Un­tried and un­eth­i­cal: why Ne­vada's new lethal in­jec­tion crosses a line

The Guardian Australia - - Science - Kathryn Harkup

To­day, Scott Ray­mond Dozier was sched­uled to be ex­e­cuted by lethal in­jec­tion in Ne­vada’s Ely State Prison. How­ever, the ex­e­cu­tion has been post­poned over con­cerns around the untested drug com­bi­na­tion pro­posed as the method of death. The post­pone­ment is the lat­est in­ci­dent in a se­ries of con­tro­ver­sial state ex­e­cu­tions car­ried out in the United States this year, and brings to the fore­ground many con­cerns and eth­i­cal is­sues around state ex­e­cu­tion – not least the use of the death penalty it­self.

In Dozier’s case, a com­pletely new three drug com­bi­na­tion has been pro­posed for Dozier’s ex­e­cu­tion. The mix­ture of di­azepam (a seda­tive), cisatracurium (a mus­cle re­lax­ant), and fen­tanyl (a pow­er­ful pain-re­liev­ing opi­oid) has raised many con­cerns – prin­ci­pally be­cause it is com­pletely un­tried.

So why is this new form of in­jec­tion be­ing pro­posed? And what cri­te­ria do ex­e­cu­tion meth­ods have to meet?

The pri­mary aim of cap­i­tal pun­ish­ment is, of course, to en­sure death. No one wants a pris­oner re­viv­ing and per­haps hav­ing to go through the pro­ce­dure again. An­other aim might be to min­imise the de­gree of suf­fer­ing ex­pe­ri­enced by the pris­oner in their fi­nal mo­ments, although a look at the meth­ods used by var­i­ous gov­ern­ments around the world shows that this is not al­ways a con­sid­er­a­tion. In the United States,

how­ever, it is a le­gal re­quire­ment that ex­e­cu­tions do not con­sti­tute “cruel and un­usual pun­ish­ment”.

A pa­per writ­ten by Harold Hill­man back in 1993 looked into the phys­i­cal suf­fer­ing of ex­e­cu­tions. He ex­am­ined the pain likely to be ex­pe­ri­enced by those un­der­go­ing ju­di­cial ex­e­cu­tion by the var­i­ous meth­ods that were in use in 1989: be­head­ing, hang­ing, ston­ing, shoot­ing, elec­tro­cu­tion, gassing and lethal in­jec­tion. The pa­per con­cluded that, with the pos­si­ble ex­cep­tion of lethal in­jec­tion, all these meth­ods were likely to cause ex­treme pain. Hill­man’s im­por­tant caveat was that the in­jec­tions had to be ad­min­is­tered suc­cess­fully.

In the US, shoot­ing, elec­tro­cu­tion, gassing and lethal in­jec­tion are all still le­gal meth­ods of ex­e­cu­tion. How­ever, most of states that still have the death penalty favour lethal in­jec­tion.

Cap­i­tal pun­ish­ment by de­lib­er­ate poi­son­ing is hardly some­thing new. In 399BC Socrates was fa­mously con­demned to death for cor­rupt­ing the youth of Athens and chose to drink hem­lock as his pun­ish­ment. From Plato’s ac­count of the death it ap­pears to be rel­a­tively pain free. There must have been some­thing else in the lethal mix­ture, as hem­lock poi­son­ing is a very un­pleas­ant way to go. The ex­act recipe used by the an­cient Greeks is not known. What­ever mix­ture was used it still took a con­sid­er­able amount of time and, ac­cord­ing to the gaoler, was not guar­an­teed to work with just one cup.

Hill­man wrote his pa­per on the pain of cap­i­tal pun­ish­ment at a time when bar­bi­tu­rates were be­ing used for ex­e­cu­tions in the US. Bar­bi­tu­rates are pow­er­ful seda­tives that cause un­con­scious­ness within min­utes and slow the rate of breath­ing un­til it even­tu­ally stops. But man­u­fac­tur­ers of bar­bi­tu­rate drugs have since changed their pro­ce­dures to pre­vent these drugs be­ing used for ex­e­cu­tions. Lethal in­jec­tions since then have there­fore had to be car­ried out us­ing al­ter­na­tive drugs.

Many states in the US favour mas­sive doses of a three drug com­bi­na­tion for ex­e­cu­tions. The idea is to se­date the pris­oner, paral­yse them and then stop their heart. But man­u­fac­tur­ers of drugs that can per­form these func­tions con­tinue to pre­vent sales for ex­e­cu­tions. This has led to some ex­treme tac­tics, in­clud­ing a rush to ex­e­cute four peo­ple in a sin­gle week in Arkansas in April this year be­fore the state’s stock of drugs went past its ex­piry date.

The ex­e­cu­tions car­ried out back in April of this year used mi­da­zo­lam, ver­curo­nium bro­mide and potas­sium chlo­ride. The first drug, mi­da­zo­lam, is a short-act­ing seda­tive. This par­tic­u­lar drug has been as­so­ci­ated with sev­eral botched ex­e­cu­tions, such as that of Clay­ton Lock­ett.

The sec­ond drug, ver­curo­nium bro­mide, blocks chem­i­cal sig­nals reach­ing re­cep­tors on mo­tor neu­rons, the nerve cells that trig­ger move­ment. The re­sult is paral­y­sis of mus­cles, in­clud­ing the mus­cles needed for breath­ing. If the pris­oner is not fully se­dated by the mi­da­zo­lam, the pain and dis­tress of suf­fo­ca­tion will be con­sid­er­able.

Once the pris­oner has been im­mo­bilised, the third drug can be ad­min­is­tered to stop the heart. Potas­sium chlo­ride has been used in sev­eral ex­e­cu­tions. Potas­sium is an essen­tial el­e­ment for the nor­mal func­tion­ing of the heart as it is in­volved not only in nerve sig­nals that co­or­di­nate the heart­beat but also in the con­trac­tions of the heart cells them­selves. An ex­cess of potas­sium causes car­diac ar­rest. Car­diac ar­rest is not al­ways painful, but the potas­sium in­jec­tion it­self is no­to­ri­ously ag­o­nis­ing and has been de­scribed as a se­vere burn­ing sen­sa­tion. The im­mo­bil­is­ing in­jec­tion of rocuro­nium bro­mide could po­ten­tially mask signs of any pain the pris­oner is ex­pe­ri­enc­ing.

On 24 Au­gust 2017, Mark James Asay was ex­e­cuted in Florida. No mi­da­zo­lam was avail­able be­cause drugs com­pa­nies had re­stricted the sales of the drug. So, an al­ter­na­tive pro­to­col was de­vised that stuck fairly closely to the pre­vi­ously used triple com­bi­na­tion. The new pro­to­col of eto­mi­date, rocuro­nium bro­mide and potas­sium ac­etate re­ceived con­dem­na­tion from sev­eral quar­ters.

Rocuro­nium bro­mide is very sim­i­lar to the ver­curo­nium used pre­vi­ously, and was not a par­tic­u­larly con­tro­ver­sial sub­sti­tu­tion. The use of potas­sium ac­etate in­stead of the usual potas­sium chlo­ride raised a few eye­brows. Potas­sium ac­etate had only been used once be­fore for lethal in­jec­tion and that was a mis­take (ap­par­ently the wrong bot­tle was picked up). How­ever, it is the potas­sium part of the com­pound that does the dam­age and so, if us­ing the right dosage, it should have ex­actly the same ef­fects as potas­sium chlo­ride.

It was the choice of eto­mi­date that caused most con­cern. Eto­mi­date is a fast-act­ing but short-last­ing seda­tive used to anaes­thetise pa­tients be­fore short, painful pro­ce­dures such as re­lo­cat­ing dis­lo­cated joints. With ther­a­peu­tic doses the ef­fects of the drug can wear off in as lit­tle as five min­utes. One minute af­ter in­ject­ing eto­mi­date into Asay’s body his foot was seen to twitch. Asay was pro­nounced dead 12 min­utes af­ter the first in­jec­tion was ad­min­is­tered.

As more and more stocks of drugs go out of date and re­place­ments are in in­creas­ingly short sup­ply even more rad­i­cal al­ter­na­tives have been pro­posed. The state of Ne­vada ran out of drugs for lethal in­jec­tions in 2016. When it made 247 so­lic­i­ta­tions for pro­pos­als from drugs com­pa­nies it re­ceived no of­fers. Not one. This was not im­me­di­ately a prob­lem: Ne­vada hadn’t ex­e­cuted any­one since 2006 and at that time had no plans to ex­e­cute any of the 81 pris­on­ers on its death row. When Dozier’s ex­e­cu­tion was sched­uled, that changed.

Any of the three drugs in the com­bi­na­tion pro­posed for Dozier’s ex­e­cu­tion – di­azepam, cisatracurium and fen­tanyl – could kill an in­di­vid­ual if ad­min­is­tered in a suf­fi­ciently high dose, but there are many un­knowns. First of all, no one can be cer­tain how these three drugs will work in com­bi­na­tion. No in­for­ma­tion has been re­leased (at the time of writ­ing) about how the drugs would be ad­min­is­tered, in what or­der or at what dosage. In fact, it be­gins to sound dis­tinctly as though an ex­e­cu­tion un­der these cir­cum­stances would be akin to an ex­per­i­ment – and there are very spe­cific laws about ex­per­i­ment­ing on pris­on­ers.

The states of Florida and Cal­i­for­nia of­fer in­mates an in­jec­tion of di­azepam im­me­di­ately be­fore the lethal in­jec­tion pro­ce­dure is started, to re­lieve anx­i­ety. It is not nor­mally part of the three drug com­bi­na­tion de­signed to re­sult in the death of the pris­oner. Though di­azepam is reg­u­larly pre­scribed to treat anx­i­ety, the anx­i­ety of im­mi­nent death is a level of dis­tress that it is dif­fi­cult to test for eth­i­cally. Con­se­quently, it may or may not be ef­fec­tive in these cir­cum­stances.

Cisatracurium paral­y­ses skele­tal mus­cles and at high dose would re­sult in death by suf­fo­ca­tion. Signs of dis­tress will be masked by this drug as the in­di­vid­ual can no longer move to sig­nal any pain they are ex­pe­ri­enc­ing.

Fen­tanyl is eas­ily the most lethal of the three drugs. The fact that fen­tanyl is al­ready killing Amer­i­can cit­i­zens at a ter­ri­fy­ing rate in the coun­try’s on­go­ing opi­oid cri­sis tes­ti­fies to its lethal po­ten­tial. How­ever, it makes the choice of its use for a de­lib­er­ate death ap­pear crass to say the very least.

Fen­tanyl kills by sup­press­ing res­pi­ra­tion, mean­ing that Dozier would suf­fo­cate. Fen­tanyl is also a pow­er­ful pain re­liev­ing drug so it should, in the­ory, be a pain­less ex­pe­ri­ence. How­ever, those who have ex­pe­ri­enced fen­tanyl over­doses speak clearly of be­ing un­able to breathe and how dis­tress­ing this is.

As more and more drug com­pa­nies re­strict the sale of cer­tain prod­ucts for lethal in­jec­tion, the op­tions avail­able dwin­dle. With over 2,800 pris­on­ers on death row across the US the man­ner of their death looks in­creas­ingly un­cer­tain – and if un­tried drug com­bi­na­tions are ap­proved for use, po­ten­tially “cruel and un­usual” too.

There are more than 2,800 pris­on­ers on death row in pris­ons across the United States. Pho­to­graph: Pat Sul­li­van/AP

Newspapers in English

Newspapers from Australia

© PressReader. All rights reserved.