Alabama’s execution problems are part of a long history of failed lethal injections

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(THE TALK) Alabama Gov. Kay Ivey has announced a pause in her state’s use of the death penalty. It follows a string of botched executions by lethal injection in the state, including two in which proceedings had to be stopped before inmates succumbed to the death drug cocktail.

The final straw appears to have been the failed attempt to kill Kenneth Smith on November 17, 2022. The state had to drop the case after difficulties securing an IV line.

But that was just the latest execution that didn’t go as planned. In September, Alabama had to stop the execution of Alan Eugene Miller after prison officers stuck needles in him for more than an hour because they couldn’t find a viable vein for an IV.

Even when the execution was carried out with the consequence of death, the manner in which it was carried out was problematic. When the state executed Joe Nathan James on July 28, 2022, the process that should normally have taken minutes to complete took more than three hours. During this time, officers repeatedly attempted to insert the IV lines needed to transport the deadly drugs and stabbed James with needles.

In a November 21 statement, Ivey ordered the state Department of Corrections to conduct a thorough review of the procedures used in executions and asked Attorney General Steve Marshall to halt the trial for two upcoming executions.

Alabama officials have traced their problems to what they have described as frivolous last-minute legal maneuvers by attorneys for death penalty advocates. In the cases of Miller and Smith, state officials claimed that they were running out of time before the death sentence expired.

But whatever the cause, Alabama’s execution troubles aren’t unique to that state.

My research shows that since 1900, in states across the country, lethal injections have been botched more often than any other type of execution method used during that time. These include hanging, electrocution, gas chamber and firing squad – even if these procedures are not without problems.

The early history of lethal injection

Lethal injection was first considered by New York State in the late 1880s when it convened a Blue Ribbon Commission to study alternatives to hanging. During their deliberations, Dr. Julius Mount Bleyer asked the commission to envision a future in which a person sentenced to death “could be executed on their bed in their cell with a 6-gram injection of morphine sulfate.”

Bleyer and his allies argued that the procedure would be painless. They said that unlike hanging, the method could not be screwed up. It would also be cheap, they claimed – all that was needed was a needle and a small amount of morphine.

Critics of the killing shot told the commission that the method could actually be easily botched, especially if doctors didn’t perform the procedure. And even if done right, proponents of capital punishment, as the maximum penalty, continued to argue that it was too humane. It would take away the fear of death and reduce the deterrent effect of the death penalty.

Ultimately, the opponents of lethal injection prevailed, backed by the medical community’s steadfast stand against it. Doctors “did not want the syringe, which has been associated with relieving human suffering, to become an instrument of death.”

Almost 100 years after the New York decision, no jurisdiction in the United States authorized execution by lethal injection. But the early debate over lethal injection foreshadowed arguments heard in 1977 during Oklahoma’s deliberations on this method of execution.

Proponents echoed Bleyer, stating that executions could be carried out by this method “without a fight, without a stench, without pain”.

This time they won.

The specific drugs for lethal injection—the anesthetic sodium thiopental and pancuronium bromide, a muscle relaxant—were not selected until four years later. Although the original law called for only these two drugs, a third drug was soon added: potassium chloride, which causes cardiac arrest.

Together, these three drugs would form what became the “standard” protocol for lethal three-drug injections. And what started in Oklahoma spread quickly. Lethal injection soon became the preferred method of execution in the United States in every state that used the death penalty.

The problems of lethal injection

From the outset, however, the administration of lethal injections proved to be a complex procedure that was difficult to do properly. Indeed, Texas’ first use of lethal injection in 1982 foreshadowed some of the problems that would later characterize the method of execution.

The Texas team tasked with executing a prisoner named Charles Brooks repeatedly failed in their efforts to insert an IV into a vein in his arm, causing blood to spurt onto the sheet covering his body. And after the IV was secured and the medication started flowing, Brooks appeared to be in considerable pain.

The difficulties in Brooks’s execution and subsequent lethal injections stem from the fact that medical ethics does not allow physicians to participate in drug selection or administration. Instead of doctors, law enforcement officials are responsible for the lethal injection procedure. In addition, the dosages of the drugs used are standardized and not tailored to the needs of specific inmates as would be the case with a medical procedure. As a result, the deadly injection drugs sometimes don’t work properly.

Despite efforts to medicalize executions, the lethal injection story has been far from smooth, sterile, and predictable. In fact, my research shows 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.

Things appear to have deteriorated since then, in part due to difficulties capital punishment states have had in acquiring drugs for the standard three-drug protocol. States have turned to questionable drug suppliers, including compounding pharmacies, which are not subject to extensive regulation by the Food and Drug Administration.

In the past decade, states have used as many as 10 different drug combinations in lethal injections. Some of them have been used multiple times while others have only been used once.

As states have experimented in hopes of finding a reliable drug protocol, my research shows that up to 20% of cases resulted in failed executions, depending on which of the newer drug protocols is used.

In some of these executions, prisoners have cried out in pain and gasped repeatedly long after they were said to have passed out.

In September 2020, an NPR investigation helped explain the high rate of botched executions. It found evidence of pulmonary edema fluid filling the lungs in many of the post-lethal injection autopsies it reviewed. These autopsies show that the inmates’ lungs failed while they continued trying to breathe, causing them to feel as if they were drowning and suffocating.

Responding to the problems of lethal injection

Alabama now joins Ohio and Tennessee as states that have suspended executions and launched investigations into failed lethal injections. Other states have revived previously discredited methods of execution — like electrocution or firing squad — and included them in their lists of execution options on the books.

The lethal injection problems have also contributed to the decision by 11 states to abolish the death penalty since 2007.

In a 2017 review of the history of the various methods of execution used in this country, Supreme Court Justice Sonya Sotomayor wrote: “States are developing a method of execution that has been generally accepted for a while. Science then reveals that … the method of execution chosen by states causes unconstitutional levels of suffering.”

And regarding the lethal injection and its problems, she remarked: “What a cruel irony of this method [of execution] what seems most humane may turn out to be our cruellest experiment yet.”

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