The Medical Execution and Medical Assistance at Executions

In 1977, Oklahoma Medical Examiner, Dr. A. Jay Chapman, marched into the Oklahoma Statehouse and dictated the formula for a cocktail of three drugs to a lawmaker looking for a more humane way to execute prisoners.
As Chapman spoke, Rep. Bill Wiseman scribbled on a legal yellow pad. That afternoon, Wiseman introduced the bill that made Oklahoma the first state to adopt “lethal injection”, the medical execution killing prisoners with medicine.

Lethal injection in the US

Since then lethal injection became the preferred method of execution in the US. Today, all US-states retaining the death penalty (29 states (Oct. 2019)) and the federal government have lethal injection as their primary method of execution.

Texas became the first state to use lethal injection when Charles Brooks on December 2nd 1982 was executed with an i.v. injection of the three drugs suggested by Dr. Chapman:

(1) sodiumthiopental, a barbiturateanesthetic, which is supposed to induce deep unconsciousness in about 20 seconds,

(2) pancuronium bromide, a total muscle relaxant that, given in sufficient dosages, paralyzes all voluntary muscles, thereby causing suffocation, and

(3) potassium chloride, which induces irreversible cardiac arrest.

However, the authorities soon faced several obstacles to the use of the “human” lethal injection:

  •  Shortly after lethal injection was introduced, the medical profession protested against the involvement of medical personnel in lethal injection. Doctors and nurses’ associations at national and international level adopted resolutions and statements against medical participation in executions. This left states to use medical technicians and sometimes willing doctors, doctors being paid in cash and their names kept secret.
  •  During the past 10 years an increasing number of pharmaceutical companies have obstructed the use of their drugs for executions. States have been forced to buy drugs from dubious wholesalers and compounding pharmacies, a practice often stopped by the Federal Drug Administration (FDA).
  •  These problems resulted in several states experimenting with untested drug combinations or single dose executions. Many executions have been stopped by the justice system due to the risk of botched executions.
  • As a result of the above-mentioned problems, a significant number of executions goes wrong resulting in prolonged suffering for the prisoner.

Probably the above-mentioned problems have contributed to the steady decline in the number of executions in the US during the past 20 years, a slow, but steady, fall in the number of states using the death penalty or having this medieval punishment in their legislation and a slow, but steady, fall in public support for the death penalty.

Lethal injection outside the US

A surprisingly low number of countries using the death penalty have adopted lethal injection as method of execution.

Besides the US only three countries use lethal injection: Viet Nam, Thailand and China:

  •  Viet Nam introduced lethal injection in 2010. Due to tighter EU regulations on the export of the drugs needed for lethal injections, Viet Nam introduced a new law in 2013 stating that Viet Nam can now use drugs produced outside the EU or domestically. Which drugs Viet Nam uses are a secret. The number of executions in Viet Nam is not known, but Amnesty estimates, that the amount exceeded 85 in 2018. It is not known whether medical personel participate in executions.
  •  Thailand introduced lethal injection in 2003, only 7 prisoners have been executed, the last in 2018 after 9 years with no executions. It is not known whether medical personel participate in executions.
  •  China introduced lethal injection in 1996, and it has increasingly replaced shooting. Mobile vans are used for lethal injection and organs might be harvested from executed prisoners for transplantation purposes. The extent of medical participation is not known. In 2007 the Chinese Medical Association agreed that organs of prisoners and other individuals in custody must not be used for transplantation, except for members of their immediate family.

The number of executions in China is a state secret, but Amnesty estimate that it should be counted in thousands.

Medical assistance at executions with traditional methods (and lethal injection)

Doctors participation in traditional executions (hanging, shooting, electric chair, gas chamber) is common and widespread. Some examples:

  •  examining prisoners before the execution, prescribing sedatives
  •  giving advice to the executioner concerning the execution
  •  monitoring the prisoner during the execution (f.ex. ECG)
  •  examining the prisoner immediately after the execution whether death has occurred

Being involved in executions in these ways violates fundamental medical ethics as much as participation in lethal injection.

Written: 2020-06-04 By Jakob Mertz