tag:theconversation.com,2011:/uk/topics/lethal-injection-8582/articlesLethal injection – The Conversation2023-08-31T03:28:02Ztag:theconversation.com,2011:article/2121052023-08-31T03:28:02Z2023-08-31T03:28:02ZAccess and attention: why serial killers like Lucy Letby often work in healthcare<p>British nurse Lucy Letby was last week sentenced to life in prison for <a href="https://www.abc.net.au/news/2023-08-21/british-nurse-lucy-letby-sentenced-prison-murder-seven-babies/102757606">murdering</a> seven infants in her care, and attempting to murder a further six.</p>
<p>As a forensic criminologist, many people have asked me why a medical professional would murder their patients. </p>
<p>While they’re very rare, serial killer healthcare workers often share common traits, and they target a specific, and very vulnerable, victim pool. </p>
<p>While limited research has been conducted on serial killer medicos, there are some trends among serial killers that can help us understand the role of the profession in the act of serial murder.</p>
<h2>‘Custodial’ killers</h2>
<p>A serial killer is usually defined as someone who kills at least three people in a series, but not in a single event – there needs to be a cooling-off period between the killings. Although the public is generally fascinated by these predators, serial killings are a rare event, comprising <a href="https://www.fbi.gov/stats-services/publications/serial-murder">fewer than 1% of all murders in any given year</a> in the United States.</p>
<p>Serial killers come from many walks of life, and not all are dysfunctional loners – many are married or in a stable relationship.</p>
<p>A <a href="https://www.sciencedirect.com/science/article/abs/pii/S1359178913001183">2014 research paper</a> found serial killers can be understood via several subtypes, including: those who kill for sexually sadistic pleasure; professional killers who are motivated by money and the power they derive from the kill; and, as relevant to Letby, “custodial killers”.</p>
<p>Custodial killers are often healthcare workers who murder helpless or dependent people in their care.</p>
<p>The paper’s author writes of custodial killers: </p>
<blockquote>
<p>The most common examples include “angel of death” cases involving nurses in hospitals or nursing homes who surreptitiously murder ill or elderly patients, usually by asphyxiation or medication overdose. This group is likely to contain the highest number of female serial killers.</p>
</blockquote>
<p>It’s likely the method of murder is linked to their profession. Healthcare workers have access to medications not available to others, as well as the knowledge to hide their crimes more effectively.</p>
<p>One research group studied 64 female serial killers in the US between 1821 and 2008, and found <a href="https://www.tandfonline.com/doi/abs/10.1080/14789949.2015.1007516?journalCode=rjfp20">nearly 40%</a> of them worked in healthcare. </p>
<p>But the question remains, why do they kill? If we look at women specifically, the 2014 research paper suggests that, unlike men who murder as a result of predatory lust and/or compulsive rage, women serial killers are typically driven by <a href="https://www.sciencedirect.com/science/article/pii/S1359178913001183">histrionic attention-seeking or financial gain</a>. </p>
<h2>Letby and healthcare killers</h2>
<p>Another research paper specifically studied the characteristics of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jip.1434">16 convicted healthcare serial killers</a>, which the authors defined as “nurses who have been convicted of at least two murders, which they have carried out within a hospital setting”.</p>
<p>While a small sample size, they found 56% were female, and the average age of those being charged was 36 years.</p>
<p>About 44% killed between five and nine victims before being caught, and 75% killed in only one location. Insulin was the most common method of murder, followed by muscle relaxant.</p>
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Read more:
<a href="https://theconversation.com/women-can-be-psychopaths-too-in-ways-more-subtle-but-just-as-dangerous-84200">Women can be psychopaths too, in ways more subtle but just as dangerous</a>
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<p>Letby fits several of these characteristics. She’s a woman, 33 years old, and murdered seven infants. She killed, as far as we currently know, in only one location, and she used insulin to murder some of her victims.</p>
<p>A 2007 book, Inside the Minds of Healthcare Serial Killers: Why They Kill, provides a checklist of 22 “red flags” for this group of killers, including:</p>
<ul>
<li><p>secretive/difficult personal relationships</p></li>
<li><p>history of depression or mental instability</p></li>
<li><p>higher incidents of death when they are on shift</p></li>
<li><p>making colleagues anxious or suspicious</p></li>
<li><p>craving attention.</p></li>
</ul>
<p>Letby certainly made her colleagues <a href="https://www.independent.co.uk/tv/news/lucy-letby-baby-murder-colleague-b2395533.html">suspicious</a>, and they <a href="https://www.theguardian.com/uk-news/2023/aug/19/doctors-were-forced-to-apologise-for-raising-alarm-over-lucy-letby-and-baby-deaths#:%7E:text=Lucy%20Letby's%20colleagues%20were%20ordered,deaths%2C%20the%20Guardian%20has%20learned.">reported her</a> in the years preceding her arrest. There were more <a href="https://www.dailymail.co.uk/news/article-11301405/Doctors-Lucy-Letbys-hospital-noticed-shift-patterns-matched-rise-babies-falling-ill.html">child deaths on her shifts</a> than on those of any other staff member, which is how she was caught.</p>
<p>One criminal psychologist suggested part of the rationale behind the killings may have been to gain the attention of a male colleague, whom prosecutors <a href="https://www.theguardian.com/uk-news/2023/jun/07/lucy-letby-texted-about-doctor-crush-hours-before-attempt-on-boys-life-court-told">claimed</a> she had a “crush” on. This would fit with research suggesting attention-seeking is a motive for female serial killers more generally.</p>
<h2>Other infamous healthcare killers</h2>
<p>Harold Shipman was an English general practitioner who is considered one of the most <a href="https://www.britannica.com/biography/Harold-Shipman">prolific serial killers</a> in modern history.</p>
<p>He was convicted of murdering 15 of his patients in 2000, but is suspected in the deaths of <a href="https://web.archive.org/web/20100413134928/http://www.the-shipman-inquiry.org.uk/6r_page.asp?ID=3401">up to 250 people</a>.</p>
<p>Most of his victims were older women in good health. He killed many by injecting them with lethal doses of diamorphine (medical-grade heroin), after which he falsified their death certificates to indicate they had died of poor health. </p>
<p>Suspicions were raised as the number of his patients dying was very high, as were the number of cremation orders his colleagues were being asked to countersign. </p>
<p>Given the patients he killed were largely in good health, misguided “altruism” cannot explain his crimes.</p>
<p>Niels Högel, a German nurse, is another example. In 2019, Högel was found guilty of using lethal injections to <a href="https://www.npr.org/2019/06/06/730281642/german-serial-murderer-nurse-is-found-guilty-of-killing-85-patients">murder 85 of his patients</a>, some of whom he attempted to resuscitate to show off to his colleagues.</p>
<h2>Medics who murder are rare</h2>
<p>The reason the Letby case (like Shipman’s before it) is causing such significant public interest and horror is because we see medics as trusted professionals.</p>
<p>We put our lives in their hands, and cases such as these cause significant fear when one is found to have breached that trust so fundamentally.</p>
<p>But it’s important to acknowledge they also cause such interest precisely because they are so rare.</p>
<p>While medics who turn serial killer are incredibly prolific, we should not fear unnecessarily for ourselves or our loved ones. </p>
<p>If you are concerned about a medical professional, you should report them to the appropriate authority. High-profile cases such as Letby’s have shown these individuals can be caught and their patterns of behaviour can be identified, and in that way we can protect the most vulnerable among us.</p><img src="https://counter.theconversation.com/content/212105/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Xanthe Mallett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>These ‘custodial killers’ are often healthcare workers who murder helpless or dependent people in their care.Xanthe Mallett, Forensic Criminologist, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952512022-11-29T13:35:15Z2022-11-29T13:35:15ZAlabama’s execution problems are part of a long history of botched lethal injections<figure><img src="https://images.theconversation.com/files/497724/original/file-20221128-5230-q7icct.jpg?ixlib=rb-1.1.0&rect=5%2C5%2C3457%2C2175&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In some cases, death row inmates have been strapped to the gurney for hours.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/DeathPenaltyProblemsExplainer/86ba64530aa64b6ba241c943b619f14a/photo?Query=alabama%20execution&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=68&currentItemNo=2">AP Photo/Sue Ogrock</a></span></figcaption></figure><p>Alabama Gov. Kay Ivey has <a href="https://www.npr.org/2022/11/21/1138357929/alabama-executions-pause-lethal-injection">announced</a> a pause in her state’s use of capital punishment. It follows a run of botched lethal injection executions in the state, including two where the procedure <a href="https://eji.org/news/kenny-smith-alabama-execution/">had to be abandoned before the inmates succumbed to the cocktail of death drugs</a>.</p>
<p>The last straw appears to have been the <a href="https://www.nytimes.com/2022/11/17/us/alabama-execution-kenneth-smith.html">failed attempt to put Kenneth Smith to death</a> on Nov. 17, 2022. The state had to call off the procedure after difficulty in securing an IV line.</p>
<p>But that was just the latest execution not to go as planned. In September, Alabama had to stop <a href="https://www.theatlantic.com/ideas/archive/2022/10/alabama-inmate-execution-alan-miller/671620/">the execution of Alan Eugene Miller</a> after prison officials poked him with needles for more than an hour because they could not find a usable vein in which to secure an IV.</p>
<p>Even when the execution was carried out resulting in death, the manner has been problematic. When the state executed <a href="https://www.cbsnews.com/news/joe-nathan-james-jr-alabama-apparently-botched-recent-execution-anti-death-penalty-group-asserts/">Joe Nathan James</a> on July 28, 2022, the process – which is normally supposed to be over in a matter of minutes – <a href="https://www.theatlantic.com/ideas/archive/2022/08/joe-nathan-james-execution-alabama/671127/">took more than three hours</a>. During that time, officials tried repeatedly to insert the IV lines necessary to carry the deadly drugs and jabbed James with needles. </p>
<p>In a statement on Nov. 21, Ivey <a href="https://www.cnn.com/2022/11/21/politics/alabama-executions-pause-review-ivey">ordered</a> the state Department of Corrections to do a thorough review of the procedures used in executions and asked the state’s attorney general, Steve Marshall, to stop the process for two upcoming executions.</p>
<p>Alabama officials <a href="https://www.nytimes.com/2022/11/21/us/alabama-executions-lethal-injection.html">have blamed</a> their problems on what they have described as frivolous, last-minute legal maneuvers by death penalty defense lawyers. In the cases of Miller and Smith, state officials claimed that they ran out of time before the death warrant was due to expire.</p>
<p>But whatever the cause, Alabama’s execution difficulties are not unique to that state. </p>
<p>My <a href="https://www.sup.org/books/title/?id=23979">research shows</a> that since 1900, in states across the country, lethal injections have been more frequently botched than any of the other type of execution methods used throughout that period. This includes hanging, electrocution, the gas chamber and the firing squad – even though these approaches are not without their problems.</p>
<h2>The early history of lethal injection</h2>
<p>Lethal injection <a href="https://www.popularmechanics.com/technology/a25689/gerry-commission-report-methods-of-execution/">was first considered by the state of New York</a> in the late 1880s when it convened a blue ribbon commission to study alternatives to hanging. During its deliberations, Dr. Julius Mount Bleyer <a href="https://books.google.com/books?id=E7S3C4_IYmYC&pg=PA73&lpg=PA73&dq=that+%E2%80%9Cthe+condemned+could+be+executed+on+his+bed+in+his+cell+with+a+6-gram+injection+of+sulfate+of+morphine.%E2%80%9D&source=bl&ots=DX7rmZpYKi&sig=ACfU3U2t-1PK08QmFL3jwZ63iRWRO6URAw&hl=en&sa=X&ved=2ahUKEwiOpYe52Zv4AhWBZjABHbQKD00Q6AF6BAgCEAM#v=onepage&q=that%20%E2%80%9Cthe%20condemned%20could%20be%20executed%20on%20his%20bed%20in%20his%20cell%20with%20a%206-gram%20injection%20of%20sulfate%20of%20morphine.%E2%80%9D&f=false">invited the commission to envision</a> a future in which a person condemned to death “could be executed on his bed in his cell with a 6-gram injection of sulfate of morphine.”</p>
<p>Bleyer and his allies <a href="https://heinonline.org/HOL/Page?handle=hein.journals/medlejo5&div=43&g_sent=1&casa_token=">argued</a> that the procedure would be painless. They said that unlike hanging, the method could not be messed up. It also would be cheap, they claimed – all that was needed was a needle and a small amount of morphine.</p>
<p>Lethal injection’s critics told the commission that the method would actually be easily botched, especially if doctors did not conduct the procedure. And even when done right, those in favor of the death penalty as the ultimate sentence further argued that it would be too humane. It would take the dread out of death and dampen capital punishment’s deterrent effect.</p>
<p>Ultimately, lethal injection’s opponents prevailed, <a href="https://www.amazon.com/Executioners-Current-Westinghouse-Invention-Electric/dp/037572446X">aided by the medical community’s unwavering stance against it</a>. Doctors “did not want the syringe, which was associated with the alleviation of human suffering, to become an instrument of death.”</p>
<p>For nearly 100 years after New York’s decision, no jurisdiction in the United States authorized execution by lethal injection. But the early debate over lethal injection foreshadowed arguments that were heard in 1977 during Oklahoma’s consideration of this execution method.</p>
<p>Proponents echoed Bleyer and <a href="https://www.motherjones.com/politics/2005/09/guilty-man/">declared</a> that executions using this method could be accomplished with “no struggle, no stench, no pain.”</p>
<p>This time they won.</p>
<p>The specific drugs to be used in lethal injection – the anesthetic <a href="https://www.acs.org/content/acs/en/molecule-of-the-week/archive/s/sodium-thiopental.html">sodium thiopental</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/339801/">pancuronium bromide</a>, a muscle relaxant – would not be chosen until four years later. Although the original law only called for those two drugs, a third drug was soon added: <a href="https://www.hrw.org/reports/2006/us0406/4.htm#:%7E:text=Potassium%20chloride%20is%20the%20drug,within%20a%20minute%20of%20injection.">potassium chloride</a>, which causes cardiac arrest. </p>
<p>Together, these three drugs would <a href="https://www.latimes.com/opinion/op-ed/la-oe-alper-3-drug-cocktail-20170420-story.html">make up what became the “standard” three-drug, lethal injection protocol</a>. And what started in Oklahoma spread quickly. Lethal injection soon became the execution method of choice across the United States in every state that had the death penalty. </p>
<h2>Lethal injection’s troubles</h2>
<p>But right from the start, administering lethal injections proved to be a complex procedure that was difficult to get right. In fact, the <a href="https://www.texasmonthly.com/news-politics/charlie-brooks-last-words/">first use of lethal injection by Texas in 1982</a> gave a foretaste of some of the problems that would later come to characterize the method of execution.</p>
<figure class="align-center ">
<img alt="A black and white photo shows a white gurney with straps in a bricked room." src="https://images.theconversation.com/files/497726/original/file-20221128-13-taimz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497726/original/file-20221128-13-taimz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497726/original/file-20221128-13-taimz1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497726/original/file-20221128-13-taimz1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497726/original/file-20221128-13-taimz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497726/original/file-20221128-13-taimz1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497726/original/file-20221128-13-taimz1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lethal injection chambers have remained relatively unchanged since being introduced in Texas in 1982.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TexasDeptofCorrectionsExecutionRoom1982/00ea6690975145cca2dfd711504ce77e/photo?Query=lethal%20injection%201982&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=14&currentItemNo=13">AP Photo/Ed Kolenovsky</a></span>
</figcaption>
</figure>
<p>The Texas team charged with executing a prisoner named <a href="https://www.history.com/this-day-in-history/first-execution-by-lethal-injection#:%7E:text=The%20first%20execution%20by%20lethal,when%20administered%20in%20lesser%20doses.">Charles Brooks</a> repeatedly <a href="https://www.thecrimson.com/article/1982/12/16/painful-questions-pbtbhe-execution-of-charles/">failed in their efforts to insert an IV</a> into a vein in his arm, splattering blood onto the sheet covering his body. And after the IV was secured and the drugs began to flow, Brooks seemed to experience considerable pain.</p>
<p>The difficulties in Brooks’ execution and in subsequent lethal injections result from the fact that medical ethics <a href="https://ir.lawnet.fordham.edu/cgi/viewcontent.cgi?article=4294&context=flr">do not allow</a> doctors to take part in choosing the drugs or administering them. In the place of doctors, prison officials are responsible for the lethal injection procedure. In addition, dosages of the drugs used are <a href="https://people.howstuffworks.com/lethal-injection5.htm">standardized</a> rather than tailored to the needs of particular inmates as they would be in a medical procedure. As a result, sometimes the lethal injection drugs don’t work correctly. </p>
<p>Despite the effort to medicalize executions, the history of lethal injection has been anything but smooth, sterile and predictable. In fact, my research reveals that of the 1,054 executions carried out from 1982 to 2010 using the standard three-drug lethal injection protocol, more than 7% were botched.</p>
<p>Since then, owing in part to <a href="https://www.themarshallproject.org/2016/04/12/how-the-drug-shortage-has-slowed-the-death-penalty-treadmill">difficulties death penalty states have had in acquiring drugs</a> for the standard three-drug protocol, <a href="https://www.sup.org/books/title/?id=35871">things appear to have gotten worse</a>. States have turned to questionable drug suppliers, including compounding pharmacies that are <a href="https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers#:%7E:text=Are%20compounded%20drugs%20approved%20by,safety%2C%20effectiveness%2C%20and%20quality.">not subject to extensive regulation by the Food and Drug Administration</a>.</p>
<p>In the last decade, states have used no less than 10 different drug combinations in lethal injections. Some of them were used multiple times, while others were used just once.</p>
<p>As states have experimented in the hope of finding a reliable drug protocol, <a href="https://www.sup.org/books/title/?id=35871">my research shows</a> that botched executions have occurred as much as 20% of the time, depending on which of the newer drug protocols is employed. </p>
<p>During some of those executions, inmates have cried out in pain and repeatedly gasped for breath long after they were supposed to have been rendered unconscious.</p>
<p>In September 2020, <a href="https://www.npr.org/2020/09/21/793177589/gasping-for-air-autopsies-reveal-troubling-effects-of-lethal-injection#:%7E:text=Most%20states%20use%20three%20drugs,as%20cruel%3F%22%20says%20Zivot.">an NPR investigation</a> helped explain the high rate of bungled executions. It found signs of pulmonary edema fluid filling the lungs in many of the post-lethal injection autopsies it reviewed. Those autopsies reveal that inmates’ lungs failed while they continued to try to breathe, causing them to feel as if they were drowning and suffocating.</p>
<h2>Responding to lethal injection’s problems</h2>
<p>Alabama now joins <a href="https://sanquentinnews.com/gov-mike-dewine-halts-executions-in-ohio/">Ohio</a> and <a href="https://www.tennessean.com/story/news/politics/2022/05/02/tennessee-governor-pauses-2022-executions-lethal-injection-review/9612950002/">Tennessee</a> as states that have paused executions and launched investigations after lethal injection failures. Other states <a href="https://account.thestate.com/paywall/subscriber-only?resume=251151894&intcid=ab_archive">have resurrected</a> previously discredited methods of execution – like electrocution or the firing squad – and added them to their menu of execution options on the books. </p>
<p>Lethal injection’s problems also have contributed to <a href="https://deathpenaltyinfo.org/state-and-federal-info/state-by-state">the decision of 11 states to abolish the death penalty since 2007</a>.</p>
<p>Reviewing the history of the different execution methods used in this country, Supreme Court Justice Sonya Sotomayor <a href="https://www.supremecourt.gov/opinions/16pdf/16-602_n758.pdf">wrote in 2017</a>: “States develop a method of execution, which is generally accepted for a time. Science then reveals that … the states’ chosen method of execution causes unconstitutional levels of suffering.”</p>
<p>And, referring specifically to lethal injection and its problems, she observed, “What cruel irony that the method [of execution] that appears most humane may turn out to be our most cruel experiment yet.”</p><img src="https://counter.theconversation.com/content/195251/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Austin Sarat does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Alabama has paused the carrying out of death sentences after a series of cases in which the state struggled with the procedure.Austin Sarat, William Nelson Cromwell Professor of Jurisprudence and Political Science, Amherst CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1538482021-02-04T19:55:36Z2021-02-04T19:55:36ZCriminal justice needs a better understanding of childhood trauma<figure><img src="https://images.theconversation.com/files/382066/original/file-20210202-19-w0gthc.jpg?ixlib=rb-1.1.0&rect=449%2C161%2C3544%2C2131&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Courts have failed to understand the role childhood trauma can play in adult criminal behaviour.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The execution of <a href="https://www.nytimes.com/2021/01/13/us/politics/lisa-montgomery-execution.html">Lisa Montgomery in Indiana</a> in January made headlines around the world. She was the first female inmate executed by the federal government since 1953. Montgomery faced the death penalty for strangling pregnant 23-year old Bobbie Jo Stinnett in 2004. Montgomery cut the unborn baby from Stinnett’s womb, claiming the child as her own. </p>
<p>Montgomery was a woman described as <a href="https://www.ctvnews.ca/world/u-s-carries-out-its-1st-execution-of-female-federal-inmate-since-1953-1.5264590">damaged and delusional</a>, who suffered from depression, schizophrenia, personality disorder, PTSD and <a href="https://www.theguardian.com/world/2021/jan/05/lisa-montgomery-death-row-execution-history">traumatic brain injury</a>. She experienced psychosis and believed God spoke to her through connect-the-dot puzzles. </p>
<p>At the time of the crime, <a href="https://apnews.com/article/lisa-montgomery-executed-d29e4250646d5e177df53efa64da6163">she suffered from pseudocyesis</a>, a rare psychiatric condition where she falsely believed she was pregnant and experienced the same hormonal and body changes. </p>
<h2>Mental illness</h2>
<p>Over the past several decades, researchers have underscored the connection between <a href="https://doi.org/10.1016/j.chiabu.2017.03.016">childhood trauma and mental illness in adulthood</a>. With colleagues, <a href="https://news.athabascau.ca/faculty/faculty-of-health-disciplines/mental-health-and-trauma-influences-on-maternal-infanticide-and-filicide/">I examine how childhood trauma affects criminal behaviour</a>. Our work is concerned with the area of maternal mental health forensics: the process of determining evidence in cases of mothers who are prosecuted for criminal behaviour, such as in cases of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174580/">maternal infanticide</a> where mothers kill their children.</p>
<p>Our culture’s lingering stigma of mental illness means that <a href="https://doi.org/10.1016/S0749-3797(98)00017-8">adverse childhood experiences</a> and their relationship to criminal behaviour remain woefully ignored. As a consequence, compassion and fair legal decisions are not made consistently. While the legal system has come a long way, there is still a long way to go. </p>
<p>It is a most heinous crime imaginable when a mother kills her child — or in this case, the child of another. It violates the archetype of the mother as all-protecting of her young. </p>
<p>Society can be quick to judge these women as sadistic and maniacal, demanding punishment to the fullest extent. With a lack of understanding of the possible mental health basis, these mothers are treated as monsters rather than victims of their mental disturbances lacking the capacity to know or appreciate the nature of their actions.</p>
<p>Exactly 20 years ago, in Houston, Texas, <a href="https://www.buggedspace.com/andrea-yates-mother-who-drowned-her-children/">Andrea Yates took the lives of her five children</a> and faced the death penalty. Yates believed she was saving her children from eternal damnation by drowning them in a bathtub. In 2002, she was convicted of murder and sentenced to life in prison, although an appellate court later ordered a second trial. </p>
<p>At that trial in 2006, <a href="https://narratively.com/he-defended-the-woman-who-drowned-her-five-children-then-dedicated-his-life-to-making-sure-it-never-happens-again/">Yates’s attorney educated the jury about her psychotic mind</a>. Yates was found not guilty by reason of insanity. Public opinion shifted from disdain to compassion for the impact of maternal mental illness, and its role in the crime. However, compassion and understanding from those determining the fate of Lisa Montgomery was lacking. </p>
<h2>A traumatizing childhood</h2>
<p>As a child, Lisa suffered repeated sexual torture and humiliation from her mother. She would strip Lisa naked and push her outside the front door as punishment. She put Lisa in cold showers and whipped her with <a href="https://deathpenaltyworldwide.org/project/savelisa/">belts, cords or hangers</a>. Her step-father built a <a href="https://www.newsweek.com/lisa-montgomery-life-sentence-death-row-abuse-1548750">secret room behind his trailer</a>, where he and others <a href="https://www.huffingtonpost.ca/entry/lisa-montgomery-death-penalty-trump-administration_n_5fa586a3c5b623bfac4f101d?ri18n=true">repeatedly raped her</a>. These types of significant childhood traumas, and even ones not so extreme, have been shown to <a href="https://www.aap.org/en-us/documents/ttb_aces_consequences.pdf">alter brain biology and lead to mental illness in adulthood</a>. </p>
<p>The impact of childhood traumas on adult mental health is like what smoking is to the lung and obesity to the heart. Research shows that extensive trauma at an early age is very common in maternal filicide. Studies confirm that <a href="https://doi.org/10.1016/S0749-3797(98)00017-8">adverse childhood experiences in the first 18 years of life</a> increase risk of psychosis and criminal behaviour. The more adverse childhood experiences one has, the greater the risk of depression, anxiety, suicidality and other mental disorders. While there are factors that can protect people from the severe effects of trauma, like having a safe relationship with an adult, not everyone who experiences adversity or trauma also experiences protective factors.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-compassion-can-triumph-over-toxic-childhood-trauma-90756">How compassion can triumph over toxic childhood trauma</a>
</strong>
</em>
</p>
<hr>
<p>When it comes to maternal mental illness, <a href="https://www.attachmenttraumanetwork.org/attachment/">childhood maltreatment at the hands of parents and guardians</a> have the most harmful effects. There is an urgent need to shift the dialogue and acknowledge that childhood traumas impact adult mental health. Studying how laws and judicial decisions can reflect our evolving appreciation of how adverse childhood experiences contribute to mental illness, criminal behaviour and insanity defences, is crucial. </p>
<p>Trauma is not the “<a href="https://www.usatoday.com/story/opinion/policing/2021/01/05/death-sentence-mentally-ill-montgomery-shows-failure-justice-system/4127792001/">abuse-excuse</a>,” as federal prosecutors called Montgomery’s life story. Rather, abuse produces negative outcomes including criminal behaviour. </p>
<p>Had Montgomery been tried in a legal system with a more nuanced understanding of mental illness her life may have been spared, and proper treatment provided. The murder of Bobbi Jo Stinnett was reprehensible and tragic. A second injustice was enacted when Montgomery, herself a victim of her mental illness, was executed.</p><img src="https://counter.theconversation.com/content/153848/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gina Wong does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The execution of Lisa Montgomery in the U.S. earlier this year demonstrates how society misunderstands the effects of mental illness and trauma on criminal behaviour.Gina Wong, Professor, Program Director, Psychologist, Athabasca UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1513582020-12-03T18:38:48Z2020-12-03T18:38:48ZTrump plan to revive the gallows, electric chair, gas chamber and firing squad recalls a troubled history<figure><img src="https://images.theconversation.com/files/372834/original/file-20201203-13-xkghzw.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C2991%2C2083&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Empty, but for how long?</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ExecutionAccess-History/84abe222995444d19e70c21723c311ca/photo?Query=electric%20AND%20chair&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=295&currentItemNo=95">AP File Photo</a></span></figcaption></figure><p>The way the federal government can kill death row prisoners will soon be expanded to ghoulish methods that include hanging, the electric chair, gas chamber and the firing squad.</p>
<p>Set to take effect on Christmas Eve, the new regulations <a href="https://www.washingtonpost.com/national-security/doj-allows-firing-squad-execution/2020/11/27/a9b65e38-30eb-11eb-860d-f7999599cbc2_story.html">authorizing</a> an alternative to lethal injections – the method <a href="https://www.bop.gov/about/history/federal_executions.jsp">currently used in federal executions</a> – were announced by the Justice Department on Nov. 27.</p>
<p>The federal move follows the example of several states, <a href="https://apnews.com/article/5175a3250b0443eeb05071ef5a25b465">including Oklahoma and Tennessee</a>, that have revived alternative methods in the face of challenges to their lethal injection protocols and <a href="https://www.themarshallproject.org/2016/04/12/how-the-drug-shortage-has-slowed-the-death-penalty-treadmill">problems in the supply of drugs</a> needed in the process.</p>
<p>It is not clear whether the administration actually intends to employ the newly announced methods. It may only want to have them in reserve if any of the individuals scheduled for execution before January’s inauguration – five, <a href="https://www.cnn.com/2020/11/25/politics/barr-trump-federal-executions/index.html">according to the Department of Justice</a> – should succeed in challenging the current execution protocol. </p>
<p>What is clear is that these new regulations send a message about the lengths the administration will go to kill as many death row inmates as possible before Joe Biden takes office and, as expected, <a href="https://apnews.com/article/joe-biden-prisons-inaugurations-coronavirus-pandemic-executions-365258989e6be8d7077b2f67d8c3e190">halts the federal death penalty</a>. </p>
<p>If the president and Department of Justice succeed in their plan, the period from July 14, 2020, the date of the first of Trump’s federal executions, through January 20, 2021 will be <a href="https://www.nytimes.com/2020/11/25/us/politics/executions-firing-squads-electrocution.html">the deadliest</a> in the history of federal capital punishment in nearly a century.</p>
<p>As someone who has studied <a href="https://www.sup.org/books/title/?id=23979">execution methods in the U.S.</a>, I see in the new regulations echoes of a troubled history of less-than-perfect execution methods. </p>
<p>To grasp their full significance, it is necessary to look at the record of hanging, the electric chair, the gas chamber and firing squads. Each of them has been touted as humane only to be sidelined because its use was found to be gruesome and offensive. Given that history, there are questions over whether the administration’s plans serve any purpose other than continuing a death penalty system deemed to be a cruel outlier among modern societies.</p>
<h2>The noose and the chair</h2>
<p>Let’s start with hanging.</p>
<p>Hanging was the execution method of choice throughout most of American history, and it was used in America’s <a href="https://www.youtube.com/watch?v=Rr67aYbaHzQ">last public execution</a> in 1936, when Rainey Bethea was put to death in Owensboro, Kentucky. When done correctly, the noose <a href="https://www.theatlantic.com/magazine/archive/2015/06/a-brief-history-of-american-executions/392270/">killed by severing the spinal column</a>, causing near instantaneous death.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/372829/original/file-20201203-21-11r1ask.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372829/original/file-20201203-21-11r1ask.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=455&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372829/original/file-20201203-21-11r1ask.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=455&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372829/original/file-20201203-21-11r1ask.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=455&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372829/original/file-20201203-21-11r1ask.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=572&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372829/original/file-20201203-21-11r1ask.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=572&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372829/original/file-20201203-21-11r1ask.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=572&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Crowds watch as attendants adjust a black hood over Rainey Bethea.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ExecutionAccess-History/77a90efd8d0447a18168e93ebaf6789b/photo?Query=Rainey%20AND%20Bethea&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=8&currentItemNo=1">AP File Photo</a></span>
</figcaption>
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<p>But, all too often, hanging resulted in a slow death by strangulation and sometimes even a beheading. Given this gruesome record and <a href="https://www.legendsofamerica.com/ah-lynching/">hanging’s association with the lynching of mainly Black men</a>, by the end of the 19th century the search for other execution methods began in earnest.</p>
<p>The first of those alternatives was the electric chair. At the time it was adopted, it was regarded as a truly modern instrument of death, a technological marvel in the business of state killing. Hailed by penal reformers as a humane alternative to hanging, the electric chair was first <a href="https://www.penguinrandomhouse.com/books/116966/executioners-current-by-richard-moran/">authorized</a> in 1888 by New York state following the <a href="https://www.popularmechanics.com/technology/a25689/gerry-commission-report-methods-of-execution/">report of a commission</a> that <a href="https://www.jstor.org/stable/983796?seq=1#metadata_info_tab_contents">concluded</a>, “The most potent agent known for the destruction of human life is electricity…The velocity of the electric current is so great that the brain is paralyzed; it is indeed dead before the nerves can communicate a sense of shock.”</p>
<p>Yet, right from the start, electrocution’s potency was a problem. Its first use in the 1890 execution of convicted murderer William Kemmler <a href="https://deathpenaltyinfo.org/news/125-years-ago-first-execution-using-electric-chair-was-botched">was horribly botched</a>. <a href="https://deathpenaltyinfo.org/stories/botched-executions-in-american-history#:%7E:text=On%20August%206%2C%201890%2C%20New%20York%20executed%20William%20Kemmler.&text=Then%20Kemmler%20let%20out%20a,2%20of%20the%20witnesses%20fainted.">Reports of the execution</a> say that “After 2 minutes the execution chamber filled with the smell of burning flesh.” Newspapers called the execution a “historic bungle” and “disgusting, sickening and inhuman.” </p>
<p>In spite of the Kemmler debacle, the electric chair <a href="https://www.penguinrandomhouse.com/books/116966/executioners-current-by-richard-moran/">quickly became popular</a>, being seen as more efficient and less brutal than hanging. From the start of the 20th century until the 1980s, the number of death sentences carried out by this method far outstripped those of any other method.</p>
<p>But electrocutions continued to go wrong, and eventually several dramatic botched executions in Florida helped turn the tide. Included were two executions, one in 1990, the other in 1997, in which the condemned inmates <a href="https://www.nytimes.com/1999/11/18/us/florida-s-messy-executions-put-the-electric-chair-on-trial.html">caught fire</a>.</p>
<h2>The gas chamber</h2>
<p>By the start of the 21st century, states all over the country were abandoning the electric chair. As Justice Carol W. Hunstein of the Supreme Court of Georgia <a href="https://caselaw.findlaw.com/ga-supreme-court/1216340.html">explained</a>, “Death by electrocution, with its specter of excruciating pain and its certainty of cooked brains and blistered bodies,” was no longer compatible with contemporary standards of decency.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/372831/original/file-20201203-13-g4vm1w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/372831/original/file-20201203-13-g4vm1w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=591&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372831/original/file-20201203-13-g4vm1w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=591&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372831/original/file-20201203-13-g4vm1w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=591&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372831/original/file-20201203-13-g4vm1w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=743&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372831/original/file-20201203-13-g4vm1w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=743&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372831/original/file-20201203-13-g4vm1w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=743&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A gas chamber at San Quentin prison from 1959.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/SanQuentinGasChamber1959/cff0724541f6411f9381056ce9b9a5c4/photo?Query=gas%20chamber%20prison&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=51&currentItemNo=48">AP Photo/Clarence Hamm</a></span>
</figcaption>
</figure>
<p>One alternative to electrocution was the gas chamber, but it too has its own <a href="https://www.amazon.com/Last-Gasp-Rise-American-Chamber/dp/0520271211">history of problems</a>. First adopted in Nevada in 1922, executions using lethal gas were to take place while the condemned slept. Death row inmates were supposed to be housed in airtight, leak-proof prison cells, separate from other prisoners. On the day of the execution, valves would be opened that would fill the chamber with gas, killing the prisoner painlessly.</p>
<p>This plan was soon abandoned because officials decided it would be impractical to implement it, and states constructed special gas chambers fitted with pipes, exhaust fans and glass windows on the front and back walls for witness viewing. But deaths by lethal gas were never pretty or easy to watch.</p>
<p>Inmates regularly fought against breathing the gas as it entered the chamber. They convulsed, jerked, coughed, twisted and turned blue for several minutes before they died.</p>
<p>Far from solving the problems associated with hangings or electrocutions, lethal gas introduced its own set of horrors to the institution of capital punishment. In fact, by the end of the 20th century, <a href="https://www.sup.org/books/title/?id=23979">5% of executions by lethal gas had been botched</a>. </p>
<p>As a result, states used gas as the sole method of execution only from 1924 to 1977, and it was last used in 1999. By then, the gas chamber had become a relic of the past because of its <a href="https://news.law.fordham.edu/blog/2016/02/21/return-of-the-gas-chamber/">inability to deliver on its promise to be “swift and painless”</a> and its association with the Nazi use of gas to kill millions during the Holocaust.</p>
<h2>The firing sqaud</h2>
<p>Finally, the firing squad. Of all of America’s methods of execution, it has been least often used. From 1900 to 2010, only 35 of America’s 8,776 executions were carried out using this method, and since 1976 just <a href="https://deathpenaltyinfo.org/executions/methods-of-execution">three people have faced a firing squad</a>, with the last one carried out in Utah in 2010.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/372832/original/file-20201203-21-4vl6ns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372832/original/file-20201203-21-4vl6ns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372832/original/file-20201203-21-4vl6ns.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372832/original/file-20201203-21-4vl6ns.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372832/original/file-20201203-21-4vl6ns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372832/original/file-20201203-21-4vl6ns.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372832/original/file-20201203-21-4vl6ns.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The execution chamber at Utah State Prison used in the U.S.’s last firing squad execution.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/FiringSquad-Appeal/607069faa7ea4355b6a0646ff1f0efdd/photo?Query=firing%20squad%20prison&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=197&currentItemNo=11">AP Photo/Trent Nelson, Pool, File</a></span>
</figcaption>
</figure>
<p>Critics point out that because death by guns evokes images of raw, frontier justice in a society awash in gun violence, this method mimicked something that the law wished to discourage. Nonetheless, Utah <a href="https://www.npr.org/2015/04/05/397672199/utah-brings-back-firing-squad-executions-witnesses-recall-the-last-one">revived the firing squad</a> in 2015 due to challenges to the state’s lethal injection protocol.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>While it has some <a href="https://repository.law.umich.edu/mjlr/vol49/iss4/1/">contemporary proponents</a> who claim it is the least cruel of all execution methods, the history of the firing squad is marked by <a href="https://deathpenaltyinfo.org/stories/botched-executions-in-american-history">gruesome mistakes when marksmen missed their target</a>. In the 1951 execution of Eliseo Mares, for example, four executioners all shot into the wrong side of his chest, and he died slowly from blood loss.</p>
<h2>A cruel history, revived</h2>
<p>While Trump’s Department of Justice is now holding out the prospect of using these previously discredited methods of execution, it cannot erase the cruelty that marks their history. That history stands as a reminder of America’s failed quest to find a method of execution that is safe, reliable and humane.</p><img src="https://counter.theconversation.com/content/151358/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Austin Sarat does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Justice Department has approved alternatives to lethal injections for federal executions. But no method of capital punishment has been without gruesome stories of what went wrong.Austin Sarat, Associate Provost and Associate Dean of the Faculty and Cromwell Professor of Jurisprudence and Political Science, Amherst CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1419592020-07-09T15:25:40Z2020-07-09T15:25:40ZFederal executions to resume, posing a new test for lethal injection<figure><img src="https://images.theconversation.com/files/346145/original/file-20200707-194418-i0309j.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C2389%2C1559&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The lethal injection chamber at a California prison.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/view-of-the-new-lethal-injection-chamber-at-san-quentin-news-photo/566030939">Wally Skalij/Los Angeles Times via Getty Images</a></span></figcaption></figure><p>Now that the U.S. <a href="https://www.usatoday.com/story/news/politics/2020/06/29/federal-death-penalty-supreme-court-allows-executions-resume/3199174001/">Supreme Court has refused to hear four inmates’ challenge</a> to the specifics of the lethal injection process, federal executions are <a href="https://deathpenaltyinfo.org/executions/upcoming-executions#year2020">expected to resume</a> next week. In July 2019, Attorney General William Barr declared an end to a <a href="https://www.nytimes.com/2019/07/25/us/politics/federal-executions-death-penalty.html">federal moratorium on executions</a> that had been in effect since 2003.</p>
<p>The inmates <a href="https://www.wsj.com/articles/judges-scrutinize-federal-death-penalty-law-in-condemned-inmates-challenge-11579133380">alleged</a> that the Justice Department’s <a href="https://files.deathpenaltyinfo.org/documents/Federal-Execution-Protocol-Addendum-7-25-19.pdf">execution instructions</a>, which call for the use of a single dose of <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Pentobarbital">pentobarbital</a>, a barbiturate that is normally used as a sedative, violates the <a href="https://www.law.cornell.edu/uscode/text/18/part-II/chapter-228">Federal Death Penalty Act</a>.</p>
<p>They claimed that the law requires federal executions to be carried out “in the manner prescribed by the state” in which the prisoner was convicted. Pentobarbital is not used in Arkansas, Iowa or Missouri, the pertinent states in their cases. They were hoping their executions would have to be carried out using drugs the federal government does not possess, sparing them at least temporarily.</p>
<p>My <a href="https://www.sup.org/books/title/?id=23979">research on America’s methods of execution</a> indicates that the promised benefits of lethal injection – a quick, painless death – have never come true. And there is no longer a national consensus about what drugs, or drug combinations, are best for putting people to death.</p>
<h2>The history of lethal injection</h2>
<p>Lethal injection has been legal in the U.S. since 1977, although its history can be traced back to the late 19th century.</p>
<p>At that time, a state commission in New York <a href="https://www.popularmechanics.com/technology/a25689/gerry-commission-report-methods-of-execution/">looked at alternatives to hanging</a>, which was then the most common method of execution. Hanging had been discredited because of several gruesome botched executions. The commission discussed lethal injection, but the state ultimately chose electrocution as its preferred method.</p>
<p>In 1953, <a href="https://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=4198&context=jclc">Great Britain’s Royal Commission on Capital Punishment</a> also considered lethal injection as a possible replacement for the gallows, but ultimately chose not to recommend its use. The Royal Commission heeded medical experts’ warnings that the drugs could cause problems and that it might be hard to find the veins of the condemned – fears that have become reality in the U.S. in recent years.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=experts">Expertise in your inbox. Sign up for The Conversation’s newsletter and get expert takes on today’s news, every day.</a></em>]</p>
<p>Others have continued to advocate for lethal injection – including people who oppose government executions altogether. Albert Camus, the French philosopher who was one of the 20th century’s leading opponents of the death penalty, famously argued that that if France was to continue using capital punishment, it should do so with “decency” by using an “<a href="https://libcom.org/files/Reflections%20on%20the%20Guillotine.pdf">anesthetic that would allow the condemned man</a> to slip from sleep to death.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/346150/original/file-20200707-194405-1g7mgrr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/346150/original/file-20200707-194405-1g7mgrr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/346150/original/file-20200707-194405-1g7mgrr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=503&fit=crop&dpr=1 600w, https://images.theconversation.com/files/346150/original/file-20200707-194405-1g7mgrr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=503&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/346150/original/file-20200707-194405-1g7mgrr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=503&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/346150/original/file-20200707-194405-1g7mgrr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=632&fit=crop&dpr=1 754w, https://images.theconversation.com/files/346150/original/file-20200707-194405-1g7mgrr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=632&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/346150/original/file-20200707-194405-1g7mgrr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=632&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An 1834 depiction of the 1793 execution of French King Louis XVI shows the guillotine, once believed to be a more humane execution method but later viewed as barbaric.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/execution-of-louis-xvi-illustration-from-the-book-news-photo/1084709370">Universal History Archive/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<h2>Replacing the electric chair</h2>
<p>During the last quarter of the 20th century, <a href="https://www.history.com/this-day-in-history/first-execution-by-lethal-injection">similar beliefs</a> about the allegedly more humane nature of lethal injection surfaced in U.S. state legislative debates seeking an alternative to the electric chair.</p>
<p>Oklahoma became the first state formally <a href="http://content.time.com/time/nation/article/0,8599,1815535,00.html">to adopt lethal injection</a> as its method of execution. At the time, it chief legislative proponents <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3393017">claimed</a> that it would be a dramatic improvement over the “inhumanity, visceral brutality, and cost” of the electric chair.</p>
<p>Oklahoma chose lethal injection, as legal scholar Deborah Denno writes, “despite the fact that the procedure had <a href="https://ir.lawnet.fordham.edu/flr/vol76/iss1/3">never been medically or scientifically studied on human beings</a>.” </p>
<p>By 2002, 20 years after Texas became the first state to carry out an execution by lethal injection, <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674010833">37 states</a> had made it their default method. </p>
<h2>How lethal injection works</h2>
<p>Over that period, a consensus <a href="https://scholarship.law.upenn.edu/cgi/viewcontent.cgi?article=1022&context=penn_law_review_online">emerged</a> among death penalty states about the exact mix of drugs that would be most effective. A three-drug protocol was developed, combining an anesthetic (usually sodium thiopental) with a paralytic agent (pancuronium bromide), and a drug to stop the heart (potassium chloride). </p>
<p>However, since 2010, shortages of those drugs have caused the consensus to disintegrate. Death penalty proponents complained that the shortages resulted from opponents’ efforts to end the death penalty by any means, saying the activists had <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2524124">pressured companies to stop making those drugs</a>. </p>
<p>Complaints about an artificially created drug shortage also found their way onto the pages of Supreme Court opinions. In the 2015 <a href="https://www.supremecourt.gov/opinions/14pdf/14-7955_aplc.pdf">Glossip v. Gross</a> decision upholding lethal injection, Justice Samuel Alito wrote that the court should not let condemned inmates delay their dates with death, because “anti-death-penalty advocates pressured pharmaceutical companies to refuse to supply the drugs used to carry out death sentences.”</p>
<h2>States search for alternatives</h2>
<p>Since 2010, states <a href="https://www.themarshallproject.org/2016/04/12/how-the-drug-shortage-has-slowed-the-death-penalty-treadmill">have gone their own ways</a> in search of supposedly humane and efficient methods for carrying out death sentences.</p>
<p>The Death Penalty Information Center, a national clearinghouse for analysis and information on issues concerning capital punishment, <a href="https://deathpenaltyinfo.org/executions/lethal-injection/overview-of-lethal-injection-protocols">reports</a> that in the past decade eight states have used just one drug, usually a lethal dose of an anesthetic. Fourteen states have employed pentobarbital. Seven have used midazolam as part of a three-drug protocol. Nebraska has used <a href="https://theconversation.com/fentanyl-widely-used-deadly-when-abused-60511">fentanyl, a powerful opioid</a>, and Nevada has authorized its use.</p>
<p>Other states have chosen <a href="https://www.theatlantic.com/politics/archive/2015/03/can-executions-be-more-humane/388249/">nitrogen hypoxia</a>, which an inmate inhales and which kills by depriving the body of oxygen, as an alternative to lethal injection. Additional alternatives condemned inmates can choose include the electric chair in Tennessee, firing squad in Utah and hanging in New Hampshire. Of these, only <a href="https://www.usatoday.com/story/news/nation/2019/08/15/tennessee-execution-stephen-michael-west-dies-electric-chair/2026482001/">Tennessee’s electric chair</a> has been used recently.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/346148/original/file-20200707-194409-1supd6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/346148/original/file-20200707-194409-1supd6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/346148/original/file-20200707-194409-1supd6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/346148/original/file-20200707-194409-1supd6b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/346148/original/file-20200707-194409-1supd6b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/346148/original/file-20200707-194409-1supd6b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/346148/original/file-20200707-194409-1supd6b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/346148/original/file-20200707-194409-1supd6b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A 2017 photo shows the three-chemical mixture used by Texas prison officials for lethal injections in the state from 1982 until 2012.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Multiple-Executions/81d77c7822e648ddaa9c1c6398e77384/53/0">AP Photo/Michael Graczyk</a></span>
</figcaption>
</figure>
<h2>Lethal injection’s continuing problems</h2>
<p>From 1982 to 2010, 7% of all lethal injections were <a href="https://www.sup.org/books/title/?id=23979">botched</a>, making it the most error prone of America’s execution methods.</p>
<p>Since then <a href="https://www.npr.org/2019/07/26/745722219/lethal-injection-drugs-efficacy-and-availability-for-federal-executions">difficulties</a> associated with lethal injection have multiplied. </p>
<p>They <a href="https://www.theatlantic.com/politics/archive/2015/03/is-this-the-end-of-lethal-injection-in-america/453564/">include</a> cases in which guards have had trouble finding a usable vein for an IV line, cases in which inmates have suddenly gasped for air or shown signs of consciousness long after the drugs started flowing, and others in which it took much longer than the expected time for the condemned person to die.</p>
<p>There have also been several badly botched lethal injections involving different drugs and protocols. Three of them occurred in 2014 alone. </p>
<p>Dennis McQuire <a href="https://www.dispatch.com/article/20140812/NEWS/308129896">gasped for air</a> for 25 minutes while the drugs Ohio used in his execution, hydromorphone and midazolam, slowly took effect. </p>
<p>Clayton Lockett in Oklahoma <a href="https://www.theatlantic.com/magazine/archive/2015/06/execution-clayton-lockett/392069/">died of a heart attack</a> – not the drugs – 43 minutes after the start of his execution. Joseph Wood repeatedly <a href="https://www.washingtonpost.com/news/post-nation/wp/2014/07/23/arizona-supreme-court-stays-planned-execution/">gasped for one hour and 40 minutes</a> before his death was pronounced in Arizona.</p>
<p>In 2018 executioners in Alabama <a href="https://theintercept.com/2018/03/03/doyle-hamm-alabama-execution-lethal-injection/">tried for two and a half hours</a> to find a vein, leaving Doyle Lee Hamm with 12 puncture marks, including six in his groin and others that punctured his bladder and penetrated his femoral artery, before his execution was called off. </p>
<p>Such deeply troubling failures <a href="https://www.npr.org/transcripts/308363674?storyId=308363674?storyId=308363674">have not</a> moved a majority on the current Supreme Court to recognize that they are constitutionally problematic. Yet they are evidence that lethal injection has not been the answer to America’s centurylong quest to find a method of execution that would be safe, reliable and humane.</p><img src="https://counter.theconversation.com/content/141959/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Austin Sarat does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The promised benefits of lethal injection – a quick, painless death – have never come true. There’s not even agreement about which drugs are best for executions.Austin Sarat, Associate Provost and Associate Dean of the Faculty and Cromwell Professor of Jurisprudence and Political Science, Amherst CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1210342019-10-16T11:25:34Z2019-10-16T11:25:34ZWhy the guillotine may be less cruel than execution by slow poisoning<figure><img src="https://images.theconversation.com/files/296722/original/file-20191011-96208-ur76yz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Could using the guillotine be more humane than execution by lethal injection?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/guillotine-bottom-view-against-blue-sky-1323991673">AlexLMX/Shutterstock</a></span></figcaption></figure><p>Concerns about the drugs used for executions are being raised again after the federal government announced it will once again execute <a href="https://www.nytimes.com/2019/07/25/us/politics/federal-executions-death-penalty.html">inmates convicted of capital crimes</a> almost 16 years after the last execution was carried out. </p>
<p>International drug companies will no longer sell <a href="https://www.nytimes.com/2016/05/14/us/pfizer-execution-drugs-lethal-injection.html">drugs for use in lethal injections in the United States</a>. But Attorney General William Barr has authorized the federal justice system to use the widely available drug pentobarbital, <a href="https://news.stlpublicradio.org/post/secret-sedative-how-missouri-uses-pentobarbital-executions#stream/0">despite concerns</a> about whether that method violates the <a href="https://constitutioncenter.org/interactive-constitution/amendment/amendment-viii">Eighth Amendment, which prohibits cruel and unusual punishment</a>. In common use, the drug controls seizures in humans and is often used to euthanize pets.</p>
<p>In 2014, several executions carried out by states with untested methods using a mixture of drugs caused <a href="https://newrepublic.com/article/118833/2014-botched-executions-worst-year-lethal-injection-history">suffering and took hours to end prisoners’ lives</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/296725/original/file-20191011-96226-1bt2zbf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/296725/original/file-20191011-96226-1bt2zbf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/296725/original/file-20191011-96226-1bt2zbf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/296725/original/file-20191011-96226-1bt2zbf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/296725/original/file-20191011-96226-1bt2zbf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/296725/original/file-20191011-96226-1bt2zbf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/296725/original/file-20191011-96226-1bt2zbf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/296725/original/file-20191011-96226-1bt2zbf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">One of the three drugs used in the botched execution of Clayton Lockett in 2014.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Oklahoma-Execution/6cf3cd81b59642029d18d97c84b18c3e/3/0">AP/File photo</a></span>
</figcaption>
</figure>
<p>Among them was the <a href="https://www.theatlantic.com/magazine/archive/2015/06/execution-clayton-lockett/392069/">botched execution of Oklahoma inmate Clayton Lockett</a>, who thrashed around in pain for 43 minutes before dying, <a href="https://www.nytimes.com/2014/05/03/us/flawed-oklahoma-execution-deeply-troubling-obama-says.html">prompted President Obama to call for a moratorium</a> on the death penalty for federal inmates.</p>
<p>While the death penalty is the ultimate punishment meted out by the state, it is not meant to be torture. </p>
<p>From the stake to the rope to the firing squad to the electric chair to the gas chamber and, finally, to the lethal injection, over the centuries the methods of execution in the United States have evolved to make execution <a href="https://ir.lawnet.fordham.edu/cgi/viewcontent.cgi?article=2636&context=ulj">quicker, quieter and less painful</a>, both physically and psychologically.</p>
<p>It wasn’t always so. And there are, perhaps, lessons in history that could provide an answer to current concerns about the unusual cruelty of execution methods in the U.S.</p>
<h2>Spectacles of physical torment</h2>
<p>Under the French monarchy in the 17th and 18th centuries, execution was meant to be painful. That would purify the soul of the condemned before his final judgment, deter others from committing crime, and showcase the power of the king to <a href="https://global.oup.com/academic/product/seeing-justice-done-9780199592692?q=Paul%20Friedland&lang=en&cc=us">impose unbearable suffering on his subjects</a>. </p>
<p>Public executions were spectacles that were part public holiday, part grim warning. Crowds gathered to watch the prisoner endure physical torments almost <a href="https://www.worldcat.org/title/discipline-and-punish-the-birth-of-the-prison/oclc/32367111">too dreadful to imagine</a>: hot pokers, boiling lead poured into wounds, dismembering hooks, and of course, the horses readied to draw and quarter.</p>
<p>Not everybody suffered so terribly, however. This parade of horrors was the fate of commoners. For nobles, a quick, relatively painless, and more <a href="https://global.oup.com/academic/product/seeing-justice-done-9780199592692?q=Paul%20Friedland&lang=en&cc=us">dignified beheading replaced an hours-long public display</a>. </p>
<p>One of the many goals of the French Revolution, which took place from 1789 to 1815, was to level society, to take away the <a href="https://www-jstor-org.proxy.lib.wayne.edu/stable/744131">privileges</a> of the nobility, who lorded over commoners.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/296730/original/file-20191011-96208-icavr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/296730/original/file-20191011-96208-icavr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/296730/original/file-20191011-96208-icavr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=353&fit=crop&dpr=1 600w, https://images.theconversation.com/files/296730/original/file-20191011-96208-icavr9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=353&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/296730/original/file-20191011-96208-icavr9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=353&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/296730/original/file-20191011-96208-icavr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=444&fit=crop&dpr=1 754w, https://images.theconversation.com/files/296730/original/file-20191011-96208-icavr9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=444&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/296730/original/file-20191011-96208-icavr9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=444&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Execution by guillotine in France, 1793.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Reign_of_Terror#/media/File:Octobre_1793,_supplice_de_9_%C3%A9migr%C3%A9s.jpg">La Guillotine en 1793 by H. Fleischmann (1908), Wikimedia</a></span>
</figcaption>
</figure>
<h2>Medium is the message</h2>
<p>The solution to disparate forms of execution and social equality was first presented to the French National Assembly on Oct. 10, 1789 by Dr. Joseph Guillotin, who presented plans for a <a href="https://gallica.bnf.fr/ark:/12148/bpt6k5788381v">bladed machine to execute criminals</a>. </p>
<p>It would be easy to use, work quickly and offer the same treatment to all condemned, regardless of social standing. His ideas finally became law in March 1791 and the guillotine was used for an execution the following year. </p>
<p>The so-called “<a href="https://www.themorgan.org/blog/national-razor-collecting-heads-french-revolution">national razor</a>” took off the heads of the royal family as well as the humblest thief. It leveled bodies and society, with all citizens subject to the same punishment. And it ended the capricious torment of the condemned by the monarchy as well as the privilege that nobles had, even regarding the manner of their deaths. </p>
<p>The guillotine was a killing machine that provided not just a convenient method of execution but the proper political and ideological message for the Revolution.</p>
<h2>Less cruel and unusual?</h2>
<p>Eventually, the <a href="https://www.britannica.com/event/French-Revolution">French Revolution became more politically radical</a>, moving from a system where the king would continue to govern within a constitutional system to a republic where the people’s representatives would wield political power to a de facto dictatorship. As the Revolution became more radical, and politicians saw plots everywhere, increasing numbers of citizens were sentenced to death.</p>
<p>With the need to execute many prisoners the guillotine was pressed into greater use. The most careful estimate for the number of French executed during the Terror, <a href="https://www.britannica.com/event/Reign-of-Terror">the height of the radical Revolution, was 17,000</a>. This number included almost exclusively those charged with political crimes. </p>
<p>It was the guillotine’s plummeting blade that took off head after head with just a bit of cleaning and sharpening in between, answering the need of the moment. <a href="https://www.worldcat.org/title/terror-the-shadow-of-the-guillotine-france-1792-1794/oclc/70335347">Thus it came to symbolize state terrorism</a> but also <a href="https://us.macmillan.com/books/9781466849310">swift and equal justice</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/296723/original/file-20191011-96262-1iirn2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/296723/original/file-20191011-96262-1iirn2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/296723/original/file-20191011-96262-1iirn2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=455&fit=crop&dpr=1 600w, https://images.theconversation.com/files/296723/original/file-20191011-96262-1iirn2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=455&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/296723/original/file-20191011-96262-1iirn2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=455&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/296723/original/file-20191011-96262-1iirn2w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=572&fit=crop&dpr=1 754w, https://images.theconversation.com/files/296723/original/file-20191011-96262-1iirn2w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=572&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/296723/original/file-20191011-96262-1iirn2w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=572&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The guillotine remained in use in France well into the 20th century. Here, workmen in the Sante Prison clean and dismantle a guillotine in Paris on May 25, 1946, after the execution of Dr. Marcel Petiot, who was convicted of mass murder during World War II.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Associated-Press-International-News-France-PETI-/79a8c39394e6da11af9f0014c2589dfb/140/0">AP</a></span>
</figcaption>
</figure>
<h2>Terrifying – but brief</h2>
<p>The guillotine remains a quick method of execution – it takes about half a second for the blade to drop and sever a prisoner’s head from his body.</p>
<p>While the moment of execution could be nothing but terrifying, that second of suffering was brief in comparison to the <a href="https://www.theguardian.com/world/2014/apr/30/clayton-lockett-oklahoma-execution-witness">43 minutes it took for Lockett to die</a> after lethal drugs were administered. </p>
<p>In the same year, 2014, convicted double murderer <a href="https://www.washingtonpost.com/news/post-nation/wp/2014/07/23/arizona-supreme-court-stays-planned-execution/">Joseph Rudolph Wood of Arizona suffered</a> for two hours before succumbing to the jerry-built drug cocktail dreamed up in a warden’s office. In 2018, an <a href="https://www.montgomeryadvertiser.com/story/news/2018/03/05/execution-attempt-so-painful-inmate-hoped-get-over-report-states/397304002/">Alabama execution had to be halted</a> after 12 attempts to place an IV line in Doyle Hamm failed. </p>
<p>The current technology of execution does not <a href="https://law.justia.com/constitution/us/amendment-08/09-methods-of-execution.html">reliably provide the humane death demanded by the Constitution</a>. In requiring an IV line and medical personnel to administer drugs it also involves medical practice with the death penalty.</p>
<p>Although the guillotine may be the <a href="https://www.theparisreview.org/blog/2018/04/06/the-bloody-family-history-of-the-guillotine/">bloodiest of deaths</a> – the French used sand bags to soak up the blood – it does not cause the prolonged physical torment increasingly delivered by lethal injections.</p>
<p>Should the U.S. consider using the guillotine to administer capital punishment? </p>
<p>It has advantages – no secret recipes for lethal injections, no botched placement of IV needles, no conflation of medicine and execution.</p>
<p>While the guillotine provides a death that is not easy to witness, the death it delivers to the condemned is quick and does not cause the extended pain of bespoke lethal injections. </p>
<p>Could such a death, as bloody as it is, pass muster with the Eighth Amendment’s mandate against cruel and unusual punishment?</p><img src="https://counter.theconversation.com/content/121034/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janine Lanza does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many recent executions in the US by lethal injections have resulted in prolonged suffering before death. A historian asks: Could the guillotine be a preferable method?Janine Lanza, Associate Professor of History, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1136342019-03-20T10:33:00Z2019-03-20T10:33:00ZDeath penalty moratorium in California – what it means for the state and for the nation<figure><img src="https://images.theconversation.com/files/264788/original/file-20190320-60982-1f25yf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Guards take apart the death penalty chamber at San Quentin State Prison on Wednesday, March 13, 2019</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/California-Death-Penalty-Moratorium/a6b3aa12060a4f40974fdb9786abda9b/14/0">California Department of Corrections and Rehabilitation via AP</a></span></figcaption></figure><p>Both celebration – and ire – followed <a href="https://www.sfchronicle.com/news/article/Gov-Newsom-orders-halt-to-California-s-death-13683693.php">Gov. Gavin Newsom’s announcement of a moratorium on the death penalty in California</a>.</p>
<p>California’s 737 death row inmates constitute <a href="https://deathpenaltyinfo.org/death-row-inmates-state-and-size-death-row-year">more than a quarter of the national number</a>. Keeping them on death row costs <a href="https://lao.ca.gov/handouts/crimjust/2016/Death-Penalty-Initiative-Statute-051716.pdf">US$150 million a year</a> more than sentencing them to life without parole.</p>
<p>California’s death penalty has been at an impasse for decades. The state has not put anyone to death since <a href="http://graphics.latimes.com/towergraphic-see-13-men-executed-california-1978/">Clarence Ray Allen</a>’s execution in 2006. </p>
<p>The state’s use of lethal injections was <a href="https://www.aclunc.org/article/california-lethal-injection-protocol">fiercely debated for years</a>. Twice – once in <a href="https://ballotpedia.org/California_Proposition_34,_the_End_the_Death_Penalty_Initiative_(2012)">2012</a> and again in <a href="https://ballotpedia.org/California_Proposition_62,_Repeal_of_the_Death_Penalty_(2016)">2016</a> – Californians voted on measures to repeal the death penalty, and rejected them. Newsom’s step, which in many ways echoes <a href="https://www.latimes.com/politics/la-pol-ca-gavin-newsom-gay-marriage-20180515-story.html">his historical move as then-San Francisco mayor to marry same-sex couples</a> in 2004, pushes the state in a new direction. </p>
<p>As a criminal justice scholar interested in <a href="https://www.history.com/news/charles-manson-was-sentenced-to-death-why-wasnt-he-executed">death and life sentences in California</a> and in <a href="https://www.ucpress.edu/book/9780520277311/cheap-on-crime">criminal justice policy generally</a>, I see Newsom’s order as a sign that the death penalty may soon end nationwide. </p>
<p>Let me explain.</p>
<h2>Losing public support</h2>
<p>While the United States Supreme Court found the death penalty <a href="https://www.oyez.org/cases/1975/74-6257">constitutional</a> in 1976, nationwide support for the death penalty is <a href="http://www.pewresearch.org/fact-tank/2016/09/29/support-for-death-penalty-lowest-in-more-than-four-decades/">at its lowest point since the 1960s</a>. With this moratorium, <a href="https://deathpenaltyinfo.org/states-and-without-death-penalty">California joins a growing list of states who moved away from putting people to death</a>. </p>
<p>Twenty states have abolished the death penalty – eight of them recently. Four more, including California, have placed a moratorium on its use.</p>
<p><iframe id="YdRDd" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/YdRDd/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Most of these states were already refraining from executing anyone when they abolished the death penalty. In addition to this <a href="http://oxfordre.com/criminology/view/10.1093/acrefore/9780190264079.001.0001/acrefore-9780190264079-e-462">wave of abolitionism</a>, the death penalty is used less frequently in the 26 states that still have it, partly because drug companies increasingly refused to <a href="https://www.washingtonpost.com/news/post-nation/wp/2018/08/13/drug-companies-dont-want-to-be-involved-in-executions-so-theyre-suing-to-keep-their-drugs-out/?utm_term=.f5c3e63dec7f">provide their drugs for use in executions</a>. </p>
<p>This shift matters because attempts to challenge the legality of the death penalty rely on the Eighth Amendment, which prohibits <a href="https://constitutioncenter.org/interactive-constitution/amendments/amendment-viii">cruel and unusual punishment</a>. What counts as cruel and unusual punishment, the Supreme Court ruled in 1958, changes over time with our <a href="https://journals.sagepub.com/doi/abs/10.1177/0734016814531779?journalCode=cjra">evolving standards of decency</a>. </p>
<p>A good example of this evolution is the gradual change in approach toward extreme punishment for juveniles. </p>
<p>In 2004, the Supreme Court <a href="https://www.oyez.org/cases/2004/03-633">abolished the death penalty for juveniles</a>. Five years later, it abolished <a href="https://www.oyez.org/cases/2009/08-7412">life without parole for offenses other than homicide by juveniles</a>. It then <a href="https://www.oyez.org/cases/2011/10-9646">dismantled mandatory life without parole schemes for juveniles</a> – even those who had committed murder. Subsequently it <a href="https://www.oyez.org/cases/2015/14-280">declared these policies retroactive</a> – meaning that even people who were sentenced decades ago, when they were juveniles, can still benefit from these new rules.</p>
<p>The Supreme Court has also wavered over extreme punishment for adults. It ruled the death penalty <a href="https://www.oyez.org/cases/2007/07-343">unconstitutional for most non-homicide crimes</a> in 2007, and Justices Stephen Breyer and Ruth Bader Ginsburg have recently <a href="http://knowledgecenter.csg.org/kc/content/justice-breyer-calls-supreme-court%E2%80%94again%E2%80%94-reconsider-constitutionality-death-penalty">expressed the view that the death penalty’s constitutionality should be reconsidered</a>. When examining “evolving standards of decency,” the Supreme Court looks at state policies. In this respect, Newsom’s announcement may be of huge importance. </p>
<h2>First mover</h2>
<p>California holds a unique position as a criminal justice pioneer. Because of the sheer size of its prison population, any policy change that increases – or decreases – incarceration in California can have dramatic effects nationwide.</p>
<p>In 1976, California moved from sentences set by the legislature to “<a href="https://www.kqed.org/lowdown/775/the-law-that-help-pack-californias-prisons">indeterminate sentences</a>” that allow judges to choose from a sentencing range. The state adopted the <a href="https://lao.ca.gov/2005/3_strikes/3_strikes_102005.htm">Three Strikes law in 1994</a>. These two changes were among the important factors leading to a <a href="https://theappeal.org/a-new-power-for-prosecutors-is-on-the-horizon-reducing-harsh-sentences/">nearly 900 percent spike</a> in the California prison population between 1976 and 2006.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/264787/original/file-20190320-60995-1hxqk9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/264787/original/file-20190320-60995-1hxqk9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264787/original/file-20190320-60995-1hxqk9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264787/original/file-20190320-60995-1hxqk9g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264787/original/file-20190320-60995-1hxqk9g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264787/original/file-20190320-60995-1hxqk9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264787/original/file-20190320-60995-1hxqk9g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264787/original/file-20190320-60995-1hxqk9g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Aswad Pop is one of 737 inmates affected by the moratorium on the death penalty in California.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/California-Death-Row/defd380a16414edeb0377e65ea8ec648/16/1">AP Photo/Eric Risberg</a></span>
</figcaption>
</figure>
<p>During the Great Recession, <a href="https://journals.sagepub.com/doi/abs/10.1177/0002716215599938">California’s lawmakers began to doubt the state could afford such a large prison population</a>. The <a href="https://law.stanford.edu/stanford-criminal-justice-center-scjc/california-realignment/">Criminal Justice Realignment, a law passed in 2011</a>, resulted in a reduction of approximately 40,000 inmates in California’s prisons. In fact, it is estimated that California’s recession-era reforms have <a href="https://journals.sagepub.com/doi/abs/10.1177/0002716215598973">accounted for much of the total nationwide decline</a> in prison population. </p>
<p>California is also <a href="https://www.amazon.com/Politics-Imprisonment-Democratic-Punishes-Offenders/dp/0195370023">unique in its political makeup</a>. The contrast between its vehemently progressive coast and deeply conservative center makes for big differences in policies from county to county – and for surprising support for punitive policies in a state that is widely seen as liberal.</p>
<p>It also means that <a href="https://www.ppic.org/content/pubs/atissue/AI_1013MBAI.pdf">legislating is often conducted by voter initiatives</a>, which are notoriously vulnerable to manipulation through misleading appeals to anger and fear. </p>
<p>California’s mercurial political climate and the size of its death row mean it might influence other states and, possibly, the Supreme Court in the future.</p>
<h2>What might happen next</h2>
<p>Several important questions loom. </p>
<p>First, would the more conservative makeup of the Supreme Court affect its willingness to reexamine the constitutionality of the death penalty? </p>
<p>Justice Kennedy, who was <a href="https://www.mcgeorge.edu/documents/Publications/10_Weisberg_ver_01_6-4-12_EIC_FINAL.pdf">especially sensitive to punishment questions</a> and <a href="https://www.scotusblog.com/2018/07/justice-kennedy-he-swung-left-on-the-death-penalty-but-declined-to-swing-for-the-fences/">skeptical of the death penalty</a>, has retired. Justice <a href="https://www.washingtonpost.com/politics/courts_law/gorsuch-casts-death-penalty-vote-in-one-of-his-first-supreme-court-cases/2017/04/21/2d9bc5dc-26a8-11e7-a1b3-faff0034e2de_story.html?utm_term=.a6eecdb16dd4">Gorsuch</a> seems to support the death penalty. The jury is still out on <a href="https://www.cnbc.com/2018/11/06/kavanaugh-seems-to-break-with-conservatives-in-death-penalty-case.html">Justice Kavanaugh’s position</a>. </p>
<p>Second, how might the moratorium impact the strategy of death penalty abolitionists in the state seeking to reform the two other types of extreme punishment – <a href="http://time.com/4998858/death-penalty-life-without-parole/">life with and without parole</a>? </p>
<p>On one hand, the distinction between the death penalty and life without parole, <a href="https://thenewpress.com/books/meaning-of-life">which was already tenuous</a>, becomes even more blurred now that no one on California’s death row will be executed. Because policy is made incrementally, it is arguably time for abolitionist states to take a hard look at their other draconian sentencing practices. </p>
<p>On the other hand, in many cases abolition and moratoria are palatable to people who are on the fence about the death penalty precisely because of the existence of an alternative punitive sentence.</p>
<p>Third, there is plenty of work to be done in California. The <a href="https://twitter.com/CAgovernor/status/1105917777494175744">powerful image of the death chamber being dismantled</a> is a reminder that behind the death penalty lies a giant machine of lengthy and expensive litigation, dilapidated housing conditions and arcane regulations, which must now be considered. With less need to fund representation in these <a href="https://www.aclu.org/other/inadequate-representation">expensive cases</a>, there might be room for other criminal justice reform.</p>
<p>Fourth, while Newsom’s announcement <a href="https://www.latimes.com/politics/la-pol-ca-death-penalty-victims-families-newsom-20190314-story.html">provoked anger and frustration in some victims, it brought relief to others</a>. In an abolitionist era, reformers should come up with solutions that treat victims with respect and award them solace and closure – albeit not necessarily through harsh punishment. </p>
<p>And finally, careful analysis of homicide rates in the next few years should be conducted in order to learn whether, as many have come to assume, <a href="https://www.ali.org/media/filer_public/3f/ae/3fae71f1-0b2b-4591-ae5c-5870ce5975c6/capital_punishment_web.pdf">capital punishment does not deter crime</a>. </p>
<p>The dismantlement of the death chamber is not the official end of the death penalty in California. But it could be the harbinger of abolition.</p><img src="https://counter.theconversation.com/content/113634/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hadar Aviram does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A law professor from the University of California, Hastings considers why a moratorium in California could be influential.Hadar Aviram, Professor of Criminal Justice and Corrections, University of California College of the Law, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/875702018-01-08T03:57:04Z2018-01-08T03:57:04ZHow does assisting with suicide affect physicians?<figure><img src="https://images.theconversation.com/files/200845/original/file-20180104-26169-16fulj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-syringe-doctors-hands-on-patients-398371651?src=zApkQ3soziZScBtoFq1Sig-1-1">Art_Photo via www. Shutterstock.com</a></span></figcaption></figure><p>When my mother was in her final months, suffering from a heart failure and other problems, she called me to her bedside with a pained expression. She took my hand and asked plaintively, “How do I get out of this mess?” </p>
<p>As a physician, I dreaded the question that might follow: Would I help her end her life by prescribing a lethal drug?</p>
<p>Fortunately for me, my mother tolerated her final weeks at home, with the help of hospice nurses and occasional palliative medication. She never raised the thorny question of what is variously termed “medical aid in dying” or <a href="https://www.medscape.com/viewarticle/885866#vp_2">“physician-assisted suicide.”</a> </p>
<p>As a son and family member who has witnessed the difficult final days of parents and loved ones, I can understand why support for MAID/PAS is <a href="http://news.gallup.com/poll/183425/support-doctor-assisted-suicide.aspx">growing</a> among the general public. But as a physician and medical ethicist, I believe that MAID/PAS flies in the face of a 2,000-year imperative of Hippocratic medicine: “Do no harm to the patient.”</p>
<p>Studies point out that even many doctors who actually participate in MAID/PAS remain uneasy or <a href="https://jamanetwork.com/journals/jama/article-abstract/187854%5D">“conflicted”</a> about it. In this piece, I explore their ambivalence.</p>
<h2>Assisted suicides</h2>
<p>In discussing end-of-life issues, both the general public and physicians themselves need to distinguish three different approaches.</p>
<p>MAID/PAS involves a physician’s providing the patient with a prescription of a lethal drug that the patient could take anytime to end life. In contrast, active euthanasia or <a href="http://www.bbc.co.uk/ethics/euthanasia/overview/introduction.shtml">“mercy killing”</a> involves causing the death of a person, typically through a lethal injection given by a physician. Finally, the term “passive euthanasia” refers to hastening the death of a terminally ill person by removing some vital form of support. An example would be disconnecting a respirator.</p>
<h2>Increasing international acceptance</h2>
<p>In the U.S. some form of legislatively approved MAID/PAS (but not active euthanasia) is <a href="https://euthanasia.procon.org/view.resource.php?resourceID=000132">legal</a> in five states and the District of Columbia. In my home state – following a passionate debate – the Massachusetts Medical Society recently decided to <a href="http://www.masslive.com/news/index.ssf/2017/12/mass_medical_society_rescinds.html">rescind its long-held opposition</a> to the practice. MMS has taken a position of <a href="http://www.masslive.com/news/index.ssf/2017/12/mass_medical_society_rescinds.html">“neutral engagement,”</a> which it claims will allow it to “serve as a medical and scientific resource … that will support shared decision making between terminally ill patients and their trusted physicians.” </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/200846/original/file-20180104-26163-fz1u4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/200846/original/file-20180104-26163-fz1u4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=437&fit=crop&dpr=1 600w, https://images.theconversation.com/files/200846/original/file-20180104-26163-fz1u4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=437&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/200846/original/file-20180104-26163-fz1u4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=437&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/200846/original/file-20180104-26163-fz1u4h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=549&fit=crop&dpr=1 754w, https://images.theconversation.com/files/200846/original/file-20180104-26163-fz1u4h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=549&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/200846/original/file-20180104-26163-fz1u4h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=549&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Physician-assisted suicide is finding more acceptance.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-doctor-giving-helping-hands-elderly-262436840">Ocskay Bence</a></span>
</figcaption>
</figure>
<p>In a few countries, MAID/PAS has grown increasingly common. In Canada, for example, MAID/PAS was <a href="http://www.npr.org/sections/thetwo-way/2016/06/18/482599089/canada-legalizes-physician-assisted-dying">legalized in 2016</a>. In Belgium and the Netherlands, both <a href="https://www.washingtonpost.com/opinions/europes-morality-crisis-euthanizing-the-mentally-ill/2016/10/19/c75faaca-961c-11e6-bc79-af1cd3d2984b_story.html?utm_term=.94c68af85b89">active euthanasia and physician-assisted suicide </a> are permitted by law, even for patients whose illnesses may be treatable, as with major depression; and whose informed consent may be compromised, as in Alzheimer’s disease. In the Netherlands, a proposed <a href="http://thefederalist.com/2017/06/30/netherlands-considers-euthanasia-healthy/">“Completed Life Bill”</a> would allow any persons age 75 or over who decide their life is “complete” to be euthanized – even if the person is otherwise healthy. </p>
<h2>U.S. physician response</h2>
<p>Among U.S. physicians, MAID/PAS remains controversial, but national data point to its increasing acceptance. A report published in December 2016 found 57 percent of <a href="http://www.healthleadersmedia.com/physician-leaders/poll-many-doctors-have-wished-patient-had-right-die">doctors agreed that physician-assisted death</a> should be
available to the terminally ill – <a href="http://www.healthleadersmedia.com/physician-leaders/poll-many-doctors-have-wished-patient-had-right-die">up from 54 percent in 2014 and 46 percent</a> in 2010. </p>
<p>Perhaps this trend is not surprising. After all, what sort of physician would want to deny dying patients the option of ending their suffering and avoiding an agonizing, painful death? </p>
<p>But this question is misleading. Most persons requesting PAS are not actively experiencing extreme suffering or inadequate pain control. Data from the Washington and Oregon PAS programs show that <a href="http://www.nejm.org/doi/full/10.1056/NEJMsa1213398">most patients choose PAS</a> because they fear loss of dignity and control over their own lives.</p>
<h2>Some physicians feel conflicted</h2>
<p>Physicians who carry out assisted suicide have a wide variety of emotional and psychological responses. In a structured, in-depth <a href="https://jamanetwork.com/journals/jama/article-abstract/187854">telephone interview survey</a> of 38 U.S. oncologists who reported participating in euthanasia or PAS, more than half of the physicians received “comfort” from having carried out euthanasia or PAS. </p>
<p>“Comfort” was not explicitly defined, but, for example, these physicians felt that they had helped patients end their lives in the way the patients wished. However, nearly a quarter of the physicians regretted their actions. Another 16 percent reported that the emotional burden of performing euthanasia or PAS adversely affected their medical practice.</p>
<p>For example, one physician felt so “burned out” that he moved from the city in which he was practicing to a small town. </p>
<p>Other data support the observation that MAID/PAS can be emotionally disturbing to the physician. </p>
<p><a href="http://www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/radiation-medicine/about/faculty-staff/kenneth-stevens.cfm">Kenneth R. Stevens Jr.</a>, an emeritus professor at Oregon Health and Science University, reported that for some physicians in Oregon, <a href="http://www.tandfonline.com/doi/pdf/10.1080/20508549.2006.11877782?needAccess=true">participation in PAS was very stressful</a>. For example, in 1998, the first year of Oregon’s “Death with Dignity Act,” 14 physicians wrote prescriptions for lethal medications for the 15 patients who died from physician-assisted suicide.</p>
<p>The state’s annual 1998 report observed that:</p>
<blockquote>
<p>“For some of these physicians, the process of participating in physician-assisted suicide exacted a large emotional toll, as reflected by such comments as, ‘It was an excruciating thing to do … it made me rethink life’s priorities,’ ‘This was really hard on me, especially being there when he took the pills,’ and ‘This had a tremendous emotional impact.’”</p>
</blockquote>
<p>Similarly, reactions among European doctors suggest that PAS and euthanasia <a href="http://www.tandfonline.com/doi/abs/10.1080/20508549.2006.11877782">often provoke strong negative feelings</a>. </p>
<h2>Why the discomfort?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/200848/original/file-20180104-26166-i5b9sv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/200848/original/file-20180104-26166-i5b9sv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=356&fit=crop&dpr=1 600w, https://images.theconversation.com/files/200848/original/file-20180104-26166-i5b9sv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=356&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/200848/original/file-20180104-26166-i5b9sv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=356&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/200848/original/file-20180104-26166-i5b9sv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=447&fit=crop&dpr=1 754w, https://images.theconversation.com/files/200848/original/file-20180104-26166-i5b9sv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=447&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/200848/original/file-20180104-26166-i5b9sv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=447&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Feeling conflicted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/geriatric-nurse-holding-hands-senior-man-329394167?src=zApkQ3soziZScBtoFq1Sig-1-4">Robert Kneschke</a></span>
</figcaption>
</figure>
<p>As a physician and medical ethicist, I am opposed to any form of physician assistance with a patient’s suicide. Furthermore, I believe that the term “medical aid in dying” allows physicians to avoid the harsh truth that they are helping patients kill themselves. This is also the view of the very influential <a href="http://annals.org/aim/fullarticle/2654458/ethics-legalization-physician-assisted-suicide-american-college-physicians-position-paper">American College of Physicians</a>. </p>
<p>I believe that the ambivalence and discomfort experienced by a substantial percentage of PAS-participating physicians is directly connected to the Hippocratic Oath – arguably, the most important foundational document in medical ethics. <a href="http://www.greekmedicine.net/whos_who/The_Hippocratic_Oath.html">The Oath clearly states</a>: </p>
<blockquote>
<p>“I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.” </p>
</blockquote>
<p>In 5th century BC Greece, Hippocrates was something of a revolutionary in this respect. As the classicist and medical historian, <a href="https://academic.oup.com/jhmas/article-abstract/XXI/2/173/699618?redirectedFrom=PDF">Ludwig Edelstein</a> has <a href="https://books.google.com/books?id=ehQgAQAAMAAJ&focus=searchwithinvolume&q=hippocrates">pointed out</a> some non-Hippocratic physicians probably did provide poisons to their dying patients, in order to spare them protracted suffering. Hippocrates opposed this practice, though he did not believe that terminally ill patients should be exposed to unnecessary and futile medical treatment.</p>
<p>Palliative care specialist <a href="http://irabyock.org/about-ira-byock/">Ira Byock</a> has <a href="https://www.pbs.org/wgbh/frontline/article/the-shadow-side-of-assisted-suicide/">observed</a> that:</p>
<blockquote>
<p>“From its very inception, the profession of medicine has formally prohibited its members from using their special knowledge to cause death or harm to others. This was – and is – a necessary protection so that the power of medicine is not used against vulnerable people.” </p>
</blockquote>
<p>Indeed, when patients nearing the end of life express fears of losing control, or being deprived of dignity, <a href="https://jamanetwork.com/journals/jama/article-abstract/2482333">compassionate and supportive counseling</a> is called for
– not assistance in committing suicide.</p>
<p>To be sure, comprehensive palliative care, including home hospice nursing, should be provided to the subset of terminally ill patients who require pain relief. But as physician and ethicist <a href="https://www.aei.org/scholar/leon-r-kass/">Leon Kass</a> has <a href="https://www.firstthings.com/article/1996/08/dehumanization-triumphant">put it</a>:</p>
<blockquote>
<p>“We must care for the dying, not make them dead.”</p>
</blockquote><img src="https://counter.theconversation.com/content/87570/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ronald W. Pies does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Massachusetts Medical Society recently reversed its long-held opposition to physician-assisted suicide. A psychiatrist notes many physicians are painfully conflicted about participating.Ronald W. Pies, Emeritus Professor of Psychiatry, Lecturer on Bioethics & Humanities at SUNY Upstate Medical University; and Clinical Professor of Psychiatry, Tufts University School of Medicine, Tufts UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/872212017-11-13T17:22:50Z2017-11-13T17:22:50ZWhy Nevada’s new lethal injection is unethical<p>Nevada has temporarily <a href="http://abcnews.go.com/US/wireStory/nevada-execution-doubt-paralytic-drug-51049570">called off</a> its first inmate execution in 11 years. Scott Dozier, sentenced for the 2002 murder of his 22-year-old drug associate, Jeremiah Miller, <a href="http://www.theforgivenessfoundation.org/index.php/scheduled-executions/4321-nevada-reschedules-execution-of-scott-dozier-from-october-16-2017-until-november-14-2017">was to be put to death</a> on Nov. 14. Dozier instructed his lawyer in August <a href="http://mcindependentnews.com/2017/08/nevada-death-row-inmate-drops-appeal-wants-execution/">not to file</a> any more appeals. </p>
<p>On Thursday, Nov. 9, however, Judge Jennifer Togliatti <a href="http://abcnews.go.com/US/wireStory/nevada-execution-doubt-paralytic-drug-51049570">temporarily postponed</a> the execution. Judge Togliatti said she was “loath to stop” Dozier’s execution, but she did so because she was concerned about the <a href="https://www.themarshallproject.org/2017/08/30/nevada-plans-to-use-fentanyl-in-upcoming-execution">untested and controversial</a> drug protocol that would be used to put him to death. She wanted to give the state Supreme Court a chance to evaluate. </p>
<p>From my perspective as a scholar of capital punishment, Nevada’s new drug protocol sheds a glaring light on the troubled <a href="http://www.telegraph.co.uk/news/2016/05/14/pfizer-blocking-use-of-its-drugs-for-lethal-injections/">state of lethal injections</a> in the United States. It also raises some serious ethical questions.</p>
<h2>Lethal injection’s crisis</h2>
<p>The first lethal injection protocol was developed by Oklahoma’s medical examiner, Jay Chapman, in the late 1970s. Back then, Oklahoma was looking for an alternative to electrocution, which was considered <a href="http://www.sup.org/books/title/?id=23979">inhuman and brutal</a>. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/194056/original/file-20171109-13323-rays9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/194056/original/file-20171109-13323-rays9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194056/original/file-20171109-13323-rays9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194056/original/file-20171109-13323-rays9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194056/original/file-20171109-13323-rays9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194056/original/file-20171109-13323-rays9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194056/original/file-20171109-13323-rays9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr. Jay Chapman, creator of the lethal injection.</span>
<span class="attribution"><span class="source">AP Photo/Ben Margot</span></span>
</figcaption>
</figure>
<p>The protocol Chapman developed called for the <a href="http://www.sup.org/books/title/?id=23979">use of three drugs</a>: The first, sodium thiopental, would anesthetize inmates and put them to sleep before the lethal drugs were administered. The second drug, pancuronium bromide, a muscle relaxant, was meant to render the inmate unable to show pain. The third drug, potassium chloride, led to a cardiac arrest and eventual death. This protocol soon became the standard and was adopted by all death penalty states – <a href="https://deathpenaltyinfo.org/states-and-without-death-penalty">now numbering at 31</a>. </p>
<p>However, by the start of this decade, pharmaceutical companies, <a href="https://www.nytimes.com/2016/05/14/us/pfizer-execution-drugs-lethal-injection.html?_r=0">“citing either moral or business reasons,”</a> refused to allow their products to be used in executions.</p>
<p>The difficulty of securing the drugs that had been part of the standard protocol led death penalty states to <a href="https://deathpenaltyinfo.org/state-lethal-injection">experiment with many different drugs</a> in many different combinations.</p>
<p>States likes Alabama and Arkansas, for example, maintained the three-drug protocol but replaced sodium thiopental in the standard drug cocktail with midazolam or pentobarbital, which doctors normally use as sedatives or for anesthesia. Other states, including Arizona and Ohio, started using a two-drug protocol, while a few, such as Georgia, Missouri and South Dakota, adopted a single drug. </p>
<p>Nevada’s new protocol involves a <a href="https://www.rgj.com/story/news/2017/08/17/nevada-announces-lethal-injection-drugs-used-upcoming-execution-las-vegas-murderer/578741001/">three-drug combination</a> – the sedative diazepam (better known as Valium), the muscle relaxant and paralytic cisatracurium and the opioid fentanyl. </p>
<p><a href="http://www.sup.org/books/title/?id=23979">My research on methods of execution</a> reveals that this combination of drugs has <a href="https://www.themarshallproject.org/2017/08/30/nevada-plans-to-use-fentanyl-in-upcoming-execution">never been used in an execution</a>. </p>
<h2>What is the problem with this</h2>
<p>Execution by a lethal injection, even when it follows the standard protocol, is a surprisingly complicated procedure. Finding usable veins and getting the drug dosages right has proved to be particularly difficult. As I found out, it has often been an <a href="http://www.sup.org/books/title/?id=23979">unreliable method of execution</a>. Since its introduction, 7 percent of all lethal injections have been botched.</p>
<p>Those complications and <a href="https://news.vice.com/story/lethal-injections-using-midazolam-may-be-americas-most-cruel-experiment-yet-says-sotomayor">difficulties increase</a> when states try out new, untested drugs or drug combinations. Convicts have taken a leading role in opposing such experimentation. In February 2017, a death row inmate in Alabama appealed to the United States Supreme Court saying that he preferred death by firing squad to an injection of midazolam. While it recognized lethal injection’s history of problems, the majority held that since Alabama did not offer the firing squad as an execution method, his preference could not be honored. In a <a href="https://www.supremecourt.gov/opinions/16pdf/16-602_n758.pdf">dissenting view</a>, however, Justice Sonya Sotomayor called the use of new drugs in lethal injection the “most cruel experiment yet.” </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/194055/original/file-20171109-13296-fr8ejt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/194055/original/file-20171109-13296-fr8ejt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=833&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194055/original/file-20171109-13296-fr8ejt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=833&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194055/original/file-20171109-13296-fr8ejt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=833&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194055/original/file-20171109-13296-fr8ejt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1047&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194055/original/file-20171109-13296-fr8ejt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1047&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194055/original/file-20171109-13296-fr8ejt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1047&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nevada death row inmate Scott Dozier, right, confers with Lori Teicher, a federal public defender.</span>
<span class="attribution"><span class="source">AP Photo/Ken Ritter, File</span></span>
</figcaption>
</figure>
<p>Nevada’s Dozier too has said that <a href="http://www.latimes.com/nation/la-na-dozier-drug-execution-20171108-story.html">he is opposed</a> to “the state’s plan to kill him using a drug protocol that has never been used in an execution.” </p>
<p>There are other troubling issues as well. Using fentanyl, a drug that is killing thousands of Americans annually during the current opioid crisis, is horrifying, to say the least. </p>
<p>In addition, figuring out the right dosage of diazepam and fentanyl in Nevada’s new protocol will not be easy. And if this is not done correctly, Dozier could even <a href="https://www.themarshallproject.org/2017/08/30/nevada-plans-to-use-fentanyl-in-upcoming-execution#.S4nW1mNce">wake up</a>
in the middle of the execution, as <a href="http://nyulangone.org/doctors/1710970447/susi-u-vassallo">Susi Vassallo</a>, a New York University professor of emergency medicine, has written on lethal injection notes. In the <a href="http://abcnews.go.com/US/wireStory/nevada-execution-doubt-paralytic-drug-51049570">words of Judge Togliatti</a>, he could be “aware of pain” and struggle to breathe.</p>
<p>Employing the powerful paralytic cisatracurium in this new drug protocol raises other ethical concerns. </p>
<p>If the combination of diazepam and fentanyl fails to work, cisatracurium will prevent Dozier from signaling to his executioners that they are botching the execution even as it happens. As <a href="http://www.childrenshospital.org/doctors/david-waisel">David Waisel</a>, an anesthesiologist at Boston Children’s Hospital, <a href="https://www.reviewjournal.com/crime/courts/doctor-questions-drug-planned-for-nevada-inmates-execution/">claimed</a>, “Cisatracurium can hide signs of inadequate anesthesia.” That is its only purpose.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/194059/original/file-20171109-13329-1eqcz0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194059/original/file-20171109-13329-1eqcz0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194059/original/file-20171109-13329-1eqcz0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194059/original/file-20171109-13329-1eqcz0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194059/original/file-20171109-13329-1eqcz0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194059/original/file-20171109-13329-1eqcz0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194059/original/file-20171109-13329-1eqcz0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Use of a new drug protocol raises many questions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/469979537?src=pVnKswBAZlEF-aPi9uC17w-1-0&size=medium_jpg">Samrith Na Lumpoon?Shutterstock.com</a></span>
</figcaption>
</figure>
<p>In other lethal injection protocols, the muscle relaxant was also designed to stop the heart. Thus, those who conduct the execution and those who witness it will not be able to see the visible signs of Dozier’s suffering if it occurs.</p>
<h2>Do citizens have a duty?</h2>
<p>In my view, if Nevada and other death penalty states insist on experimenting with new drugs to keep the machinery of death running, citizens and government officials alike need to take responsibility to prevent any cruelty.</p>
<p>Writing about the use of the guillotine in France more than half a century ago, Albert Camus, philosopher, author and journalist, <a href="http://users.clas.ufl.edu/burt/deathsentences/CamusGuillotine.pdf">said</a>, </p>
<blockquote>
<p>“Society must display the executioner’s hands on each occasion, and require the most squeamish citizens to look at them, as well as those who, directly or remotely, have supported the work of those hands from the first.” </p>
</blockquote>
<p>While lethal injection is different from the guillotine, in modern times the imperative remains the same.</p><img src="https://counter.theconversation.com/content/87221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Austin Sarat does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nevada plans to use a new drug protocol for executing Scott Dozier, who murdered a 22-year-old. A scholar explains why this is problematic.Austin Sarat, Professor of Jurisprudence and Political Science, Amherst CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/719502017-02-21T10:24:46Z2017-02-21T10:24:46ZNurses should not participate in executions by lethal injection<figure><img src="https://images.theconversation.com/files/154522/original/image-20170127-30404-mihtja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">San Quinten State Prison lethal injection room</span> <span class="attribution"><a class="source" href="http://www.flickr.com/photos/37381942@N04/4905111750/in/set-72157624628981539/">Wikimedia Commons</a></span></figcaption></figure><p>In some US states, prisoners condemned to die are killed using lethal injections. This takes place in two steps which make the prisoner unconscious and then stop breathing. Nurses are often present, but do they really need to be present? A group of senior nurses from the UK, Australia and the US <a href="http://journals.sagepub.com/doi/full/10.1177/0969733016677870">recently debated this issue</a>. They concluded that, unfortunately, the international nursing codes of ethics lacks sufficient detail to be helpful to nurses faced with the decision to take part, or not, in an execution.</p>
<p>There are many ways of executing prisoners, but only death by lethal injection involves nurses. Lethal injection requires access to veins in the body. The heart rate of the prisoner is observed until it has stopped, permanently. Doctors are always present to certify the death but nurses, along with doctors, may assist with any aspect of the execution. The normal role of the nurse is to care. Taking part in executions is not something they are trained for or would expect to do.</p>
<p>Some US states have laws which say that nurses do not have to take part, but some oblige them to. The <a href="http://www.nursingworld.org/">American Nurses Association</a> (ANA), a trade union and professional organisation, says that nurses should not take part in executions. But it cannot stop them. The <a href="http://www.icn.ch/">International Council of Nurses</a>, to which organisations like the ANA belong, tells nurses to continue to care for prisoners up to the point of execution. But the exact point when care should stop is not clear.</p>
<p>One task that nurses often do for their patients is to find veins to take blood samples or to give drugs. This is exactly what is needed in a prisoner before a lethal injection and nurses do take part in this step of the execution. It is not known how much further nurses take part. Some claim not to be present at the point of giving the lethal drugs. This may not count in taking part in the execution. But the execution could not have taken part without the nurse doing the job.</p>
<h2>Justifying the unjustifiable</h2>
<p>Nurses are part of the prison system. They justify taking part in executions if the prisoner is also a patient saying they cannot leave them in the terrible moments before they die. They can provide comforting words and company for the prisoner and be a familiar face. They say this is like caring for a terminally ill patient. But a terminally ill person is not being punished and their death cannot be prevented. </p>
<p>The thought of safety when a person is going to be deliberately killed and facing inevitable death seems strange. But things do go wrong in executions by lethal injection. In <a href="http://www.deathpenaltyinfo.org/some-examples-post-furman-botched-executions">botched executions</a>, either the prisoner does not die immediately, or they die in pain. The speed and comfort of the execution depends on the nurse having good access to one of the prisoner’s veins. If this access is poor, then the drugs which put prisoners to sleep and which kill them will not reach their targets: the brain and the heart. </p>
<p>Nurses may be experts in finding veins to give drugs and some say that leaving this to executioner technicians may put the patient at more risk of pain. But many people who are not nurses or doctors can be trained to find veins for taking blood in hospital. This is the same as finding a vein for an execution. It is hard to explain why a nurse must do this.</p>
<p>Nurses and doctors take part in executing patients by lethal injection. Doctors must be there to certify death even if they do nothing else. Nurses may be present for the comfort of the prisoner, but they may also play a more active role. It is impossible to believe that a nurse would ever be asked to give the lethal dose of drugs. It is also impossible to believe that any nurse would want to be the person who did this. To maintain the caring role of the nurse, the point when a nurse no longer accompanies a condemned prisoner ought to be a long way from the execution chamber.</p><img src="https://counter.theconversation.com/content/71950/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger Watson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In the US, nurses take part in executions by lethal injection. They justify their role by saying it makes executions ‘safer’.Roger Watson, Professor of Nursing, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/599372016-06-02T13:58:56Z2016-06-02T13:58:56ZLethal injections and the tragedy of America’s execution addiction<figure><img src="https://images.theconversation.com/files/124849/original/image-20160601-2812-1pb1nxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The execution chamber at Utah State Prison.</span> <span class="attribution"><span class="source">T Woodard</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>It began in Utah back in 1977. On January 17 of that year, <a href="http://news.bbc.co.uk/onthisday/hi/dates/stories/january/17/newsid_2530000/2530413.stm">Gary Gilmore</a> became the first man to be executed in the US for more than a decade, ending a national moratorium on the death penalty. Gilmore, guilty of murdering two men during a 24-hour spree, insisted on being executed and chose to die by firing squad. </p>
<p>It is possible that if this mentally disturbed, indeed suicidal man, had not elected to be shot that day, the history of the death penalty would have been completely different and the lethal injection never invented.</p>
<p>As it was, Gilmore’s intransigence over the issue of his destruction meant that the <a href="http://time.com/3742999/gary-gilmore-history/">death penalty was acceptable once more</a> and states were faced with a series of tough choices. Should they kill or not? If so, what’s the best way of going about it? And how were the <a href="http://www.deathpenaltyinfo.org/states-and-without-death-penalty">states that eventually reinstated capital punishment</a> going to answer to legal challenges based on the <a href="https://www.law.cornell.edu/constitution/eighth_amendment">Eighth Amendment</a> that outlawed any form of punishment that was “cruel or unusual”?</p>
<p>Enter <a href="http://time.com/101143/lethal-injection-creator-jay-chapman-botched-executions/">Jay Chapman</a>, a young forensic pathologist with no medical expertise in the field of pharmacology, who was tasked by an Oklahoma legislator to develop a more humane method of execution than the firing squad, hanging or the electric chair. It was a chance event that may have been precipitated by a simple remark made by Chapman that animals are put to death more humanely than humans. Such a bald comparison between man and beast inspired strong feelings in the Oklahoma legislature and Chapman was asked to right this wrong by developing a safe, effective and humane drug protocol for the now resurgent killing states to use.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/124967/original/image-20160602-23281-xktjt0.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/124967/original/image-20160602-23281-xktjt0.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124967/original/image-20160602-23281-xktjt0.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124967/original/image-20160602-23281-xktjt0.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124967/original/image-20160602-23281-xktjt0.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124967/original/image-20160602-23281-xktjt0.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124967/original/image-20160602-23281-xktjt0.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124967/original/image-20160602-23281-xktjt0.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">US states that retain the death penalty on their statute books.</span>
<span class="attribution"><span class="source">Death Penalty Information Center</span></span>
</figcaption>
</figure>
<p>Chapman’s solution was <a href="http://www.theguardian.com/world/2015/apr/29/supreme-court-lethal-injection-inventor-death-penalty-doubts">devastatingly simple</a>:</p>
<blockquote>
<p>We simply took the standard set for anaesthesia in surgical procedures, then all we did was take the amounts of drugs to lethal levels recommended by a toxicologist.</p>
</blockquote>
<p>This standard set consisted of three drugs: Sodium Thiopental to bring about unconsciousness, Pancuronium Bromide which paralyses the body, and Potassium Chloride to stop the heart. It was the potassium which did the actual killing, the other two drugs were applied rather to ameliorate its searing effects so that the patient could die violently of a heart attack, yet peacefully and without pain. Since its inception, <a href="http://www.amnestyusa.org/our-work/issues/death-penalty/lethal-injection">around 1,000 people have been killed this way in the US</a> according to Amnesty International. Lethal injection is by far the most favoured mode of execution there – and is a <a href="http://www.globalpost.com/dispatch/news/regions/140502/these-are-the-countries-where-lethal-injection-legal-death-penalty-US">system that has been exported around the world</a>. </p>
<p>Yet the protocol has no real basis in standard medical methodology. It was never tested then – and never has been since. But then again, as Chapman says: </p>
<blockquote>
<p>People talk about the drug not being “tested”“. What does that mean? Should we be lining people up against the wall and testing them with different legal drugs?</p>
</blockquote>
<p>Ludicrous as this suggestion may sound, that appears to be what penitentiaries across the country have been doing, due to a complex set of global circumstances that means the favoured three-drug model is no longer possible simply because the European pharma companies that used to supply these drugs <a href="http://www.theatlantic.com/international/archive/2014/02/can-europe-end-the-death-penalty-in-america/283790/">have since refused to do so</a>.</p>
<h2>Drug dealings</h2>
<p>In 2009, <a href="http://www.wsj.com/articles/SB10001424052748704754304576095980790129692">Hospira</a> – the company that supplied that crucial first drug <a href="http://www.drugs.com/cdi/thiopental.html">Thiopental</a> (crucial because it allowed the killing states to prove that the lethal injection was humane) – suddenly found that it could no longer source its active ingredients in America. After an exhaustive search it found a company near Milan in Italy which agreed to provide the missing component. But once the Italian government caught wind of what the drug was being used for, it <a href="http://articles.chicagotribune.com/2011-01-21/business/ct-biz-0122-execution-drug-20110121_1_hospira-executions-capital-punishment">refused to allow its export</a>. This was to provide a pattern that was initially ad hoc but eventually became a semi-official embargo. First <a href="https://www.theguardian.com/business/2011/apr/14/britain-bans-export-us-execution-drugs">Britain</a>, then <a href="http://www.nbcnews.com/news/other/german-drug-firm-halts-us-anesthetic-exports-after-finding-it-f8C11376235">Germany</a> suspended the rights of companies to export drugs to America for use in lethal injections. </p>
<p>Oklahoma is called the Sooner State and has a reputation of being first to the party. In the case of the lethal injection, this reputation is deserved, for when they found out they could no longer source Thiopental they switched to another drug, <a href="http://www.everydayhealth.com/drugs/pentobarbital">Pentobarbital</a>, supplied by a company based in Illinois called Lundbeck. Pentobarbital is a pretty good switch for Thiopental – but perhaps officials at Oklahoma state pen should have paid attention to the name of the company. Lundbeck is a Danish company and, when the liberal Danes discovered what their Pentobarbital was actually being used for – not for treating seizures as it was designed to do but for masking them – <a href="http://www.theguardian.com/world/2011/jul/01/lundbeck-us-pentobarbital-death-row">they ceased to ship the drug stateside</a>. </p>
<p>By then it was 2011, which proved to be a bad year for the lethal injection. The halting of supplies by Lundbeck was followed by a Europe-wide decision of nearly every big pharmaceutical company to refuse to provide any drugs to America for lethal injections, an embargo encouraged and <a href="http://www.theatlantic.com/international/archive/2014/02/can-europe-end-the-death-penalty-in-america/283790/">backed by the European Union itself</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/124963/original/image-20160602-23285-3g8c9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124963/original/image-20160602-23285-3g8c9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124963/original/image-20160602-23285-3g8c9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124963/original/image-20160602-23285-3g8c9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124963/original/image-20160602-23285-3g8c9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124963/original/image-20160602-23285-3g8c9r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124963/original/image-20160602-23285-3g8c9r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The execution chamber in San Quentin prison in California.</span>
</figcaption>
</figure>
<p>The embargo slowly took effect. By 2013 the amounts of lethal stock in the drug cupboards of Texas, Ohio and Oklahoma had <a href="http://www.independent.co.uk/news/world/americas/america-is-running-out-of-lethal-injection-drugs-because-of-a-european-embargo-to-end-the-death-10106933.html">dwindled to such a degree</a> that death by lethal injection was, <a href="http://edition.cnn.com/2013/11/15/justice/states-lethal-injection-drugs/">for all intents and purposes, foreclosed</a>. By 2015 the number of executions in the 31 states still using this form of extreme punishment was <a href="http://www.nytimes.com/2016/05/14/us/pfizer-execution-drugs-lethal-injection.html?_r=0">down to just 28</a>, compared to 98 in 1999. </p>
<p>Although this dramatic reduction has been a massive global success for abolitionism, it is not a definitive victory by any means – the death penalty is being defeated not because it is immoral, unconstitutional or because it contravenes the Eighth Amendment. Rather, it is abolition by a technicality – you can use the drugs but only if you can find them. And, in any case, abolition by technicality has not proved sufficient to put an end to state-sponsored killing. </p>
<p>Faced with the possibility of not being able to kill their criminals, in 2014 many death penalty states started <a href="http://www.theguardian.com/world/2014/apr/30/oklahoma-execution-history-botched-execution">to simply try other drugs</a> to see how they kill. For although the lethal injection always came with a veneer of medical legitimacy, it was never a truly medical procedure. There was no medical evidence that the original drug combination was safe and painless – quite the contrary – so what was to stop states trying other drugs? Nothing, it transpires, nothing legally and nothing medically. So that’s what they started to do.</p>
<h2>The terrible botched death of Clayton Lockett</h2>
<p>On April 29, 2014 the state of Oklahoma executed a man called Clayton Lockett for his <a href="http://www.tulsaworld.com/news/courts/death-row-inmate-killed-teen-because-she-wouldn-t-back/article_e459564b-5c60-5145-a1ce-bbd17a14417b.html">terrible crimes</a>. They didn’t have the right drugs to kill Lockett and they didn’t have the right medical staff on hand either, but that didn’t dissuade them. Unfortunately, <a href="http://www.theatlantic.com/magazine/archive/2015/06/execution-clayton-lockett/392069/">things went very wrong indeed</a>. </p>
<p>It was decided to try a new batch of drugs that was doing the rounds now that the key drugs were no longer being shipped from Europe. Instead of Pentobarbital, they chose <a href="http://www.drugs.com/cdi/midazolam.html">Midazolam</a>, not a very good killing drug to say the least as it is a sedative primarily used on children and the aged because its effects are so mild. </p>
<p>But it was not just ineffective drugs that led to the terrible botching of Lockett’s death – Oklahoma has <a href="http://www.theguardian.com/us-news/2016/may/19/oklahoma-botched-execution-drug-mary-fallin">since been criticised</a> for a lack of technical know-how in the killing room that day. It began when the executioners tried to insert a needle into the arm of Clayton Lockett, usually a routine procedure. </p>
<p>The executioners repeatedly tried and repeatedly failed. Eventually they found a vein in Lockett’s groin, at which point the warden asked for a "modesty sheet”. The provision of the sheet preserved Lockett’s modesty, perhaps, but it also meant that the staff couldn’t see what they were doing – and, after 16 minutes, the blinds were drawn which meant that those legally permitted to observe the procedure were no longer able to observe the procedure.</p>
<p>Behind the curtain it would appear that the botching went on. It had taken nearly an hour to find a vein and during this interminable search it was observed that the IV had infiltrated tissue. This meant the treatment could fail and would probably produce undue suffering. Finally, outside the chamber, corrections director <a href="http://www.nbcnews.com/storyline/lethal-injection/oklahoma-prisons-boss-robert-patton-resigns-amid-probe-botched-executions-n474606">Robert Patton</a> and general council <a href="http://www.dailymail.co.uk/wires/ap/article-3443303/Fallins-general-counsel-resigns-amid-execution-inquiry.html">Steve Mullins</a>, argued and then agreed to stay the execution. Unfortunately, in the meantime, what the executioners had been unable to achieve through intention, <a href="http://www.independent.co.uk/news/world/americas/oklahoma-ineptitude-in-execution-blamed-for-lower-support-implementation-of-death-penalty-a6776231.html">they had brought about by ineptitude</a>. Lockett, after <a href="http://www.theguardian.com/world/interactive/2014/may/01/oklahoma-execution-clayton-lockett-timeline-document">more than an hour</a> – according to a timeline released by the Oklahoma Department of Corrections – had died of a heart attack. A lethal injection procedure is supposed to take about 15 minutes. </p>
<p>Even at this stage it was argued that Lockett could have, and should have, <a href="http://time.com/82787/oklahoma-botched-execution-clayton-lockett-lethal-injection-problems/">been revived</a>, so that he could be nursed to health and killed “properly” at a later date. In the end this did not happen, which was yet another breach of standard procedure. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/124846/original/image-20160601-1946-1r4rxeu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/124846/original/image-20160601-1946-1r4rxeu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124846/original/image-20160601-1946-1r4rxeu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124846/original/image-20160601-1946-1r4rxeu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124846/original/image-20160601-1946-1r4rxeu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124846/original/image-20160601-1946-1r4rxeu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124846/original/image-20160601-1946-1r4rxeu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Oklahoma State Penitentiary which staged the botched execution of Clayton Lockett in 2014.</span>
<span class="attribution"><span class="source">Charles Duggar - Oklahoma State Penitentiary</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>By the end of the whole appalling Grand Guignol staged in Oklahoma that day, it was unclear if the untested drugs were the cause of Lockett’s suffering or not, but, as reports came in from other botchings using similar drug combinations, such as the extended asphyxiations of <a href="http://www.theguardian.com/commentisfree/2014/jan/22/ohio-mcguire-execution-untested-lethal-injection-inhumane">Dennis McGuire</a> in January 2014 and <a href="https://www.washingtonpost.com/news/post-nation/wp/2014/07/23/arizona-supreme-court-stays-planned-execution/">Joseph R Wood III</a> in July the same year. It became clear that these new protocols had transformed the rapid efficiency of the lethal injection into an extended mode of torture.</p>
<p>The “<a href="http://www.deathpenaltyinfo.org/node/6142">Oklahoma report</a>” was released in May of this year criticising, in no uncertain terms, the officials whose professional duty it had been to carry out executions in recent years. </p>
<p>Here are some of the indictments levelled against Oklahoma’s legalised killing machine after a string of botched executions, including that of Lockett. Their pharmacist ordered the wrong drugs. Even then a top official in the governor’s office insisted the execution go ahead, with the wrong drug. The attitude of those in charge of the executions was described as “careless, cavalier and in some circumstances dismissive of established procedures that were intended to guard against the very mistakes that occurred”. More than once the state used the incorrect drug to kill a prisoner, and – in a strange legal twist – when the state administered the incorrect drugs, this meant that prisoners were <a href="https://www.washingtonpost.com/news/post-nation/wp/2016/05/19/oklahoma-grand-jury-says-lethal-injection-process-muddled-by-inexcusable-failure/">not legally allowed to challenge the procedure before their deaths</a>.</p>
<p>Mullins was singled out by the report as “flippant and reckless”, allowing executions to go ahead even though he knew the incorrect drugs had been obtained. He has since quit his post. The list of errors goes on and on; the report is more than 100 pages long.</p>
<h2>Cruel irony</h2>
<p>Some of the methods that states have used to get around the recent drugs embargo are worthy of a HBO mini-series. Some have been sourcing non-regulated versions of key drugs in India and importing them, illegally, into the US. How do we know? Because <a href="https://www.buzzfeed.com/chrismcdaniel/illegal-execution-drugs-held-in-india?utm_term=.jyPdOBkNdr#.oxjXn0OGXK">the FDA caught them</a>. Other states have made extensive use of poorly regulated compound drug companies to synthesise the embargoed drugs. The FDA is cracking down on this practice.</p>
<p>The awful, tragic irony is that these state authorities charged with taking the lives of criminals are attempting suspect acts in order to continue doing so. In one recent case, a consignment of drugs was <a href="http://themissouritimes.com/8173/doc-hearing-shows-legislative-action-executions-likely/">paid for in cash</a> with no receipts, making it impossible to trace the provenance or quality of the drugs in question. To compound this obsession with secrecy, even the staff charged with carrying out the execution <a href="https://www.buzzfeed.com/chrismcdaniel/missouri-paid-executioners-in-cash?utm_term=.fn2xP78mx3#.pwgm9WGgmz">were paid in cash</a>. </p>
<p>Around the same time as the news came out of the Oklahoma hearing, Pfizer announced that it would <a href="http://www.theguardian.com/world/2016/may/13/pfizer-blocks-drugs-lethal-injections">no longer supply its products</a> to any agency involved in capital punishment. This effectively means that the embargo is now complete and abolition has effectively been achieved on a technicality. But this is neither safe nor satisfactory. The only satisfactory end to this barbaric practise will be when the US Supreme Court acts. But the court, when <a href="http://www.npr.org/sections/thetwo-way/2015/06/29/418520718/supreme-court-says-okla-s-use-of-midazolam-in-lethal-injection-is-legal">last given the chance in 2015 – largely as a result of the Lockett killing – to ban capital punishment</a> refused to do so … but only by a margin of five to four.</p>
<p>The embargo on drugs inevitably feeds into this process. The public may not give a damn about the difference between Pentobarbital and Midazolam, but people are starting to sit up and take notice when they see news reports about botched executions. So it seems likely that the practice of experimenting with new drug combinations will have a limited shelf life, as the public reactions to increased botching will be too negative. Even though most people in the US still favour the death penalty, those who are in control of its fate – the judges – are themselves subject to more localised pressures of opinion and, of course, must uphold the Eighth Amendment. Deaths by botching are clearly in breach of that. </p>
<p>So much so that, following Lockett’s execution the US president, Barack Obama, <a href="http://www.bbc.co.uk/news/world-us-canada-27265443">called for a federal review of America’s death penalty procedures</a>: Americans should “ask ourselves some difficult and profound questions around these issues”, he said.</p>
<h2>Tragic farce</h2>
<p>Which raises the question, what happens next? Already several states have started to look for alternatives. Many still have the right to execute by other means on their statute books. Some states have spoken of <a href="http://www.theguardian.com/world/2015/mar/24/utah-execution-firing-squad-death-penalty">using the firing squad</a>, others <a href="http://www.telegraph.co.uk/news/worldnews/northamerica/usa/11546979/Oklahoma-becomes-first-US-state-to-approve-foolproof-nitrogen-gas-for-executions.html">nitrogen gas</a>. And then there is, of course, Hollywood’s favourite, “Old Sparky” (the electric chair). </p>
<p>Yet most states are painfully aware of the effect these more graphically violent and symbolically loaded methods may have on a wavering public opinion. At the moment, many continue to play a dangerous game to keep on killing criminals.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/124961/original/image-20160602-23270-cns88l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/124961/original/image-20160602-23270-cns88l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=768&fit=crop&dpr=1 600w, https://images.theconversation.com/files/124961/original/image-20160602-23270-cns88l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=768&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/124961/original/image-20160602-23270-cns88l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=768&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/124961/original/image-20160602-23270-cns88l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=965&fit=crop&dpr=1 754w, https://images.theconversation.com/files/124961/original/image-20160602-23270-cns88l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=965&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/124961/original/image-20160602-23270-cns88l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=965&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘Old Sparky’: the electric chair at Sing Sing penitentiary.</span>
</figcaption>
</figure>
<p>Yet it is not only the 31 states who have capital punishment on their books that face tricky decisions. The whole issue of capital punishment teeters on a knife edge. If you find the latest tactics of places such as Oklahoma questionable, is not the current abolitionist strategy problematic as well? It is undoubtedly the case that the drug embargo has led to greater suffering on the part of those who have still been executed by lethal injection. If you are an abolitionist, are you comfortable with suspension on a technicality, when this pushes states to use crueller means to kill?</p>
<p>Either way, it is probably the end of the road for the lethal injection. Its brief life has been a rip-roaring yarn of vision, carpetbagging and malpractice that says so much about attitudes to death, revenge, science and the law – as well as our dependence on drugs. As you read this, I am preparing my pitch for HBO. “It’s like Breaking Bad,” I’ll say, “with chemists and everything. Only Jessie is a prison warden and the drugs they deal don’t make you get high, they kill you. Where’s it set? Oklahoma, where else?”</p><img src="https://counter.theconversation.com/content/59937/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William David Watkin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When drug companies refused to ship chemicals to the US for use in lethal injections it led to several botched executions, reopening the debate over the death penalty.William David Watkin, Professor of Contemporary Philosophy and Literature, Brunel University LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/459152015-11-06T12:55:36Z2015-11-06T12:55:36ZAlbert Pierrepoint: a ‘haunted hangman’ and the death penalty today<figure><img src="https://images.theconversation.com/files/100935/original/image-20151105-16235-1qxbx5e.jpg?ixlib=rb-1.1.0&rect=12%2C30%2C1011%2C702&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gallows legacy. Albert Pierrepoint and the nature of the executioner.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/121483302@N02/15775540288/in/photolist-29sFb-4n9Qfw-q32LvW-oxHo2n-ohyHMr-7CLgze-74TMdi-s3fj9E-sEu9R-o78A8E-29s53-37841-aayyym-rMXeTn-886VNx-a6yjCB-92VZNU-nX49n1-fh3qJ1-7gQg-j9QFE-4JYT-byxCwr-4ZGka3-5BcZio-a6wAHa-jcH9WS-5AYBUR-2mKRHu-23G6T7-6MmUDf-66djBA-6dkDnA-7gN4yE-7BFCJx-4GFFZa-5BCTGd-5A17MF-7h3Bhj-pXiYuU-KhpPd-4idfA2-82BTWj-7CHDth-YbTNG-fyjsaS-9r9UQC-e2xNHk-qAAEc-mdLbC">Global Panorama</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Fifty years ago this Sunday, Britain passed a law which brought an end to the death penalty for murder and consigned the noose to history. One executioner, though, did not simply recede into the shadows. Albert Pierrepoint was not the last British hangman, but he was certainly the most famous. His legacy lives on as a symbol of the terrible responsibility of those charged to do the state’s killing and a benchmark for our understanding of the job.</p>
<p>The 1965 Murder (Abolition of Death Penalty) Act was a trial measure, with abolition <a href="http://news.bbc.co.uk/onthisday/hi/dates/stories/december/16/newsid_3258000/3258437.stm">finalised in 1969</a>. But parliamentary votes on reintroduction continued into the 1990s, and it was only relatively recently that the last remnants of the death penalty were definitively removed from UK law. Only in 1998 did treason and piracy cease to be capital offences. </p>
<h2>Bridge to the past</h2>
<p>Pierrepoint came to embody our strange relationship with the institution. As the son and nephew of hangmen, he seemed to continue some kind of artisan family tradition. His oddly sympathetic public profile was established during the 1940s when he carried out multiple hangings of Nazi war criminals. By the time Pierrepoint had resigned from the executioners’ list in 1956 he had hanged around 450 people. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/100541/original/image-20151102-16535-1uyvqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/100541/original/image-20151102-16535-1uyvqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/100541/original/image-20151102-16535-1uyvqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=515&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100541/original/image-20151102-16535-1uyvqn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=515&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100541/original/image-20151102-16535-1uyvqn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=515&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100541/original/image-20151102-16535-1uyvqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=648&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100541/original/image-20151102-16535-1uyvqn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=648&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100541/original/image-20151102-16535-1uyvqn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=648&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The public face of the death penalty. Albert Pierrepoint.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ninian_reid/12278766983/in/photolist-jH2TD2-jG5Ju3-dXsMVL-jvMHXU-bo99Lg">Ninian Reid</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>After his retirement, he dispensed expertise about hanging for television and radio audiences, acted as a film consultant and, in 1974, published a memoir, <a href="https://books.google.co.uk/books/about/Executioner_Pierrepoint.html?id=510vAQAAIAAJ">Executioner: Pierrepoint</a>. In the post-abolition era, Pierrepoint <a href="http://cmc.sagepub.com/content/early/2015/09/15/1741659015603623.abstract">was an authentic link</a> with the practice of hanging; a bridge to memories of capital punishment. And there are three significant aspects in his cultural persona that have helped build our modern narrative of the executioner.</p>
<h2>Civilised hanging</h2>
<p>The first was Pierrepoint as an <a href="http://www.ibtimes.co.uk/50th-anniversary-last-execution-britain-how-hangman-albert-pierrepoint-did-his-job-1460839">efficient and professional hangman</a>. This was a portrayal that he contributed to in his memoir and media interviews. It stressed the meticulous care he took and emphasised his speed and efficiency. It was in keeping with 20th century understandings of execution. The bodily suffering of the condemned should be minimised or, <a href="http://muse.jhu.edu/journals/social_research/summary/v078/78.3.garland.html">preferably, non-existent</a>. Whether this could actually be achieved is debatable but it was important that hanging was understood to have been “modern” and civilised.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/100939/original/image-20151105-16249-jl9znk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/100939/original/image-20151105-16249-jl9znk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/100939/original/image-20151105-16249-jl9znk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=741&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100939/original/image-20151105-16249-jl9znk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=741&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100939/original/image-20151105-16249-jl9znk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=741&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100939/original/image-20151105-16249-jl9znk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=932&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100939/original/image-20151105-16249-jl9znk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=932&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100939/original/image-20151105-16249-jl9znk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=932&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A section from Pierrepoint’s testimony to the Royal Commission on Capital Punishment in 1950.</span>
<span class="attribution"><a class="source" href="http://www.nationalarchives.gov.uk/education/candp/punishment/g12/g12cs3s2.htm">National Archives</a></span>
</figcaption>
</figure>
<p>Famously, Pierrepoint also renounced the death penalty in his memoir, stating that it achieved nothing but revenge. My trawl through the archives of the time shows that those who opposed the reintroduction of capital punishment seized on this as compelling support. This “reformed hangman” aspect of Pierrepoint’s external cultural persona earned him respect and fascination. But this appears to have been an oversimplification; statements he made in interviews I have read were more equivocal. Pierrepoint does not seem to have been firmly against capital punishment in all circumstances.</p>
<h2>Regrets</h2>
<p>The final aspect of Pierrepoint’s cultural persona is that of the haunted hangman, traumatised by guilt and regret. It is a noteworthy portrayal because it does not draw on his self-image. In fact, it contradicts his accounts of being untroubled about those he had hanged, even if they were subsequently pardoned. </p>
<p>Some press reports about Pierrepoint when he died in 1992 suggested that he was troubled by his past. However, the clearest portrayal of Pierrepoint in this way is found in the <a href="http://www.imdb.com/title/tt0462477/">eponymous biopic</a>. In this film, the character of Pierrepoint, played by Timothy Spall, is haunted by executing an acquaintance and, eventually, traumatised by the many hangings he has carried out. It is an appealing idea, one perhaps that the public cling to, that life is not easily taken by anyone.</p>
<h2>Fraught future</h2>
<p>Maybe Pierrepoint had an easy ride. Now that it is more than <a href="http://www.theguardian.com/world/2014/aug/13/britain-last-executions-hanging-criminals-low-key">half a century since anyone was hanged</a> in Britain, we can use him to understand better how this conflicting cultural persona of the executioner has contemporary relevance in the US, where the death penalty is increasingly <a href="http://www.slate.com/blogs/the_slatest/2015/10/23/lethal_injection_in_the_u_s_is_a_farce.html">beset by scandal</a>. </p>
<p>Pierrepoint was able to construct an air of professionalism around the mechanics of the gallows, but that is not a luxury afforded to his modern-day equivalents. The availability of the drugs necessary to perform lethal injections is increasingly restricted, which has forced states that retain the death penalty to <a href="http://www.theguardian.com/us-news/2015/jan/14/oklahoma-experimental-lethal-injection-protocol-supreme-court">“experiment” with alternative drugs</a>, or add other <a href="http://www.amnesty.org.uk/press-releases/utahs-reintroduction-firing-squads-usas-latest-attempt-fix-unfixable">execution methods</a>. </p>
<p><a href="http://www.theguardian.com/world/2014/dec/13/botched-oklahoma-execution-clayton-lockett-bloody-mess">High-profile botched executions</a> by lethal injection have raised the problem of how to carry out those “civilised” executions that avoid pain and suffering, and which helped to create the Pierrepoint persona in the UK. This seems almost impossible now for the Americans who try to do the same under intense scrutiny. The prospect of putting people to death in the gas chamber, electric chair or by firing squad feels like a step backwards.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/100938/original/image-20151105-16231-80d7e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/100938/original/image-20151105-16231-80d7e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/100938/original/image-20151105-16231-80d7e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100938/original/image-20151105-16231-80d7e6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100938/original/image-20151105-16231-80d7e6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100938/original/image-20151105-16231-80d7e6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=567&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100938/original/image-20151105-16231-80d7e6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=567&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100938/original/image-20151105-16231-80d7e6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=567&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Protests at the Supreme Court.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/80014607@N05/8700016493/in/photolist-efMRNn-zu1tr-s4Hnjf-av6Vi5-zu1bg-zu15u-zu13Q-zu17a-zu1cf-zu12M-zu14S-zu127-zu18Q-zu16m-7m8M15-zu1mi-zu1n5-zu1ny-cXe3E-ywyq-ywy9-zu1vp-ywy5-zu1pm-zu1de-zu1g5-zu1ex-3TmdFT-zu1hG-zu1gX-55QUN-4zGV5L-apL7xv-4zGVeh-zu19z-zu1ah-zu1io-zu1kK-ywyf-zu1jo-efTZdG-zz25D-nJdVRY-zu1vL-efTZjW-efTYVu-ywya-ebcu2z-7ewf59-zu1sg">Thomas Muther, Jr.</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In an echo of Pierrepoint’s life, some former executioners and prison governors in the US have spoken <a href="http://www.salon.com/2015/10/08/i_executed_62_people_im_sorry_an_executioner_turned_death_penalty_opponent_tells_all/">out against the death penalty</a>. They have detailed their trauma, and campaign groups raise this potential for capital punishment to harm people other than just the condemned prisoner as an argument for abolition. </p>
<p>Pierrepoint would have had no truck with that, I suspect. But those somewhat contradictory narratives around his career – the quest for professionalism, his apparent reformation and the biopic tale of a man haunted by his deeds – remain deeply relevant in understanding how today’s executioners might think, and how the public might view them.</p><img src="https://counter.theconversation.com/content/45915/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lizzie Seal is a member of the Howard League for Penal Reform.</span></em></p>50 years after the UK first experimented with removing the death penalty for murder, one name has become our bridge to the hangman’s noose.Lizzie Seal, Senior Lecturer in Sociology/Criminology, University of SussexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/392932015-04-08T10:05:28Z2015-04-08T10:05:28ZUtah’s firing squad plan is another twist in America’s long quest for a perfect execution method<p>Concerned that the Supreme Court may soon declare lethal injection unconstitutional, some states are making back-up plans. </p>
<p>In March, Utah’s governor signed <a href="http://www.nbcnews.com/news/us-news/utah-enacts-firing-squads-backup-execution-method-n328911">legislation</a> that will bring back the firing squad as the state’s official execution method in the event that injection – the method used by every state that still retains the death penalty – is no longer possible. </p>
<p>Utah’s legislation has received a lot of attention, in part because the state occupies a symbolically important place in the history of the modern American death penalty. </p>
<p>In 1977, it was the first to kill anyone after a ten-year suspension of executions in the United States. (The Supreme Court had found the death penalty capriciously applied, and thus unconstitutional, in <a href="http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=408&invol=238">a 1972 case</a>. But it <a href="http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=428&invol=153">permitted executions to resume</a> four years later when states presented the Court with new sentencing guidelines aimed at reducing arbitrariness.) </p>
<p>Standing in front of five rifles poking through a slotted wall, convicted murderer Gary Gilmore famously uttered, “Let’s do it,” and with his death, the modern era of executions in the United States was born. </p>
<p>In addition, Utah has the distinction of being the only state in the past century to use the firing squad to kill people. Its modern use of a bloody, antiquated execution method has long set it apart from other states. </p>
<h2>Why all the attention paid to Utah’s firing squad plan?</h2>
<p>Despite Utah’s historical notoriety and uniqueness, the attention its back-up plan has received in the press in recent weeks is, from a practical standpoint, unwarranted. </p>
<p>The state has been responsible for only six of the 1,403 executions that have occurred nationally since Gilmore was put to death. Its last execution was five years ago. Before that, it hadn’t killed anyone in 11 years. It is unlikely to execute anytime soon. </p>
<p>And while Utah eliminated the firing squad altogether in 2004, leaving lethal injection its sole method of execution, it has permitted those sentenced before then to be executed by gun if they so wish. Ronnie Gardner, the most recent man executed in Utah, chose to be shot by the state’s correctional officers in 2010. So this new legislation is not exactly unearthing a relic from the distant past. </p>
<p>Still, the attention paid to Utah in recent weeks is important because it captures a national and historically unprecedented moment of disillusionment about the administration of the death penalty. </p>
<p>Utah’s decision powerfully represents a dawning realization that the cosmetic and humanistic concerns that have long shaped executions in the United States may be incompatible with one another. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/77218/original/image-20150407-26502-ai0xfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/77218/original/image-20150407-26502-ai0xfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/77218/original/image-20150407-26502-ai0xfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77218/original/image-20150407-26502-ai0xfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77218/original/image-20150407-26502-ai0xfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77218/original/image-20150407-26502-ai0xfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77218/original/image-20150407-26502-ai0xfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77218/original/image-20150407-26502-ai0xfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Execution by firing squad.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-94093558/stock-photo-firing-squad.html">Shutterstock</a></span>
</figcaption>
</figure>
<h2>The search for a quiet and humane form of execution</h2>
<p>Since the nineteenth century, American elites have searched for a mode of execution that was professional in appearance and humane in practice, one that would display the state’s sober-minded restraint while taking life as quickly and painlessly as possible.</p>
<p>As early as the 1830s, states began searching for ways to take the condemned out of this world with as little fanfare and medieval ritual as possible. Worried about jeering execution day crowds, elites moved executions behind walls and eventually into the bowels of prisons where sober decorum would prevail. </p>
<p>A complex division of tasks within the execution chamber, moreover, cleansed the punishment of vengeful overtones. </p>
<p>The “law” was no longer a local sheriff publicly carrying out a hanging on behalf of an aggrieved community, but multiple bureaucrats, each responsible for performing a small step in a highly-choreographed procedure. One tied the hands, another bound the feet, another secured the noose, and another pulled the lever to release the trap door. No single person embodied the state.</p>
<p>And since the 1890s, a persistent dark optimism has produced revolutions in killing technologies every few decades. </p>
<p>From shooting and hanging to electrocuting to gassing to injecting, Americans have continuously introduced new killing technologies that have promised to minimize the discomfort, for witnesses and the condemned, caused by the state’s exercise of its sovereign power over life and death. </p>
<h2>The latest solution: Lethal injections</h2>
<p>With lethal injections, first used by Texas in 1982 and gradually adopted by every other state with the death penalty, Americans thought they had finally arrived at a perfect solution. </p>
<p>What could better project an aura of professional competence and dignified restraint than an execution in which the condemned person looked like a patient being put to sleep for an operation?</p>
<p>But it hasn’t always gone that way. Officials sometimes have trouble accessing inmates’ veins. In 2009, Ohio officials spent two hours unsuccessfully trying to establish an IV line into Romell Broom <a href="http://thelede.blogs.nytimes.com/2009/09/16/botched-execution-described-as-torture/?_r=0">before giving up</a>. Broom left the execution chamber alive, his body punctured in eighteen different sites by failed attempts to find a vein. </p>
<p>And last year, Oklahoma technicians incorrectly inserted the needle into Clayton Lockett’s groin, missing his vein and releasing the drugs into the surrounding tissue. After being declared unconscious, Lockett began writhing and attempted to sit up. <a href="http://www.nytimes.com/2014/09/05/us/oklahoma-report-on-clayton-lockett-execution.html">He died of a heart attack</a> 43 minutes after the execution began and seven minutes after rattled officials tried to abort it.</p>
<p>In response to incidents like these, attorneys for condemned inmates have launched <a href="http://www.scotusblog.com/case-files/cases/glossip-v-gross/">a new legal attack</a> on lethal injection. </p>
<p>The Court previously upheld the constitutionality of lethal injection <a href="http://scholar.google.com/scholar_case?case=10752510346595419167&hl=en&as_sdt=6&as_vis=1&oi=scholarr">in a 2008</a> decision, but much has changed since then. Cut off from European suppliers, who are barred by European Union regulations from selling drugs that will be used in executions, states have struggled in recent years to find reputable vendors of execution drugs. Some have revised their execution protocols altogether, incorporating new drugs that can be made in historically under-regulated domestic <a href="http://www.npr.org/2013/10/26/241011316/lacking-lethal-injection-drugs-states-find-untested-backups">compounding pharmacies</a>. </p>
<p>As they begin using new drugs from new sources, moreover, states continue to lack the expertise needed to safeguard the quality of the chemicals and ensure their proper use on inmates. </p>
<p>At its recent annual meeting, the American Pharmacists Association <a href="http://www.cnn.com/2015/04/03/health/pharmacists-discouraged-from-providing-drugs-for-lethal-injection/">voted to discourage </a>its members from participating in executions. Anesthesiologists, too, have been <a href="http://www.theaba.org/PDFs/BOI/CapitalPunishmentCommentary">professionally barred</a> from assisting prison personnel, leaving the condemned in the hands of under-trained technicians who lack the skills required to ensure that they are properly sedated when their hearts and lungs shut down. </p>
<p>As a result, the risk that lethal injection will cause preventable, excessive pain for the condemned may now seem unacceptably high. The Court <a href="http://scholar.google.com/scholar_case?case=15343542124860317253&hl=en&as_sdt=6&as_vis=1&oi=scholarr">has long held</a> that while inmates are not entitled to a pain-free execution, they must not be subjected to “unnecessary pain.” </p>
<p>The recent and ongoing problems faced by states trying to carry out death sentences may convince a majority of the Justices that lethal injection is inherently failure-prone and therefore unconstitutional.</p>
<h2>A trade off between appearance and reliability</h2>
<p>In scrambling to come up with a plan B, officials in states like Utah are grappling with the fact that there may be a trade-off between an execution that is easy to watch when it goes according to plan and one that ends life quickly and reliably. </p>
<p>In a <a href="https://www.amherst.edu/aboutamherst/news/news_releases/2012/05.2012/node/398298">survey</a> of nearly 9,000 executions that have happened in the United States, legal studies scholar Austin Sarat found that lethal injection was by far the most error-prone mode of execution of them all. While three percent of all executions have been botched since 1900, over seven percent of lethal injections haven’t gone according to plan. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/77220/original/image-20150407-26502-1p5zl1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/77220/original/image-20150407-26502-1p5zl1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/77220/original/image-20150407-26502-1p5zl1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=498&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77220/original/image-20150407-26502-1p5zl1u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=498&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77220/original/image-20150407-26502-1p5zl1u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=498&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77220/original/image-20150407-26502-1p5zl1u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=626&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77220/original/image-20150407-26502-1p5zl1u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=626&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77220/original/image-20150407-26502-1p5zl1u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=626&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The execution of William Kemmler, August 6, 1890 by electric chair.</span>
<span class="attribution"><a class="source" href="http://commons.wikimedia.org/wiki/File:Kemmler_ex%C3%A9cut%C3%A9_par_l%27%C3%A9lectricit%C3%A9.jpg">Le Petit Parisien - Supplément littéraire illustré, 17 août 1890.</a></span>
</figcaption>
</figure>
<p>Shooting people kills them more quickly and reliably than electrocuting, gassing, or poisoning them. But it’s harder to watch or read about than lethal injection. </p>
<p>The raw violence of the act puts it at odds with the aesthetic values that have historically shaped the development of capital punishment in the United States. Guns uncomfortably blur the line between the righteous violence of the state and the lawless violence of the criminal. The gun is, historically speaking, the only instrument of execution that is also commonly used by criminals. Its use in executions reminds us of a past in which there was less of a distinction between the state that carried out the law and those it punished. </p>
<p>Indeed, in its jarring loudness, its bloodiness, and its mutilating effects on the body, execution by firing squad comes much closer to expressing the “eye for an eye” logic that has long stoked Americans’ demand for the death penalty, but that has, since the nineteenth century, been carefully excised from its actual administration. </p>
<p>That, in the end, is what is most newsworthy about Utah’s decision to return to the gun. In the violent imagery it conjures, execution by firing squad has the power to remind Americans of a simple truth that lethal injection has, for a long time, made it easy for them to forget: executions are acts of extreme, body-mutilating violence.</p><img src="https://counter.theconversation.com/content/39293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel LaChance does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The search for clean and painless executions may have failed, raising questions about the constitutionality of capital punishment.Daniel LaChance, Assistant Professor of History, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/225612014-02-06T06:40:25Z2014-02-06T06:40:25ZDeath penalty crisis reveals macabre options still open in US<figure><img src="https://images.theconversation.com/files/40805/original/nwxptkqy-1391614932.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Abolished in New Mexico, but legally open in other states.</span> <span class="attribution"><span class="source">Shelka04</span></span></figcaption></figure><p>American exceptionalism on the death penalty is at it again, and this time we have truly outdone ourselves: we tortured someone to death. Last month, the Ohio execution of Denis McGuire using untested death penalty drugs <a href="http://www.theguardian.com/commentisfree/2014/jan/22/ohio-mcguire-execution-untested-lethal-injection-inhumane">lasted 26 minutes</a> – that’s longer than any execution on Ohio’s books in the past 15 years. </p>
<p>One <a href="http://www.foxnews.com/us/2014/01/25/family-executed-ohio-inmate-sues-state-drug-makers-alleging-cruel-and-unusual/">account describes</a> him as experiencing “repeated cycles of snorting, gurgling, and arching his back, appearing to writhe in pain”. Yet the death penalty in America lives on. </p>
<p>What gives? Maybe lethal injections. Over the past several years, Big Pharma has steadfastly <a href="https://theconversation.com/ohio-execution-lethal-injections-are-based-on-guesswork-22062">refused to sell</a> death penalty drugs to American prisons, or even to distributors who don’t agree to its terms. As a result, bloodthirsty states have been smuggling the drugs, borrowing from other states, and making new deadly concoctions of their own (and the pressure is now <a href="http://www.theguardian.com/world/2014/jan/28/tulsa-compounding-pharmacy-lethal-injection-execution">also on to name</a> the small compounding pharmacies making these drugs). And we all know how the last option is working out. That’s Ohio. It’s tantamount to a crisis. </p>
<p>Here in the United States, Ohio’s lethal injection snafu has led to calls for a moratorium on executions and the abolition of the death penalty. And maybe that’s what will ultimately give – the death penalty itself. Six states – Connecticut, Illinois, New Mexico, New York, New Jersey and most recently Maryland – <a href="http://www.reuters.com/article/2013/05/02/us-usa-maryland-deathpenalty-idUSBRE9410TQ20130502">have abolished</a> the death penalty in the past six years. We haven’t seen that sort of abolition fervour in over 50 years.</p>
<p>But I’m not so optimistic. The other thing that Ohio’s desperation to execute has brought are calls to move to another form of execution. </p>
<h2>A dance macabre</h2>
<p>Some have <a href="http://www.foxnews.com/opinion/2014/01/27/want-death-penalty-to-be-compassionate-bring-back-firing-squad/">called for</a> a return to the firing squad. This isn’t as historical as it sounds. Utah is famous for this execution method. Death penalty aficionados will recall Gary Gilmore was killed this way in 1977 and Utah resurrected this method for the first time in 14 years <a href="http://www.ohio.com/news/utah-firing-squad-executes-convicted-killer-1.188949">when it executed</a> Ronnie Lee Gardner in 2010. </p>
<p>Oklahoma authorises this method too. It’s cheap and effective. And since most of the shooters have blanks (the shooters don’t know who is shooting blanks and who isn’t), everyone involved is somehow absolved of responsibility for taking another human being’s life.</p>
<p>Others have called for a return to death by electrocution. My state, Virginia, allows for death by electrocution as an alternative to lethal injection if an inmate chooses it, and at least half a dozen other death penalty states do as well. Most famous for this method of execution is Florida. <a href="http://www.nydailynews.com/archives/news/condemned-man-catches-fire-electric-chair-article-1.751043">Anyone remember</a> when a man caught fire during his execution in Florida’s “<a href="http://weburbanist.com/2011/03/20/old-sparky-the-shocking-history-of-the-electric-chair/">Old Sparky</a>” in 1997. Experts came to the conclusion that it was “possible he experienced pain”.</p>
<p>Not to leave any execution method out, New Hampshire and Washington State still authorise death by hanging, although it has been decades since anyone has been executed this way. The last public hanging was Rainey Bethea in Virginia <a href="http://deathpenaltyusa.org/usa1/date/1936.htm">in the 1930s</a>, and it was apparently so gruesome to watch that the immediate result was a move to outlaw public executions. But hanging in private happened as recently as 1996 <a href="http://articles.philly.com/1996-01-25/news/25653644_1_clara-lambertson-lethal-injection-delaware-correctional-center">in Delaware</a>.</p>
<p>Last but not least, some are calling for a return to death by gas chamber, which is still on the books in four states (and was a preferred method of execution in Nazi Germany, let the record reflect). It <a href="http://www.salon.com/2010/08/01/gas_chamber_interview/">is known for</a> inflicting a slow and painful death.</p>
<p>Each of these moves would take America from a more civilised execution method to less civilised execution method. But my own feelings about that are mixed. Lethal injection is so civilised that it has been viewed much like putting down a cat – an unfortunate happenstance, but the best we could do. It misses the violence that is inherent in taking another human being’s life.</p>
<p>Not so with these other execution methods. They are bloody, brutal, macabre and utterly uncivilised. But then again, so is the death penalty. They would just make us deal with it.</p><img src="https://counter.theconversation.com/content/22561/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Corinna Barrett Lain does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>American exceptionalism on the death penalty is at it again, and this time we have truly outdone ourselves: we tortured someone to death. Last month, the Ohio execution of Denis McGuire using untested…Corinna Barrett Lain, Professor of Law, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/220622014-01-16T00:16:57Z2014-01-16T00:16:57ZOhio execution: lethal injections are based on guesswork<figure><img src="https://images.theconversation.com/files/39146/original/hgjr3jnr-1389804173.jpg?ixlib=rb-1.1.0&rect=0%2C3%2C1280%2C860&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Designed for other uses.</span> <span class="attribution"><span class="source">Phil and Pam</span></span></figcaption></figure><p>Ever since the time of the guillotine, doctors have been at the centre of the death penalty. Joseph Guillotin, the physician who suggested the device be used in 18th-century France, was actually against the death penalty – he hoped that a more humane method of decapitation would be a prelude to ending capital punishment. </p>
<p>It was nearly 200 years later, in 1977, that the end came for the guillotine. That same year, anaesthetist Stanley Deutsch proposed the so-called triple cocktail for lethal injection, consisting of a fast-acting anaesthetic (sodium thiopental), a muscle-paralysing agent (pancuronium) and a cardiotoxin (potassium chloride) to stop the heart for an execution in Oklahoma. There was a perception that this might be somehow more humane, despite reports of botched executions – deaths that took longer than they should, signs of skin burns and convulsions – and more than 1100 prisoners have been executed in this way. </p>
<p>But pressure by drug manufacturers and European export controls mean the supply of these drugs (and subsequent substitutions such as pentobarbital, a barbituate used for severe forms of epilepsy) is now limited, leading to executing states using different concoctions and combinations. The reported last words of Michael Lee Wilson in Oklahoma earlier this month, that he felt his “whole body burning” around 20 seconds into his execution, prompted <a href="http://www.theguardian.com/world/2014/jan/13/ohio-man-execution-lethal-injection-method">some to suggest</a> this may have played a part. </p>
<h2>Untested drugs?</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/39144/original/6kqrdyqb-1389803608.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/39144/original/6kqrdyqb-1389803608.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/39144/original/6kqrdyqb-1389803608.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/39144/original/6kqrdyqb-1389803608.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/39144/original/6kqrdyqb-1389803608.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/39144/original/6kqrdyqb-1389803608.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/39144/original/6kqrdyqb-1389803608.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dennis McGuire.</span>
<span class="attribution"><span class="source">Ohio Dept of Rehabilitation and Correction</span></span>
</figcaption>
</figure>
<p>Much has been made about untested drugs being used in Ohio’s <a href="http://www.usatoday.com/story/news/nation/2014/01/13/judge-wont-stop-ohio-execution-by-untried-drugs/4454099/">execution</a> of Dennis McGuire, because the state opted to use a sedative called midazolam and a painkiller, hydromorphone, due to a shortage of pentobarbital. </p>
<p>In one sense being untested is true of all drugs used in executions, as no pharmaceutical company has ever developed a drug to be used to kill someone – this would be in complete breach of medical ethics. As a consequence, the executioners had to make a guess (and not necessarily an educated one) about what the lethal toxic dose is of the drug concerned.</p>
<h2>Exporting death</h2>
<p>The biggest change to how lethal injections are used came in 2011, when the European Union (which is fundamentally opposed to the death penalty) <a href="http://content.time.com/time/world/article/0,8599,2102266,00.html">introduced export controls</a> to prevent drugs being used for executions. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/39142/original/42j6q4hk-1389799139.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/39142/original/42j6q4hk-1389799139.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=720&fit=crop&dpr=1 600w, https://images.theconversation.com/files/39142/original/42j6q4hk-1389799139.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=720&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/39142/original/42j6q4hk-1389799139.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=720&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/39142/original/42j6q4hk-1389799139.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=905&fit=crop&dpr=1 754w, https://images.theconversation.com/files/39142/original/42j6q4hk-1389799139.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=905&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/39142/original/42j6q4hk-1389799139.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=905&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Off labelling.</span>
<span class="attribution"><span class="source">James Heilman </span></span>
</figcaption>
</figure>
<p>The ban on exports of sodium thiopental for executions led the US to switch to pentobarbital. Then following pressure from the medical profession and others, Lundbeck, the Danish manufacturer of pentobarbital (sold as Nembutal), introduced a controlled <a href="http://nation.time.com/2013/08/07/the-hidden-hand-squeezing-texas-supply-of-execution-drugs/">distribution mechanism</a> to tighten up its supply chain, preventing use by US prisons.</p>
<p>Despite <a href="http://www.texasmonthly.com/story/texas-began-stockpiling-execution-drugs-shortage">attempts at stockpiling</a> by executioners, the shelf life of their pentobarbital was limited to 2013.</p>
<p>The next switch was (to a very limited degree) propofol, the world’s most widely used anaesthetic and the drug infamously involved <a href="http://www.telegraph.co.uk/culture/music/michael-jackson/10272782/Michael-Jackson-sought-propofol-long-before-death-says-doctor.html">in the botched</a> (and fatal) treatment of Michael Jackson.</p>
<p>When German firm Fresenius Kabi, which supplies the majority of the drug to the US, curbed shipments after it learned that Missouri’s Department of Corrections had bought <a href="http://www.economist.com/news/united-states/21588916-technical-hitch-stays-executioners-needle-cruel-and-unusable">an unsanctioned batch</a>, Missouri governor Jay Nixon was so worried about the risk to supplies of propofol for patient care last October that he blocked the execution of Allen Nicklasson. He said his interest was “in making sure justice is served and public health is protected.”</p>
<p>All these drugs are important for use in critical care units or operating theatres in hospitals. They weren’t developed to be used in an execution chamber with <a href="http://bit.ly/19u2rTb">poorly trained</a> non-medical staff.</p>
<p>The pressure from manufacturers and countries that don’t want their drugs involved in executions has had a massive impact. The numbers of executions in the US last year fell to <a href="http://www.npr.org/2013/12/19/255397766/executions-in-u-s-drop-close-to-20-year-low-in-2013">the lowest level</a> since 1994 with 39 prisoners executed in 2013 in the US.</p>
<h2>Homemade solutions</h2>
<p>Executioners in the US have been forced to look at alternatives, for example the use of <a href="http://health.howstuffworks.com/medicine/healthcare/what-is-a-compounding-pharmacist.htm">compounding pharmacies</a> who are allowed to make small batches of a prescribed medication. But such <a href="http://online.wsj.com/news/articles/SB10001424052702303754404579312680341438784">unregulated</a> pharmacies are also controversial in the US; as recently as 2012, botched manufacturing processes led to sizeable fungal meningitis outbreaks. </p>
<p>Other death penalty countries also use lethal injections, <a href="http://www.telegraph.co.uk/news/worldnews/1574560/Lethal-injection-replaces-firing-squad-in-China.html">increasingly</a> and most notably China, where the process is even more secretive. </p>
<p>And the effect of the EU restrictions has been global, not just limited to the US – even Vietnam has struggled to execute prisoners on death row and is considering <a href="http://www.theguardian.com/world/2013/nov/08/vietnam-firing-squad-executions">resuming executions</a> by firing squad.</p>
<p>It’s clear the problems with supply plus the desperation of executioners to find replacement drugs have highlighted that the lethal injection method is anything but a humane process.</p><img src="https://counter.theconversation.com/content/22062/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Nicholl does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Ever since the time of the guillotine, doctors have been at the centre of the death penalty. Joseph Guillotin, the physician who suggested the device be used in 18th-century France, was actually against…David Nicholl, Consultant Neurologist & Honorary Senior Lecturer, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.