Say Execution Drug May Hide Suffering
The New York Times
October 7, 2003
NASHVILLE, Oct. 1
— At the Riverbend Maximum Security Institution here, through
a set of double doors next to several vending machines, a gurney
stands ready to deliver prisoners to their executions by lethal
Just about every
aspect of the death penalty provokes acrimonious debate, but this
method of killing, by common consensus, is as humane as medicine
can make it. People who have witnessed injection executions say
the deaths appeared hauntingly serene, more evocative of the operating
room than of the gallows.
But a growing number
of legal and medical experts are warning that the apparent tranquillity
of a lethal injection may be deceptive. They say the standard
method of executing people in most states could lead to paralysis
that masks intense distress, leaving a wide-awake inmate unable
to speak or cry out as he slowly suffocates.
In 2001, it became
a crime for veterinarians in Tennessee to use one of the chemicals
in that standard method to euthanize pets.
The chemical, pancuronium
bromide, has been among those specified for use in lethal injections
since Oklahoma first adopted that method of execution in 1977.
Only now, though, is widespread attention starting to focus on
Spurred by a lawsuit
by a death row inmate here, advances in human and veterinary medicine,
and a study last year that revealed for the first time the chemicals
that many other states use to carry out executions, experts have
started to question this part of the standard lethal injection
paralyzes the skeletal muscles but does not affect the brain or
nerves. A person injected with it remains conscious but cannot
move or speak.
In Tennessee and
about 30 other states, the chemical is used in combination with
two others. The other chemicals can either ease or exacerbate
the suffering the pancuronium bromide causes, depending on the
dosages and the expertise of the prison personnel who administer
A judge here recently
found that pancuronium bromide, marketed under the trade name
Pavulon, has "no legitimate purpose."
gives all the appearances of a serene expiration when actually
the subject is feeling and perceiving the excruciatingly painful
ordeal of death by lethal injection," the judge, Ellen Hobbs
Lyle, wrote, describing the worst-case scenario. "The Pavulon
gives a false impression of serenity to viewers, making punishment
by death more palatable and acceptable to society."
A simpler and more
humane alternative to the three-chemical combination, many experts
agree, is the method usually used in animal euthanasia: a single
lethal dose of a barbiturate called sodium pentobarbital.
Dr. Sherwin B. Nuland,
who teaches medicine at Yale and wrote "How We Die"
(Knopf, 1994) said he was baffled to hear that pancuronium bromide
was used in executions.
me that it makes no sense to use a muscle relaxant in executing
people," he said. "Complete muscle paralysis does not
mean loss of pain sensation."
Dr. Nuland, who described
himself as a cautious supporter of the death penalty, said a humane
death could be achieved in other ways, including by using the
other two chemicals in the standard method, without the pancuronium
The challenge to
the use of pancuronium bromide was brought in chancery court here
by Abu-Ali Abdur'Rahman, who is on death row for a 1986 murder.
Judge Lyle wrote that the use of the chemical "taps into
every citizen's fear that the government manipulates the setting
and gilds the lily." But despite her misgivings, she ruled
that the use of the drug did not violate the Constitution's ban
on cruel and unusual punishment, because it was widely used and
because "there is less than a remote chance that the prisoner
will be subjected to unnecessary physical pain or psychological
The case is on appeal.
52, is being held at the Riverbend prison, along with 92 other
death row inmates. He is short and slight, and his long beard
has turned gray. He spoke to a visitor through thick glass.
I'm less than an animal," Mr. Abdur'Rahman said. "The
poison they put into our veins needs to be challenged. Had my
attorneys not researched this, I doubt very much it would have
come to light."
The American Veterinary
Medical Association condemns pancuronium bromide when it is the
sole chemical used or when it is used in combination with the
usual animal euthanasia drug, sodium pentobarbital. That is because,
an association report in 2000 said, "the animal may perceive
pain and distress after it is immobilized."
is now the dominant way Americans are executed. It is used in
all 38 states that have the death penalty except Nebraska, which
uses electrocution. In 10 states, prisoners may choose between
lethal injection and a second method, including hanging, firing
squad, electrocution and lethal gas.
In most methods of
lethal injection, pancuronium bromide is the second drug in a
The first is sodium
thiopental, a so-called ultra-short-acting barbiturate. It can
be effective for only minutes. In surgery, it is used to induce
rather than maintain anesthesia. Doctors like it because patients
who encounter immediate complications awaken quickly enough to
The third is potassium
chloride, which stops the heart and causes excruciating pain if
the prisoner is conscious.
"It would basically
deliver the maximum amount of pain the veins can deliver, which
is a lot," Dr. Mark J. S. Heath, an anesthesiologist who
teaches at Columbia, testified at a hearing for Mr. Abdur'Rahman.
One problem with
the combination of chemicals, Dr. Heath said in an interview,
is that the sodium thiopental could be inadequate or wear off.
That would leave the prisoner conscious, paralyzed, suffocating
and subject to extreme pain from the potassium chloride.
"You're in a
chemical tomb," he said.
The possibility of
improper doses or sequences and of bungled injections is increased,
Dr. Heath said, because doctors may not take part in executions
under most codes of medical ethics.
The reason for pancuronium
bromide in the standard lethal injection method is not well understood.
Judge Lyle found that Tennessee's method "was developed simply
by copying the same method used in some 30 other states."
Deborah W. Denno,
a law professor at Fordham University who published a study of
the chemicals used in lethal injections last year, said that assembling
information for it was difficult.
has been so hidden," said Professor Denno, who described
herself as an opponent of the death penalty.
Four states said
their protocols for lethal injection were confidential; three
said they had none. Except for New Jersey, which does not use
pancuronium bromide, all 28 states that supplied Professor Denno
with information used the same three-chemical combination. So
does the federal government.
"The idea of
even having a lethal injection protocol specifying exact chemicals
is a very recent phenomenon," Professor Denno said, "and
that's only because prison officials have been pressed to provide
them. Nobody really knew what chemicals were being used."
The earliest protocol,
in Oklahoma, was based on advice solicited by a state senator
from a professor in the state's medical school. The professor,
Stanley Deutsch, recommended an ultra-short-acting barbituate
and a neuromuscular blocking drug like pancuronium bromide.
"I can assure
you that this is a rapid, pleasant way of producing unconsciousness,"
Dr. Deutsch wrote in 1977.
In a recent interview,
Dr. Deutsch stood by his initial finding, saying his method does
not cause suffering. "They use such a massive amount of the
penthothal that I don't think there is any chance that people
will awaken," he said.
Other states, typically
acting through their corrections departments and individual prison
wardens, apparently copied Dr. Deutsch's advice without subjecting
it to independent medical scrutiny.
The prison warden
who developed Tennessee's method, for instance, testified that
he did not consult with anyone with a medical or scientific background.
The warden, Ricky J. Bell, declined to be interviewed.
A spokeswoman for
the Tennessee attorney general also declined to comment and directed
a reporter to the state's legal papers. They do not defend the
use of pancuronium bromide beyond noting that it is widely used
and so should not be considered cruel and unusual punishment under
The state's legal
papers also argued that the ban on pancuronium bromide in pet
euthanasia does not apply to Mr. Abdur'Rahman because he is not
a "nonlivestock animal," which the law says includes
pets, captured wildlife, exotic and domesticated animals, rabbits,
chicks, ducks and potbellied pigs.
Carol Weihrer, who
underwent eye surgery in 1998, testified for Mr. Abdur'Rahman
at the hearing in May. Anesthesia was administered before the
surgery, as was pancuronium bromide to immobilize the eye. But
the anesthesia was ineffective. Ms. Weihrer testified that the
experience was terrifying and torturous. She could not, she said,
communicate that she was awake.
using every ounce of my strength to try to move," she said.
The surgery went
on for hours. She did not suffocate because she was on a respirator.
Ms. Weihrer called
the experience "worse than death."