Lethal Injection

Lethal injection is now virtually the universal method of execution in the United States, with all but one of the 59 executions carried out during 2004 being by this method. Of the 885 executions in the US to the end of 2004, 776 have been by lethal injection, including those of eight women.

Lethal injection was first considered as a means of execution in 1888 when New York's J. Mount Bleyer MD put it forward in an article in the Medico-Legal Journal suggesting that it would be more humane, cheaper and rob the prisoner of the hero status that often attached to hangings. He suggested the intravenous injection of six grains of Morphine. The idea did not catch on and New York introduced the electric chair instead.

The British Royal Commission on Capital Punishment (1948-1953) also examined lethal injection but decided against it, partly due to pressure from the BMA who were concerned about the ethics of doctors participating in executions.

It was again put forward in 1977 by Dr. Stanley Deutsch, who at the time chaired the Anaesthesiology Department of Oklahoma University Medical School. In response to a call by an Oklahoma state senator Bill Dawson for a cheaper alternative to repairing the state's derelict electric chair, Deutsch described a way to administer drugs through an intravenous drip so as to cause death rapidly and without pain. "Having been anaesthetised on several occasions with ultra short-acting barbiturates and having administered these drugs for approximately 20 years, I can assure you that this is a rapid, pleasant way of producing unconsciousness," Deutsch wrote to the senator in February 1977.

Oklahoma thus became the first to legislate for it in 1977. Texas introduced similar legislation later in the same year to replace their electric chair and carried out the first execution by this method on December 7th 1982 when Charles Brooks was put to death for the murder of second hand car salesman David Gregory in Huntsville Texas in 1976. Brook's girlfriend Vanessa Sapp witnessed the procedure, which began at 12.07 a.m. He was certified dead at 12.16 a.m. There was no apparent problem and Brooks seemed to die quite easily. At first he raised his head, clenched his fist and seemed to yawn or gasp before passing into unconsciousness.

37 American states now use lethal injection either as their sole method or as an option to one of the traditional methods. These being Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington and Wyoming. Alabama has allowed lethal injection from July 1st 2002 as an option to electrocution and has executed four people by this method up to the end of 2003.

Texas has carried out the vast majority of lethal injections in the US, with 313 to the end of 2003. Many states have modified their old execution chambers to save the cost of building a new facility - California carries out injections within the gas chamber at San Quentin and Washington under the gallows traps at Walla Walla State Penitentiary.

The Philippines have also decided to use lethal injection for future executions to replace the electric chair and carried out its first execution since 1976, when Leo Echegaray was put to death for child rape on the 4th of February 1999. A further 6 men have been executed by this method to the end of 2000 but there have been no executions since.

Guatemala has also switched to lethal injection after a botched firing squad execution in 1996 and has carried out three executions since then. The first occurred on the 10th February 1998, when Manuel Martinez, a 42-year-old peasant, was put to death for killing four children, their parents and their aunt in 1995 in a dispute over a small plot of land.

On the 29th June 2000 two members of a Guatemalan kidnapping ring were executed in consecutive and televised executions. Amilcar Cetino Perez and Tomas Cerrate Hernandez were members of a notorious kidnap gang believed to be responsible for death threats against the family of President Alfonso Portillo.

China also been experimenting with lethal injection and is moving to this method to replace shooting.

During early 2003 it has introduced a fleet of eighteen mobile execution vehicles. These are specially converted 24 seat minibuses, which will operate in the southern province of Yunnan and the cities of Harbin and Shanghai. The windowless execution chamber at the back contains a metal bed on which the prisoner is strapped down. The executioner presses a button that starts an automatic injection process which can be watched on a video monitor next to the driver's seat and be recorded if required. Efficiency and cost were apparently the main reasons for the introduction of these vehicle according to Yunnan officials. On was quoted as saying : "With lethal injection, only four people are required to execute the death penalty: one executioner, one member of the court, one from the procuratorate and one forensic doctor. A dozen guards are also required to keep watch around the van". Thailand has moved to lethal injection to replace shooting from December 2003.

U S Federal executions.

The American Federal Bureau of Prisons has a $300,000 lethal injection facility at the federal prison in Terre Haute, Indiana. The death house is located inside a non-descript brick building outside the main penitentiary compound, and consists of five viewing rooms surrounding the execution chamber.

The chamber is a stark, hospital-like room lined with green tiles and bare except for the large gurney equipped with five Velcro restraints and a sink in one corner.

The intravenous tubes pass through a small opening in the wall and into the executioner's room nearby. All but one room, the executioner's, are equipped with large two-way windows with curtains. The executioner's room is fitted with one-way glass. During an execution, prison officials will maintain an open telephone line to the Justice Department in Washington. The President has sole authority to grant last-minute clemency. Overhead, a camera linked to a monitor inside the executioner's room will watch the process to note whether the prisoner suffers any pain during the procedure.

On the 11th of June 2001 Timothy McVeigh, the Oklahoma City bomber became the first person to be executed under Federal law since 1963. He had placed a bomb outside the Alfred P Murrah Federal Building, killing 168 people and injuring 850. The intravenous drip that delivered the lethal chemicals went to a catheter in McVeigh's right leg. The first drug was administered at 8.10 a.m., with the second being given at 8.11 and the final one at 8.13 and he was pronounced dead at 8.14 a.m. On the 19th of June 2001, Juan Raul Garza, a Mexican-American drug lord and murderer was executed on the same gurney.

A prisoner found guilty after 1994 of a federal capital crime (of which there are now over 60) in states that do not allow for lethal injection as a method of execution can't legally be executed in Terre Haute. For those prisoners, the federal government will "contract out" the executions and they will use that state's normal method. Two further executions have been carried out under Federal jurisdiction since.

The American military has also moved to lethal injection (from hanging) and now has a facility in the basement of the military prison at Ft. Leavenworth, Kansas which is currently housing six or seven inmates.

Typical execution procedure.

Lethal injection protocols vary from state to state. Typically the prisoner is strapped to a gurney (which is a wheeled hospital style trolley bed) or a fixed execution table rather like an operating theatre table (see photo) by leather or webbing straps over the body and legs. Their bare arms are strapped to boards projecting from the sides of the gurney. Trained technicians then insert a 14 gauge catheter (the largest commercially available needle) into a vein in each arm, a process that sounds much simpler than it often is. Once the catheters are in place, they are flushed with 10ml of a Heperin solution, to prevent clots forming inside the catheter, then a 1000 ml bag of saline solution is connected to the catheter ends and the prisoner is either wheeled into the execution chamber or the curtains surrounding it are drawn back to allow the witnesses to see the procedure. When the condemned person has made any final statement, the prison warden gives the signal for the execution to begin and the technician(s), hidden from view behind a two way mirror, begins to manually inject the three chemicals comprising typically 15 - 50 cc of Sodium thiopental, 15 - 50 cc of Pavulon (the generic name for Pancuronium bromide) and 15 - 50 cc of Potassium chloride. There is a short interval between each chemical during which saline solution is injected to clean the IV line and prevent any chemical reaction which could block it. Typically the actual injections will take from three to five minutes to complete.

All the chemicals used in America are standard medical drugs. Sodium thiopental is a short acting barbiturate which is used widely as an anaesthetic and normally causes unconsciousness very quickly if injected into a vein. Pavulon is a muscle relaxant that paralyses the diaphragm and thus arrests breathing whilst Potassium chloride finishes the job by causing cardiac arrest. It is used in cardiac surgery to stop the heart.

In most cases the prisoner is unconscious about a minute after the Sodium thiopental has been injected and is dead in around eight minutes, with no obvious signs of physical suffering.

In some states a fully automated lethal injection machine is used that runs off a 12 volt battery. It injects the chemicals in the right order and amount once the catheters are in place. This considerably assists matters and avoids the problems of mixing of the chemicals which can lead to a reaction causing precipitation which makes them impossible to inject.

The machine has eight syringes. Three with lethal Chemicals that are electrically operated, three with lethal chemicals which are mechanically operated (back-up) and two filled with saline solution used to bleed or purge air form the manifold and the IV lines. Two buttons control the machine, one for the lethal syringes and one for the identical looking harmless ones. The two executioners each press a button, and the syringes release the drugs into the IV line.

Multiple executions. In Arkansas in 1994, prison officials, citing the disruptive impact of executions on staff and other prisoners and the high cost of "rehearsal time" and overtime pay, took steps to reduce both problems by conducting multiple executions. They carried out two unrelated executions on the night of May the 11th and a further three on August the 3rd of that year with a 45 minutes interval between them so that the chamber could be cleared between each prisoner and to allow prison officials time to replace needles and tubes used to administer the injection. The sheet on the gurney was also changed between executions.

Texas has also carried out multiple executions. On 30th January 1995, in that state's first multiple execution in 44 years. 33-year-old Clifton Russell was put to death just after midnight and Willie Williams, 38, was injected about an hour and a half later. Texas carried out a further double injection in 1997. (Dorsie Johnson-Bey & Davis Losada on the 5th June)

Is lethal injection the humane alternative?

Execution by lethal injection takes much longer from start to finish than any other method, typically 30 - 45 minutes depending on the execution protocol and ease or otherwise of locating a vein. In the U.K. a hanging took around 15 seconds to carry out in the later part of the 20th century. For the majority of this time the condemned person is fully aware of what is happening to them and able to experience their execution. They know that they will be dead at the end of it and the fear of suffering (particularly in front of an audience) and of the unknown is strong in most of us. It is difficult to see therefore how it can be considered more humane, as the prisoner is subjected to far more mental anguish over a longer period.

It is fair to say that injection is much less dramatic than the electric chair or hanging and probably easier for the staff and witnesses as it looks more like a surgical procedure than an execution. But does it cause the prisoner less suffering overall?

When all goes well, the only physical pain is the insertion of the catheters. If the person's veins are easy to find this can be done in a minute or so. The catheters are connected to the saline drip and the prisoner is wheeled into the execution chamber where they are in full view of the witnesses and journalists. After they have made their final statement the injection of the lethal chemicals can begin and they may pass almost instantly from full consciousness into unconsciousness or they may feel themselves becoming drowsy and know that they are beginning to die.

In modern hanging they are alive one second and unconscious the next (if everything goes to plan). It is unlikely that they feel themselves slipping into death.

Not everyone is of the opinion that death by lethal injection is painless - Dr. Edward Brunner, chairman of the Department of Anaesthesia at North-western University Medical School, submitted an affidavit on behalf of death row inmates in Illinois in which he states that lethal injection "create[s] the substantial risk that prisoners will suffocate or suffer excruciating pain during the three chemical injections but will be prevented by the paralytic agent from communicating their distress." It is notable also that Albert Pierrepoint, who was one of Britain's most prolific hangmen and who witnessed an early lethal injection execution considered that the process was "sadistic" mainly due to the length of time it took to render the prisoner unconscious.

In the minds of the American public and of jurors in capital cases the perception of lethal injection is of a clean, clinical and painless end. 71% of those responding to my 2001 survey considered injection to be the least cruel form of execution.

This perception is a great advantage to the state because the public are much more willing to accept execution in this form and jurors more willing to convict and pass the death sentence. The media interest in the eventual execution is also diminished. Texas which has carried out around a third of all post 1977 executions finds that there is now very little interest in them unless the criminal is particularly notorious and thus avoids much of the protest that attends other methods.

There was intense media interest in the three hangings in Washington and Delaware and the two shootings in Utah because these methods were perceived as old fashioned and barbaric.

Utah may well abandon shooting in favour of injection not because either execution was in any way botched but because they were perceived as being gruesome. It is probable that there will be only a very few if any more hangings in Washington for the same reason.

One wonders, however, if injection is as much of a deterrent as hanging or the electric chair, to would be criminals or whether they feel it is a "soft option"? This is an important point because if the state is going to take the life of a person surely it should seek to produce the maximum deterrence from doing so within the realms of a providing the prisoner with a quick and pain free death. Interestingly in those states that allow the prisoner the choice of execution method, not everyone does choose injection.

The problems with injection.

One of the main problems with lethal injection is the aqueous pressure in the executee's veins. Veins have an internal pressure (blood pressure) which has to be overcome to allow injection into them. A doctor, when giving a normal intravenous (IV) injection, has to equal and then slightly exceed this pressure. If he produces a pressure that is too great he will rupture the vein. The doctor accomplishes this through his training, fingertip dexterity and experience built up from giving repeated injections. He feels the pressure in the vein against the top of the plunger of the syringe. In the case of a lethal injection the volume of the of fluid required to fill the plumbing of the IV tubes running between the executioner's cubicle and the prisoner means that the syringes must be of 50 - 60 cc capacity. Syringes of this size are too big to give any real feel to the person administering the injection. Thus too much pressure can easily be applied and a rupture of the vein may occur. This can happen in the case of giving a non lethal injection into the good healthy veins in a normal person.

It is not unusual for the condemned prisoner to be a former intravenous drug abuser, with delicate, collapsed veins that can stand far less overpressure. This is also true of people who are insulin injecting diabetics. When a person with normal veins is frightened their veins contract and become hard to find.

Before insertion of the catheters a good vein must be located. It is not unusual for an "cut-down procedure" to have to be performed to find a usable (not necessarily suitable) vein. This entails a minor surgical procedure on the arm, leg or groin carried out under local anaesthetic, using a sub-cutaneously injected dose of Xylocaine or similar local anaesthetic, administered by a medical technician. The public are seldom made aware of this and the witnesses would not typically see any evidence of it during the execution.

To produce a quick and painless death it is vital that the chemicals are injected into a vein, rather of an artery. Veins carry blood to the heart and arteries away from the heart. The path of the chemicals (particularly the potassium chloride) should be via the quickest route to the heart so as not to prolong the execution. If an artery is used by mistake, instead of a vein, the blood carrying the chemicals has to go the "long way round" significantly increasing the time taken to stop the heart. The distinction between a vein and an artery is not an easy one to make. Even a doctor can make a mistake! It is clear from reading reports of executions that the time between commencing the injection and certifying death varies a great deal.

Botched Lethal Injections

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