium bromide and finally potassium chloride (which causes the
lethal cardiac arrest).
The medicalization of capital punishment began
in 1982 with the first lethal injection in Texas, and for most of the time
we've relied on this method, states first injected the condemned with sodium
thiopental, a strong barbiturate sedative (in general, barbiturates are
stronger than benzodiazepines like midazolam).
But death penalty states lost their access to
sodium thiopental when the pharmaceutical company Hospira stopped making it following European pressure. The
European Union even specifically blocks the export of drugs that could
potentially be used in executions to the United States.
Executioners next turned to pentobarbital,
another barbiturate that can induce a deep medical coma, but its Danish
manufacturer Lundbeck then cut off our supply of that drug, too. Now, prison officials
are relegated to partnering with local compounding pharmacies whose skills in
drug synthesis aren't ready for prime time. Or, they can get creative and use a
drug so common its supply can't be cut off by the EU or a single manufacturer
-- a drug like midazolam.
The only problem with that is that midazolam's
a lousy drug for lethal injection. Besides the fact that there are stronger
sedatives that it makes more sense to use, we know it's not very soluble,
meaning it can easily become a solid in the vial or IV tubing, especially the
higher the dose gets. Moreover, potassium chloride only makes its solubility
worse, precipitating more of the drug out of solution, enough that trying to
force in the injection through the precipitate can break the vein, spilling the
drugs out into the arm tissue where they're not going to have their intended
effects.
We know that consciousness is a continuum, and
from the descriptions of Smith's execution, he was likely in a semi-conscious
state for some of his execution. He could have been more fully conscious, but
we'd be unaware because the paralytic he got would have prevented him from
speaking.
We can't run experiments determining what
prisoners really experience with any of the cocktails. After all, the
experimental subject would be dead, one way or another, following the
procedure. But the evidence we've got -- a number of botched executions using midazolam with subjects moving
and attempting to speak after they're supposed to have been rendered
unconscious, makes it clear this method is unacceptable.
To compound matters, decent physicians aren't willing to participate. Relevant specialties like
anesthesiology will kick out a member who facilitates executions. The resulting procedure
is archaic. Medics are fumbling around in the middle of the night trying to
place peripheral IV lines right before the execution, having difficulty finding
veins, when larger central or PICC lines could have been placed beforehand with
imaging guidance.
We certainly can't trust the neurological
examination skills of these executioners, so they'd be better off using a more
objective EEG monitoring protocol to assess the how deeply unconscious their
subjects are. But setting up one of the commercially available systems would
require the help of companies and vendors that probably have ethical standards
that wouldn't allow them to participate in executions.
We've just elected a new president who has embraced
torture in the fight against terrorism. So perhaps quibbles about
how humane lethal injection procedures may or may not be as means of exiting
condemned murders seem a little quaint.
But the Constitution hasn't changed. The Eighth
Amendment still prohibits cruel and unusual punishment. Yet
lethal injection is only becoming more cruel and unusual. If we want to
efficiently dispatch these murderous criminals into a deep coma and then stop
their hearts, we've got a lot of work to do devising a better protocol.
However, no good medical professionals want to
do that work. No modern, well-run company that wants any kind of international
standing for itself will assist. That suggests that it's time for America to
take a cue from the rest of the world. Our options just ran out. We can no
longer mask the barbarity of what we are doing.
Bridge to the PRPS opinion on the death penalty.
