Lethal Injection Protocol

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A brief discussion about the current lethal injection protocol and how it is inhumane. I propose a detailed, alternative protocol based upon the humane practice of Euthanasia, which would ensure a humane death instead of a potentially suffocating death due to the use of Pancuronium bromide currently being used for Capital Punishment.

Submitted: November 29, 2015

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Submitted: November 29, 2015

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Lethal Injection Protocol

by Michael Dale Sipes, Jr.

 

The current method of lethal injection uses three drugs which when ideally administered by injection into a vein produces a quick painless humane death. The first drug sodium thiopental is used to induce unconsciousness, the second drug Pancuronium bromide causes muscle paralysis and respiratory arrest and lastly potassium chloride stops the heart. When this cocktail is administered properly, using trained medical professionals death is theoretically quick, painless and therefor humane. There have been many cases where the condemned inmate was not sufficiently sedated or regained consciousness, and literally suffocating to death before the third and final drug was injected to stop the heart. Timing is a critical factor in the administration of the first drug and on a whole, the entire three-part procedure using sodium thiopental. Sodium thiopental is an ultra-short-acting barbiturate which following proper intravenous injection, rapidly reaches the brain and causes unconsciousness in 30 to 45 seconds. Approximately one minute following injection, peak concentration of approximately 60% of the total dose of the drug has reached the brain. After 5 to 10 minutes, times vary due to various factors, the concentration of sodium thiopental drops low enough that consciousness returns. Imagine being strapped to a board with people watching you and suddenly you could not breathe but you could not tell anyone, not even bat an eye as to the fact that you are fully conscious and was slowly and excruciatingly dying of asphyxiation. That raises the first question, how to determine if the condemned is conscious or not? Since Doctors in the United States refuse to participate in the practice of execution due to it being against their Hippocratic Oath to do no harm the procedure is usually performed by prison staff and sometimes emergency medical technicians. Sometimes the drug does not enter the blood stream at all, because the IV was not placed into a vein correctly or because the inmate had bad veins due to IV drug use.

The first problem with the current three drug cocktail lies with the possibility of the condemned being conscious while suffocating to death and not being able to cry out or exhibit the usual agonal breathing associated with asphyxiation. Due to the paralytic action of Pancuronium Bromide the only effect it has is to give the observers the impression that the condemned is unconscious and not experiencing excruciating pain and that the procedure is painless and humane, when in reality the condemned is suffering excruciating pain with no means to let anyone know. Therefor the logical thing would be to do away with the paralytic drug Pancuronium Bromide so that those administering the death sentence can be absolutely sure the condemned is unconscious when the final drug is given that induces death. There is absolutely no need for the use of Pancuronium Bromide in the administration of Capital punishment if sufficient amounts of the sedative and hypnotic drug sodium thiopental is used. With sufficient sodium thiopental given as a drip and not a bolus injection, the inmate will be rendered unconscious for the duration of the execution and therefore unable to move which makes Pancuronium bromide a redundant and sometimes suffocating drug which leads to excruciating suffocation. The key to a painless and humane execution is the correct usage of the first drug sodium thiopental, given in a continuous drip, not a bolus administration, thus assuring continuing anesthesia and sedation till death. When an inmate who is condemned to die suffocates while waiting for his or her heart to stop this is completely contrary to what is considered a humane execution and violates the 8th amendment rights of the condemned.

A more humane procedure then the one used now, would consist of the administration of Sodium thiopental drip by IV in a concentration that is adequate for continued sedation by a licensed physician based upon body weight and vital signs. The physician’s role would only be to anesthetize the "patient', after the physician has successfully anesthetize the "patient" he or she leaves, thus upholding his or her Hippocratic Oath of doing no harm since the physician only induced anesthesia, a normal practice by physicians. Immediately following anesthetizing the inmate, sodium pentobarbital is administered through the same IV port that is supplying the sodium thiopental by an EMT or other medically trained individual in a dosage that is three times the normal lethal amount required, based upon the patients weight. Within 5 to 10 minutes the inmate would lapse into a deep coma, the heart would stop shortly thereafter resulting in a painless and humane death. This protocol, which uses two drugs as opposed to the current three, eliminates the need for pancuronium bromide altogether, which is a redundant and potentially suffocating drug that can cause excruciating pain and suffocation while the individual is completely conscious but unable to speak or move. This would also eliminate any doubt as to whether the inmate was conscious during the execution process due to the fact that consciousness would be completely negated by the continuous administration of the first drug sodium thiopental by a drip and not a bolus injection and then unconsciousness would continue to be negated by the rapid succession administration of sodium pentobarbital which in itself causes sedation and coma. The entire procedure would take place while the inmate was unconscious following the beginning of the sodium thiopental drip. This two drug procedure eliminates Pancuronium bromide as well as potassium chloride, which has been shown to cause an excruciating burning sensation as it is administered through an IV. There would also only be one IV injection needed instead of two or three which would cut down on the pain the inmate must endure and the difficulty of the procedure. It has been shown that overdoses of sodium pentobarbital makes an individual fall into a deep sleep and their breathing stops and then within 15 to 30 minutes the heart stops, resulting in a humane peaceful death.

This practiced is used in many countries in Europe and Asia where Euthanasia has been accepted, practiced and perfected. The condemned inmate facing capital punishment should be given the same pharmaceutical regiment for death as those seeking Euthanasia for reasons of morality and human decency of the highly provocative process of capital punishment. There are organizations specifically designed for Euthanasia for those who do not want to suffer any longer or at all. Those organizations have adopted a two drug regiment both given by mouth, but for those who cannot swallow an IV method is also available. First an antiemetic to inhibit vomiting due to the bitter taste of the second drug pentobarbital, a lethal, fast-acting and completely painless barbiturate which is dissolved in ordinary drinking water or juice. After taking it the patient falls asleep within a few minutes, after which sleep passes peacefully and completely painlessly into death. There is a very fine line between what an inmate convicted of capital punishment deserves and what they are entitled to. Regardless of the nature of the crime, the condemned inmate will suffer the ultimate fate, death, so the means of that death should be as humane as possible, for the inmate is required by law to be put to death in a humane manner, no matter what the crime. By inducing anesthesia with sodium thiopental, one of two methods can then be used to induce death, quickly and humanely. The patient is injected with a lethal dosage of pentobarbital or the medication can be placed directly into the inmates’ stomach using a gastronomy feeding tube, then the lethal dosage of pentobarbital would be injected directly into the stomach, causing the condemned to remain unconscious and die painlessly shortly thereafter. There are problems with the use of a gastronomy feeding tube as opposed to the IV method. One being that the condemned would have to be put on a sodium thiopental drip in order to induce and maintain unconsciousness before the second drug pentobarbital takes effect and renders the inmate in coma and the correct placement of the tube must be considered. To better understand why IV placement is critical and why pancuronium bromide should not be used in any lethal injection protocol it is imperative to discuss two cases where the current protocol failed. The first case is the murder of twenty-nine year old Sandra Lee Long by Brian Steckel. Steckel convinced Sandra to allow him into her home in order to use her phone. However, once inside his true intentions played out as he propositioned her for sex in which she replied no and asked him to leave. He then strangled her until she was half-conscious, making her unable to defend herself; Steckel then sexually abused her with a screwdriver, and raped her from behind. Apparently, still in a rage because Sandra had refused to have sexual relations with him, he set her on fire, which was the ultimate cause of her death due to smoke inhalation and severe burns. During his execution by lethal injection, the mechanical device used to deliver the three drug lethal injection protocol of sodium thiopental, pancuronium bromide and potassium chloride failed to function properly. Steckel had two IV’s placed, one in each arm. For 12 minutes the injection machine sat making a clicking noise until it was determined that the main IV line was blocked. The machine was then switched to the backup IV line, though the sedative drug sodium thiopental was not administered. Steckel continued to stay conscious as the paralytic pancuronium bromide took effect and was unable to cry out or relay to anyone that he was suffocating as he waited for the potassium chloride to stop his heart. Due to being conscious, the potassium chloride caused him to feel as if his veins were on fire since potassium chloride causes extreme pain when injected into a vein in concentration sufficient to cause death by cardiac arrest. Some would argue that it was a fitting end to Steckel due to the manner, in which Sandra died, burning to death. Nevertheless, in order to achieve the objective of inducing the most humane death possible, we must remove ourselves from the mindset of culpability and justice served. Focusing solely on the problems with the current three-drug protocol and developing a humane lethal injection protocol that is consistent, definitive and humane. Consequently, the primary maker of sodium thiopental in the United States, Hospira stopped manufacturing the drug and the European Union banned the export of the drug for this purpose resulting in the use of pentobarbital instead of sodium thiopental at the end of 2010.

Another example of how inconsistent and problematic the current lethal injection protocol is would be the case of Christopher J. Newton. In 2001, Newton murdered his cellmate Jason Brewer and received the death penalty. He was strapped to the table for lethal injection, which was blotched from the very beginning. The individuals who were placing or attempting to place an IV into his arm had significant trouble doing so and it took over 2 hours and 10 attempts before the IV was in place. When the drugs were administered witnesses, viewing the execution reported that his stomach heaved his mouth and chin twitched and he suffered at least two mild convulsions. This would have been impossible if the paralytic drug sodium thiopental had been properly injected into his vein. In addition to the apparent lack of effectiveness of the paralytic drug or its placement in the surrounding tissue and not into the vein as intended, it took a full 16 minutes for Newton to die. On average, the amount of time it takes from the beginning of administration of the first drug to death is 8 minutes. With his death taking twice as long and with obvious signs he was not unconscious this clearly demonstrates two critical flaws in the current protocol. The personnel used to place the IV and administer the drugs, and the drug pancuronium bromide, which rendered Brian Steckel unable to alert anyone that he was still conscious and suffocating while awaiting death from potassium chloride. The personnel who place the IV into the condemned inmate’s vein should be a skilled EMT or phlebotomist and not a prison official. In most cases, prison officials with no official medical training are tasked with placing IVs into individuals whose veins are difficult to find due to IV drug use or obesity. Most lethal injection protocols say little or nothing at all about the training, credentials, or experience required of persons who will be on the execution team, either the person who inserts the IV or the persons responsible for injecting and monitoring the drugs. No state lethal injection protocol expressly requires the team to include an anesthesiologist or someone with training in anesthesiology. In a humane lethal injection protocol, the use of trained medical personnel to carryout difficult and skilled tasks such as IV placement to ensure drugs are administered into a vein and not into surrounding tissue should be a minimum requirement. Lastly, pancuronium bromide was partly responsible for the agonizing deaths in both of the executions for different reasons. In conclusion, medical evidence suggests that a simpler and more humane method would consist of a two-drug method of execution. This would not only be simpler to perform, but most importantly would ensure a humane death was achieved every time. First, an EMT would place two IV ports into two veins, one in each arm or leg if the veins in the condemned are hard to find due to IV drug use or other factors such as extreme obesity. Second, an injection of sodium thiopental sufficient to cause unconsciousness with the dosage calculated and based upon the subjects weight and tolerance. Lastly, immediately following confirmation that unconsciousness has been achieved an injection into the same IV port by the EMT of pentobarbital sufficient to induce death quickly followed by a saline flush. This would not only be a simpler procedure requiring the use of only two drugs, but would completely eliminate the fear of suffocation and therefor the possibility of an excruciating and painful inhumane death. Pancuronium bromide should not be used for lethal injection because it has led to agonizing deaths by suffocation and is therefore an inhumane part of any lethal injection protocol.

The search for a painless and quick death continues but the method outlined would better serve to carry out the execution in a manner that is as humane as possible. Lethal injection is one-step closer to the ultimate humane method of putting criminals who have committed horrid and brutal crimes to death. Although some may argue that, a criminal who has committed atrocious crimes should be put to death in a manner that is consistent with their culpability. While this may be true to some degree, what punishment can be more severe than death? Lethal injection is by far a more humane method of execution than earlier methods of execution, but the search for the ultimate manner of inducing death humanely continues.

 

Revised 11/29/2015


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