Does execution by lethal injection involve conscious asphyxiation?

April 23, 2007

Execution by lethal injection may cause death by asphyxiation, and prisoners being executed may be conscious and may experience pain, claim the authors of a new study published this week in PLoS Medicine. Leonidas Koniaris and colleagues from the University of Miami assessed data from two US states that release information on executions together with previously published work on the drugs used in the protocols for lethal injections. They conclude that these protocols may not reliably effect death through the mechanisms intended.

Lethal injection is used for execution in a number of countries, most notably the US and China. The current regimens for lethal injection in the US are based on one drawn up by legislators in Oklahoma, which in turn to appear to have been based on personal opinion rather than independent research. The drugs used are a barbiturate, thiopental (which acts as an anesthetic, but does not have any analgesic effect), a neuromuscular blocker, pancuronium bromide (which causes muscle paralysis); and an electrolyte, potassium chloride (which stops the heart from beating). Each of these drugs on its own was apparently intended by those who derived the protocols to be sufficient to cause death; the combination was intended to produce anesthesia then death due to respiratory and cardiac arrest. Following a number of executions in the US, however, it has recently become apparent that the regimen as currently administered does not work as intended. Some p risoners take many minutes to die, and others become very distressed.

The authors concluded that in the current regimen thiopental might not be fatal and might even be insufficient to induce surgical anesthesia for the duration of the execution, and that the doses of potassium chloride used did not reliably induce cardiac arrest. Hence, potentially aware inmates are likely to die through asphyxiation induced by the muscle paralysis caused by pancuronium. The authors conclude that even if lethal injection is administered without technical error, those executed may suffocate, and therefore ''the conventional view of lethal injection as an invariably peaceful and painless death is questionable.''

In a related editorial the PLoS Medicine editors discuss the study's findings and their reason for publishing it in the journal. They state that "It is not our intention to encourage further research to "improve" lethal injection protocols. As editors of a medical journal, we must ensure that research is ethical, and there is no ethical way to establish the humaneness of procedures for killing people who do not wish to die," and note that "the data presented by Koniaris and colleagues adds to the evidence that lethal injection is simply the latest in a long line of execution methods that have been found to be inhumane." They argue that the evidence presented in this paper "will further strengthen the constitutional case for the abandonment of execution in the US."
-end-
Citation: Zimmers TA, Sheldon JP, Lubarsky DA, López-Muñoz F, Waterman L, et al. (2007) Lethal injection for execution: Chemical asphyxiation? PLoS Med 4(4): e156.

IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040156

PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-04-koniaris.pdf

Related image for press use: http://www.plos.org/press/plme-04-04-koniaris.jpg

- Caption: Lethal injection table - provided by California Department of Corrections and Rehabilitation

CONTACT:

Dr. Leonidas G. Koniaris
University of Miami
Surgery, Cell Biology, Anatomy
3550 SCCC
1475 NW 12th Ave
Miami, FL 33156
United States of America
+1 305 243-1684
+1 305 243-7083 (fax)
lkoniaris@med.miami.edu

Related PLoS Medicine Editorial:

Citation: The PLoS Medicine Editors (2007) Lethal injection is not humane. PLoS Med 4(4): e171.

IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER:: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040171
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-04-editorial.pdf

PLOS

Related Cardiac Arrest Articles from Brightsurf:

Outcomes for out-of-hospital cardiac arrest during COVID-19 pandemic
This study used a large US registry of out-of-hospital cardiac arrests to asses the association between the COVID-19 pandemic and the outcomes of out-of-hospital cardiac arrests, including in areas with low and moderate COVID-19 disease.

Cardiac arrest is common in critically ill patients with COVID-19
Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among patients aged 80 or older, finds a study published by The BMJ today.

In-hospital cardiac arrest in COVID-19
Outcomes of in-hospital cardiac arrest among patients with COVID-19 are examined in this case series.

New risk tool developed for cardiac arrest patients
Experts have developed a risk score to predict cardiac arrest patient outcomes.

Intravenous sodium nitrite ineffective for out-of-hospital cardiac arrest
Among patients who had an out-of-hospital cardiac arrest, intravenous sodium nitrite given by paramedics during resuscitation did not significantly improve their chances of being admitted to or discharged from the hospital alive, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Getting to the heart of epinephrine use in pediatric cardiac arrest patients
The effectiveness of epinephrine treatment during resuscitation of adult patients with cardiac arrest is generally promising, but little is known about its effects in pediatric patients.

Bystanders can help more cardiac arrest victims survive
Only 8% of Americans survive cardiac arrest outside a hospital, but that percentage could increase significantly if bystanders recognize cardiac arrest and perform simple lifesaving tasks, a UVA Health physician says in a New England Journal of Medicine article.

Opioid-related cardiac arrest patients differ from other cardiac arrests
People who suffer cardiac arrest due to an opioid overdose are younger, have fewer chronic medical conditions and may be more likely to be to receive bystander CPR, according to a review of emergency response records in Maine.

Selective coronary angiography following cardiac arrest
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.

Sudden cardiac arrest in athletes: Prevention and management
It's marathon season, and every so often a news report will focus on an athlete who has collapsed from sudden cardiac arrest.

Read More: Cardiac Arrest News and Cardiac Arrest Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.