Lethal Injection Protocol

Culled From http://www.fcc.state.fl.us/fcc/reports/monitor/methmon.html and other related websites

After being cleared by the Governor and Attorney General, a sedative is offered and the condemned is led to the execution chamber where he is secured to a gurney by his legs, stomach, chest, biceps, and wrists. Intravenous tubes are inserted into both arms (One primary, one backup) and a saline drip is started.

After the warden asks for a last statement, the prisoner is administered a lethal dose of Sodium Pentathol to render unconsciousness. After the first injection, the lines are again cleared with saline to avoid any possible chemical reactions that may cause clogging. Following unconsciousness, the prisoner is administered a dose of Pancuronium Bromide, which causes muscle relaxation and the collapse of the diaphragm and lungs. After another saline flush, the condemned is finally administered potassium chloride to stop the prisoner's heart. In its entirety, the average execution takes around 17 minutes, about 2 of which actually involve chemical administration.

Some reports I have read suggest that an Anal Plug and Catheter are used to avoid any "messy cleanup", but this either isn't standard procedure, or isn't mentioned elsewhere.
Also, different states appear to use different chemicals to induce the initial unconsciousness.

I was watching a news story about the execution of Timothy McVeigh and was appalled by the fact that none of the news reporters seemed to know anything about lethal injection. One reporter even went so far to say a witness said that McVeigh "struggled to keep his eyes open as the lethal injection surged through his veins"!! I did a report on the death penalty and feel that it is the right and responsiblity of the public to know how our government is killing people. The following is from http://abcnews.go.com/sections/us/deathrow/deathrow_execut.html. It is the best article I have found. The website also talks about the four other types of executions used in the United States; electrocutions, firing squads, gas chambers, and hangings.

"A deadly cocktail drips from an IV into the convict's arm. Texas and many other states use a three-drug combination. The first drug, sodium thiopental, a barbiturate, renders the prisoner unconscious. The next, pancuronium bromide, a muscle relaxant, paralyses the diaphragm and lungs. The third, potassium chloride, causes cardiac arrest.

Many claim lethal injection is the most humane form of execution. But doctors say administering a lethal injection can be difficult, when the convicts have scarred veins. This is sometimes the case because drug abuse is so common among death row inmates. The federal government, the military and 32 states have used this method of execution."

Lethal Injection

Once the appeals process has been exhausted and a time and date has been set for the execution, the inmate is moved from death row to death watch, a part of the prison closer to the execution chamber and away from the general population of death row.

In their final days, the condemned is permitted visitation by family, friends, lawyers, and religious figures if so desired.

When it comes to the final few hours, protocol for the upcoming execution are as follows:

  1. The inmate is allowed one last meal of their choice.
  2. The warden and the chaplain will visit and accompany the condemned until the very end.
  3. The witnesses, usually the family of the condemned, family of the victim, warden, medical personnel, spiritual advisors, guards, state selected witnesses, reputable citizens, and selected media representatives, are allowed into the witness room and instructed to remain silent.
  4. The prisoner dresses for the execution and stays with their religious advisor until the warden gives the word to make the way to the chamber. (Prisoners are brought there only a few minutes before the scheduled execution time)

Once the condemned is in the chamber, they are strapped to a gurney. Arms, wrists, ankles, and body are all secured with padded restraints. The head may be left unrestrained to enable the prisoner to look at the witnesses; this is all dependent on whether or not the prison has a one way mirror or just a pane of glass between the two. When the restraints are in place two intravenous tubes are inserted, one in each arm. A curtain is pulled back to reveal the witnesses.

An execution team, usually trained personnel of the prison, is assembled to administer the three chemicals. They are injected precisely in this order:

  1. Sodium-thiopental- this is a barbiturate that induces general anesthesia to put the prisoner to sleep. (The executed will feel nothing from this stage on)
  2. Pancuronium bromide- This is a muscle relaxant that causes the person to stop breathing by paralyzing the diaphragm and lungs.
  3. Potassium chloride- This interrupts the electrical signaling in the heart and results in cardiac arrest.

After waiting approximately 1-2 minutes a medical examiner will pronounce the prisoner dead. The body is then rolled out and depending on the want of the family, remanded to them or to the state to be disposed of.

The killing was the best part. It was the dying I couldn't take
-Craig Volk-

There has been a trend to 'medicalize' the capital punishment since the French Revolution according to Dr. Guillotin's proposal about decapitation should be carried out by a machine (the guillotine) as a more humane method of performing death penalty. Details concerning such a project were referred to a committee, conducted by the secretary to the Academy of Surgeons. Furthermore doctors got involved again in designing more state-of-the art methods like that of electrocution for the same reason in the United States: Harold P. Brown and his assistant Dr. Fred Peterson showed experimental results at Columbia University by administering a series of DC shocks to a dog. By 1,000 V DC, the dog agonized but not died. Eventually, Brown finished the dog off with an additional charge of 330 V AC. On a follow-up demonstration, a second dog became the first creature ever publicly reprieved from execution by electrocution.

The most recent example is the case of Michael Angelo Morales, convicted of raping and murdering the teenage girl Terri Winchell in 1981.

At the appointed time (February 22, 2006), the warden of the San Quentin State Prison should give the final order. A trained technician would press the plunger on a syringe connected to a catheter in a convict’s arm, allowing a bolus of sodium thiopental to rush into its vein. Morales should render unconscious in 5 to 10 seconds. After the catheter was flushed with saline, the technician would inject pancuronium bromide.

Pancuronium-muscle relaxation effects, at a correct dosage, last around 45 minutes and it is currently used with general anaesthesia in surgery as an aid to intubation or ventilation. It has no sedative or analgesic effects.

Within 30 seconds Morales should be fully unable to move. At this point breathing stops, as the muscles of the chest and diaphragm have been paralyzed. He should be still alive but, if left in this condition, would expire in approximately three minutes from hypoxia.

Finally, the technician would be ready to inject a large amount of potassium chloride which interferes with the heart’s capability to contract. Within minutes, the inmate's heart reaches asystole in which its activity ceases. It is at this time that a doctor not present for any of the proceedings, upon listening to the convict’s heart, should pronounce the prisoner dead.

According to the above facts it is possible, while unlikely, for convicts executed by lethal injection to be conscious, paralyzed and under unendurable pain during the last minutes of their lives.

Faced with this possibility and the Amendment VIII implications of it, the United States Court of Appeals for the Ninth Circuit judge ordered the state of California to bring in two anesthesiologists to ensure that Morales was fully sedated and unconscious prior to the lethal dose of potassium.

The AMA have long opposed doctors having any role in executions, including monitoring a prisoner's vital signs or giving technical advice except in certifying death. In accordance, the two anesthesiologists designed to oversee the Morales execution refused to participate after learning they would be expected to tell prison officials whether Morales needed more medication, thereby allowing the execution to proceed.

Then the judge gave officials two ways: find a doctor who wanted being involved, or kill Morales with an overdose of thiopental instead of the three-drug protocol. As no such individual willing to participate in an execution could be found, prison officials chose the second option, but drug administration can only be performed by a professional legally authorized to inject intravenously.

Thus the Morales penalty is now on hold indefinitely.

There is a controversy over whether this is actually an ethical dilemma for anesthisiologists. It has been argued that it does not 'since doctors participating in the death penalty are not damning in and of itself any more than Navy doctors are Hippocratic hypocrites for participating in war. The doctors who drug Morales will be helping him and not doing harm, so long as they do not do the lethal injection. Of course, some doctors are performing euthanasia and assisted suicide, which are explicitly prohibited by the Hippocratic oath, so whatever' (1). And the same can be said about the doctors' participation in developing modern execution techniques.

Some things are simply beyond our purview. Decisions of life and death should be made above our pay grade. The state, no matter how careful the protocols or how due the process, should not be in the deal of killing people in cold blood.

(1) http://blog.neo-libertarian.com/

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