This article is about the execution and euthanasia method. For the Ice Cube album, see Lethal Injection (album). O'Shea Jackson (born June 15 1969 better known by his Stage name Ice Cube, is an American Actor, Screenwriter, producer, and Lethal Injection is a 1993 and the 4th solo album by California-based rapper Ice Cube.

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Lethal injection refers to the practice of injecting a person with a fatal dose of drugs for the explicit purpose of causing the death of the subject. Death is the termination of the biological functions that define living Organisms It refers both to a specific The main applications for this practice are euthanasia, suicide, and capital punishment. Euthanasia (literally "good death" in Ancient Greek) refers to the practice of ending a life in a painless manner Capital punishment, the death penalty or execution, is the Killing of a person by judicial process as Punishment. Lethal injection gained popularity in the twentieth century as form of execution intended to supplant other methods, notably electrocution, hanging, firing squad, gas chamber, and decapitation, that were considered to be less humane. Capital punishment, the death penalty or execution, is the Killing of a person by judicial process as Punishment. Execution by electrocution (usually referred to after its method of implementation as the Electric Chair) is an execution method originating in the United States in which the Hanging is the lethal suspension of a person by a ligature The Oxford English Dictionary states that hanging in this sense is "specifically to put to death Execution by firing squad is a method of Capital punishment, particularly common in times of war A gas chamber is an apparatus for killing consisting of a sealed chamber into which a Poisonous or Asphyxiant gas is introduced Decapitation (from Latin, caput, capitis, meaning head or beheading, is the cutting off of the head of a person or animal The humaneness of lethal injection has been debated. It is now the most common form of execution in the United States: every American execution in 2005 was conducted by lethal injection. ^[1]

Lethal injection has also been used in cases of euthanasia to facilitate voluntary death in patients with terminal or chronically painful conditions. Euthanasia (literally "good death" in Ancient Greek) refers to the practice of ending a life in a painless manner Both applications have used similar drug combinations. ^[2]

The concept of lethal injection as a means of putting one to death was first proposed in 1888 by Julius Mount Bleyer,^[3] a New York doctor who praised it as being cheaper and more humane than hanging. Year 1888 ( MDCCCLXXXVIII) was a Leap year starting on Sunday (click on link for calendar of the Gregorian calendar (or a Julius Mount Bleyer (MD was the New York doctor who first proposed Lethal injection in 1888 New York ( is a state in the Mid-Atlantic and Northeastern regions of the United States and is the nation's third most populous Hanging is the lethal suspension of a person by a ligature The Oxford English Dictionary states that hanging in this sense is "specifically to put to death ^[4] Bleyer's idea, however, was never used. The British Royal Commission on Capital Punishment (1949–53) also considered lethal injection, but eventually rejected it after pressure from the British Medical Association (BMA). The term Royal Commission may also be used in the United Kingdom to describe the group of Lords Commissioners who may act in the stead of the Year 1949 ( MCMXLIX) was a Common year starting on Saturday (link will display the full calendar of the Gregorian calendar. Year 1953 ( MCMLIII) was a Common year starting on Thursday (link will display full calendar of the Gregorian calendar. History The BMA founded in 1832 by Charles Hastings was originally known as the Provincial Medical and Surgical Association (PMSA the first meeting of which was held in the boardroom ^[4]

Nazi Germany's T-4 Euthanasia Program used lethal injection (with drugs that differed from the modern method) as one of several methods to destroy "life unworthy of life. Nazi Germany and the Third Reich are the common English names for Germany under the regime of Adolf Hitler and the National Socialist German Workers Action T4 (Aktion T4 was a program in Nazi Germany spanning October 1939 until August 1941 during which physicians killed 70273 peoplespecified in Hitler's "

In 1977, Oklahoma's state medical examiner, Jay Chapman, proposed a new, 'more humane' method of execution, known as Chapman's Protocol: "An intravenous saline drip shall be started in the prisoner's arm, into which shall be introduced a lethal injection consisting of an ultra-short-acting barbiturate in combination with a chemical paralytic. Oklahoma ( is a state located in the South Central region of the United States of America. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. In Medicine, saline (also saline solution) is a general term referring to a sterile solution of Sodium chloride (table Salt) in water Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation Paralysed redirects here For other uses see xx Paralysed (disambiguation Paralysis is the complete loss of Muscle function "^[5] After being approved by anesthesiologist Stanley Deutsch, Reverend Bill Wiseman introduced the method^[6] into the Oklahoma legislature where it passed and was quickly adopted (Title 22, Section 1014(A)). An anaesthetist ( English) or anesthesiologist ( US English) also "anaesthesiologist" is a medical doctor trained to administer Since then, thirty-seven of the thirty-eight states using capital punishment have introduced lethal injection statutes. ^[5] On 7 December 1982, Texas became the first state to use lethal injection to carry out capital punishment, for the execution of Charles Brooks, Jr.. Events 43 BC - Marcus Tullius Cicero assassinated 1696 - Connecticut Route 108, one of the oldest highways Year 1982 ( MCMLXXXII) was a Common year starting on Friday (link displays the 1982 Gregorian calendar) Texas ( is a state geographically located in the South Central United States and is also known as the Lone Star State. Charles Brooks Jr ( September 1, 1942 &ndash December 7, 1982) was a convicted Murderer who was the first person executed ^[7]

The People's Republic of China began using this method in 1997, Guatemala in 1998, the Philippines in 1999, Thailand in 2003, and Taiwan in 2005. Talk People's Republic of China) PEOPLE'S REPUBLIC OF CHINA ARTICLE GUIDELINES Guatemala (República de Guatemala) is a country in Central America bordered by Mexico to the north and west the Pacific Ocean to the southwest The Philippines ( Filipino: Pilipinas, officially known as the Republic of the Philippines (fil ''Republika ng Pilipinas'' RP The Kingdom of Thailand (ˈtaɪlænd ราชอาณาจักรไทย, râːtɕʰa-ʔaːnaːtɕɑ̀k-tʰɑj Taiwan ( Taiwanese: Tâi-oân/Tāi-oân (historically 大灣/台員/大員/台圓/大圓/台窩灣 is an Island in East Asia. ^[8]

Contents 1 Procedure in US executions 2 Lethal injection drugs 2.1 Sodium thiopental 2.2 Pancuronium bromide 2.3 Potassium chloride 3 Euthanasia protocol 4 Constitutionality in the United States 5 Ethics of lethal injection 6 Controversy: Arguments against 6.1 Awareness 6.2 Research 6.3 Single drug 6.4 Cruel and unusual 7 Controversy: Arguments in support 7.1 Commonality 7.2 Anesthesia awareness 7.3 Dilution effect 7.4 Single drug 8 Related articles 9 Resources 10 References

Procedure in US executions

The person who is condemned is fastened onto a gurney; two intravenous cannulae ("IVs") are inserted, one in each arm. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. A cannula (from Latin "little reed" plural cannulae) or canula is a tube which can be inserted into the body often for the delivery or removal 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 and secured to the prisoner's IV, and secured so the line doesn't snap during the injections. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein.

The arm of the subject is swabbed with alcohol before the cannula is inserted. In Chemistry, an alcohol is any Organic compound in which a Hydroxyl group ( - O[[hydrogen H]]) is bound to a Carbon ^[9] The needles and equipment used are also sterilized. There have been questions about why these precautions against infection are performed despite the purpose of the injection being death. There are several explanations: cannulae are sterilized during manufacture, so using sterile ones is routine medical procedure. Secondly, there is a chance that the prisoner could receive a stay of execution after the cannulae have been inserted, as happened in the case of James Autry in October 1983 (he was eventually executed on March 14, 1984). A stay of execution is a court order to temporarily suspend the execution of a court judgement James David Autry ( August 27, 1954 &ndash March 14, 1984) was a convicted Murderer in the U Year 1983 ( MCMLXXXIII) was a Common year starting on Saturday (link displays the 1983 Gregorian calendar) Events 1489 - The Queen of Cyprus, Catherine Cornaro, sells her kingdom to Venice. Year 1984 ( MCMLXXXIV) was a Leap year starting on Sunday (link displays the 1984 Gregorian calendar) Finally, it would be a hazard to prison personnel to use unsterilized equipment.

Following connection of the lines, saline drips are started in both arms. This too is standard medical procedure: it must be acertained that the connections are clear, ensuring that the chemicals don't mix in the IV lines and block up the needle, preventing the drugs from reaching the inmate and botching the execution. A heart monitor is attached so that prison officials can monitor when death has occurred.

The intravenous injection is usually a sequence of drugs given in a set sequence, designed to first induce unconsciousness followed by death through paralysis of respiratory muscles and/or by cardiac arrest through depolarization of cardiac muscle cells. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein. See also Unconscious mind. Unconsciousness, more appropriately referred to as loss of Consciousness or lack of consciousness is Paralysed redirects here For other uses see xx Paralysed (disambiguation Paralysis is the complete loss of Muscle function A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of In biology depolarization is a decrease in the Absolute value of a cell's Membrane potential. The cardiac muscle is a type of involuntary striated Muscle found in the walls of the Heart. The execution of the condemned in most states involves three separate injections (in sequential order):

1. Sodium thiopental: ultra-short action barbiturate, an anaesthesic agent capable of rendering the person unconscious in a few seconds. The fictional truth drug Hyoscine-pentothal does not describe real pentothal accurately
2. Pancuronium: non-depolarizing muscle relaxant, causes complete, fast and sustained paralysis of the skeletal striated muscles, including the diaphragm and the rest of the respiratory muscles; this would eventually cause death by asphyxiation. Pancuronium is a Chemical compound, used in medicine as the Bromide salt pancuronium bromide. For other types of diaphragm see Diaphragm. In the Anatomy of Mammals the thoracic diaphragm is a sheet of Muscle
3. Potassium chloride: stops the heart, and thus causes death by cardiac arrest. The Chemical compound potassium chloride (KCl is a Metal Halide salt composed of Potassium and Chlorine. A cardiac arrest, also known as cardiorespiratory arrest, cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of

The drugs are not mixed externally as that can cause them to precipitate. Precipitation is the formation of a Solid in a Solution during a Chemical reaction. Also, a sequential injection is key to achieve the desired effects in the appropriate order: administration of the barbiturate is essential to minimize physical distress during the process; the infusion of the muscle relaxant induces complete paralysis but not unconsciousness, and the injection of a highly-concentrated solution of potassium chloride can cause severe pain in the site of the IV Line as well as along the punctured arm. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein.

The intravenous tubing leads to a room next to the execution chamber, usually separated from the subject by a curtain or wall. Typically a technician trained in venipuncture inserts the needle, while a second technician, who is usually a member of the prison staff, orders, prepares, and loads the drugs into the lethal injection syringes. In medicine venipuncture or venepuncture (also known as phlebotomy, venesection, blood draw, drawing blood or taking blood Two other staff members take each of the three syringes and secures 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 will signal that the execution may commence, and the executioner(s) (either prison staff or private citizens depending on the jurisdiction) will then manually inject the the three drugs in sequence. During the execution, the subject's cardiac rhythm is monitored. Death is pronounced after cardiac activity stops. Death usually occurs within seven minutes, although the whole procedure can take up to 2 hours, as was the case with the execution of Christopher Newton on May 24, 2007. Christopher J Newton ( November 13, 1969 &ndash May 24, 2007) was an American criminal whose 2007 execution by the state of Events 1218 - The Fifth Crusade leaves Acre for Egypt. 1276 - Magnus Ladulås is crowned Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. 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 executed individual’s death certificate.

In some states, there was a lethal injection machine used by Massachusetts-based Fred A. Leuchter that was comprised of two components. The Commonwealth of Massachusetts ( is a state located in the New England region of the northeastern United States. Frederick A (Fred Leuchter Jr (born 1943 is an American execution technician who rose to controversy for his Testimony in defense of Holocaust The delivery module and the control module. Two staff members each have a station in which they key the machine on and depress 3 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 executioners don't have as much feelings as guilt. The delivery module as its called has 8-syringes. The end syringes containing saline, syringes 2, 4, 6 containing the lethal drugs for the main line and syringes 1, 3, 5 containing the injections for the back-up line. Monitoring lights are also on the panel and the delivery module in which one system red light meant the system was on, three more red lights meant the injections were armed, three yellow lights meant the injections where operating and three green lights meant the injections were complete. The system has now since been discontinued. ^[10]

Lethal injection drugs

The following drugs are a representation of a typical lethal injection as practiced in the United States for capital punishment.

Sodium thiopental

• Lethal Injection dosage: 2-5 grams

Sodium thiopental (US trade name: Sodium Pentothal) is an ultra-short acting barbiturate, often used for anesthesia induction and for medically induced coma. The fictional truth drug Hyoscine-pentothal does not describe real pentothal accurately The typical anesthesia induction dose is 3-5 mg/kg (a person who weighs 200 pounds, or 91 kilograms, would get a dose of about 300 mg). Loss of consciousness is induced within 30-45 seconds at the typical dose, while a 5 gram dose—14 times the normal dose—is likely to induce unconsciousness in 10 seconds.

Thiopental reaches the brain within seconds and attains a peak brain concentration of about 60% of the total dose in about 30 seconds. At this level, the subject is unconscious. Within 5 to 20 minutes the percentage in the brain falls to about 15% of the total dose, since the drug redistributes to the rest of the body. At this concentration in the brain, the anesthetic effects wear off and consciousness returns. These are the typical pharmacokinetics for the induction dose.

The half-life of this drug is about 11. Half-Life (computer-game page here It's already listed in the disambiguation page 5 hours [1], and the concentration in the brain remains at around 5-10% of the total dose during that time. When a 'mega-dose' is administered, as in 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. This is the reason why an ultra-short acting barbiturate, such as thiopental, can be used for long-term induction of medical coma.

After a 5 gram dose consciousness will be regained in about 5 to 6 half-lives, which occurs in about 57-69 hours. The effects of such a high dose, however, include profound respiratory depression (depression of the brainstem respiratory center) and vascular collapse (vasodilatation and myocardial depression), which is in itself lethal. The brain stem (or brainstem) is the lower part of the Brain, adjoining and structurally continuous with the Spinal cord.

Historically, thiopental has been one of the most commonly used and studied drugs for the induction of coma. Protocols vary for how the medication is given, but the typical doses are anywhere from 500 mg up to 1. 5 grams. It is likely that these data were used to develop the initial protocols for lethal injection, according to which one gram of thiopental was used induce the coma. Now, most states use 5 grams to be absolutely certain it is effective.

Barbiturates are the same class of drugs used in medically assisted suicide, but it is the only drug used, in contrast to the three drug cocktail typically employed for capital punishment. In euthanasia protocols, the typical dose of thiopental is 20 mg/kg [2] and a 91 kilogram man would receive 1. 82 grams. The lethal injection dose used in capital punishment is therefore about 3 times more than the dose used in euthanasia.

Pancuronium bromide

• Lethal Injection dosage: 100 milligrams

Pancuronium bromide (Trade name: Pavulon) is a non-depolarizing muscle relaxant (a paralytic agent) that blocks the action of acetylcholine at the motor end-plate of the neuromuscular junction. Pancuronium is a Chemical compound, used in medicine as the Bromide salt pancuronium bromide. Paralysed redirects here For other uses see xx Paralysed (disambiguation Paralysis is the complete loss of Muscle function The Chemical compound acetylcholine (often abbreviated ACh) is a Neurotransmitter in both the Peripheral nervous system (PNS and Central A neuromuscular junction ( NMJ) is the Synapse or junction of the Axon terminal of a Motoneuron with the motor end plate, the Binding of acetylcholine to receptors on the end-plate causes depolarization and contraction of the muscle fibre; non-depolarizing neuromuscular blocking agents like pancuronium stop this binding from taking place.

The typical dose for pancuronium bromide is 0. 2 mg/kg (a person who weighs 200 pounds, or 91 kilograms, would get a dose of around 9 mg). With a 100 milligram dose, the onset of paralysis occurs in around 15 to 30 seconds, and the duration of paralysis is around 4 to 8 hours. Paralysis of respiratory muscles will lead to death in a considerably shorter time.

Other drugs in use are tubocurarine chloride and succinylcholine chloride, both considerably stronger, but most states stick to using Pavulon. Tubocurarine chloride is an antagonist of Nicotinic neuromuscular acetylcholine receptors that is used to paralyse patients undergoing Anaesthesia. Suxamethonium chloride (also known as succinylcholine, scoline, or colloquially as sux) is a medication widely used in Emergency medicine and

Pancuronium bromide is a derivative of the alkaloid malouetine from the plant Malouetia bequaertiana. [3]

Potassium chloride

Main Article: Potassium chloride

• Lethal Injection dosage: 100 mEq (milliequivalents)

Potassium is an electrolyte that is 98% within the cells. The Chemical compound potassium chloride (KCl is a Metal Halide salt composed of Potassium and Chlorine. The equivalent (Eq or eq is a reasonably common Measurement unit used in Chemistry and the biological sciences. Potassium (pəˈtæsiəm is a Chemical element. It has the symbol K (kalium from qalīy Atomic number 19 and Atomic mass 39 The 2% remaining outside of the cell has great implications for cells that generate action potentials. Doctors prescribe potassium for patients when there is insufficient potassium, called hypokalemia, in the blood. Hypokalemia refers to the condition in which the concentration of Potassium in the blood is low The potassium can be given orally, which is the safest route; or it can be given intravenously, in which case there are strict rules and hospital protocols on the rate at which it is given.

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 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 higher than normal. Hyperkalemia ( AE) or Hyperkalaemia ( BE) is an elevated blood level of the Electrolyte Potassium. Without a negative resting potential, cardiac cells cannot generate impulses that lead to contraction.

Depolarizing the muscle cell inhibits its ability to fire by reducing the available number of Na channels (they are placed in an inactivated state). EKG changes include faster repolarization (peaked T-waves), PR interval prolongation, widening of the QRS, and eventual sine-wave formation and asystole. The heart eventually stops in systole. 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.

Euthanasia protocol

Euthanasia can be accomplished either through oral, intravenous, or intramuscular administration of drugs. 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:

First a coma is induced by intravenous administration of 1 g thiopental sodium (Nesdonal), if necessary, 1. 5-2 g of the product in case of strong tolerance to barbiturates. Then 45 mg alcuronium chloride (Alloferin) or 18 mg pancuronium bromide (Pavulon) is injected. In order to ensure optimal availability, these agents are preferably given intravenously. However, there are substantial indications that they can also be injected intramuscularly. In severe hepatitis or cirrhosis of the liver, alcuronium is the agent of first choice. [4]

Intravenous administration is the most reliable and rapid way to accomplish euthanasia and therefore can be safely recommended. A coma is first induced by intravenous administration of 20 mg/kg thiopental sodium in a small volume (10 ml physiological saline). Then a triple intravenous dose of a non-depolarizing neuromuscular muscle relaxant is given, such as 20 mg pancuronium bromide or 20 mg vecuronium bromide (Norcuron). The muscle relaxant should preferably be given intravenously, in order to ensure optimal availability. Only for pancuronium dibromide are there substantial indications that the agent may also be given intramuscularly in a dosage of 40 mg. [5]

Constitutionality in the United States

In 2006, 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. Factual background In 1983, Clarence E Hill was convicted of the murder of a Pensacola Florida police officer and subsequently sentenced to 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. ^[11] Lower courts evaluating these challenges have reached opposing conclusions. For example, courts have found that lethal injection as practiced in California,^[12] Florida,^[13] and Tennessee^[14] is unconstitutional. On the other hand, courts have found that lethal injection as practiced in Missouri,^[15] Arizona,^[16] and Oklahoma^[17] is constitutionally acceptable. On September 25, 2007, the United States Supreme Court agreed to hear a lethal injection challenge arising from Kentucky, Baze v. Rees. Baze v Rees, 553 US ___ ( 2008) is a United States Supreme Court case ^[18]. In Baze, the Supreme Court addressed whether Kentucky's particular lethal injection procedure comports with the Eighth Amendment and will determine the proper legal standard by which lethal injection challenges in general should be judged, all in an effort to bring some uniformity to how these claims are handled by the lower courts. ^[19] Although uncertainty over whether executions in the United States would be put on hold during the period in which the United States Supreme Court considers the constitutionality of lethal injection initially arose after the course agreed to hear Baze^[20], no executions took place during the period between when the court agreed to hear the case and when its ruling as announced, with the exception of one lethal injection in Texas hours after the court made its announcement. ^[21]

On April 16th, 2008 the Supreme Court rejected Baze v. Rees thereby upholding Kentucky's method of lethal injection in a split 7-2 decision. Baze v Rees, 553 US ___ ( 2008) is a United States Supreme Court case ^[22] Ruth Bader Ginsberg and David Souter dissented. ^[23] Several states immediately indicated plans to go forward with executions.

Ethics of lethal injection

The American Medical Association believes that a physician's opinion on capital punishment is a personal decision. The American Medical Association (AMA founded in 1847 and incorporated 1897 is the largest association of Physicians and Medical students in the United States Since the AMA is founded on preserving life, they argue that a doctor "should not be a participant" in executions in any form with the exception of "certifying death, provided that the condemned has been declared dead by another person. "[6] Amnesty International argues that the AMA's position effectively "prohibits doctors from participating in executions. Amnesty International (commonly known as Amnesty or AI) is a Western based international Non-governmental organization which defines its mission as "to " [7] The AMA, though, does not have the authority to prohibit doctors from participation in lethal injection, nor does it have the authority to revoke medical licenses, since this is the responsibility of the individual states.

Typically, most states do not require that physicians administer the drugs for lethal injection, but many states do require that physicians be present to pronounce or certify death.

Controversy: Arguments against

Awareness

Opponents of lethal injection believe that it is not actually humane as practiced in the United States. Opponents argue that the thiopental is an ultra-short acting barbiturate that may wear off (anesthesia awareness) and lead to consciousness and an excruciatingly painful death wherein the inmate is unable to express his pain because he has been rendered paralyzed by the paralytic agent. Anesthesia awareness, or "unintended intra-operative awareness" occurs during general anesthesia, when a patient has not had enough general anesthetic or Analgesic

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 due to the rapid redistribution of the drug out of the brain to other parts of the body. Teresa Zimmers, a molecular biologist from the University of Miami Miller School of Medicine, has commented that the amount of thiopental administered to those being executed "would be an unacceptably low dose if the inmate was a pig scheduled for euthanasia. "^[24]

Additionally, opponents argue that the method of administration is also flawed. They state that since the personnel administering the lethal injection lack expertise in anesthesia the risk of failing to induce unconsciousness is greatly increased. Also, they argue that the dose of sodium thiopental must be customized to each individual patient, not restricted to a set protocol. 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 humane death, rather than actually providing a humane death. 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. Pancuronium is a Chemical compound, used in medicine as the Bromide salt pancuronium bromide. Therefore the default function of pancuronium bromide would be to suppress the autonomic nervous system, specifically to stop breathing.

Research

In 2005, University of Miami researchers, in cooperation with an attorney representing death row inmates, published a research letter in the medical journal The Lancet. The University of Miami (also known as Miami of Florida, UM, or just The U) is a private non-sectarian University founded in 1925 This article is about the journal For other uses of the term "lancet" see Lancet (disambiguation. The article presented protocol information from Texas and Virginia which showed that executioners had no anaesthesia training, drugs were administered remotely with no monitoring for anaesthesia, data were not recorded and no peer-review was done. Their analysis of toxicology reports from Arizona, Georgia, North Carolina, and South Carolina showed that post-mortem concentrations of thiopental in the blood were lower than that required for surgery in 43 of 49 executed inmates(88%); 21 (43%) inmates had concentrations consistent with awareness. The fictional truth drug Hyoscine-pentothal does not describe real pentothal accurately [8] This led the authors to conclude that there was a substantial probability that some of the inmates were aware and suffered extreme pain and distress during execution. 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 anaesthesia 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 2007 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 [9]confirmed and extended the conclusions made in the Lancet article and go further to disprove the assertion that the lethal injection process is humane. 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. These findings also appear to be further supported by increased reporting of problematic lethal injections in the United States.

Single drug

The execution can be painlessly accomplished, without risk of consciousness, by the injection of a single large dose of barbiturate. Consciousness has been defined loosely as a constellation of attributes of Mind such as Subjectivity, Self-awareness, Sentience, and the Barbiturates are drugs that act as central nervous system Depressants and by virtue of this they produce a wide spectrum of effects from mild Sedation ^[25] By this logic, the use of any other chemicals is entirely superfluous and only serves to unnecessarily increase the risk of torture during the execution. Torture, according to the United Nations Convention Against Torture, is "any act by which severe pain or suffering, whether physical or mental is intentionally Another possibility would be the infusion of a powerful and fast-acting narcotic, such as fentanyl, which would ensure comfort while suppressing the subject's respiratory drive. The term narcotic (ναρκωτικός is believed to have been coined by the Greek physician Galen to refer to agents that benumb or deaden causing loss Fentanyl is one of the most powerful Opioid Analgesics with a potency approximately 81 times that of Morphine. Another drug that could be used is sodium pentobarbital, which is used in animal euthanasia. Pentobarbital is a short-acting Barbiturate that is available as both a Free acid and a Sodium salt, the former of which is only slightly soluble in water Put to sleep redirects here For its literal meaning see Sleep or Anaesthetic. When administered in an overdose, it causes rapid unconsciousness. Respiratory arrest follows next, through paralysis of the diaphragm and collapse of the lungs. Respiratory arrest is the cessation of Breathing. It is a Medical emergency and it usually is related to or coincides with a Cardiac arrest. The drug would then suppress cardiac activity, thus causing death.

Cruel and unusual

On occasion, there have also been difficulties inserting the intravenous needles, sometimes taking over half an hour to find a suitable vein. ^[26] Typically, the difficulty is found in convicts with a history of intravenous drug abuse. Opponents argue that the insertion of intravenous lines that take excessive amounts of time are tantamount to be cruel and unusual punishment. In addition, opponents point to instances where the intravenous line has failed, or where there have been adverse reactions to drugs, or unnecessary delays during the process of execution.

On December 13, 2006, Angel Nieves Diaz was not executed successfully in Florida using a standard lethal injection dose. Events 1294 - Saint Celestine V abdicates the papacy after only five months Celestine hoped to return to his previous life Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. Ángel Nieves Díaz ( August 31, 1951 &ndash December 13, 2006) was a Puerto Rican 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 spokesperson denied Diaz had suffered pain, and claimed the second dose was needed because Diaz had some sort of liver disease. ^[27] After performing an autopsy, the Medical Examiner, Dr. 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. ^[28] Two days after the execution, Governor Jeb Bush suspended all executions in the state and appointed a commission “to consider the humanity and constitutionality of lethal injections. ”^[29]

A study published in 2007 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". PLoS Medicine is a Scientific journal covering the full spectrum of the medical sciences it began operation on October 19, 2004. ^[30]

Controversy: Arguments in support

Commonality

The combination of a barbiturate induction agent and a nondepolarizing paralytic agent is used in thousands of anaesthetics 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. Cardioplegia is the intentional and temporary cessation of cardiac activity primarily used in Cardiac surgery. 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 every day surgery to avoid controversy. The only modification is that a massive coma-inducing dose of barbiturates is given. In addition, similar protocols have been used in countries that support euthanasia or physician-assisted suicide. [10]

Anesthesia awareness

Thiopental is a rapid and effective drug for inducing unconsciousness, since it causes loss of consciousness upon one circulation through the brain due to its high lipophilicity. Lipophilicity, fat-liking, refers to the ability of a Chemical compound to dissolve in fats oils lipids and non-polar solvents such as Hexane or Only a few other drugs, such as methohexital, etomidate, propofol, or fentanyl have the capability to induce anesthesia so rapidly. Methohexital (marketed under the brand name Brevital) is a drug which is a Barbiturate derivative Etomidate is a short acting Intravenous anaesthetic agent used for the induction of General anaesthesia and for Sedation for short procedures Propofol is a short-acting Intravenous sedative agent used for the induction of general Anesthesia for adults and children maintenance of general anesthesia and Fentanyl is one of the most powerful Opioid Analgesics with a potency approximately 81 times that of Morphine. Supporters argue that since the thiopental is given at a much higher dose than for medically-induced coma protocols, it is effectively impossible for a patient to wake up.

Anesthesia awareness occurs when general anaesthesia is inadequately maintained, for a number of reasons. Anesthesia awareness, or "unintended intra-operative awareness" occurs during general anesthesia, when a patient has not had enough general anesthetic or Analgesic In modern medical practice general anaesthesia ( AmE: anesthesia) is a state of total unconsciousness resulting from General anaesthetic drugs Typically, anaesthesia is induced with an intravenous drug, but maintained with an inhaled anesthetic given by the anesthesiologist (note that there are several other methods of safely and effectively maintaining anesthesia). Inhalational anaesthetics are gases or Vapours possessing Anaesthetic qualities Barbiturates are used only for induction of anesthesia and these drugs rapidly and reliably induce anesthesia, but wear off quickly. A neuromuscular blocking drug may then be given to cause paralysis which facilitates intubation, although this is not always required. In Medicine, intubation refers to the placement of a tube into an external or internal orifice of the body The anesthesiologist has the responsibility to ensure that the maintenance technique (typically inhalational) is started soon after induction to prevent the patient from waking up.

General anesthesia is not maintained with barbiturate drugs. An induction dose of thiopental wears off after a few minutes because the thiopental redistributes from the brain to the rest of the body very quickly. However, it has a long half-life, which means that it takes a long time for the drug to be eliminated from the body. If a very large initial dose is given, little or no redistribution takes place (since the body is saturated with the drug), which means that recovery of consciousness requires the drug to be eliminated from the body, which is not only slow (taking many hours or days), but unpredictable in duration, making barbiturates very unsatisfactory for maintenance of anaesthesia.

The "ultra-short" acting thiopental has a half-life of approximately 11. 5 hours (however, the action of a single dose is terminated within a few minutes by redistribution of the drug from the brain to peripheral tissues) and the long acting phenobarbital has a half-life of approximately 4-5 days. It contrasts towards the inhaled anesthetics have extremely short half-lives and allow the patient to wake up rapidly and predictably after surgery.

The average time to death once a lethal injection protocol has been started is about 7-11 minutes. [11] Since it only takes about 30 seconds for the thiopental to induce anesthesia, 30-45 seconds for the pancuronium to cause paralysis, and about 30 seconds for the potassium to stop the heart, death can theoretically be attained in as little as 90 seconds. Given that it takes time for the machine to administer the drug, time for the line to flush itself, time for the machine to change the drug being administered, and time to ensure that death has occurred, the whole procedure takes about 7-11 minutes. Procedural aspects in pronouncing death also contribute to delay and, therefore, the condemned is usually pronounced dead within 10 to 20 minutes of starting the drugs. Supporters of the death penalty say that a huge dose of thiopental, which is between 14-20 times the anesthetic induction dose and which has the potential to induce a medical coma lasting 60 hours, could never wear off in only 10 to 20 minutes.

Dilution effect

Death penalty supporters state that the claim that pancuronium dilutes the sodium thiopental dose is erroneous. Supporters argue that pancuronium and thiopental are commonly used together in surgery every day and if there were a dilution effect, it would be a known drug interaction.

Drug interactions are a complex topic. A drug interaction is a situation in which a substance affects the activity of a drug, i Some drug interactions can be simplistically classified as either synergistic or inhibitory interactions. In addition, drug interactions can occur directly at the site of action, through common pathways or indirectly through metabolism of the drug in the liver or through elimination in the kidney. Pancuronium and thiopental have different sites of action, one in the brain and one at the neuromuscular junction. Since the half-life of thiopental is 11. 5 hours, the metabolism of the drugs is not an issue when dealing with the short time frame in lethal injections. The only other plausible interpretation would be a direct one, or one in which the two compounds interact with each other. Supporters of the death penalty argue that this theory does not hold true. They state that even if the 100 mg of pancuronium directly prevented 500 mg of thiopental from working, there would be sufficient thiopental to induce coma for 50 hours. In addition, if this interaction did occur, then the pancuronium would be incapable of causing paralysis.

Supporters of the death penalty state that the claim that the pancuronium prevents the thiopental from working, yet is still capable of causing paralysis, is not based on any scientific evidence and is a drug interaction that has never before been documented for any other drugs. Supporters of the death penalty question if this is an invented false claim.

Single drug

Amnesty International, Human Rights Watch, the Death Penalty Information Center, and other anti-death penalty groups have not proposed a lethal injection protocol which they believe is more humane. Amnesty International (commonly known as Amnesty or AI) is a Western based international Non-governmental organization which defines its mission as "to Human Rights Watch is a United States -based international Non-governmental organization that conducts research and advocacy on Human rights. Supporters of the death penalty argue that the lack of an alternative proposed protocol is testament to the fact that the humaneness of the lethal injection protocol is not the issue. Instead supporters argue that the issue is the continued existence of the death penalty, since if the only issue was the humaneness of the procedure, then Amnesty International, HRW, or the DPIC should have already proposed a more humane method.

Regardless of an alternative protocol, some death penalty opponents have claimed that execution can be more humane by the administration of a single lethal dose of barbiturate. Supporters of the death penalty, however, state that the single drug theory is flawed concept. Terminally ill patients in Oregon who have requested physician-assisted suicide have received lethal doses of barbiturates. The protocol has been highly effective in producing a humane death, but the time to cause death can be prolonged. Some patients have taken days to die, and a few patients have actually survived the process and have regained consciousness up to three days after taking the lethal dose. [12] In a Californian legal proceeding addressing the issue of the lethal injection cocktail being "cruel and unusual," state authorities said that the time to death following a single injection of barbiturate is approximately 45 minutes. [13]

Scientifically this is readily explained. Barbiturate overdoses typically cause death by depression of the respiratory center, but the effect is variable. Some patients may have complete cessation of respiratory drive, whereas others may only have depression of respiratory function. In addition, cardiac activity can last for a long time after cessation of respiration. Since death is pronounced after asystole and given that the expectation is for a rapid death in lethal injection, multiple drugs are required; specifically potassium chloride to stop the heart. In medicine asystole is a state of no cardiac electrical activity hence no contractions of the Myocardium and no cardiac output or blood flow In fact, in the case of Clarence Ray Allen a second dose of potassium chloride was required to attain asystole. Clarence Ray Allen ( January 16, 1930 &ndash January 17, 2006) was an American Killer who was executed by Lethal The position of most death penalty supporters is that death should be attained in a reasonable amount of time.

Supporters of the death penalty agree that the use of pancuronium bromide is not absolutely necessary in the lethal injection protocol. Some supporters believe that the drug may decrease muscular fasciculations when the potassium is given, but this has yet to be proven.

Related articles

• Capital punishment in the United States
• Euthanasia

Resources

Lethal Injection Web-Based Clearinghouse

References

• Bean, Matt. "Lethal injection—the humane alternative?", Court TV, June 8, 2001. Events 68 - The Roman Senate accepts emperor Galba. 536 - St Silverius becomes Pope (probable Year 2001 ( MMI) was a Common year starting on Monday according to the Gregorian calendar.  
• Liptak, Adam. "Critics Say Execution Drug May Hide Suffering", New York Times, October 7, 2003. Events 3761 BC - The epoch (origin of the modern Hebrew calendar ( Proleptic Julian calendar) Year 2003 ( MMIII) was a Common year starting on Wednesday of the Gregorian calendar.  
• "Prisoners 'aware' in executions", BBC News, 14 April 2005. Events 43 BC - Battle of Forum Gallorum: Mark Antony, besieging Julius Caesar 's assassin Decimus Junius Brutus in Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar.  
• Kevin Bonsor. How Lethal Injection Works. HowStuffWorks. com. Retrieved on September 3, 2005.
• Koniaris, Leonidas G. et al (2005). "Inadequate anaesthesia in lethal injection for execution". The Lancet 365 (9468): 1412–1414. doi:10.1016/S0140-6736(05)66377-5. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document.  

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