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Helping Karl
New York Times
June 2006
If the sodium thiopental did not work because the dose was too low, for example, or if the drugs were given in the wrong order, an inmate could still be conscious when the paralyzing drug and the potassium were injected. In that case, the paralyzing agent would cause a feeling of suffocation. And the potassium chloride would cause a burning sensation, muscle cramping and chest pain like that of a heart attack.
The pain from the potassium would not last long: once the drug stopped the heart, the person would lose consciousness in 10 to 15 seconds, Dr. Dershwitz said. But while the pain lasted, the inmate would be paralyzed and unable to complain, and would appear serene to witnesses.
Pavulon "gives a false sense of peacefulness," said Dr. David A. Lubarsky, chairman of anesthesiology at the University of Miami.
Indeed, because drugs like Pavulon can mask suffering, many states outlaw them for animal euthanasia.
Execution by barbiturate alone would take longer than the current method, Dr. Dershwitz said. Although prisoners would quickly lose consciousness and stop breathing, they could not be pronounced dead until electrical activity in the heart had stopped. That could take as long as 45 minutes.
In addition, Dr. Dershwitz said, barbiturates could cause "significant involuntary jerking" that would be disturbing to witnesses even though an unconscious prisoner would not feel it.
Intravenous barbiturates are not the only option, Dr. Dershwitz said. Drugs could also be injected into a muscle instead of a vein, to avoid another source of lawsuits: pain among inmates whose veins are hard to find. But injection into a muscle would take much longer to work than the intravenous method.
Another possibility might be an oral dose of barbiturates, like those doctors in Oregon can prescribe to assist suicide of some terminally patients. But prisoners would have to swallow the pills, and Professor Denno said there had never been a procedure in which prisoners had been required to participate in their own executions, essentially agreeing to commit suicide.
Dr. Chapman said that when he first proposed the three-drug technique, he imagined that it would be carried out by people with enough medical training to start intravenous lines, mix and measure the drugs, and give them in the right order.
He was then Oklahoma's chief medical examiner, and came up with the formula at the request of a legislator who was looking for a humane alternative to the electric chair. His idea became law in Oklahoma and was also adopted by 36 other states.
Once the lethal injection laws were passed, professional groups like the American Medical Association, state medical societies and associations for anesthesiologists and nurses quickly distanced themselves, saying it would be unethical for members to participate. That creates a Catch-22 in which the medical establishment refuses to perform lethal injections and yet says no one else is qualified to do so.
Although some doctors and nurses do help in executions, lethal injection in many states is carried out by paramedics, technicians or other prison employees who do not have special training in anesthesia.
Dr. Chapman said that his original protocol had called for enough barbiturate to cause death by itself and that he had added the Pavulon just as a backup, and the potassium chloride to speed the process by stopping the heart quickly. "I think the whole concept of execution is that it's carried out rapidly," he said.
Whether inmates have actually felt pain or suffocation from lethal injection is not known with certainty.
"I don't think any human has had a giant bolus of potassium chloride injected and then come back to chat about it," Dr. Lubarsky said.
