Talk:Lethal injection

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This article has been cited as a source by a media outlet. See the 2004 press source article for details. "Lawyers: Inmates died in 'agony' from injections" (March 15, 2004). Greenville News. [1].

Contents 1 edited for clarity 2 help me understand 3 1982 vs 1983 4 It was in 1982 (Part 2) 5 Procedure 6 The first 7 Poison not chemicals 8 Cognitive dissonance 9 Lethal drugs section 10 Controversy section 11 Errors in the arguments against section 12 Confusion in the controversy section 13 Price 14 Inflammatory? 15 False reporting of Lancet study 16 karl brandt 17 ===Lethal injection= 18 agruments against section 19 arguments against 20 Nice work JayW 21 Trypanophobia, Lethal Injection and the Constitution 22 Just a thought...

[edit] edited for clarity

The original as follows...

"The American Medical Association's Code of Ethics prohibits doctors from participating in executions [2]. However there is always a physician present to officially declare the prisoner dead."

is neither correct nor clear.

--Every1blowz 18:58, 2 December 2005 (UTC)

Comment: the external link a) will not be available as long as the article b) (to say the least) doesn´t has the quality of the article ..may be just substantiated personal opinion say: what has pet pharmacology to do with capital sentence?

Comment: Shouldn't this article mention the use of lethal injection by the Nazi Dr. Karl Brandt between 1939 and 1941 as part of the T-4 Euthanasia Programme?

While I won't remove, delete this reference (nor would I change it unless I can find a source that says otherwise), I find it hard to believe that Brandt was the "inventer" of the entire concept of lethal injection. I also see this as a really bad violation of Godwin's Law. --L. 23:58, 14 July 2005 (UTC)

I am wondering why can't they use some kind of encephalogram to monitor brain behavior of the person being executed. Presumably being in a lot of pain would involve a high level of brain activity, unlike being unconscious. So if such high level of activity were detected, some other procedure could be used to finish the person off quickly. Watcher

Article at the moment: "Some doctors object to participating in executions, claiming that it violates their Hippocratic oath." -- is there actually any debate on this? Can we replace it with "Some doctors object to participating in executions, as that violates their Hippocratic oath." Ojw 20:50, 5 Feb 2005 (UTC)

The few physicians that are willing to participate probably would disagree. I have no objection to changing the wording, however. -- Bk0 03:41, 6 Feb 2005 (UTC)

You're guaranteed to find "some" physicians who agree with any given proposition, and it's pretty meaningless to impute positions to such unnamed persons. A more informative statement would be something like, "The American Medical Association's Code of Medical Ethics forbids physician participation in executions, including such activities as "prescribing or administering... medications that are part of the execution procedure; monitoring vital signs... attending or observing an execution as a physician... rendering of technical advice regarding execution...selecting injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection devices; and consulting with or supervising lethal injection personnel." The AMA's Code of Medical Ethics is advisory rather than having any force in law, but most American physicians abide by it." But then someone would scream that that's "Americocentric". Perhaps some other similarly explicit code of ethics from some suitably non-American country can be found. Whether an action "seems" to violate one of the Hippocratic oaths is someone's (unattributed) opinion; explicit codes of medical ethics come with their own attribution.- Nunh-huh 03:55, 6 Feb 2005 (UTC)

Wordy rather than Americocentric maybe. This article will mostly be about America anyway, so no objection to mentioning AMA. The Hippocratic oath is universal so might be more relevant and understandable to many people. (it's also a moral thing rather than a legal one, so the two might be orthogonal)

My question was do the doctors who administer lethal injections believe that it's not a violation of their oath or are they ignoring that oath? Is the statement "this oath prohibits killing people" merely the opinion of "some doctors" (as the article currently implies)? Ojw 14:59, 6 Feb 2005 (UTC)

"The" Hippocratic Oath is in fact several different similar oaths, and there are many physicians today who have never taken any one of them: they are far from universal. Almost no modern physicians have taken anything near the original oath, which is pledged to pagan gods, entails an obligation to financially support one's teachers, forbids urological surgery, euthenasia, and medical abortions, etc. The "Hippocratic" oaths have no special position regarding medical practices, other than their historical influence on current medical ethics, as manifested by medical boards and the various legal systems. - Nunh-huh 21:42, 6 Feb 2005 (UTC)

Removed the section refering to the hipocratic oath. If states acting in accordance with the oath, then abortion would be illegal in the state of California.

[edit] help me understand

So...why don't they just give them f*cking megadoses of these things? Shoot them full of like 10 syringes worth of Sodium thiopental and the other drugs? Surely that would lay to rest any questions about whether or not the prisoner was aware?

They do give a very large dose of each drug. The main point of contention seems to be the use of a very short acting barbiturate (thiopental) rather than a longer acting drug (like pentobarbital) and then the use of a paralytic immediately afterward, which would hide the fact that the prisoner is still conscious if the initial barbiturate was not effective. --Bk0 00:16, 17 October 2005 (UTC)

The person who added the section on controversy is obviously biased about the death penalty. It is true that pentothal is an ultra-short acting barbiturate and is given in anesthesia induction. But it is also a drug used for medical induced comas and the difference is the dosing of the drug to take advantage of its unique pharmacokinetics. Medical induced comas are an extremely rare procedure. Typically it is only used for patient with severe brain injury either from trauma or following a neurosurgical procedure. Using barbiturates decreases the brain activity and therefore decreases metabolic requirements and metoboloic byproducts which may increease brain swelling. Keeping the swelling to a minimum, increases the likelihood of a better outcome.

To suggest that the anesthesia is inadequate is completely naive. There are so many drugs out there that can knock a person out completely. To suggest that people in the medical community do not understand the pharmacokinetics of an "ultra-short" acting barbiturate is the height to stupidity. After 5 grams of pentothal, you could probably saw a person in half and not see any changes on an electroecephalogram. Maybe we should change the name to "ultra-potent" or "ultra-long" to confuse the idiots who think it only works for a few seconds.

Anesthesia awareness does occur. But this occurs when the anesthesiologist is trying to not give too much, yet at the same time trying to give enough drugs to prevent awareness. In lethal injection, there is no concern about adverse effects from too much drugs. After all, the convict will be dead in a few seconds anyways.

[edit] 1982 vs 1983

Since it appears that both are quoted as the date for the Texas thing, I have added a parenthetical citing the History Channel. Andre (talk) 01:30, May 17, 2005 (UTC)

My feeling is that the History Channel is just plain wrong. The Texas Department of Criminal Justice [2][3][4], Clark County Prosecutor [5][6], Death Penalty Information Center [7] all say 1982. Evil Monkey∴Hello 02:24, May 17, 2005 (UTC)

Some more site that say 1982: Florida Corrections Commission [8], Texas Execution Information Center [9], Amnesty International [10][11]. 02:33, May 17, 2005 (UTC)

• The History Channel is no kind of source. The Texas Department of Criminal Justice website is perfectly sufficient to demonstrate the 1982 date. Demi ^T/_C 02:40, 2005 May 17 (UTC)

I don't know why the History Channel isn't a source. I've modified the page to say that the History Channel quotes the date as 1983. It does, and it's valid to point out the discrepancy. Andre (talk) 19:57, May 18, 2005 (UTC)

Okay then some more sources. Lethal injection: a stain on the face of medicine from the British Medical Journal [12] has 1982 as well as a source for that date (Anderson K. A more "palatable" way of killing; Texas carries out first execution by lethal injection. Time 1982 Dec 20:28.). How Stuff Works [13]. I'm sorry but IMHO the History Channel is just plain wrong. Evil Monkey∴Hello 00:26, May 19, 2005 (UTC)

And another one, this time a from the New York Times - it is their article from December 7, 1982 on the execution itself [14]. I will quote:

HUNTSVILLE, Tex., Tuesday, Dec. 7 -- The state of Texas injected Charles Brooks Jr. with a deadly combination of sedatives and drugs just after midnight today, making him the first condemned prisoner in the United States to die by lethal injection.

Evil Monkey∴Hello 00:30, May 19, 2005 (UTC)

It doesn't matter how many sources state otherwise, we should report that the History Channel has it as the other date. Maybe it should only be a footnote, but it deserves to be reported. Andre (talk) 20:41, May 19, 2005 (UTC)

Should we report a discrepancy in a secondary source, casting doubts on primary sources. What about if I found Charles Brooks death certificate? Or his death warrant? Would we still need to report about the History Channel and what seems to be a mistype on their part? Evil Monkey∴Hello 05:29, May 20, 2005 (UTC)

Sorry, I see no need to report this here, as this article is about Lethal Injection and not the errors of The History Channel's fact-checkers. Demi ^T/_C 06:43, 2005 May 20 (UTC)

"Sodium thiopental, in a dose high enough to cause death by itself: to put the victim to sleep" *assumes* what is explicitly controverted in the "Is Lethal Injection Painless?" section. It is, in fact, factually wrong. The dose of sodium pentathal is not sufficient to cause death by itself, although it may well cause unconsciousness long enough for the other two drugs to take effect. But if given along, the person will eventually wake up.

[edit] It was in 1982 (Part 2)

I am asuming good faith here. However you must accept that there isn't any controversy over the year the first lethal injection in the United States occurred. Although the History Channel state 1983, every other source states 1982. This would suggest that someone at the HC has just made a typo when entering dates.

You said in your addition to the article that all HC programs use 1983 — could you please tell me the names of them (and the specific episodes) so that I can contact the HC to help them correct it. I'm am interested to know what it would take to prove you when these executions took place. As soon as I can (there is a strike today at uni) I will get a scan of the New York Times article about the execution. I have also found the Boston Globe article from 1982 on ProQuest. Would you accept it if I went to the extreme of finding Charles Brooks's death certificate? Evil Monkey∴Hello 21:58, 3 August 2005 (UTC)

--This is a little reply as an anonymous user here. Death certificates and birth certificates a NOT always 100% accurate. Take my grandmother as an example for a moment. She has found two separate birth certificates for her name. No, they aren't for different people. All the information on them are describing her; however, one says she was born in August, the other says she was born in October... TWO YEARS after the one that says August. Something similar could have occured in this case. ~Anonymous--

This is a reply by the user Ahnighito, the person who first brought this issue to attention. I am very much dissapointed in the fact Evil Monkey is continuously changing the appropriate edit when this is a date that is unconfirmed. As I recall, this is against Wikipedia rules and should therefore cease immediately. We are here to provide the correct information and if we cannot do that, then provide both sides of the argument. Mr. Andre has already stated that he edited the article to credit the History Channel with the other date. You, Evil Monkey, have no right whatsoever in correcting the edits of someone who has more authority on this website. Also, for your precious information. It is not only the History Channel that is stating its 1983. You're obviously turning a blind eye to every single website out there that does not say 1982 which is not a professional way of doing things. Do you realize you are arguing with someone who has a Ph.D in History? Do you realize you are arguing with a network whose historians have probably researched this issue more than you ever have? Kid, you're not even 20 years old yet. Call if age discrimination if you will, but you should respect your elders. Second of all, my birthday happens to be December 7, 1983 and I know for a fact Brooks was executed on the same date and year. Do not try to tell me different. I have rearched the events of my birthday since I was 10 years old. (Currently I'm 21). The only time ever that I have seen the execution date as 1982 is when you brought it up. So what if Texas' website says 1982? So what if the New York Times says 1982? The point is there are two different dates floating about and both should be mentioned. Now quit being a childish brat. The way you're acting is just like the public schools refusing to teach both sides of the Origin of Life Argument. This is not vandalism, as you've said to me before. This is correcting mistakes that should not be on a site that people depend on for information.

I agree with you that the dates on documents can be wrong. However in with this date, I don't think that it is the case. We are talking about an event that only occurred just over 20 years ago. You say that I am ignoring other sources than the History Channel -- can you provide some links so I can check them out. At this point all I can say is that I am completely unconvinced that many other credible sites have systematically made errors in the date. Evil Monkey∴Hello 05:40, 5 August 2005 (UTC)

The date of the first execution in the modern era was December 7, 1982. (By the way, the history channel does not disagree. [15]) There is no controversy about this. I happen to have Lexis, which allows me to research news articles:

1. Dan Balz, Supreme Court Denies Stay; Texas Executes Man by Drug Injection, Washington Post, Dec. 7, 1982, at A1.
2. Bruce Nichols, Charlie Brooks Dies with a Yawn, United Press International, Dec. 7, 1982.
3. Robert M. Press, Texas Execution Rekindles Debate Over Death Penalty's Impact on Crime, Christian Science Monitor, Dec. 8, 1982, at 7.

The list goes on and on. Unended 15:09, August 6, 2005 (UTC)

oh really? The history Channel doesn't disagree? They sure do on the documentary of execution methods and on this URL, asshole. http://www.historychannel.com/tdih/tdih.jsp?category=general&month=10272964&day=10272972 Now let the correct/debated date be posted and quit being a bitch about it.

There is no debate, unless you seriously believe that all of these periodicals reported on Charlie Brooks being executed by the State of Texas a year early. What you have found is merely an error in the history channel's website, one not repeated on the specific history channel website that I posted a link to. I have sent an e-mail to the history channel so they can correct their error on that single page you found. Unended 23:27, August 9, 2005 (UTC)

Please stop making personal attacks against editors. Calling people bitches, assholes and childish brats doesn't help. And remember to sign your posts by adding ~~~~. Evil Monkey∴Hello 00:26, 10 August 2005 (UTC)

You speak of deleting editor's comments. You delete ours all the time. The info needs to be displayed.

I'd just like to comment here that I feel sorry for, but commend, those on the 1982 side who had to spend valuable time debating this... There has to be a better way of resolving disputes than this. We need tinfoil-hat detectors or something... --Gantlord 17:56, 17 January 2006 (UTC)

[edit] Procedure

The "procedure" as described on the present page refers specifically to how lethal injection is practiced in the US. What about other countries? More research is needed here. For the meantime I have added a brief intro noting the (theoretical) variety of means that could be used, and a subheading noting that the currently described technique is "procedure in the US". WebDrake 18:35, 18 October 2005 (UTC)

[edit] The first

Wasn't Nathan in 1821 the first executed this way in the USA? (http://users.bestweb.net/~rg/execution/WEST%20VIRGINIA.htm) Pibwl [[User_talk:Pibwl|talk]] 18:59, 21 November 2005 (UTC)

[edit] Poison not chemicals

Run some thought experiments before you deny that it's poison. Scenario 1: a "government" runs out of the non-lethal chemicals and uses just the poison. Would we still call the process "lethal injection" or would we come up with a new name? Scenario 2: a "government" runs out of the traditional poisons and starts finding new ones, eventually using all of the known poisons. Again, does the "government" change the name of the process to something else or retain the terminology "lethal injection?" - Naif 22:10, 24 November 2005 (UTC)

All chemicals are lethal in sufficient quantity. The designation of poison vs chemical is arbitrary based on, eg, intent and potency of toxicologic effect. It should be noted that there is no non-lethal chemical used in the typical lethal injection cocktail. All three of the cited drugs can be lethal in and of themselves. --Bk0 (Talk) 23:36, 24 November 2005 (UTC)

Question: are all three chemicals injected in sufficient quantity to make them a poison? I believe only one is. On a separate issue, I don't believe anybody considers "water" a poison, although it, too, is a chemical that is lethal in too high of a dosage. -- Naif

Technically at least two are: pancuronium bromide and KCl. I remember reading somewhere that the thiopental was also used in lethal dosages, however I don't remember where and I haven't seen that claim again since. I don't believe the dosages of the drugs are adjusted for individual prisoners (ie, a 120lb inmate receives the same amount as a 300lb inmate) so I doubt the thiopental would necessarily be of sufficient quantity in all executions. --Bk0 (Talk) 10:51, 25 November 2005 (UTC)

[edit] Cognitive dissonance

Please study this article, Cognitive dissonance, before making any edits. Traditional taboos against the use of poison, typically used only against human beings by assassins and so-called "barbarians," are what prevent "modern" human beings from accepting that lethal injection is a fig-leaf for state-sponsored poisoning. -Naif 22:14, 24 November 2005 (UTC)

[edit] Lethal drugs section

I copy-edited this section as it was listed for such. Hopefully I haven't changed any of the meaning while doing so. Might be worth someone checking it in case... Didsbury ryder 19:49, 5 January 2006 (UTC)

Thanks for editing it... I made some small changes after your corrections. I think it is more concise now. I originally wrote about this topic in my blog and thought other might find an analysis and/or explanation of the drugs interesting. I'm an ER doctor with a past history of extensive neurosurgical ICU experience...but I typically put people onto a diprivan drip to completely knock them out.

[edit] Controversy section

Much of the controversy section was filled with incorrect information. There is no need for "correct" dosing of the pentothal... its a massive overdose designed to put a person into a coma extremely rapidly. There is no cross reactivity with pancuronium. There is no need for an anesthesiologist to give an overdose. There are of bunch of drugs that can completely knock a person out. Pentothal appears to be the most efficient. To argue that the medical community does not know how to place a person in a coma is ridiculous.

Also, there are comments on how the vetinary association states that pancuronium is inhumane. Well it is only inhumane if used alone... you can read the other person's link.

If an anti-death penalty person would like to re-write the "problems with starting an IV" section then let them. These are about the most inconsequential arguments that I have ever heard...

This is utterly ridiculous. There is a need for "correct" dosing of sodium thiopental: it is the barbiturate responsible for anesthetizing the person prior to the injection of other drugs intended to kill the person. Asserting it is a "massive overdose" is not sufficient, especially given the manner in which the drugs are injected (i.e., remotely). There is indeed cross reactivity with pancuronium; your assertion to the contrary is simply wrong. Furthermore, the heart of the controversy is not in the fact that sodium thiopental is given, but that other, wholly unnecessary drugs are. This creates a needless risk that threatens to torture the person receiving the injection. There is a reason this procedure is not followed to euthanize terminally ill humans or even animals, for whom the AVMA prohibits (along with many state laws) injecting both a barbiturate in combination with a paralyzing agent. (You are dead wrong that the AVMA prohibits pancuronium only when used alone; the 2004 panel explicitly prohibited use of a barbiturate in combination with a neuromuscular blocking agent.)

Yes, there are many drugs that can "completely knock a person out," including kill them. Some of them, alone, would do the trick and do it humanely (such as a massive dose of sodium pentobarbital). So the question is: why are we injecting people with needless chemicals that needlessly increase the risk they will expierence torture? I understand that sadists support such endeavors, and perhaps one could offer the principle of sadism in support, but otherwise? Unended 01:29, 11 January 2006 (UTC)

I reverted the section, and I included the proponents' counter argument at the end. Anybody can feel free to expand on that argument, of course. Unended 01:47, 11 January 2006 (UTC)

To unended: I see that you wrote "proponents of the staus quo" ovbiously invalidates many of your claims and makes the controvesy section one sided and derogatory towards the pro-death penalty argument. Arguements in open source that are incorrect, misleading and false will get corrected. You should read the drugs section to understand pentothal better.

I have experience with these drugs and I have given barbiturates to patients to maintain medical comas (cases that involve brain swelling). I typically use diprivan for comas, but sometimes barbiturates are better especially for patients who are about to go into DTs. Patients in the operating room get thiopental and then non-depolarizing agents like pancuronium every day, probably on the order of tens of thousands of operations a day. Its

I see that you recommend pentobarbital, but its onset of action takes longer than pentothal. You need more education on drugs before you take obviously biased and make it one sided.

First, you need to understand the purpose of the section within the context of a Wikipedia article: it is about the controversy surrounding lethal injection as practiced today (and, yes, there is one). As such, the section's purpose is to lay out the critics' arguments against the status quo. Naturally, for the sake of neutrality, the position of those who defend the status quo may be presented as well. I encourage you to present this position.

But your revisions to date have not only entirely eviscerated a detailed section which accurately represented the critics' position, but it then disingenuously misrepresented the critics' position. For example, your revision states: "In addition, pro-death penalty advocates state that groups opposed to the death penalty have not proposed a combination of drugs which they believe is more humane." But, in fact, the article before you revised it stated, "The opponents say that because death can be painlessly accomplished, without risk of consciousness, by the injection of a single large dosage of barbiturate, the use of any other chemicals is entirely superfluous and only serves to unnecessarily increase the risk of torture during the execution." I am reverting. Again, you are welcome to add the arguments offered by defenders of the status quo in juxtaposition to those of the critics. That is the purpose of this section of the article: controversy. What you may not do is misrepresent the position of the critics or eliminate an entire detailed section accurately characterizing their arguments as have been presented in courts of law.

You may have experience with these drugs, but I have experience with litigation and experts who have experience with these drugs. As for pentobarbital, what does its onset of action matter, if that is the only drug given? The AVMA recommends a single large dose of pentobarbital to euthanize animals like cats, dogs, and primates (which humans are). The reason is obvious: in a large dose, it results in painless, unconscious death. You appear to be thinking like a surgeon, not a humane killer. What patients in the operating room get by professional anesthesiologists under close supervision has no relevance to what people being killed by hidden technicians with a remote control get. Surgeons operating on people with the intent to save them have different goals from those whose aim is to kill a person humanely. Unended 02:57, 12 January 2006 (UTC)

Previous phrasing said "The claim that the pancuronium prevents the pentothal from working yet still is capable of causing paralysis without any scientific evidence is only testiment to the fact that oppenents of the death penalty are willing to lie.". Imo this is a character attack on opponents of the lethal injection and hurts objectivity. I rephrased it to emphasize the point that the claim is not supported by scientific evidence, which is objective.

Edited the orignal so that it doesn't sound like an "attack." Added the opinion that supporters of the death penalty are concerned that theories about drug interactions that have never occured before in the history of drug interactions are now appearing in the debate on lethal injection.

[edit] Errors in the arguments against section

First, sodium thiopental is an ultrashort-acting barbiturate, used in surgery only in the induction phase of anesthesia, specifically so that the patient may awaken and breathe on his or her own if any complications arise in inserting a breathing tube pre-surgery. It is not used to maintain a patient in a surgical plane of anesthesia because of its short-acting nature.

actually, barbiturates are not used in maintenence of anesthesia since they have a LONG half life. If a patient was to get a dose that lasts longer than the induction phase, the drug would have had to be dosed higher. If at the higher dose, and once the drug reaches a steady state, the effects of this drug are now dependent on the half life... which happens to be very long. therefore, the above statement is factually incorrect.

also, thiopental is used in anesthesia not "in surgery." The sentence sturcture is incorrect to try and imply that thiopental has "only" one use.

Second, the second injected chemical, pancuronium bromide, may act to dilute the initial injection of sodium thiopental.

Of course this is not true read the dilution section... only makes anti-death penalty people sound like liars. someone should try and show two other drugs in which different sites of action, and where one drug doesn;t work yet the other one does in the acute setting. It doesn't exist.

Third, because the personnel involved in administering the injection lack training and expertise in anesthesia, the risk of failing to induce unconsciousness is greatly increased. The dose of sodium thiopental must be measured with precision, and the calculation of the proper amount of the drug depends upon both the concentration of the drug and the size and condition of the subject. Because of the manner in which the drugs are administered (remotely, with no observation of the inmate), the risk of errors in the injection causing insufficient amounts of chemicals to enter the bloodstream is greatly increased.

The dose is 5 grams. An anesthesiologist, nurse, or a tech could deliver the dose. The dose of pentothal is not measured with precision.... its 5 grams. "the calculation of the proper amount" does not depend on the "concentration of the drug" (which is also incorrect) and the dose is not adjusted for the size of the patient. Another factual error. the condemmed is observed in the process (another error). Otherwise the risks of not given enough drugs because of the "remoteness" of the delivery probably only holds true if there is a problem with the IV which can occur. But it is unlikely that not enough pentothal is given since another 5 grams could be given. If not enough potassium is given then the dose is repeated until there is effect.

I think pain can not be monitored during executions because of the use of pancuronium bromide,, that is a muscular relaxant mostly used to facilitate endotracheal intubations, of course with the use of the sedatives, all brain activity is diminished, the person being executed is completely alert, but he can not move at all, but eventhough the person might be in excruciating pain,, any type of cerebral monitoring is unreliable due to the sedatives..Danny_109

PD: with the amount of benzodiazepines they use to sedate the person being executed you can easily intubate a horse...danny_109

I also opposed the use of paralizers during executions,, that is inhumane, not even animals are put out like that, if the government " must " kill someone then the paralizers should be off the list and only the sedatives and the potasium mix should be used,or a lethal morphine or meperidine dose, sedating the person and reducing respiratory stimulus that brings on my oppinion a quick and humane death..danny_109

to Danny_109: Your statement makes no sense. It does not sound like you have medical training or even an understanding of the drugs. The condemmed is in a COMA. If what you say is true, then everyone who has every received anesthesia must be awake in the process. Morphine and demerol are opiod analgesics and not anesthetics. It is unethical to perform very painful procedures under opioids alone. Its either an anesthetic (local or general), or an opioid/sedative combination. Sure morphine and demerol can be lethal in overdose, but so is pentothal, and pentothal happens to be what is given for inducing COMAS. If you were more knowledgeable, then you would know that both morphine (histamine release) and demerol (siezures) are bad choices. A better opioid would be fentanyl or remifentanyl. In addition, death (as defined under lethal injection) is when the electrical activity in the heart stops. In a respiratory failure patient, cardiac activity can occur for a long time... (I've see it at over an hour). You should probably abstain from forming medical opinions or support your claims with some facts. As an example you state: "with the amount of benzodiazepines they use to sedate the person being executed you can easily intubate a horse" ...wrong drug class. Pentothal is a barbiturate.

You're misunderstanding what Danny is trying to say. He's (rightly) pointing out that pancuronium or some other antinicotinic beast of a chemical is entirely unnecessary for the purpose of humane execution by lethal injection. Even if one were to assume that 100% of people (which is statistically unprovable) are in a GCS3 coma after the thiopental dose as given, the issue remains that the pancuronium could be avoided entirely in light of the fact that the condemned is going to be killed off by the massive K+ administration anyway.

Actually, the glascow coma scale was designed for trauma. Even though it is used in nontrauma, it is a bad indicator for levels of anesthesia. The stages are from 1-4 with 1 being amnesia, 2 delirium, 3 surgical plane, and 4 overdose. Since the typical dose of thiopental is about 250mg and induces unconsciousness in over 98% of patients, and since the SD for the effectiveness is probably about 100 mg, and given that the dose is 5 grams, you are looking at at least 45 standard deviations. I have no idea how many thousands of decimal points you would have to go back to say that it is not 100%. If what you are saying is true, then DNA evidence is reasonable doubt in and of itself... 1/50 billion is still not 100%. Makes no sense. As for your defense of Danny, he claimed that "all brain activity is diminished, the person being executed is completely alert." The problem with people who oppose the death penalty is that they distort the truth. If there is any semblance on honesty, they should say that the pancuronium is not necessary (which is true—I agree), but instead they come out and claim that people are awake!!! Just look at the different arguments against lethal injection: 1)not enough pentothal 2)wrong drug 3) wears off 4)pancuronium blocks the pentothal from working yet still is capable of working, 5) dilution effect 6)an anesthesiologist is the only person capable of giving 5 grams of a drug 7)IVs are cruel and unusual 8) cats and dogs don’t get pancuronium (which is a retarded claim as well since these are typically intraperiotoneal injections—and death is not pronounced in cats by and EKG--obviously the AVMA is politically biased and its retarded that it even enters the debate). The anti-death penalty crowd can come out and say that pancuronium is not necessary. But they can’t come out and say that the person is awake. That is a lie. ER MD 20:07, 25 January 2006 (UTC)ER_MD

ER-MD - (I'll admit "a priori" to being an opponent of the death penalty - although I'll try not to let this colour my thoughts on the subject)

I've read through the entire discussion properly this time, and I must admit that I was the one who had misunderstood Danny's argument and had taken a defensive stance a little too hastily. Your reasoning is fundamentally sound - and I must agree with you that many points raised in opposition to the specific method of lethal injection are motivated more by political agenda than scientific thought.

In response to:

1)not enough pentothal 2)wrong drug 3) wears off - These three points are fundamentally the same, and I do agree with you that 5 grams (over 50mg/kg IV!) of thiopental is a dose well beyond the point at which any realistic dose/response curve will have reached its ED100 (probably not far from LD100 either!). I think we can safely say that the chance of a person still being conscious following such a bolus (if you can even call it that) due to some peculiar mutation in GABA receptor/chloride channel structure/whatever is almost insignificantly small.

Objections 4 and 5 baffle me even more. Pharmacology is an ever-growing body of knowledge admittedly, but I cannot imaging how that large, twice-positively charged piperidinium substituted steroid is going to bind to anything vaguely resembling the barbiturate's site, regardless of whatever weird metabolites may be produced. Talk of any "dilution effect" seems just bizarre - what kind of volumes are we dealing with anyway?

Perhaps only point 6 has some logic to it, not in the way you've quoted it, but in the sense that a "botched" process could (conceivably) lead to a scenario in which the thiopental is somehow not administered, or the pancuronium is given first. Then again, no methods of humane capital punishment are foolproof, apart from perhaps gassing in a sealed chamber with CO... even then, with a fool around, all bets are off!

Point 7 is a little redundant, since while some may find forced IVs more scary, others will fear the idea of a noose, or a shot to the head more. Based on what you would call POV.

So, in short, I do agree with you that many, if not most objections are based on either exaggeration or fabrication, but I still find it difficult to accept that a substance should have been unnecessarily added to the process, and one which, when administered to a conscious person (which is admittedly not the case here) leads to probably the single most terrifying death by poisoning one can imagine. Fair enough, the risk is practically zero, but it's still bad for lethal injection's PR!

Unrelated: there's an error in "...recommends animals like cats and dogs be euthanized by a single injection of a long-acting barbiturate such as sodium pentobarbital." Sodium pentobarbital (e.g., Nembutal) is a short-acting barbiturate, though longer-acting than thiopental.

That's no error: it's in the AVMA's report: "Desirable barbiturates are those that are potent, longacting, stable in solution, and inexpensive. Sodium pentobarbital best fits these criteria and is most widely used, although others such as secobarbital are also acceptable."Unended 02:27, 23 February 2006 (UTC)

At least you are honest about it. The anti-death penalty crowd should simply state that they don't believe pancuronium is necessary and propose a lethal injection protocol which they think if effective. Its almost funny, in that they argue pentothal + potassium = coma plus death, but pentothal + pancurnonium + potassium = awake and an excruciatingly painful death. I would bet that most pro-death penalty people would be fine to change whatever drugs necessary just so long as executions were carried out fast.

ER_MD, the argument is precisely that pancuronium bromide (as well as potassium chloride) is (are) completely unnecessary. There is, however, contrary to what you say, a legitimate concern about consciousness, not because there is any dispute that 5g of sodium thiopental is sufficient to induce unconsciousness but because there is a dispute about the amount of sodium thiopental that inmates in fact receive. You seem to take on faith that simply because prison officials say that 5g of sodium thiopental is administered that it in fact is. (You should also note that the professed amount ranges from 2 to 5 grams depending on the state.) Executions are non-public events. Most states keep their execution protocols secret, including how and by whom the drugs are administered. Because there is no way to know the credentials of the individual responsible for administering the injections and because, in all cases, the injections are administered remotely, sight unseen and through equipment unknown, there is no way to know exactly what amount of barbiturate the inmate is actually receiving. Hence the concern. Inmates may be conscious, and there is evidence (even aside from the recent Lancet article) that some inmates have in fact been conscious during the administration of the pancuronium bromide and potassium chloride (this includes anecdotal evidence from witnesses). The issue is risk, which I would think a medical doctor should understand. The drugs currently used by states to execute people create a completely unnecessary risk of torture. That is the very reason the AVMA believes such procedures should never be used to euthanize mammals.Unended 02:27, 23 February 2006 (UTC)

Unended: True the pavulon and potassium are not required. I would support a single drug protocol so long as people on the "left" would agree--its not a big deal to me how long it takes to die although I would prefer a shorter protocol. I would do this: give one condemmed a 5 gm pentothal dose and then see how long it takes to get to flat-line--who knows 45 mintues, 3 hours? After the guy gets his 5 grams, we should bag-valve-mask him to see how long it takes for him to wake up. I've seen full arrests (people who come into the ER with no pulse/respirations and they have cardiac activity sometimes for over an hour. Of course we have tubed them, and started ACLS drugs and CPR. The longest time frame that I have seen cardiac activity in a patient who was pretty much dead but had the faintest of a pulse (BP was like 30 systolic) was about 6 hours. (they were on a vent too)

As for knowing how much drugs poeple get--that is a fact unless the IV falls apart. You put 5 grams in on a pump...it goes into the body period. So your statement implying that people don't get 5 grams is wrong. The drugs are given on a line with port attachments like in anesthesia. On drug is given and then then next.. Its actually pretty simple. Who pushes the drugs does not make any difference since the drugs are all onthe same line and get into the person in the correct order. Certified nerse practitioners push these same drugs, I have my nurses push etomidate, ketamine, and diprivan, rocuronium, pancuronium, succinylcholine, and some times I give these drugs myself. Being in a different room makes no difference either. Lets say theoretically that the IV is dislodged and only a little pentothal get is, then drugs 2 and 3 don't get to the patient and a repeat dose would also fail since the line got dislodged. You could do endless speculations on the problems with the protcol, but anyway you cut it, the patient will first be knocked out. You can't get drugs 2 and 3, while having a failure for the frist drug to get in since they are on the same line. As for your assertion of "risk" that it fails. Well, I don't think 5 grams fails and I don't even think that a 1 gram dose fails. Again the normal dose is 250 mg and that lasts 5 to 20 minutes. Once you are above 4 times the dose, the tail phase of distribution has about 30% of the drugs in the brain...which is still enough place teh person in stage 4 anesthesia. In fact the 250 induction dose does just that for a short period of time. The Risk of conscsiouness is zero if the patient get a 1 gm dose. As the other contributor mentioned, there is no such thing as a mutated GABAa receptor that does not bind the barbiturate class. With the amount of drug, you are past surgical plane anesthesia and you are in overdose. (I've have two barbiturate overdoses in y career--one I intubated pecasue they were completely out and the other who was only in stage two and we simply watched and gave 1/2NS with 3 amps bicarb as maintence fluids.

Again, as stated above, there is no risk...the person being executed is in stage 4 anesthesia--there is no consciouness. Personally, since I work in the ER, I don't do anesthesia, but I do do deep sedation such as etomidate to put a shoulder or hit back into joint. The patients wake up in 5-10 minutes and have no idea what happened. As for the AVMA, their claim that a nondepolarizer and a barbiturate dont' work good together is politically motivated--show me one pubmed article. And if what they say is true, then the AVMA needs to state the anesthesiologists have been practicing medicine wrong for the last 40 years. I don't think so. (author was drinking when writing this entry) :) ER MD 09:47, 24 February 2006 (UTC)

As for the AVMA's idiotic statement in relationship to which barbiturate to use: The half life of thiopental is 11.5 hours and pentobarbital is 16.9 hours. Big difference here. ...and some thiopental is actually degraded to pentobarbital. If people could only understand that the main difference between the ultra-short class (thiopental) and the short acting barbiturates (pentobarbital)is the differences in induction. With a highly potent induction agent, a smaller dose can be used, and that is why methohexital and thiopental are used (and because they are aren't too expensive). The smaller dose allows conversion over to the inhaled anesthetics without a huge dose of barbiturate that will linger around you system forever after the surgery is over.ER MD 10:01, 24 February 2006 (UTC)

[edit] Confusion in the controversy section

The controversy section seems to alternate randomly between saying "proponents/opponents of lethal injection" and "proponents/opponents of the death penalty". These are two different things, and this is an article about lethal injection, so it should use only the former. Itub 16:17, 22 February 2006 (UTC)

It should be supporters/opponents of the death penalty since that is a real position. Nobody goes around stating their position as "I'm anti-lethal injection." There are no opponents of the death penalty who "support" lethal injection. There probably is a large percentage that would agree that lethal injection is humane, but the only people who would oppose lethal injection would be the death penalty opponents. It would be illogical and unlikely that a proponent of the death penalty would argue that they oppose lethal injection. So while supporter/oppenent of lethal injection is more precise, it is not really an identifiable group. ER MD 18:37, 24 February 2006 (UTC)

Most of that section is about technicalities related with the execution method, not about politics related with the death penalty. There are four possible groups, and I'd say that there are people with all of these positions. 1) Oppose death penalty, and therefore oppose lethal injection; 2) oppose dead penalty, but accept that lethal injection is the "least worst" method of execution; 3) favor death penalty, and favor lethal injection as the ideal method; 4) favor death penalty, but oppose lethal injection as the ideal method. Yes, you might not see people marching on the streets saying that they are pro-death penalty and anti-lethal injection, but that doesn't mean that the opinion doesn't exist. Itub 19:13, 24 February 2006 (UTC)

Actually just reviewed the section, nowhere in it does somebody use the phrase "supporters of lethal injection" or "opponents of lethal injection." ER MD 18:40, 24 February 2006 (UTC)

Yes, it does:

Opponents of lethal injection as currently practiced argue that...

Proponents of lethal injection as currently practiced counter that...

Opponents of lethal injection as currently practiced point out, however, that...

Supporters of lethal injection dispute this claim.

Itub 19:13, 24 February 2006 (UTC)

My bad...changed the phrasing in the arguments in support section. I have not touched the arguments against section...someone else can do that. In reference to the 4 possible groups, technically you are correct. But I don't think that describing people as supporting lethal injection, or opposing lethal injection are well identified groups. As an example, read any newspaper article. Nobody states that there are groups out there that are "anti-lethal injection" ...they are refered to as "anti-death penalty advocates" or "opponents of the death penalty." Another good example would be that the pro-choice movement is not a "pro-partial birth abortion movement" or groups that "support partial-birth abortion." They are "pro-choice" and "do not oppose partial-birth abortion" or support the "doctor-patient relationship."

As for a disclaimer, I think that there may be some in the anti-death penalty camp that would argue that lethal injection is humane. That could be placed in the arguments against section--but you can do it--I have abstained from modifying the arguments against section. As for people who support the death penalty but oppose lethal injection--I don't think that that groups exists, and if it does it is small. Likewise, I'm sure that there are some people who support the death penalty that argue we should torture people, but nobody should give credence to such fringe ideas. Its impossible to address every single idea regarding every possible viewpoint. ER MD 20:02, 24 February 2006 (UTC)

[edit] Price

Don't think of me as a sucidal person, but, what is the price for a standard lethal injection? I need to know only a rough estimate for a project. Thanks

According to the Texas Dept of Criminal Justice, the cost per execution for drugs used is $86.08 [16]. Evil Monkey - Hello 02:27, 2 March 2006 (UTC)

[edit] Inflammatory?

The line "Supporters of the death penalty question if this is an invented false claim" is based on the fact that there is no supporting evidence. People who support the death penalty believe that this is a blatant lie and is cogent to the debate.

[edit] False reporting of Lancet study

The article cites an article in the Lancet, but by misreading or misrepresenting the figures - deliberately or accidentially to the same effect - it dramatically overstates the Lancet findings. The Wikipedia article states:

University of Miami researchers reported in the medical journal The Lancet that they believed in 43 out of the 49 executions they investigated, the level of thiopental in the blood was lower than that required for surgery.

The person who edited this in relied on a link to a BBC story about the article, rather than reading the article itself. As a result, an error (or misrepresentation) in the BBC story has now polluted Wikipedia. The number given is utterly wrong, as one can discover by no more involved a task than reading the U-Miami/Lancet study. While the numbers 43 and 49 do indeed appear in the study, one appears as an integer, and the other appears as a percentage. The study did not find that of 49 executed inmates, 43 of those inmates had concentrations consistent with awareness, it found that of "49 executed inmates[,] 21 (43%) inmates had [thiopental] concentrations consistent with awareness." By failing to appreciate the significance of the percentage sign in the study, the BBC and Wikipedia have inflated the findings of the study from 43% to almost 90%. Error corrected. Simon Dodd 16:56, 13 April 2006 (UTC)

• Moreover, I have removed the link to the BBC news report. Not only is it redundant, as it merely describes a study which is available online, but through either honest error or intentional distortion, the story grossly misrepresents the study's actual result, as described above. For these reasons, in my view, the BBC story should not be linked from this article; as a matter of first preference, the study itself should be linked, or failing that (should the article cease to be available online without charge, for example), a news story that accurately reflects the study's content should be cited. Simon Dodd 17:00, 13 April 2006 (UTC)

It might do you some good to read the article you profess to be faithful to. The research letter did indeed state precisely that 43 of 49 persons had sodium thiopental concentrations "lower than that required for surgery" (and that's a direct quote). Error corrected. Unended 05:38, 19 May 2006 (UTC)

[edit] karl brandt

This has been inserted a few times. While it is true that many Jews were probably executed using some form of a "lethal injection," the reference here is not appropriate. The reason being is that it politicizes the history. A good example is where you could write that gun control was supported by Pol Pot and Stalin. While it may be cogent to the methods by which either dictator asserted their control over the population and valid within the individual articles on the dictators, the reference would not belong in the Gun Control article. The pro-gun crowd could mention that the citizenry owning firearms is a deterence to total governmental control, but stating that Pol Pot and Stalin supported gun control is a POV attempt to skew the debate. Likewise, that is the same attempt here.ER MD 08:44, 23 April 2006 (UTC)

[edit] ===Lethal injection=

Biased the page should be deleted 65.42.16.140 05:07, 18 May 2006 (UTC) ==

This article was written in an advocate style. It is purely unobjective. When reading the article, it is very clear that the author is against the use of lethal injection. He cites strong reasoning and examples against its use and almost a harmonious world before its implementation, and balances the reasoning of the proponents unfairly; no coherent and sound logic is applied to the 38 states who have adopted the use of lethal injection other than they are wrong to do so. It also appears no original research was done. The compounds used for a lethal injection do not define a lethal injection, as they are common knowledge by any security guard who works in a maximum security prison, or anyone who watches a movie about it. Additionally, the aspects of these compounds are incorrectly applied, and subjectively viewed as used only for death penality, and their functions seem to be defined and heart-felt on this subjective basis. The author is ranting about his ideology against the inhumane use of chemicals and capitol punishment. This article is mis-leading and unbalanced. Lethal injection is not viewed fairly. Some author has simply modified his tone, and used an encyclopedia to stack facts in a way which have no decipherable cultural meaning or value. I have used Wikipedia for a few years, but now I am a little suspicious. I really believe this article is completely ridiculous to be found in an encyclopedia. And I am indifferent to the death penalty itself, other than as a means for discussion. I cite you, and I am starting to see headlines about how you are a sham. Delete this article and keep me faithful.

ds

Your argument does not make sense. There is a watered down history, a simplistic procedure, explanation of the drugs, a quick aspect on ethics, and then there is an arguments against section (which granted is full of errors), and then there is and arguments in support section which pretty much blows the arguments against section out of the water.

[edit] agruments against section

Somebody needs to re-write the section since there is a lot of deception using the phrases ultra-short and long-acting barbiturates. It seems to confuse people who have no understanding of pharmacology. ER MD 08:07, 19 May 2006 (UTC)

Well, somebody ought to tell the American Veterinary Medical Association. They seem to belive that sodium pentobarbital is a long-acting barbiturate, and they recommend using it, and it alone, to kill non-human primates. And sodium thiopental, or pentothal, is uncontroversially ultrashort-acting. But that's not even the real point, is it? Since we both acknowledge that a lethal dose of any barbiturate is sufficient to kill a human being, and since we both know that prisons inject a lethal dose of barbiturate as the first drug, all other drugs are gratuitous to the execution. Suggesting the State has the prerogative to inject additional drugs into dead inmates is no different than giving the State carte blanche with respect to any other cadaver. The government may not defile dead bodies, at least not without prior authorization from the deceased. Or do you think the government may do whatever it wants with any dead civillian body?

Actually, the AVMA, according to your link, only argues that a long acting barbiturate be used. They then state that pento and secobarbital best fit that description (among other descriptors) both of which happen to short acting barbiturates which is actually pretty funny (are they dumb, or are they just trying to bias/manipulate language?). They did this to distort the truth of the matter... Induction is best acheived with a short-acting barbiturate drug and is actually even better with an ultra-short since the time to anesthesia is much quicker. They word it this way to take advantage of the unfortunate naming convention of the barbiturate class of drugs. The "ultra-short" drugs which have a half-life of about 11 hours and the "short" of about 20-35 hours, and the "long" class having about 96 hours. Of course with the ultra-short and the short acting barbiturates, doseage is much more of an issue for the duration of the effect. In addition, the fact that they even mention the use of extremely expensive drugs such as paralytics in their euthanasia report is unbelievably retarded. Nobody interested in putting an animal to sleep would spend the 60 dollars on a parlytics. The inclusion is even more suspect since this combination of drugs is extremely common in surgies throughout the world. Obviously, the AVMA wrote their biased position statment to directly oppose capital punishment/lethal injection. If you are conviced of the meds, the next time you get a surgery as for a phenobarbital induction as opposed to a pentothal induction--see what type of reaction you get from the anesthesiologist (maybe a vet will agree to do your anesthesia). (I've actually see it happen--person took 4 grams of phenobarbital and didn't wake up for 4 days even with diaysis.) As for your position piece on lethal injection being gratuitus... stick to the science. If the patient is knocked out, there is no "gratuitus" medication. I knock people out all the time and do painful procedures without a wink (although brevital has fallen out of favor for sedation in the ED for better drugs without cardiovasc effects). Finally, the patient is not dead until the they are flat line. "Or do you think the government may do whatever it wants with any dead civillian body?"--makes no sense. ...your ideology is getting in the way of understanding how lethal injection works. ER MD 08:29, 27 May 2006 (UTC)

[edit] arguments against

I opted to finally do a re-write on the opponent section since it was not structured well and a list of how long it took for some individuals to die was not really encyclopedic. Hopefully, I fully represent the opponent side. ER MD 21:39, 13 June 2006 (UTC)

[edit] Nice work JayW

Nice work on the history section... ER MD 05:10, 20 June 2006 (UTC)

Thanks. :) JayW 18:24, 20 June 2006 (UTC)

[edit] Trypanophobia, Lethal Injection and the Constitution

Does anyone know if a trypanophobe (someone with a phobia of needles and injections) has ever been executed via lethal injection? If so, who and when? I'm doing a research paper about the constitutionality of lethal injection, so this is an aspect I'd like to cover. Thanks! - Katami 00:00, 16 July 2006 (UTC)

Everyone ever executed by lethal injection has self-diagnosed themselves as a trypanophobe. ED MD 00:42, 16 July 2006 (UTC)

That's not quite what I meant, but I see your point. Thank you! Katami 12:07, 9 October 2006 (UTC)

[edit] Just a thought...

Has anyone ever proposed the use of a lethal dose of heroin as a method of capital punishment? If not, why not? -- The Anome 12:14, 9 October 2006 (UTC)

It has been proposed but the idea is punishment and not getting a person high. Barbiturates work better as well and there is a known dose that is effective. If a heroin protocol was to be devised then it would be opposed by the anti-death penalty crowd as experimentation. Pseudotumor 19:19, 9 October 2006 (UTC)