Lethal Injection: A Closer Look

In what eyewitnesses described as a surreal scene of chaos, it took Florida Department of Corrections staff 34 minutes to end the life of Angel Nieves Diaz on December 14, 2006.

During the execution, Diaz winced, gasped for air, and appeared to be in pain.

He was gasping for air for 11 minutes. Twenty-six minutes into the procedure, Diaz's body suddenly jolted. He was given a second round of drugs after the execution team observed that the first round had failed to kill him. He was finally pronounced dead by a hooded physician 34 minutes after the execution began.

Explanations of Diaz's Suffering Defy Medical Logic

Department of Corrections spokeswoman Gretl Plessinger told the press Diaz had liver disease, which slowed the effectiveness of the drugs and necessitated the second round.

But Plessigner's explanation doesn't add up.

The idea that liver disease would have made the drugs less effective defies all medical logic. Patients with liver disease are usually more sensitive, not less sensitive, to the anesthetic drugs. From my own conversation with execution eyewitnesses, I believe that something went terribly awry with this execution. It is quite likely that Mr. Diaz was conscious and in extreme pain.

I believe that he was tortured to death.

The State of Florida has a constitutional duty to carry out this punishment in a manner that does not torture the inmate. Clearly, Florida failed to meet this obligation on the night of December 14th.

Standard Method a Questionable Method

Lethal injection is the method that is used for 99 percent of executions in the United States. In theory, the process is similar to having anesthesia for surgery.

In an operating room, the patient lies down and an intravenous line is started in an arm vein. An anesthesiologist then injects medications into the IV intended to render the patient unconscious and unable to perceive pain.

For a lethal injection, the "patient" is an inmate who is condemned to die. The injection will render the patient lifeless. This injection contains a triple overdose of anesthesia drugs: sodium thiopental, which induces unconsciousness; pancuronium bromide, which paralyzes the breathing muscles; and potassium chloride, which stops the heart.

The drugs are usually mixed and injected by prison guards with no medical training. Furthermore, there can also be problems inserting the needle into the patient's vein. For an execution, the person inserting the IV into the prisoner often has little training or experience. This part of the procedure is sometimes made more difficult by the fact that many death row inmates have scarred, tortuous veins from previous drug abuse.

Recent Cases Suggest Cruel and Unusual Punishment

In Diaz's case, the needles in both arms missed their targets. As a result, not only did he suffer a slow and agonizing death because the drugs were not delivered into his veins, but he was also chemically burned by the highly concentrated drugs flowing under his skin. This was illustrated by 11-and-12-inch chemical burns on his arms revealed during his autopsy.

In another recent execution in Ohio, witnesses were treated to the horrifying spectacle of an inmate who did not die when the drugs were administered. In this case, three to four minutes into the execution, the inmate raised his head off the table and said, "It don't work, it don't work."

The inmate's IVs were removed and reinserted as he begged for some other alternative. In the Florida case, after the inmate took 34 minutes to die, an autopsy showed 11 and 12 inch chemical burns on the deceased inmate's arms and evidence that IVs in both arms had missed the veins.

These episodes lead to the inevitable question: Would a doctor be better qualified to perform the lethal injection, rather than a prison guard with no medical training?

Certain physicians -- such as anesthesiologists -- are specifically trained to deal with the equipment and drugs used for lethal injection. But like all physicians, anesthesiologists are ethically forbidden from participating in executions because medical professionals have a moral obligation to heal and comfort and to never use their skills to cause harm. It is a sacred pact that the medical profession has made with society since the dawn of medicine.

When physicians have forsaken this obligation -- as the involvement of physicians in Nazi atrocities starkly reminds us -- not only are physicians degraded, but society suffers as well.

A Lethal Paradox

Thus, lethal injection inevitably leads to this paradox: It is ethically wrong to torture inmates to death with unskilled execution personnel, but also ethically wrong to bring skilled personnel into the execution process. Courts in several states are currently wrestling with this dilemma.

One day after the humanity of Diaz's execution was publicly questioned, Florida Gov. Jeb Bush, an ardent supporter of capital punishment, suspended state executions.

In an unrelated move, a federal judge in California proposed a moratorium on executions by lethal injection. U.S. District Judge Jeremy Fogel declared that Florida's method of lethal injection was in risk of violating the constitutional ban on cruel and unusual punishment.

On December 19, 2006, Maryland's Court of Appeals suspended state executions until the manual detailing lethal injection procedures can be reviewed.

Prisoners won the right themselves to question whether lethal injection violates the civil rights of an inmate in June 12, 2006 -- but judges did not then decide whether or not that form of execution constitutes something cruel and unusual.

Yet the legal challenges to lethal injection continue to increase. At least one state -- New Jersey -- is considering abolishing capital punishment altogether.

It is possible that lethal injection, unlike some of its victims, will die a rapid and painless death.

Dr. Jonathan Groner is a pediatric surgeon and associate professor of clinical surgery at The Ohio State University College of Medicine. He has written extensively about the role of physicians in lethal injection, and his articles have appeared in the British Medical Journal, Health and Human Rights: An International Journal, Ethics and Medicine, and The Lancet. He has also been actively involved in several legal cases involving lethal injection in the United States.