A Doctor’s Guide to Botched Executions

lockett execution chamber
I give what could be lethal injections for a living.

That’s right. Nearly every day I give someone an injection of midazolam, vecuronium, and an IV solution containing potassium chloride–the three drugs in the “cocktail” that was supposed to kill convicted murderer Clayton Lockett quickly and humanely in Oklahoma.

Here’s the difference between an executioner and me. I use those medications as they are intended to be used, giving anesthesia to my patients, because I’m a physician who specializes in anesthesiology. Midazolam produces sedation and amnesia, vecuronium temporarily paralyzes muscles, and the right amount of potassium chloride is essential for normal heart function. These drugs could be deadly if I didn’t intervene.

My job is to rescue the patient with life support measures, and then to reverse the drugs’ effects when surgery is over. The “rescue” part is critical. When Michael Jackson stopped breathing and Dr. Conrad Murray didn’t rescue him in time, propofol–another anesthesia medication–turned into an inadvertently lethal injection.

When anesthesia medications are used in an execution, of course, no one steps in to rescue the inmate. This gives new meaning to the term “drug abuse”. In my opinion, the whole concept of lethal injection is a perversion of the fundamental ethics of practicing medicine.

Not for amateurs

Though lethal injection is supposed to be more humane than the electric chair or the gas chamber, often it doesn’t work as planned. Mr. Lockett died on April 29 after the injection of midazolam, vecuronium, and potassium chloride into his system. It is unclear from media reports how much of which drug he actually received. Apparently, prison staff had difficulty finding a vein.

The drugs were injected, they thought, into the large femoral vein in Mr. Lockett’s groin, which should have killed him within moments.

But witnesses reported that Mr. Lockett was still groaning and trying to breathe for over 40 minutes before he died. The medications probably were deposited into his muscles and soft tissues rather than entering the bloodstream directly. As they were slowly absorbed, they probably caused muscle weakness, air hunger, agitation, and gradual suffocation before Mr. Lockett’s heart finally stopped.

Lethal injection, to be done right, should be done by physicians who are experts in getting needles into veins, and in giving anesthesia drugs. Logically, anesthesiologists would be the first choice. A bipartisan panel of criminal justice experts in Washington just released a major study on the death penalty, and says, “The proper administration of anesthesia is crucial to the humane execution of an inmate.”

But the American Society of Anesthesiologists and the American Medical Association agree that a physician, “as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution.”

I can’t imagine intentionally doing harm to a helpless person under my care, no matter how vicious a crime he might have committed, any more than I could harm one of my children. When a gunshot victim—usually a young man—is rushed to surgery, I don’t want to know if the police think he was an innocent victim or a shooter himself. My task is to take care of him, not to judge.

So if lethal injection is to continue, the task will fall to others, not to anesthesiologists. Some well-meaning people want to make the process better. They argue in favor of using a single anesthetic drug, such as thiopental, in a large enough dose to produce death without needing other drugs to paralyze breathing or stop the heart.

But that would still be practicing medicine. The drugs must be obtained under a physician’s prescriptive authority, and the technique of injecting them into a vein requires medical training even if it’s delegated to a nurse or a technician.

Other options?

No doubt some readers will think that I must be a bleeding-heart Los Angeles liberal. They would be wrong. I’m a Texas native, and earned the rank of major in the US Army Reserve. I know how to shoot a gun, and am not at all squeamish.

There’s no doubt in my mind that I would be capable of violence against anyone who physically threatened my family.

My purpose is not to argue for the abolition of the death penalty. The Constitution leaves that decision up to each state. My argument is that capital punishment should not involve either the misuse of medical techniques and drugs, or the practice of anesthesiology by people who are not qualified to do so.

Anyone who supports the death penalty shouldn’t flinch at considering other options, and I’m sure modern technology could come up with an electric chair far superior to the ones of the past.

If a needle is still preferred, I’m surprised no one has considered the option of air embolism. The injection of a large volume of air into the heart will stop the circulation very effectively, just like an air lock in your fuel line. The technique is quite simple; it involves no drugs and little teaching.

Find a large syringe and attach a long needle—three inches or so is best. Draw air into the syringe. Insert the needle under the breastbone in the direction of the left shoulder, aiming down at a 30-45 degree angle. When blood starts to fill the syringe, inject the air forcefully into the heart. Repeat if necessary. (For a practical demonstration of the injection technique, see the movie “Pulp Fiction”.)

Too gruesome? I thought it might be, but let’s face facts. No execution—taking the life of an unwilling person by force—can be truly humane.

Lethal injection has the highest failure rate of all methods of execution due to its technical complexity. Today it is often difficult to obtain the proper medications since many corporations don’t want to supply drugs for that purpose. No other method of execution attempts to hide behind white-coat respectability and pretend that it’s neither cruel nor gruesome.

No other method of execution dishonors the profession of medicine and the pledge to do no harm.

Perhaps life imprisonment without parole isn’t such a bad alternative.

Karen Sullivan Sibert, MD (@KarenSibertMD) is a practicing anesthesiologist  and associate professor of anesthesiology at a major medical center in Los Angeles. She writes at aPennedPoint, where this piece originally appeared.