If killers must be executed, let it be done humanely

On December 16th, 2010, officials in the US state of Oklahoma executed a death-row inmate with a drug cocktail that includes a sedative typically used to put down animals.

John David Duty, 58, is thought to be the first US prisoner to be executed using the sedative pentobarbital. Duty, was pronounced dead at 6:00 pm local time at the Oklahoma State Penitentiary.

The 58-year-old Duty was convicted of the December 19th, 2001, murder of 22-year-old Curtis Wise, who was Duty's cellmate at the Oklahoma State Penitentiary in McAlester. Wise was strangled to death with shoelaces. At the time, Duty was serving three life sentences for rape, robbery and shooting with intent to kill, all dating from 1978.

Pentobarbital is a short-acting barbiturate that was first synthesized in 1928. Sodium pentobarbital is also used for judicial executions by lethal injection in the People's Republic of China.

Sodium Pentothal produces induction of anesthesia within 60 seconds of administration, reflecting its rapidity of central nervous system penetration. The person’s blood pressure will decrease during the procedure and the heart rate will increase.

One possible complication is the condemned person waking up during the procedure. It is estimated that about 30,000 patients per year in the United States wake up during surgery. This development is in part the result of the widespread use of short-acting general anesthetics combined with blanket use of neuromuscular blockade. The patients are paralyzed with regard to motion, but otherwise are awake and aware of what is happening to them and also feel pain during the surgery. At present, special devices that measure brain wave activity are used to monitor the patient's state of consciousness. When I was scheduled for open heart surgery, I was overwhelmed by this fear of being conscious during the operation. As it turned out, I didn’t wake up until hours after the operation.

Lethal injection is used for capital punishment by the federal government and 36 States, at least 30 of which use the same combination of three drugs: sodium thiopental (a barbiturate to induce anesthesia), pancuronium bromide (a muscle relaxant that paralyzes all the muscles of the body) and potassium chloride (a salt that speeds the heart until it stops). This protocol was developed in 1977 for the state of Oklahoma by then–Chief Medical Examiner Jay Chapman, but it has never been codified or sanctioned by the U.S. Food and Drug Administration (FDA).

A shortage of sodium thiopental in the US forced the state to make the change. A judge's ruling to allow Oklahoma to substitute pentobarbital for sodium thiopental was upheld by a federal appeals court the week he was executed.

Sodium thiopental, an anesthetic, is usually used in the state's lethal injection formula, which also includes drugs that paralyze muscles and stop the heart. Lawyers representing Duty and two other death-row inmates argued during a court hearing in November that use of the sedative is inhumane and that inmates could be conscious but paralyzed when the other drugs were administered.

"No one who has been put to death has come back and testified about what it felt like," said lawyer Jim Rowan, a board member of the Oklahoma Coalition to Abolish the Death Penalty.

California, Arkansas, Tennessee and Maryland have delayed executions because of protocol changes, which include the use of the new drugs, Death Penalty Information Center executive director Richard Dieter told the Associated Press news agency.

"I think Oklahoma is the only state where this issue has come to a head over a new drug," Mr Dieter said, adding that other state courts wanted more time to review the changes.

Several of the 35 US states that use lethal injections are hunting for alternatives to sodium thiopental after Hospira, the sole US manufacturer of the drug, said new batches would not be available until early 2011.

Sodium thiopental, better known as Sodium Pentothal, thiopental, thiopentone sodium, or Trapanal is a rapid-onset short-acting barbiturate general anaesthetic. A general anesthetic is one that puts the person in a state of unconsciousness. Sodium thiopental is a depressant and is sometimes used during interrogations.

Along with pancuronium bromide and potassium chloride, thiopental is used in 34 states of the U.S. to execute prisoners by lethal injection. A very large dose of the anaesthetic is given, placing the subject into a rapidly induced coma.

Executions using the three drug combination are usually effective in approximately 10 minutes, but have been known to take several times this amount of time. The use of thiopental alone is hypothesized to cause death in approximately 45 minutes. The use of sodium thiopental has been the cause of current Supreme Court challenges to the lethal injection protocol, after a study in the medical journal The Lancet, where autopsy studies on executed inmates revealed that there was not a high enough concentration of thiopental in their blood to have caused unconsciousness. If that is so, then they would have suffered from suffocation prior to dying.

Let me say that suffering from suffocation is a scary way to die. I once suffered from congestive heart failure which is a condition in which your lunges are overwhelmed with fluid and your breathing becomes laboured.

Pentathol is a barbiturate used as a surgical anesthetic. In surgery, a dose of up to 150mg is used; in execution, up to 5,000mg is used. This is a lethal dose. From this point on if the prisoner is still alive, he should feel nothing.

Pancuronium bromide is also known as Pavulon, is a muscle relaxant given in a strong enough dose to paralyze the diaphragm and lungs. This drug takes effect in 1-3 minutes. A normal medical dose is 40 – 100mcg per kilogram; the dose delivered in an execution is up to 100mg.

Potassium chloride: This is a toxic agent which induces cardiac arrest. Not all states use this as the first two drugs are sufficient to bring about death.
Saline solution is used to flush the IV between each dose. Within a minute of two after the final dose is given, a doctor declares the prisoner dead.

It is beyond me why the IV has to be flushed. Its procedure seems as if its purpose is similar to the state of Texas passing a law that a condemned prisoner cannot be given a cigarette just before his execution because it is bad for his health.

Anti-death penalty advocates claim that execution by lethal injection, as practiced in the United States, is inhumane. It has been argued that the ultra-short acting barbiturate may wear off leaving the convict fully conscious yet rendered immobilized by the paralytic agent and able to feel the burning pain of the potassium injection. One of the suppositions for this argument is the need for a paralytic agent. If the anesthetic is sufficient and the potassium is lethal, then the paralytic has no use unless the anesthesia wears off.

I believe that the only reason why the paralytic agent is used is to keep the condemned man from writhing and screaming in front of the witnesses. If he is to suffer, he has to suffer without anyone knowing it.

Following a shortage of thiopental that led a court to delay an execution in California, a company spokesman for Hospira, the sole American manufacturer of the drug, expressed strong reservations about the use of thiopental in the lethal injection procedure.

On December 8th, 2009, the State of Ohio became the first to use a single dose of sodium thiopental for its capital execution, following the failed use of the standard three-drug cocktail during a recent execution, due to inability to locate suitable veins. Kenneth Biros was executed using the single-drug method. The execution took 43 minutes and was concluded at 11:47 a.m., including approximately 30 minutes to complete the process of inserting the needle, and about 10 minutes between administering the single dose and the pronouncement of death. Of course, one is forced to ask the rhetorical question; ‘How long was the prisoner conscious before he died?'

The state of Ohio executed a second man using sodium thiopental on January 7th , 2010. Vernon Smith was pronounced dead 8 minutes after the time of injection. The state of Ohio executed a third man using sodium thiopental on April 20th, 2010. Daryl Durr was pronounced dead at 10:36 a.m. Most recently, William Garner was executed in Ohio with sodium thiopental.

The Superior Court of Maricopa County, Arizona originally sentenced Landrigan to death in 1990 after convicting him of first-degree felony murder in the strangulation and stabbing death of Chester Dean Dyer of Phoenix. At the time of the murder Landrigan, was an escapee from an Oklahoma prison, where he was serving time following a conviction in that state of assault and battery with a deadly weapon, second-degree murder, and possession of marijuana.

Regardless of whether Landrigan's legal team was simply using the drug shortage as a stalling tactic, their legal maneuvering brought to the fore a contentious dispute over the science (or some would say lack thereof) behind lethal injection executions in the U.S. For more than two decades, it has been argued that the FDA should be required to certify the safety and effectiveness of drugs used to carry out executions (as it does for drugs used to euthanize animals). The FDA, wanting to stay out of the capital punishment debate, disagrees.

In 2008, the U.S. Supreme Court upheld a lower court ruling that the state of Kentucky's three-drug method of lethal injection did not constitute ‘cruel and unusual punishment,’ as defined by the Eighth Amendment. However, some scientists disagree.

There's no record of a medical or scientific inquiry into whether this would be the best method. There simply isn't any medical evidence to support this approach. Part of the paradox is that it looks like a medical procedure, but it hasn't been rigorously tested. There are no controlled trials, data collection, and analysis or peer review of the processes to determine whether it works the way it's been said to work.

Sodium thiopental was chosen to render the person deeply unconscious and unable to feel the paralysis brought on by the pancuronium bromide, which causes the person to lose the ability to breathe. The potassium chloride is extremely painful. It gives a burning sensation.

Some people have said that three to five grams of sodium thiopental alone should be enough to induce death. In December 2009 Ohio became the first state to use a single dose of sodium thiopental to execute death-row inmates.

Researchers looked at whether or not inmates died painlessly after the sodium thiopental, and it's not always clear that that is so. They also determined that the doses of sodium thiopental used are not always as ‘massive’ as claimed. It's not even clear how much a massive dose is in this context. The researchers found that, at most, the highest doses were two times the lethal dose for animals, regardless of the inmate's weight. Perhaps is should be four or more times more massive.

Sodium thiopental has quite a long shelf life—up to 48 months in its unconstituted form. Once you add liquid, it's been reported to be stable for 24 hours or, if it's kept cold, it can last for seven days. They typically prepare it on the day of execution. Shelf life may be a problem because states perform executions infrequently and now don't have a supply of new doses.

I am concerned that condemned prisoners are possibly suffering pain or being suffocated before they become unconscious. I realize that there are many people, especially families of victims of these killers who are being put to death that they really don’t care if the condemned prisoners suffer while being executed.

My response to that kind of thinking is that we as a society should not stoop down to the level of those who are executed. As I said in my speech before a United Nations crime conference in 1980, let it be quick and painless. And let it be final.

This doesn’t necessary mean that I am advocating capital punishment. I am merely saying that if killers must be executed, let them be executed humanely.