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Lethal injection

Lethal injection is a method of capital punishment that administers a combination of drugs intravenously to induce unconsciousness, respiratory arrest, and cardiac failure, intended to produce death more rapidly and with less visible distress than prior execution techniques such as electrocution or gas chambers.^[1] Adopted by Texas in 1977 as a perceived humane alternative, it was first implemented there on December 7, 1982, with the execution of Charlie Brooks, and has since become the dominant execution method across U.S. states authorizing the death penalty.^[2] As of 2025, lethal injection remains the most frequently employed protocol, accounting for the majority of the 35 executions carried out nationwide that year, though drug shortages and sourcing challenges have prompted some states to authorize alternatives like nitrogen hypoxia or firing squads.^[3]^[4] The standard protocol historically utilized a three-drug sequence: a barbiturate such as sodium thiopental or pentobarbital to render the inmate unconscious, a paralytic agent like pancuronium bromide to halt breathing, and potassium chloride to induce cardiac arrest.^[5] Variations have emerged, including single-drug protocols with high doses of pentobarbital, as federal and state authorities adapted to pharmaceutical manufacturers' refusals to supply execution-grade drugs, often relying on compounded versions whose potency and sterility raise additional risks.^[6]^[7] Despite its design to minimize suffering, lethal injection has been marred by frequent procedural failures, with empirical analyses indicating higher botch rates compared to other methods—defined by difficulties in venous access, inadequate sedation, or prolonged time to death—potentially resulting in conscious suffocation or chemical burns from unanesthetized exposure to paralytics and salts.^[8]^[9] Autopsy toxicology and eyewitness accounts from multiple executions reveal instances where inmates exhibited signs of awareness and distress, challenging claims of inherent humanity and fueling Eighth Amendment litigation, though the U.S. Supreme Court upheld midazolam-based protocols in 2015 amid ongoing disputes over causal mechanisms of pain.^[10]^[9] These issues stem from first-principles challenges in achieving reliable intravenous delivery under stress and ensuring supramaximal anesthesia against physiological variability, compounded by non-medical personnel conducting procedures.^[11]

History

Origins and Early Proposals

Lethal injection as a method of capital punishment was first proposed in the late 19th century amid efforts to develop more reliable and less visibly brutal alternatives to hanging, which often resulted in prolonged suffering or botched executions. In 1888, New York physician J. Mount Bleyer advocated for the intravenous administration of a high dose of morphine to induce rapid unconsciousness and death, claiming it would be both more humane—producing death within minutes without physical trauma—and cost-effective compared to constructing gallows or employing executioners. Bleyer's proposal was considered by a New York legislative commission tasked with reforming execution methods, but it was ultimately rejected due to concerns over public perception of injecting poisons and the method's untested nature in humans for capital purposes.^[12]^[13] Similar ideas emerged elsewhere but gained no traction before the mid-20th century. For instance, British authorities evaluated lethal injection in the 19th century but dismissed it in favor of hanging, citing insufficient evidence of instantaneous and painless death. These early concepts drew from medical practices like euthanasia in veterinary or terminal care settings, where sedatives were used to ease suffering, but lacked empirical validation for judicial executions, as no state conducted trials or adopted the method.^[14] The modern protocol for lethal injection originated in the United States during the post-Furman v. Georgia era, following the 1972 Supreme Court moratorium on executions. In 1977, Oklahoma State Medical Examiner Dr. Jay Chapman proposed a three-drug sequence to lawmakers seeking a humane alternative to electrocution or other methods reinstated after Gregg v. Georgia (1976). Chapman's blueprint involved an initial intravenous saline drip, followed by sodium thiopental to anesthetize, pancuronium bromide to paralyze muscles, and potassium chloride to induce cardiac arrest, aiming to ensure unconsciousness before lethality. Oklahoma enacted the protocol on May 10, 1977, becoming the first jurisdiction to authorize lethal injection, though it was not used until Texas implemented it in 1982.^[15]^[16]^[17]

Adoption in the United States

Oklahoma enacted the first state statute authorizing lethal injection as a method of execution on May 11, 1977, following the U.S. Supreme Court's reinstatement of capital punishment in Gregg v. Georgia (1976), with lawmakers citing humanitarian and economic motivations for replacing electrocution.^[18]^[19] Texas followed suit the next day, adopting lethal injection statutes amid similar concerns over the perceived inhumanity of prior methods like the electric chair.^[20] The protocol originated from consultations with Oklahoma's state medical examiner, Dr. Jay Chapman, who drew from veterinary euthanasia practices to propose a three-drug sequence aimed at inducing unconsciousness, paralysis, and cardiac arrest.^[20] Texas conducted the first lethal injection execution on December 7, 1982, when Charles Brooks, Jr., convicted of murdering an auto mechanic in 1976, was put to death at the Huntsville Unit penitentiary.^[2]^[21] By 1981, five states had enacted lethal injection laws, reflecting a broader shift toward this method as a supposedly more reliable and less visually disturbing alternative to hanging, firing squads, or electrocution, which had faced public and legal scrutiny for causing prolonged suffering.^[20] Adoption accelerated in the 1980s and 1990s, with states amending statutes to designate lethal injection as the primary or exclusive execution method; for instance, by the early 2000s, it had supplanted other techniques in 36 of the 38 states then authorizing capital punishment, excepting Nebraska's retention of electrocution until 2009 and a few allowances for inmate choice.^[20] The rapid proliferation stemmed from legislative efforts to standardize executions post-Gregg, minimizing constitutional challenges under the Eighth Amendment's prohibition on cruel and unusual punishment, as lethal injection was marketed as clinically precise and painless based on medical analogies.^[20] However, early implementations varied in protocol details, with some states initially permitting alternatives before mandating the intravenous approach exclusively.^[22] Federal adoption occurred later, with the U.S. government authorizing lethal injection for military executions in 1983 and civilian federal death row in 1994 under the Federal Death Penalty Act, though the first federal lethal injection took place in 2001 for Timothy McVeigh.^[16] This method's dominance persisted despite subsequent litigation over drug sourcing and administration, as states viewed it as the most defensible option amid evolving pharmacological and legal landscapes.^[20]

Global Implementation

China became the first country outside the United States to carry out an execution by lethal injection in 1997, marking the method's initial global expansion beyond American jurisdictions.^[19] Prior to this, Taiwan had legalized lethal injection in 1995 as the first non-U.S. jurisdiction to do so, though it has never conducted an execution using the method.^[23] The adoption in China reflected a shift from traditional firing squads, driven by state efforts to modernize execution procedures and reduce public spectacle, with lethal injection increasingly administered via mobile execution vans for efficiency.^[24] By the early 2000s, China had expanded its use, executing an estimated 1,800 people in 2004 alone, the majority by injection, surpassing global totals from all other nations combined that year.^[25] Vietnam adopted lethal injection as its sole method of execution in 2011, abolishing firing squads effective from 2013 to align with perceived humanitarian standards while maintaining high execution volumes for crimes such as drug trafficking and murder.^[26] Between 2013 and 2017, Vietnamese authorities executed at least 429 individuals by this method, with procedures conducted secretly at one of 11 designated facilities, often without prior warning to prisoners.^[27] The country maintains opacity on exact figures, but reports indicate hundreds of executions annually in peak years, primarily via intravenous administration of barbiturates and paralytics.^[28] Other nations have implemented lethal injection on a limited scale. The Philippines authorized the method in 1993 and conducted seven executions between 1996 and 2000 before abolishing capital punishment in 2006.^[29] Guatemala performed one lethal injection execution in 2000, after which the practice ceased amid legal challenges and a moratorium on the death penalty.^[29] Globally, lethal injection remains confined to a handful of countries, with China accounting for the vast majority of cases—estimated in the thousands annually as of 2023, though official statistics are classified as state secrets.^[30] This contrasts with broader international trends toward abolition, as only China, Vietnam, and the United States actively employ the method today.^[31]

Evolution and Recent Developments

Following the initial adoption of lethal injection in the late 1970s, the standard protocol in the United States evolved from a three-drug combination—sodium thiopental for anesthesia, pancuronium bromide as a paralytic, and potassium chloride to induce cardiac arrest—to variations driven by pharmaceutical supply disruptions beginning around 2010.^[32] European manufacturers halted exports of execution drugs to the U.S. due to ethical concerns, leading states to seek alternatives like pentobarbital, initially sourced from compounding pharmacies or foreign suppliers.^[33] This shift prompted "second-generation" protocols, including single-drug pentobarbital regimens adopted by states such as Missouri in 2012 and the federal government for its 2020 resumption of executions after a 17-year hiatus.^[34]^[35] Legal scrutiny intensified with U.S. Supreme Court cases examining protocol risks, such as Baze v. Rees (2008), which upheld the three-drug method absent evidence of severe pain exceeding electrocution alternatives, and Glossip v. Gross (2015), which approved midazolam as a sedative substitute despite its association with prolonged consciousness and distress in executions like Oklahoma's 2014 Clayton Lockett case, where a vein collapse delayed death by 43 minutes.^[34]^[10] These rulings emphasized states' leeway in protocol adjustments while requiring identification of feasible, less painful alternatives, contributing to further experimentation with drugs like fentanyl combinations in some jurisdictions.^[34] Autopsy data from midazolam-based executions revealed pulmonary complications, such as fluid buildup causing air hunger, in cases from 2014–2020, underscoring physiological uncertainties in sedative efficacy.^[36] By 2025, lethal injection remained the dominant method, accounting for 33 of 40 U.S. executions that year, with states like Florida, Texas, Alabama, and South Carolina conducting the majority amid resolved but intermittent supply issues via domestic compounding.^[37] However, persistent drug access barriers—exacerbated by manufacturer refusals and federal import restrictions—led some states to authorize backups like nitrogen hypoxia (first used in Alabama in 2024) or firing squads, reflecting lethal injection's operational vulnerabilities rather than outright abandonment.^[38] Execution numbers climbed to 35 by October 2025, reversing prior declines tied to protocol litigation, though states like Ohio deferred cases to 2028 citing unresolved drug reliability.^[37]^[39] Ongoing secrecy in drug sourcing, mandated by laws in over 30 states, has fueled challenges alleging Eighth Amendment violations from untested admixtures, with empirical botch rates estimated at 7–10% since 1982 based on visible failures like convulsions or extended durations.^[40]

Protocols and Procedures

United States Protocols

Lethal injection protocols in the United States vary across the 27 states that authorize capital punishment, primarily involving intravenous delivery of pharmaceutical agents to induce unconsciousness followed by cardiac arrest, with execution teams rather than licensed physicians handling administration due to medical ethics restrictions.^[5] The inmate is typically restrained to a gurney in a dedicated chamber, where one or two peripheral IV lines are inserted into the arms or, if veins prove inadequate, central venous access is established in the groin or neck by trained personnel such as emergency medical technicians.^[41] Saline flushes precede and follow drug injections to confirm line patency, with electrocardiographic monitoring used to verify heart cessation, after which death is pronounced by a physician observing from an adjacent room.^[42] Drug regimens have evolved from a standard three-drug sequence— an anesthetic barbiturate (historically sodium thiopental, now often pentobarbital or midazolam), a paralytic neuromuscular blocker (such as pancuronium bromide or vecuronium bromide), and potassium chloride to disrupt cardiac rhythm— to single- or two-drug alternatives amid shortages of commercially sourced pharmaceuticals.^[43] As of 2025, at least 17 states employ pentobarbital as a single agent in doses of approximately 5 grams, administered to suppress central nervous system function and respiration, as exemplified by Texas, which has executed more individuals by this method than any other state since adopting lethal injection in 1982.^[44]^[2]^[45] State-specific variations persist; for instance, Florida's protocol incorporates etomidate as the initial sedative, fentanyl for analgesia, cisatracurium as the paralytic, and potassium chloride, while Tennessee announced in early 2025 a shift to a new compounded pentobarbital formulation for resumed executions.^[42]^[46] Secrecy statutes in over 30 jurisdictions shield drug suppliers, compounding pharmacies, and executioner identities to mitigate litigation and procurement challenges stemming from manufacturer refusals to supply execution-grade chemicals.^[7] At the federal level, the Bureau of Prisons previously utilized a single 5-gram pentobarbital dose during 13 executions in 2020–2021, but Attorney General Merrick Garland rescinded this protocol in January 2025 after a review concluded it risked unconstitutional pain and suffering, imposing an indefinite moratorium despite a subsequent executive order directing resumption.^[47]^[48] No federal executions have occurred since, with protocols remaining under revision as of October 2025.^[49]

International Protocols

Lethal injection protocols outside the United States vary by country and are often shrouded in secrecy, particularly in nations with high execution volumes like China, where official details are classified to maintain state control over the process. Unlike the relatively documented U.S. procedures, international variants lack standardization and public oversight, with many relying on a sequence of sedative, paralytic, and cardiac-arrest drugs akin to early American models, though empirical verification is limited by restricted access to execution sites and records. Countries employing this method include China, Vietnam, and Thailand, where it serves as the primary or sole execution technique for capital offenses such as murder and drug trafficking.^[23]^[31] In China, lethal injection was introduced nationwide in 1996 as a shift from firing squads, enabling executions in fixed chambers or mobile "execution vans" for efficiency and reduced visibility, with the latter involving prisoners strapped to a bed inside a converted vehicle where a technician inserts an intravenous line before a remote button activates the drug flow. Protocols reportedly mirror the U.S. three-drug regimen—typically sodium thiopental for anesthesia, pancuronium bromide for paralysis, and potassium chloride for cardiac arrest—though some accounts suggest a simplified two-drug approach, and confirmation of death relies on observable cessation of heartbeat, respiration, and pupil dilation without advanced monitoring. China's opacity, driven by national security classifications, impedes independent assessment of efficacy or complications, but state media highlight the method's supposed cleanliness and cost-effectiveness over alternatives. Annual executions number in the thousands, far exceeding global totals elsewhere, underscoring its scale despite unverifiable procedural consistency.^[50]^[51]^[24] Vietnam adopted lethal injection as the exclusive method in 2011 via Decree 82/2011/ND-CP, replacing firing squads to align with perceived humanitarian standards, though drug procurement challenges from European export restrictions have delayed implementations, prompting occasional consideration of reverting to shootings. The process employs a three-drug cocktail administered intravenously in designated facilities, targeting rapid unconsciousness followed by paralysis and heart stoppage, with executions conducted for crimes like large-scale drug offenses; as of 2022, at least 11 such sites operate nationwide, but exact numbers of procedures remain undisclosed, complicating empirical analysis of outcomes.^[52]^[53]^[28] Thailand transitioned to lethal injection in 2003 under royal decree, abolishing shooting as the default, with executions involving intravenous delivery of sedatives and lethal agents in prison settings; the method has been applied sporadically, including in 2018 for a murder conviction, marking the first since 2009 amid a de facto moratorium. Detailed pharmacological sequences are not publicly specified, but alignment with conventional protocols is inferred from regional patterns, prioritizing cardiac arrest with minimal reported malfunctions. Guatemala legalized lethal injection in 1996, executing once in 1998 before a hiatus, using it as the primary option over firing squads, though subsequent constitutional challenges and low usage rates limit data on procedural reliability. Across these nations, the absence of mandatory post-execution autopsies or failure disclosures contrasts with U.S. litigation-driven transparency, potentially masking physiological risks like incomplete anesthesia.^[54]^[29]^[23]

Step-by-Step Execution Process

The execution process for lethal injection typically begins with the condemned inmate being escorted from a holding cell to the execution chamber, often shortly before the scheduled time, and secured to a gurney with restraints on the arms, legs, and torso to prevent movement.^[55] Medical team members, who may include execution technicians rather than licensed physicians, then insert one or two intravenous (IV) catheters into the inmate's veins, usually in the arms but sometimes in the legs or neck if peripheral veins are inadequate; a primary IV line is established, with a backup prepared, and saline solution is flushed through to confirm patency.^[55]^[56] Electrocardiograph leads may be attached to monitor heart activity, and the inmate is given an opportunity for final statements before a curtain or partition is opened for witnesses, including officials, media, and victims' representatives, to observe from an adjacent room.^[56] Once the warden confirms readiness and gives the signal, the execution team in a separate room administers the drugs sequentially through the IV lines using pre-filled syringes, starting with a sedative or anesthetic intended to induce unconsciousness, followed by a paralytic agent to immobilize muscles, and concluding with a potassium-based solution to induce cardiac arrest.^[55]^[43] In protocols employing multiple syringes, such as those with 11 syringes in some states, the drugs are alternated between primary and backup lines, with saline flushes between doses to clear the tubing; consciousness is checked via physical stimuli like a sternal rub after the initial sedative, delaying subsequent injections if responsiveness persists.^[56] The process aims for rapid progression, with unconsciousness expected within seconds to minutes, paralysis shortly after, and heart stoppage within 30-60 seconds of the final drug, though actual timelines vary based on dosage, vein access, and individual physiology.^[56] Upon observing a flatline on the heart monitor or absence of vital signs, a physician or qualified medical personnel enters the chamber to pronounce death, typically after confirming no pulse and respiratory arrest, at which point the official time of death is recorded and announced.^[56] The body is then removed from the gurney, prepared for autopsy as required by law in most jurisdictions, and released to family or buried per state procedures; witnesses are escorted out, and the chamber is secured.^[55] Protocols differ across states—for instance, some use single-drug overdoses instead of three-drug sequences due to pharmaceutical shortages, and IV placement may involve femoral veins under local anesthesia—but the core sequence emphasizes sequential IV delivery without real-time anesthesia monitoring or reversal capabilities.^[43]^[55]

Pharmacological Components

Conventional Three-Drug Protocol

The conventional three-drug protocol for lethal injection, first proposed by Oklahoma medical examiner Jay Chapman in 1977, involves sequential intravenous administration of sodium thiopental (or a substitute barbiturate such as pentobarbital), pancuronium bromide, and potassium chloride.^[57]^[15] This sequence aims to induce unconsciousness, paralyze respiratory and skeletal muscles, and induce cardiac arrest, respectively, with typical dosages of approximately 5 grams of sodium thiopental, 100 milligrams of pancuronium bromide, and 240 milliequivalents of potassium chloride, though variations exist across states.^[58]^[59] Sodium thiopental, a short-acting barbiturate, is administered first to suppress central nervous system activity, rendering the inmate unconscious within 30-60 seconds if properly dosed, thereby preventing perception of subsequent drugs' effects.^[59]^[32] Pancuronium bromide, a non-depolarizing neuromuscular blocking agent, follows to inhibit acetylcholine at motor endplates, causing flaccid paralysis that halts spontaneous breathing and masks involuntary movements, with onset in 1-3 minutes.^[58]^[60] Potassium chloride, injected last, elevates serum potassium levels to disrupt cardiac electrophysiology, inducing ventricular fibrillation or asystole within seconds, leading to circulatory collapse.^[59]^[61] Oklahoma adopted this protocol in 1977 as part of the first U.S. lethal injection statute, with Texas conducting the inaugural execution using it on December 7, 1982, on Charlie Brooks; by 2006, over 30 states had implemented similar three-drug regimens modeled on Oklahoma's approach.^[20]^[62] The protocol's design assumes effective venous access and drug potency, but empirical analyses indicate risks of incomplete anesthesia, where pancuronium bromide could exacerbate asphyxiation without visible indicators due to paralysis, potentially prolonging distress if thiopental fails to achieve sufficient depth.^[1]^[59] Supply shortages of sodium thiopental, stemming from European export restrictions since 2011, prompted some states to substitute alternatives like midazolam, though the core three-drug structure persisted in many protocols until shifts toward single-drug methods in the 2010s.^[63]^[64]

Alternative and Single-Drug Protocols

Alternative protocols for lethal injection diverged from the conventional three-drug sequence following drug shortages initiated by European pharmaceutical restrictions in the early 2000s, which halted exports of sodium thiopental for use in executions, and intensified after the U.S. Supreme Court's 2008 decision in Baze v. Rees prompted states to revise procedures amid constitutional challenges.^[63] These adaptations prioritized drug availability from domestic compounding pharmacies, often under secrecy laws, to maintain execution timelines.^[65] Single-drug protocols, in particular, emerged as a streamlined approach, substituting a massive overdose of a barbiturate for the multi-drug combination to induce unconsciousness, respiratory failure, and cardiac arrest.^[66] The predominant single-drug protocol employs pentobarbital, a short-acting barbiturate originally used in veterinary euthanasia, administered intravenously in a total dose of approximately 5 grams, typically divided across two syringes of 2.5 grams each to ensure complete delivery despite potential vein issues.^[41] ^[67] ^[68] This dosage, far exceeding therapeutic levels, suppresses central nervous system activity to cause rapid coma followed by cessation of breathing and heart function within minutes.^[69] Ohio pioneered the single-drug method on December 8, 2009, initially with sodium thiopental before shifting to pentobarbital amid further supply constraints by late 2010.^[43] By 2025, at least ten states—including Arizona, Georgia, Idaho, Missouri, North Carolina, Oklahoma, South Dakota, Tennessee, Texas, and Utah—have adopted or maintained pentobarbital-based single-drug protocols, often as the primary or fallback option.^[5] For instance, Texas implemented it in April 2021, sourcing compounded pentobarbital covertly due to manufacturer embargoes.^[5] Tennessee revised its protocol to pentobarbital in January 2025 following a multi-year pause and review, executing Oscar Smith on May 22, 2025.^[5] The federal government briefly authorized a pentobarbital single-drug addendum in July 2019 for its resumed executions but rescinded it on January 15, 2025, citing risks such as pulmonary edema.^[5] ^[47] Other single-drug variants include sodium thiopental or sodium pentothal in states like Arizona and Kentucky, though pentobarbital supplanted them due to similar sourcing barriers.^[5] Limited two-drug alternatives, such as a barbiturate paired with a paralytic like pancuronium bromide in Montana, represent hybrid simplifications but retain elements of the original sequence, prioritizing anesthesia before paralysis.^[5] These protocols generally involve pre-execution vein access via peripheral IV lines, with saline flushes between syringes to prevent precipitation, and monitoring for consciousness via verbal response or tactile stimuli.^[41] Despite procedural safeguards, reliance on compounded drugs—unregulated for potency or sterility—has prompted litigation over variability in efficacy.^[65]

Mechanisms of Action and Physiological Effects

Lethal injection protocols primarily employ barbiturates for sedation, neuromuscular blockers for paralysis, and electrolytes for cardiac arrest, with the intended sequence inducing unconsciousness prior to respiratory cessation and heart stoppage. In the conventional three-drug regimen, sodium thiopental, administered at doses of 3-5 grams intravenously, acts as a barbiturate that potentiates GABA_A receptor activity by prolonging chloride ion channel opening, leading to neuronal hyperpolarization, rapid onset of unconsciousness within 30-60 seconds, and suppression of cerebral metabolism.^[70] ^[1] At lethal levels, it depresses respiratory and circulatory centers in the brainstem, potentially causing apnea and hypotension independently, though its duration of deep anesthesia is short, typically 5-10 minutes, raising risks of awareness if subsequent drugs are delayed.^[71] Thiopental lacks intrinsic analgesic properties and may even counteract pain relief, leaving the subject vulnerable to nociception from later agents if consciousness persists.^[1] Pancuronium bromide, dosed at 100 mg, follows as a non-depolarizing neuromuscular blocking agent that competitively antagonizes acetylcholine at postsynaptic nicotinic receptors on skeletal muscle endplates, inhibiting depolarization and causing flaccid paralysis, including diaphragmatic arrest that halts spontaneous breathing within 1-2 minutes.^[72] ^[73] This paralysis preserves consciousness and sensory perception intact, as it spares autonomic and central nervous system functions, potentially masking distress signals like convulsions or gasping if anesthesia is inadequate; physiologically, it exacerbates hypoxia by preventing compensatory respiratory efforts, contributing to hypercapnia and acidosis.^[1] In executions, pancuronium's role extends beyond facilitating IV access to ensuring immobility, though it accelerates death via anoxic cardiac failure if respiration fails before the final drug.^[32] Potassium chloride, injected at 240 mEq (approximately 18 grams), induces hyperkalemia that disrupts myocardial repolarization by elevating extracellular potassium, precipitating ventricular fibrillation or asystole within seconds of reaching the heart, with death ensuing from electromechanical dissociation.^[74] ^[75] Without prior unconsciousness, this elicits intense burning pain along venous pathways and central chest agony due to chemical irritation of nociceptors and cardiac tissue, comparable to severe electrolyte imbalance effects documented in medical overdoses.^[76] The overall process, if sequenced correctly, culminates in cardiopulmonary collapse, but empirical analyses indicate frequent reliance on asphyxiation from combined respiratory depression and paralysis rather than isolated potassium cardiotoxicity, as evidenced by autopsy findings of pulmonary edema consistent with hypoxic agonal states.^[1] ^[77] Alternative single-drug protocols, such as pentobarbital at 5 grams or more, leverage barbiturate overdose to progressively suppress CNS function via enhanced GABAergic inhibition, transitioning from sedation to coma, respiratory arrest through medullary depression, and eventual circulatory failure from vasodilation and myocardial weakening.^[78] ^[79] This method avoids paralytics, theoretically reducing risks of unanesthetized suffering, but high doses still provoke pulmonary congestion and cerebral hypoxia, with death occurring over 10-20 minutes via cumulative organ depression rather than instantaneous cardiac halt.^[77] Variations like midazolam-based regimens, intended as sedatives, exhibit weaker anesthetic potency and shorter half-lives, often failing to achieve reliable unconsciousness and permitting paradoxical agitation or awareness during subsequent hypoxia.^[36] Across protocols, physiological outcomes hinge on venous access efficacy and drug purity, with adulterated or compounded agents risking incomplete effects or exaggerated toxicity, such as barbiturate-induced vascular injury.^[77]

Efficacy and Empirical Outcomes

Success Rates and Statistical Data

Since its first use in Texas on December 7, 1982, lethal injection has accounted for approximately 1,400 executions in the United States as of 2024, representing over 90% of post-1976 executions overall.^[80] Empirical analyses define "success" variably, typically as completion within protocol timelines (e.g., death within 10-15 minutes without visible distress, multiple IV attempts exceeding 30 minutes, or equipment failures), with failure rates derived from state execution logs, witness accounts, and autopsy reports. Research by political scientist Austin Sarat, examining U.S. executions from 1890 to 2010, found a 7.1% botch rate specifically for lethal injections, higher than other methods like electrocution (1.9%) or hanging (7.4%), attributed to challenges in intravenous access and drug administration.^[81] ^[82] A 2024 analysis by the nonprofit Reprieve, reviewing 1,428 lethal injection attempts since 1982, identified 73 botched cases (5.1%), where botches included collapsed veins, air embolisms, or prolonged consciousness; this figure may undercount due to limited transparency in state records.^[83] Half of these botched executions involved Black inmates, who faced 220% higher odds of failure compared to white inmates, potentially linked to physiological factors like vein sclerosis from intravenous drug use rather than systemic incompetence alone.^[84] In contrast, states like Texas, with over 500 lethal injections since 1982, report lower failure rates (under 5% by their logs), often due to experienced teams and pentobarbital protocols, though independent verification is restricted by secrecy statutes.^[82] Recent trends show elevated failure rates amid drug shortages and protocol shifts. In 2022, 7 of 20 attempts (35%) were botched, including three-hour IV insertions in Alabama and multiple failures in Oklahoma, per reviews of official transcripts.^[40] ^[85] This marked a spike from the 1990s-2000s average of 2-3% annually, correlating with compounded pentobarbital use and reduced medical oversight, though death occurred in all cases, typically via respiratory arrest within 20 minutes post-injection.^[86] No lethal injection has resulted in survival to natural release, underscoring its physiological efficacy despite procedural variability.^[82]

Incidence of Botched Executions

A botched lethal injection execution is typically defined as one involving prolonged delays in preparation, such as difficulty establishing intravenous access exceeding 30-45 minutes; equipment malfunctions; or post-injection signs of consciousness, distress, or suffering, including convulsions, gasping, or vocalizations, as documented in witness testimonies, official reports, or court records.^[82]^[84] This definition, drawn from analyses by legal scholars like Austin Sarat, emphasizes gross incompetence or unnecessary agony rather than routine procedural variations.^[82] From the first lethal injection execution of Charles Brooks in Texas on December 7, 1982, through 2010, 76 out of 1,054 such procedures were classified as botched, yielding a rate of approximately 7.2%, the highest among execution methods examined.^[82] A 2024 review by the anti-death penalty organization Reprieve, analyzing 1,407 lethal injection executions or attempts from 1976 to December 2023, identified 73 botched cases, or about 5.2%, with the count deemed conservative due to secrecy in drug sourcing and procedural details that limits full verification.^[84] These figures derive primarily from public records, media accounts, and state investigations, though organizations like the Death Penalty Information Center (DPIC) and Reprieve, which advocate against capital punishment, may classify borderline cases—such as minor vein access delays—as botched more readily than state officials, potentially inflating rates absent independent audits.^[82]^[84] Recent years show elevated incidence, with 7 of 20 execution attempts in 2022 (35%) deemed botched by DPIC, including Alabama's execution of Joe Nathan James Jr. on July 28, 2022, where intravenous line insertion took over three hours amid reports of the inmate's audible distress.^[40]^[87] Other 2022 examples include Arizona's February 8 attempt on Murray Hooper, halted after nearly two hours of failed IV efforts, and Oklahoma's November 18 execution of John Grant, marked by convulsions and pulmonary edema lasting 20 minutes post-injection.^[40] Earlier high-profile cases, such as Oklahoma's April 29, 2014, execution of Clayton Lockett—where a botched vein insertion led to 43 minutes of writhing and moaning before death from a heart attack—underscore recurring issues with intravenous access and drug efficacy, often linked to non-medical personnel performing procedures.^[82]^[88] Racial disparities appear in the data, with Reprieve finding Black inmates experienced botched executions at twice the rate of white inmates (8% versus 4%), potentially attributable to physiological factors like vein accessibility or systemic selection biases in execution teams, though causal mechanisms remain understudied due to limited transparent empirical data.^[84] Overall, while most lethal injections proceed without visible complications—totaling 1,413 by August 2024—the botch rate exceeds that of historical methods like electrocution (1.9%) or hanging (7.1% in limited samples), prompting debates over procedural competence amid pharmaceutical restrictions on execution drugs.^[89]^[82]

Causes of Failures and Mitigation Factors

The primary causes of lethal injection failures center on difficulties in establishing reliable intravenous (IV) access, which occurs in a significant portion of documented botched executions. Execution teams, often lacking formal medical training, frequently struggle to locate suitable veins in condemned individuals, particularly those with histories of intravenous drug use, obesity, or vascular damage, leading to prolonged insertion attempts exceeding 25-35 minutes in cases such as those of John Barbee and Donnis Musgrove in Texas in 2022.^[40]^[40] When IV lines fail or infiltrate surrounding tissue—as in the 2014 execution of Clayton Lockett in Oklahoma, where midazolam leaked subcutaneously instead of entering the bloodstream—drugs are not properly delivered, resulting in incomplete anesthesia, visible distress, and eventual death from secondary causes like heart attack rather than the intended overdose.^[90] Drug selection, sourcing, and administration errors compound these vascular challenges. Supply shortages have prompted states to substitute barbiturates like pentobarbital with alternatives such as midazolam, a sedative not equivalent in inducing coma, leading to instances of apparent consciousness and respiratory distress, as evidenced by autopsies showing pulmonary edema (fluid-filled lungs) and signs of asphyxiation in executions like that of Joseph Wood in Arizona in 2014, where 640 milligrams of drugs over nearly two hours failed to suppress gasping and moaning.^[91]^[36] Protocols using paralytics like pancuronium bromide after inadequate sedation can mask outward signs of suffering while allowing internal sensations of drowning or suffocation, with forensic analyses indicating that potassium chloride induces cardiac arrest only after potential awareness of pain if prior steps fail.^[9]^[1] Compounding issues arise from unverified compounded drugs or improper mixing by non-pharmacists, contributing to variable efficacy.^[84] Empirical data on failure incidence vary by definition, with advocacy analyses reporting botch rates of approximately 7% for lethal injections since 1982—higher than historical methods like electrocution (1.9%)—defined to include IV delays, equipment malfunctions, or prolonged procedures, though severe cases involving evident agony represent a smaller subset.^[92]^[93] One study of 73 botched executions found racial disparities, with Black individuals comprising half despite being 34% of those executed, attributed to higher prevalence of vein damage from socioeconomic factors, though such claims originate from anti-death penalty organizations and require independent verification.^[83] Mitigation efforts have focused on protocol refinements to address vascular and pharmacological risks, including adoption of single-drug regimens using high-dose barbiturates like pentobarbital (5,000 mg or more), which eliminate paralytics and reduce sequencing errors, with proponents arguing lower botch potential compared to multi-drug sequences, though empirical comparisons remain limited and some states report persistent issues regardless of formulation.^[94]^[84] States like Ohio have implemented femoral central venous access or surgical cut-downs as backups when peripheral veins fail, shortening insertion times and improving delivery reliability in tested scenarios. Enhanced pre-execution vein mapping via ultrasound and mandatory timeouts for line verification aim to preempt infiltration, while some jurisdictions mandate post-audit reviews after anomalies, as in Alabama's 2022 pause following multiple IV failures to revise training.^[95] Increased protocol transparency, including disclosure of drug testing and team qualifications, has been proposed to facilitate iterative improvements, countering secrecy-driven errors, though legal barriers persist.^[96] Despite these measures, reliance on non-medical personnel and ethical refusals by physicians limit comprehensive safeguards, with no protocol guaranteeing absence of physiological variability or unseen distress.^[32]

Legal Framework

Constitutionality in the United States

The constitutionality of lethal injection as a method of execution in the United States has been challenged primarily under the Eighth Amendment's prohibition on "cruel and unusual punishments," with the Supreme Court consistently upholding it as a permissible means of capital punishment when administered according to established protocols that do not create a substantial risk of severe pain.^[97]^[98] In Baze v. Rees (2008), the Court, in a fragmented 7-2 decision, rejected claims that Kentucky's three-drug protocol—sodium thiopental, pancuronium bromide, and potassium chloride—posed an unconstitutional risk, holding that a method violates the Eighth Amendment only if it presents a "substantial risk of serious harm" that is "objectively intolerable," rather than mere possibility of mishap.^[97]^[99] Chief Justice Roberts's plurality opinion emphasized deference to state procedures designed to ensure humane execution, noting that safeguards like IV monitoring and qualified personnel mitigate risks sufficiently for constitutional compliance.^[98] Subsequent rulings reinforced this framework. In Glossip v. Gross (2015), a 5-4 decision upheld Oklahoma's use of midazolam as the first drug in place of unavailable barbiturates, clarifying that challengers bear the burden to identify a "known and available" alternative method that significantly reduces the substantial risk of severe pain without introducing its own serious risks.^[100]^[101] Justice Alito's majority opinion critiqued lower court findings for underestimating midazolam's sedative effects and overemphasizing speculative harms, while dissenting justices argued the drug's inefficacy heightened suffocation risks during paralysis and cardiac arrest.^[100] The Court in Bucklew v. Precythe (2019), another 5-4 ruling, dismissed an "as-applied" challenge by Missouri inmate Russell Bucklew, who claimed his rare congenital condition would cause choking on tumor blood during pentobarbital injection; it required proof of a feasible alternative (like lethal gas) via clear and convincing evidence at trial, not speculation, and affirmed states' broad latitude in execution methods absent demonstrated unconstitutionality.^[102]^[103] These precedents establish that lethal injection protocols are presumptively constitutional if they approximate a "humane" death akin to surgical anesthesia, with empirical evidence of rare botched executions (occurring in fewer than 7% of cases per federal reviews) failing to meet the substantial-risk threshold.^[99] Challenges often falter due to evidentiary hurdles, as inmates must demonstrate not just potential pain but a superadded risk beyond that inherent in any execution.^[100] As of October 2025, no Supreme Court decision has invalidated lethal injection outright, though states like Alabama and others have adopted alternatives such as nitrogen hypoxia amid drug shortages, reflecting practical adaptations rather than constitutional invalidity; recent denials of stays, as in Boyd v. Hamm on October 23, 2025, underscore ongoing judicial approval of state protocols.^[104]^[43] Lower courts continue to scrutinize specific implementations under these standards, with secrecy in drug sourcing sometimes complicating but not prohibiting challenges.^[105]

International Legal Status

Lethal injection serves as a primary method of execution in countries that retain capital punishment, including China, Vietnam, Thailand, Taiwan, and the United States, with China accounting for the vast majority of global executions via this means, estimated in the thousands annually though exact figures remain state secrets.^[106]^[107] Vietnam has confirmed its use of lethal injection since 2012, administering it through automated machines to ensure a three-drug protocol.^[108] Thailand adopted the method in 2003 but has maintained an unofficial moratorium on executions since 2018, while retaining it legally.^[108] Under international law, no treaty explicitly prohibits lethal injection as an execution method for states that have not abolished the death penalty. The International Covenant on Civil and Political Rights (ICCPR), ratified by over 170 countries, allows capital punishment for the most serious crimes in non-abolitionist states but mandates that it must not inflict "cruel, inhuman or degrading treatment or punishment" per Article 7.^[109] The Second Optional Protocol to the ICCPR, ratified by 90 states as of 2024, aims for abolition but does not address methods directly, leaving retentionist nations like China (non-party to the protocol) free to employ lethal injection without violating binding obligations on the technique itself.^[110] Regional instruments, such as Protocol No. 13 to the European Convention on Human Rights, prohibit the death penalty entirely in peacetime for signatories, rendering lethal injection moot in Europe, while the American Convention on Human Rights similarly restricts it across most of the Americas except the U.S.^[108] Human rights monitoring bodies have critiqued lethal injection's risks, with the UN Committee Against Torture arguing in general comments that it may inherently breach torture prohibitions due to frequent protocol failures causing conscious asphyxiation or chemical burns, regardless of intent for "humaneness."^[111] The UN Human Rights Committee has urged states to adopt moratoriums on all executions, implicitly including those by injection, citing empirical evidence of botched procedures in the U.S. and elsewhere that prolong suffering.^[112] However, these positions reflect interpretive advocacy rather than settled prohibitions; international customary law permits retentionist states to select methods like injection over alternatives such as shooting or hanging, provided they minimize evident pain, though enforcement relies on domestic compliance absent universal jurisdiction.^[113]^[114]

Regulatory Challenges and Secrecy Measures

States face significant regulatory hurdles in procuring and administering lethal injection drugs, primarily due to the lack of FDA approval for execution-specific uses and restrictions on interstate commerce. The Food and Drug Administration (FDA) has historically refused to regulate or approve drugs explicitly for lethal purposes, viewing them as outside its jurisdiction when intended solely for executions, as affirmed in a 2019 U.S. Department of Justice Office of Legal Counsel opinion that concluded FDA authority does not extend to substances used in capital punishment even if they are unapproved or misbranded for that application.^[115] This stance has led to instances where the FDA seized and declined to release illegally imported execution drugs, such as sodium thiopental shipments in 2010-2011, exacerbating shortages after European manufacturers halted exports.^[116] Compounding pharmacies, often relied upon for alternatives like pentobarbital, operate under lax federal oversight for non-standard preparations, complicating compliance with pharmaceutical safety standards and raising questions about drug potency and sterility absent rigorous investigational new drug protocols.^[117] ^[118] Pharmaceutical manufacturers' refusals to supply drugs for executions, citing ethical policies or pressure from advocacy groups, have driven states toward unregulated "gray markets" or foreign sources, undermining supply chain integrity and prompting legal challenges over whether such acquisitions violate federal drug laws.^[119] For instance, major producers like Pfizer announced in 2016 that their products could not be used in lethal injections, forcing states to seek anonymous compounding entities whose formulations evade standard FDA scrutiny.^[120] These sourcing difficulties have contributed to protocol delays, with some states pausing executions for years, as seen in federal cases where untested mixtures led to litigation over Eighth Amendment risks.^[121] To circumvent supplier boycotts and ensure continuity, at least 14 states have enacted secrecy statutes shielding the identities of drug manufacturers, compounding pharmacies, and execution personnel from public disclosure, often imposing criminal penalties for leaks.^[122] Texas, for example, maintains strict confidentiality over its pentobarbital supplier under state law, with documents from October 2025 revealing sourcing from a Connecticut firm but protected from broader revelation to avoid reprisals.^[7] Similar measures in Tennessee and South Carolina obscure procurement details, enabling gray-market purchases but limiting oversight of drug quality, as regulators and courts cannot verify compliance without access to supplier data.^[123] ^[124] Critics argue these laws reduce accountability and foster untested protocols, potentially increasing botched execution risks, while proponents contend they are necessary countermeasures to targeted corporate and activist interference that prioritizes non-lethal uses over state authority.^[125] ^[94] In Arizona, secrecy has compounded transparency issues amid recent execution restarts, with withheld protocol details hindering independent assessments of drug viability.^[126] Such measures have faced constitutional challenges, including First Amendment suits alleging they suppress public information essential for evaluating execution efficacy, as in a 2025 ACLU case against South Carolina's 2023 statute prohibiting disclosure of procurement sources.^[127] Despite this, courts have largely upheld secrecy provisions, balancing state interests in uninterrupted justice administration against disclosure demands, though empirical data on their impact remains sparse due to the opacity they enforce.^[120] By mid-2025, over two dozen jurisdictions retained capital punishment with varying secrecy protocols, illustrating a patchwork regulatory landscape where federal inaction amplifies state-level improvisation.

Ethical and Philosophical Debates

Arguments Supporting Lethal Injection

Proponents of lethal injection as an execution method emphasize its design to produce a rapid loss of consciousness followed by cardiac arrest or respiratory failure, thereby minimizing the condemned's awareness of suffering in comparison to methods involving physical trauma such as electrocution or hanging.^[128] The protocol typically begins with a high dose of a barbiturate like sodium thiopental or pentobarbital to induce deep anesthesia, succeeded by a paralytic agent and potassium chloride to halt the heart, simulating a controlled medical euthanasia process that avoids the visible convulsions or burns associated with electrical execution. This sequence, when administered correctly via intravenous lines, is intended to ensure death within minutes without the inmate experiencing pain, as affirmed by state corrections officials who describe it as a dignified and efficient procedure.^[128] ![Lethal injection execution chamber][float-right] The method's clinical appearance contributes to its preference among states, providing a less psychologically burdensome experience for execution teams, witnesses, and the public by resembling hospital procedures rather than overt violence, which reduces the spectacle of brutality seen in firing squads or gas chambers.^[38] In the 2008 Supreme Court case Baze v. Rees, Kentucky defended its three-drug protocol as substantially equivalent to accepted medical practices for sedation and euthanasia, arguing that any risk of inadvertent pain is negligible and does not rise to unconstitutional levels, a position upheld by the Court in rejecting challenges to the method's inherent cruelty.^[129] Empirical data from state records indicate that the vast majority of lethal injections—over 90% in analyses excluding minor procedural delays—proceed without observable signs of distress, contrasting with higher rates of visible failure in pre-1980s methods like electrocution, where botched cases often exceeded 1-2% but involved more graphic outcomes.^[130] Advocates further contend that lethal injection aligns with retributive justice by delivering certain death without prolonging the process, as evidenced by its adoption in all 27 U.S. states authorizing capital punishment as the primary method by 2020, reflecting legislative consensus on its reliability over alternatives amid drug supply challenges.^[131] Courts and state attorneys general have consistently maintained that the protocol's safeguards, including monitoring for vein access and dosage verification, mitigate rare complications, positioning it as a practical advancement over historically erratic techniques that inflicted undeniable physical agony.^[132]

Arguments Opposing Lethal Injection

Opponents of lethal injection contend that the method inflicts severe, unnecessary suffering, contradicting claims of its humanity. Empirical data from execution autopsies indicate that inmates frequently experience pulmonary edema, resulting in drowning-like sensations of asphyxiation and panic while potentially conscious due to insufficient anesthesia. A 2022 analysis of 43 U.S. lethal injection autopsies found fulminant pulmonary edema with frothy airways in 77% of cases, suggesting respiratory distress incompatible with a painless death.^[77]^[36] The protocol's use of paralytic agents like pancuronium bromide exacerbates this by immobilizing inmates, concealing outward signs of agony and enabling "invisible" torment from chemical burns caused by potassium chloride if barbiturate anesthesia fails. Toxicology evidence from multiple executions reveals sub-anesthetic levels of sedatives such as thiopental or midazolam, with one study documenting no detectable barbiturate in 43% of cases and inadequate doses in another 43%, permitting awareness during the burning injection of paralytics and heart-stopping agents.^[1]^[133] Midazolam, increasingly used amid drug shortages, has been criticized by anesthesiologists for producing "reliably zero" anesthetic depth, as evidenced in botched cases where inmates exhibited prolonged gasping.^[36] Botched executions further demonstrate the method's unreliability, with visible failures in 35% of 2022's 20 U.S. attempts, including extended convulsions and distress signaling conscious pain. High-profile incidents include Clayton Lockett's April 29, 2014, execution in Oklahoma, where collapsed veins led to subcutaneous drug injection, causing him to writhe, speak, and suffer for 43 minutes before a heart attack; and Joseph Wood's July 23, 2014, Arizona execution, marked by 640 gasps over nearly two hours.^[85]^[134] Such outcomes, opponents argue, violate the Eighth Amendment's prohibition on cruel and unusual punishment by subjecting inmates to experimental protocols prone to error without medical safeguards.^[82] Medical ethics provide another critique, as the procedure requires clinical skills but relies on non-physicians due to professional prohibitions, heightening risks of mishandling. The American Medical Association holds that physicians must not participate in executions, deeming it incompatible with healing duties, a stance echoed by anesthesiology bodies opposing any involvement in lethal injections.^[135]^[136] This reliance on unqualified personnel, combined with secrecy in drug sourcing and protocols, perpetuates a cycle of trial-and-error refinements that fail to eliminate suffering, rendering lethal injection inherently flawed rather than reliably humane.^[32]

Medical and Professional Ethics

The American Medical Association (AMA) maintains a longstanding policy opposing physician participation in executions, including those by lethal injection, on the grounds that such involvement fundamentally contravenes core medical ethics by enlisting healers in the act of state-sanctioned killing.^[135] The AMA's Code of Medical Ethics explicitly prohibits physicians from performing tasks such as selecting injection sites, inspecting or testing lethal injection devices, prescribing or administering lethal drugs, monitoring sedation, supervising personnel, or certifying death during the procedure, arguing that these actions erode public trust in the profession's commitment to beneficence and non-maleficence.^[135] This stance aligns with interpretations of the Hippocratic Oath, which historically prohibits using medical knowledge to inflict harm, as physicians are sworn to apply treatments for the benefit of patients rather than to facilitate punishment.^[137] Similar positions are held by other professional bodies, including the American Society of Anesthesiologists (ASA), which endorses the AMA's opposition and discourages anesthesiologists from any role in capital punishment, emphasizing that executions fall outside the practice of medicine.^[138] The consensus across major medical organizations—encompassing groups like the American Nurses Association and American Pharmacists Association—holds that participation violates principles of respect for persons, autonomy, and the profession's role in alleviating suffering rather than causing death, potentially medicalizing a penal process and blurring the line between therapeutic care and judicial retribution.^[139] Ethicists contend that even indirect involvement, such as advising on protocols to reduce suffering, undermines the physician-patient relationship, as the inmate is not a voluntary patient seeking healing but a subject of compulsory termination.^[140] Despite these ethical prohibitions, medical professionals have occasionally participated in lethal injections under conditions of anonymity and state secrecy, raising dilemmas about professional accountability; for instance, some states have enacted laws shielding participants from licensure repercussions, prioritizing execution continuity over ethical enforcement.^[141] This tension highlights a causal disconnect between medical oaths, which prioritize patient welfare, and legal imperatives that may compel or incentivize involvement, though professional bodies maintain that no protocol can reconcile killing with healing without compromising the integrity of medical practice.^[142] Proponents of minimal participation, arguing it could ensure humane administration, face rebuttal from ethicists who assert that even purportedly compassionate involvement perpetuates harm and public skepticism toward physicians' impartiality.^[143]

Controversies and Criticisms

Drug Sourcing and Supply Disruptions

States procuring drugs for lethal injection have encountered persistent supply disruptions primarily due to pharmaceutical manufacturers' refusals to authorize sales for capital punishment, stemming from ethical policies against facilitating executions.^[144]^[145] Major producers, including those in Europe, halted exports of key agents like sodium thiopental and pentobarbital after advocacy campaigns highlighted their use in lethal protocols.^[146]^[147] For instance, the European Union implemented strict export controls on such drugs in March 2012, effectively blocking shipments to U.S. prisons following pressure from human rights groups and national governments.^[146]^[148] Pentobarbital, a barbiturate adopted as a primary or single-drug alternative in states like Texas, Missouri, Georgia, and Ohio, became particularly scarce after its original supplier, Denmark-based Hospira (later acquired by Pfizer), ceased production for execution purposes in 2011 and explicitly banned such uses by 2016.^[149]^[150] U.S. manufacturers followed suit, with Pfizer announcing in 2016 that all FDA-approved suppliers of potential execution drugs had restricted sales for this application, exacerbating nationwide shortages.^[149] These restrictions prompted federal and state authorities to source from compounding pharmacies, which mix custom formulations but operate with less regulatory oversight, leading to variability in drug quality and further legal challenges.^[151]^[152] Supply issues have directly halted or delayed executions across multiple jurisdictions. In Texas, the Department of Criminal Justice reported in 2023 that its pentobarbital stock would expire by September, leaving future lethal injections uncertain without new acquisitions.^[150] Indiana exhausted its supply after two executions in late 2024 and early 2025, prompting Governor Mike Braun to acknowledge the depletion in June 2025.^[153] Similarly, South Carolina's drugs expired amid appeals, contributing to a shift toward firing squads as an alternative in 2021.^[38] At the federal level, the sole supplier of pentobarbital announced in July 2024 it would discontinue production for executions, compounding prior difficulties during the Trump administration's 2020 rush for no-bid compounding contracts.^[144]^[154] To circumvent disruptions, many states enacted secrecy laws shielding drug sources, suppliers, and protocols from public disclosure, as seen in Texas and Tennessee, where compounding details remain classified under statutes protecting participants from harassment or lawsuits.^[152]^[123] This opacity, justified by officials to maintain supply chains, has fueled litigation over transparency and drug efficacy, with courts occasionally ordering limited disclosures.^[155] In response to persistent shortages, states like Alabama adopted nitrogen hypoxia in 2024 as a non-drug method, while others explored gray-market imports or domestic compounding, though these alternatives have not fully resolved sourcing vulnerabilities.^[149]^[156]

Claims of Racial Disparities

Claims that racial minorities, particularly Black defendants, face disproportionate application of the death penalty—and thus execution by lethal injection—have been advanced by death penalty opponents and some empirical studies. Since the reinstatement of capital punishment in 1976, Black individuals have accounted for approximately 34% of the 1,600 executions in the United States, predominantly via lethal injection after its adoption in 1982, despite comprising about 13% of the general population.^[157] This raw disparity is often cited as evidence of systemic bias, though proponents of the death penalty argue it aligns with Black offenders' representation in homicide convictions, which hovered around 50% in FBI Uniform Crime Reports from the 1980s to 2020s. Studies on sentencing, such as a 1990 U.S. General Accounting Office review of 25 studies, found that in 82% of cases, the race of the victim influenced charging and sentencing outcomes, with white-victim homicides more likely to result in death sentences regardless of defendant race. Specific to lethal injection, a 2024 report by the anti-death penalty group Reprieve analyzed 1,254 lethal injections from 1982 to 2023 and claimed Black prisoners experienced botched procedures at more than twice the rate of white prisoners, with odds 220% higher after controlling for state and decade.^[84] Botched executions were defined as those involving multiple needle sticks, prolonged procedures exceeding 45 minutes, or visible pain, occurring in 8% of Black executions versus lower rates for others; in states like Oklahoma, 83% of botched lethal injections involved Black prisoners despite their comprising 22% of executions there.^[84] The report attributes this to racial bias in execution teams' preparation or vein access, potentially exacerbated by neglect, though it does not empirically test alternative explanations like physiological differences in vascular access or drug response variability across demographics. Reprieve, an organization advocating against capital punishment, has been criticized for selective framing of data to emphasize cruelty, and independent verification of botch classifications relies on media and court records prone to inconsistent reporting.^[83] Empirical research on defendant race effects in death sentencing shows mixed results after controlling for variables like crime severity, prior record, and victim demographics. A 2022 study using mock jurors found Black defendants received death sentences 18% more often than white defendants for identical facts, suggesting implicit bias.^[158] Conversely, a Tennessee analysis of death-eligible murders from 1977–2007 found no significant defendant race effect after multivariate controls, attributing observed disparities to legal aggravators rather than race alone.^[159] Victim race remains a robust predictor: in Georgia, post-Furman v. Georgia (1972) data indicated a 6% higher death-sentencing rate for white-victim cases after adjusting for over 230 non-racial factors, per the Baldus study underpinning McCleskey v. Kemp (1987), where the Supreme Court rejected statistical disparities as insufficient proof of unconstitutional bias without direct evidence of discrimination.^[160] These findings highlight that while raw execution statistics show overrepresentation of Black inmates in lethal injections, causal attribution to racial animus versus offense patterns or prosecutorial discretion requires disentangling confounding variables, with advocacy sources like the Death Penalty Information Center—known for opposing capital punishment—often emphasizing unadjusted figures.^[161]

Alternative Methods and Protocol Shifts

Due to persistent shortages of pharmaceutical-grade drugs like sodium thiopental and pentobarbital, starting around 2010, numerous U.S. states modified their lethal injection protocols from the traditional three-drug sequence (sodium thiopental or pentobarbital for anesthesia, pancuronium bromide for paralysis, and potassium chloride for cardiac arrest) to single-drug regimens using high doses of pentobarbital alone.^[162]^[163] Missouri pioneered this shift in 2012, substituting a one-drug protocol with pentobarbital after the European Union restricted exports of execution drugs, a move influenced by anti-capital punishment advocacy.^[164]^[165] By 2013, states including Ohio, Arizona, and Texas followed suit, citing reliability amid supply disruptions from manufacturers like Pfizer, which by 2016 explicitly barred sales of their products for lethal injections.^[149] These changes aimed to simplify administration and reduce risks of incomplete anesthesia, though empirical data from autopsies and witness accounts indicate variable efficacy, with some executions still prolonging consciousness and distress.^[166] Compounding pharmacies emerged as a workaround, producing unapproved versions of pentobarbital, but this prompted further legal challenges over drug potency and sterility, exacerbating execution delays.^[155] In response, over 30 states enacted secrecy statutes by 2015 to shield suppliers from public scrutiny and litigation, arguing that transparency deterred pharmaceutical participation; critics, including the Death Penalty Information Center, contend these laws obscure substandard sourcing, though state officials maintain they ensure procedural continuity without evidence of systemic failure beyond isolated incidents.^[155]^[5] Protocol refinements also included midazolam-based cocktails in states like Florida and Oklahoma post-2013, after pentobarbital scarcity intensified, despite subsequent botched cases revealing potential for air hunger and convulsions due to midazolam's inadequate sedative depth compared to barbiturates.^[167] Faced with unresolved lethal injection obstacles, several states authorized alternative execution methods, prioritizing rapid and verifiable lethality over perceived clinical sterility. Nitrogen hypoxia, involving inhalation of pure nitrogen to induce asphyxiation, gained traction; Oklahoma pioneered authorization in 2015 following a botched midazolam injection, with Alabama conducting the first U.S. execution via this method on Kenneth Smith on January 25, 2024, after two failed lethal injection attempts.^[168]^[169] Alabama executed Alan Eugene Miller similarly on September 26, 2024, and Anthony Boyd on October 23, 2025, reporting quicker unconsciousness than typical injections, though witnesses observed gasping and seizures lasting several minutes, prompting UN experts to deem it violative of international standards against cruel punishment— a claim disputed by state protocols emphasizing nitrogen's painless inertness based on industrial accident data.^[170]^[171]^[172] States like Mississippi, Oklahoma, and Alabama now permit inmate election of nitrogen if lethal injection drugs are unavailable, viewing it as a causal improvement in reliability absent pharmaceutical dependencies.^[5] Firing squads reemerged as a fallback, authorized in Idaho, Mississippi, Oklahoma, South Carolina, and Utah, often as primary alternatives when injections falter.^[173] South Carolina approved it in 2021 amid drug unavailability, while Idaho's 2025 legislation elevated it to the default method effective July 1, 2026, if lethal injection proves infeasible, citing historical precedents like Utah's last use in 2010 on Ronnie Lee Gardner, where ballistic evidence confirmed instantaneous fatality via heart disruption.^[174]^[175] Proponents argue this mechanical approach minimizes variables like vascular access failures in injections, supported by forensic analyses showing near-certain lethality from multiple rifle rounds, contrasting empirical injection mishaps; detractors highlight aesthetic revulsion but lack data equating it to greater suffering than documented injection agonies.^[176]^[38] Other relics like electrocution and lethal gas persist as electives in states such as Tennessee and Arizona, but adoption lags due to equipment obsolescence and past malfunctions, underscoring a broader causal pivot toward methods insulated from supply chain activism.^[177]

References

[1]
Lethal Injection for Execution: Chemical Asphyxiation? - PMC
Apr 24, 2007 · Lethal injection for execution was conceived as a comparatively humane alternative to electrocution or cyanide gas.
[2]
Death Row Information - Texas Department of Criminal Justice
The State of Texas adopted lethal injection as means of execution in 1977 and executed the first inmate by lethal injection on December 7, 1982. Charlie Brooks ...
[3]
Why the death penalty is being used more in the US this year
Oct 10, 2025 · The U.S. has seen 35 executions so far in 2025, with seven more scheduled for later this month. This year's total already surpasses last ...
[4]
'Remarkable': States adding firing squad, more execution methods
Jun 5, 2025 · Between 2021 and 2023, 100% of all executions in the U.S. were done by lethal injection. In the last year and a half, 16% have been carried out ...
[5]
State-by-State Execution Protocols - Death Penalty Information Center
Authorizes lethal injection, 3-drug protocol (Midazolam, Rocuronium bromide, Potassium chloride), or nitrogen hypoxia, or electrocution.
[6]
Lethal Injection Drugs' Efficacy And Availability For Federal Executions
Jul 26, 2019 · Federal executioners will now use pentobarbital, a single drug used by states including Georgia, Missouri and Texas.
[7]
In Texas, new details about its execution drug underscore a closely ...
Oct 14, 2025 · A state law shields its source of pentobarbital, the sedative used in lethal injections. But documents reviewed by NBC News offer a glimpse ...Missing: United | Show results with:United
[8]
[PDF] Capital Punishment - dpic-cdn.org
Introduction. On 21 February 1930, convicted murderer Eva Dugan, 52, was hanged from the gallows of the Arizona State Prison in Florence, Arizona. Wit.<|separator|>
[9]
Some executed US prisoners may have suffocated - PMC - NIH
Condemned prisoners who are killed by lethal injection may often suffocate while still conscious and be aware of what is happening to them, shows a new ...
[10]
Timeline of Lethal Injection Protocol Regulations - Capital Punishment
June 29, 2015: The U.S. Supreme Court ruled in a 5-4 vote that the sedative midazolam may be a part of a lethal injection protocol. The justices heard the ...
[11]
Botched Statistics on Botched Executions: Refuting Austin Sarat's ...
Introduction. In 2014, Austin Sarat presented findings on the botch rates of various execution methods. Sarat's statistics on death penalty botch rates have ...
[12]
Lethal Injection | Overview, Uses & History - Lesson - Study.com
In the late 19th century, J. Mount Bleyer, M.D. from New York, proposed a plan to inject inmates with a high dose of morphine. Bleyer claimed this was more ...
[13]
Lethal Injection | TIME
Nov 10, 2009 · The first proposal for using injected drugs as a form of capital punishment came in the late 19th century, when a New York commission on ...
[14]
Capital Punishment Is Bad For Business - POLITICO Magazine
Apr 28, 2015 · Lethal injection was first proposed in the 19th Century by a New York doctor who argued it would be cheaper than hanging. Britain rejected ...
[15]
Three-Drug Protocol Persists for Lethal Injections, Despite Ease of ...
May 1, 2014 · The three-drug combination used on Mr. Lockett was modeled on a plan first developed in Oklahoma in 1977 by Dr. Jay Chapman, then the state's ...
[16]
https://deathpenaltyinfo.org/stories/history-of-the-death-penalty-timeline
[17]
The death penalty and the untold story of lethal injection | TPR
Apr 22, 2025 · Jay Chapman, who first proposed using pharmaceuticals administered intravenously to carry out the courts' ultimate sentence. Chapman ...
[18]
[PDF] A First Amendment Challenge to State Secrecy Statutes Regarding ...
319, 373–74 (1997). Oklahoma was the first state to adopt lethal injection, which it did for economic and humanitarian reasons on May 11, 1977; Texas followed ...
[19]
[PDF] LETHAL INJECTION: - Amnesty International
In 1997, China became the first country outside the USA to carry out a judicial execution by lethal injection. Three other countries_Guatemala, Philippines ...
[20]
I. Development of Lethal Injection Protocols - Human Rights Watch
Apr 1, 2006 · In 1977, Oklahoma legislators passed the first lethal injection statute. Texas passed a lethal injection statue the next day. By 1981, five ...
[21]
First execution by lethal injection | December 7, 1982 | HISTORY
Texas, the national leader in executions, adopted the lethal injection procedure as a more humane method of carrying out its death sentences, as opposed to the ...
[22]
Methods of Execution | Death Penalty Information Center
In 1977, Oklahoma became the first state to adopt lethal injection as a means of execution, though it would be five more years until Charles Brooks would become ...
[23]
These are the countries still using lethal injection to kill people
Jul 30, 2016 · The United States was the first country to use lethal injection. Today, 32 states still use it as a method of execution.
[24]
Dialogue – Issue 29: China Continues Move to Lethal Injection as ...
... death penalty in China, the SPC recently announced the number of executions carried out to date in 2007 has been at an historic low. Since taking back the ...
[25]
China plans larger-scale use of lethal-injection execution - The Lancet
Last year, China executed at least 1800 people, more than were executed in the rest of the world combined, according to Amnesty International's annual report ...
[26]
Vietnam ends death penalty for crimes against the state, bribery, drugs
Jun 25, 2025 · Execution by firing squad in Vietnam was abolished in 2011 and replaced by the administration of a lethal injection.
[27]
Communist Vietnam's secret death penalty conveyor belt - Daily Mail
Apr 12, 2024 · Data published in 2017 by Vietnamese media outlets - that had previously been classified - revealed 429 people had been executed between 2013 ...
[28]
[PDF] Viet Nam - Death Penalty - The Advocates for Human Rights
May 7, 2024 · Viet Nam maintains 11 lethal injection execution facilities, but the number of executions per year is unknown. As of the end of 2022, more ...
[29]
[PDF] LETHAL INJECTION: - Amnesty International
Since 1977, four countries -- USA, China, Guatemala and the Philippines -- have used the injection of medicines in lethal doses to effect executions. A fifth ...
[30]
Global: Executions soar to highest number in almost a decade
May 29, 2024 · A total of 1,153 executions took place in 2023, which does not include the thousands believed to have been carried out in China, marking an ...
[31]
Death penalty: Methods of execution used around the world
Aug 10, 2015 · We take a look at five widely used execution methods. 1. Lethal injection Carried out in: China, Vietnam, USA
[32]
So Long as They Die: Lethal Injections in the United States | HRW
Apr 23, 2006 · This 65-page report reveals the slipshod history of executions by lethal injection, using a protocol created three decades ago with no ...
[33]
Lethal drugs in capital punishment in USA: History, present, and ...
A recent decision of The European Union to prohibit the export of drugs used in capital punishment to the USA along with domestic firms ceasing to manufacture ...Missing: changes | Show results with:changes
[34]
The Emergence of Second‐Generation Lethal Injection Protocols: A ...
Aug 12, 2017 · U.S. Supreme Court decisions, including Baze v. Rees (2008) and Glossip v. Gross (2015), have evaluated and condoned lethal injection protocols.Missing: evolution | Show results with:evolution
[35]
Death Penalty - U.S. New Death Sentences and Executions by Year
The Bureau of Prisons adopted a single-drug lethal injection protocol using pentobarbital in order to resume federal executions in July 2020. The Supreme ...
[36]
Gasping For Air: Autopsies Reveal Troubling Effects Of Lethal Injection
Sep 21, 2020 · The evidence explained why multiple inmates in recent years had gasped for air after their executions began.Missing: developments | Show results with:developments
[37]
U.S. executions climb to 35 in 2025 with several more planned
Oct 12, 2025 · Ten states have carried out executions in 2025, with Florida, Texas, Alabama and South Carolina leading the count.
[38]
Firing Squads Replace Scarce Lethal Injection Drugs In Some State ...
May 19, 2021 · Unable to obtain lethal injection drugs, some states have turned to outmoded alternatives, which also includes the electric chair, ...Missing: changes | Show results with:changes
[39]
A look at the status of US executions in 2025 - WVTM
Aug 5, 2025 · Twenty-eight men have died by court-ordered execution so far this year in the U.S., and nine other people are scheduled to be put to death ...
[40]
As Lethal Injection Turns Forty, States Botch a Record Number of ...
Dec 7, 2022 · On December 7, 1982, Texas strapped Charles Brooks to a gurney, inserted an intravenous line into his arm, and injected a lethal dose of ...
[41]
[PDF] EXECUTION PROCEDURE MANUAL FOR SINGLE DRUG ...
Death by lethal injection is caused by the administration of a lethal quantity of a short-acting barbiturate, such as Pentobarbital. A prescribed quantity of ...
[42]
[PDF] used in the lethal injection - Florida Department of Corrections
The procedures aim for a humane, dignified death, avoiding unnecessary pain, and are designed to establish the process for lethal injection executions.<|separator|>
[43]
Lethal Injection | Death Penalty Information Center
On May 22, 2025, Tennessee executed Oscar Smith by lethal injection, marking the state's first execution in five years despite a pending lawsuit challenging ...
[44]
Lethal injection protocols - Lethal Injection Information Center
There are 16 medicines in US lethal injection protocols, including Pentobarbital, Midazolam, and Sodium Thiopental. Some states use 1 drug, others use 3 or ...Missing: United | Show results with:United
[45]
How many doses of lethal injection drugs does Texas have?
Jun 30, 2023 · The U.S. Food and Drug Administration seized the drugs and later ruled that they couldn't be brought into the United States because they were ...
[46]
Tennessee prepares to resume death row executions in 2025 with ...
Jan 3, 2025 · Tennessee says it is ready to resume death row executions in 2025. The Department of Corrections announced it will use a drug for lethal injections.<|control11|><|separator|>
[47]
[PDF] Review of the Federal Execution Protocol Addendum and Manner of ...
Jan 8, 2025 · On July 1, 2021, the Attorney General issued a memorandum instituting a moratorium on federal executions pending the Department of Justice's ...
[48]
Attorney General Garland Withdraws Federal Execution Protocol ...
Jan 16, 2025 · Attorney General Garland withdrew the federal execution protocol due to uncertainty about pentobarbital causing unnecessary pain, but a ...
[49]
Trump's executive order resumes executions, after Biden ... - NPR
Jan 21, 2025 · ... Federal Bureau of Prisons to rescind its lethal injection protocol and stop using pentobarbital to execute prisoners. A Justice Department ...<|separator|>
[50]
[PDF] The Problematic Nature of Execution by Lethal Injection in the ...
Abstract. The United States and the People's Republic of China perceive the death penalty as a fundamental feature of the criminal justice system. Lethal ...
[51]
Determination of Death in Execution by Lethal Injection in China
Since 1997, execution in China has been increasingly performed by lethal injection. The current criteria for determination of death for execution by lethal ...
[52]
[PDF] Why Vietnam Justifies the Death Penalty? - Melbourne Law School
Capital sentence is switched from execution by a firing squad to the administration of lethal injection in 2011 according to the Decree no. 82/2011/NĐ-CP ...
[53]
Viet Nam must not resume executions by firing squad
Nov 8, 2013 · An EU export ban on the chemicals needed for lethal injections has meant that Viet Nam has struggled to find drugs to carry out executions.<|separator|>
[54]
Thailand executes first prisoner by lethal injection since 2009 | Reuters
Jun 19, 2018 · He was the seventh person to be executed by lethal injection since Thailand introduced the method in 2003 to replace execution by firing squad.
[55]
III. Lethal Injection Procedures - Human Rights Watch
Apr 4, 2006 · The basic procedure states use in lethal injection executions is as follows: The condemned prisoner is brought to the execution chamber ...
[56]
What happens during a typical three-drug lethal injection - CNN
Nov 28, 2023 · A trio of chemicals is administered in three steps: First, an anesthetic renders an inmate unconscious; then a second drug paralyzes them; and finally, a third ...
[57]
Op-Ed: The ignoble history of the 3-drug death penalty cocktail
Apr 20, 2017 · In the late 1970s, a medical examiner in Oklahoma, Jay Chapman, developed a procedure that involved, first, an anesthetic to render the prisoner ...
[58]
Lethal Injection | Death Penalty Information Center
All states and the federal government use lethal injection as their primary method of execution. States use a variety of protocols using one, two, or three ...<|separator|>
[59]
Cruel and Usual?: Is Capital Punishment by Lethal Injection Quick ...
Oct 27, 2010 · Sodium thiopental was chosen to render the person deeply unconscious and unable to feel the paralysis brought on by the pancuronium bromide, ...
[60]
Lethal Injection Challenges Across the Country
Mar 1, 2011 · The drug “cocktail” used to execute prisoners typically contains three drugs: sodium thiopental (to induce unconsciousness); pancuronium ...Missing: conventional | Show results with:conventional
[61]
Lethal injection | Research Starters - EBSCO
Lethal injection was first proposed in the nineteenth century as an alternative to hanging. Death by hanging was often slow and painful. Experts at the time ...
[62]
[PDF] So Long as They Die - Lethal Injections in the United States
Apr 1, 2006 · Nevada was the first state to adopt lethal gas executions, in 1921. In an attempt to make lethal gas executions more humane, the Nevada ...
[63]
Lethal drugs in capital punishment in USA: History, present, and ...
History evolved over time in the favor of more humane ... The Emergence of Second-Generation Lethal Injection Protocols: A Brief History and Review.
[64]
Navigating the new era of assisted suicide and execution drugs
Sep 28, 2017 · Most lethal injection protocols have followed this three-drug order and layout. ... dose first drug, technically creating a two-drug protocol.<|separator|>
[65]
Compounding Pharmacies - Death Penalty Information Center
Compounding pharmacies combine, mix, or alter drugs; traditionally compounding is used to meet the specific needs of an individual patient in response to a ...Missing: conventional | Show results with:conventional
[66]
Why the Justice Department's Plan to Use a Single Drug for Lethal ...
Jul 29, 2019 · Federal executions will only use one drug: pentobarbital. Some states have already used the chemical for executions including Texas, Missouri and Georgia.
[67]
[PDF] Attachment D OP-040301 - Oklahoma.gov
A qualitative analysis of the compounded drug to be used in the execution shall be performed no more than thirty (30) calendar days prior to the execution date.
[68]
Secret sedative: How Missouri uses pentobarbital in executions
Aug 18, 2017 · Missouri's protocol calls for inmates to be injected with five grams of pentobarbital. That makes for a quick, lethal dose. Witnesses say it ...
[69]
Deliberate Self-poisoning with a Lethal Dose of Pentobarbital ... - NIH
Pentobarbital (PB) is a euthanasia drug in doses of 2 to 10 grams, causing death within 15–30 minutes. We report a case of recovery from lethal ...
[70]
Thiopental: Uses, Interactions, Mechanism of Action | DrugBank Online
Thiopental binds at a distinct binding site associated with a Cl- ionopore at the GABAA receptor, increasing the duration of time for which the Cl- ionopore is ...
[71]
Sodium Thiopental - an overview | ScienceDirect Topics
Thiopental is a barbiturate drug, and barbiturates cause sedation, general anesthesia, and at higher doses, produce coma and death.
[72]
Pancuronium - StatPearls - NCBI Bookshelf - NIH
Pancuronium bromide is a long-acting, bis-quaternary aminosteroid, non-depolarizing, neuromuscular blocking drug (NMBD), which was first synthesized in 1964.
[73]
Pancuronium: Uses, Interactions, Mechanism of Action - DrugBank
Pancuronium is a neuromuscular blocker used as an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation ...Pharmacology · Interactions · Spectra
[74]
Life and Death Row: How the lethal injection kills - BBC Three
Mar 5, 2018 · When the potassium reaches the inmate's heart, it disrupts the delicate balance of sodium and potassium ions that keep the heart beating. The ...
[75]
Death by potassium chloride intravenous injection - PubMed
Potassium chloride intravenous injection is used in suicide attempts and lethal procedures for state-sanctioned punishment.
[76]
II. Lethal Injection Drugs - Human Rights Watch
Apr 4, 2006 · While potassium chloride acts quickly, it is excruciatingly painful if administered without proper anesthesia. When injected into a vein, it ...
[77]
Execution by lethal injection: Autopsy findings of pulmonary edema
Aug 27, 2022 · Pentobarbital is a Barbiturate and these drugs have long been known to cause vascular injury if improperly administered, with inadvertent intra- ...Missing: physiological | Show results with:physiological
[78]
Pentobarbital - StatPearls - NCBI Bookshelf - NIH
Feb 25, 2024 · Pentobarbital primarily acts on the central nervous system (CNS). At elevated doses, pentobarbital functions as an anticonvulsant for emergent ...
[79]
Pentobarbital: Uses, Interactions, Mechanism of Action - DrugBank
Pentobarbital binds at a distinct binding site associated with a Cl- ionopore at the GABAA receptor, increasing the duration of time for which the Cl- ionopore ...Missing: protocol | Show results with:protocol
[80]
Lethal injection: a stain on the face of medicine - PMC
Lethal injection is the standard method used to perform capital punishment in the United States (fig 1). All 65 executions in America in 2001 were performed ...
[81]
https://www.statista.com/statistics/319660/botched-executions-in-the-united-states/
[82]
Botched Executions | Death Penalty Information Center
15%) went wrong in some way. Lethal injection had the highest rate of botched executions. In his book, he defines a botched execution as follows: Botched ...
[83]
New study shows more botched executions for Black prisoners - NPR
Apr 18, 2024 · Reprieve, which advocates against the death penalty, found that nationwide, half of the botched lethal injection executions were of Black people ...
[84]
[PDF] Lethal injection in the modern era: cruel, unusual and racist
Apr 1, 2024 · Black people had 220% higher odds of suffering a botched lethal injection execution than white people. • Botched lethal injection executions.
[85]
More than a third of executions in 2022 were 'botched,' a report finds
Dec 21, 2022 · IV insertion is a common problem with lethal injection This year, 18 people were executed in Texas, Oklahoma, Arizona, Alabama, Missouri and ...
[86]
A third of US executions botched in 2022 - report - BBC
Dec 16, 2022 · "After 40 years, the states have proven themselves unable to carry out lethal injections without the risk that it will be botched," Mr Dunham ...
[87]
[PDF] 2022 Saw Record Number of Botched Executions - dpic-cdn.org
Dec 16, 2022 · (Washington, D.C.) As lethal injection turns 40 years old this year, 2022 can be called “the year of the botched execution.” Seven of the 20 ...
[88]
https://files.deathpenaltyinfo.org/legacy/documents/LockettInvestigationReport.pdf
[89]
https://www.statista.com/statistics/199086/total-number-of-executions-in-the-us-by-method/
[90]
Two Botched Executions Put Spotlight on Lethal Injection Process ...
Jun 1, 2014 · On April 29, 2014, Oklahoma death row prisoner Clayton Lockett died of a heart attack following the state's failure to properly set the IV used ...
[91]
Failed Experiments: Stop All Lethal Injections Now - ACLU
May 1, 2014 · The horrifying experiences of recent executions make clear these assurances are false. The drugs used in recent executions produced not a sleep into death.
[92]
Lethal Injections Are to Blame for Over 100 Botched Executions in ...
Dec 8, 2022 · The first inmate put to death by lethal injection in the U.S. was Charles Brooks Jr. on December 7, 1982.
[93]
Why lethal injections fail - The Week
compared to 3.1 percent for hanging and 1.9 percent for electrocution.
[94]
[PDF] Lethal Injection Secrecy Laws: A Cruel and Unusual Solution for the ...
Dec 23, 2024 · 55. Mark Berman, Drug Companies Don't Want to be Involved in Executions, so They're Suing to. Keep Their Drugs Out, WASH.
[95]
Alabama's execution problems are part of a long history of botched ...
Nov 29, 2022 · Alabama now joins Ohio and Tennessee as states that have paused executions and launched investigations after lethal injection failures.<|separator|>
[96]
[PDF] lethal injections: protocol plagued with secrecy and flaws ushering ...
Jan 24, 2024 · proposal.12 New York's rejection of lethal injections as a primary method of execution was based in part on concerns of the public that the ...
[97]
Baze v. Rees | 553 U.S. 35 (2008) - Justia U.S. Supreme Court Center
The lethal injection protocol is unconstitutional under the Eighth Amendment's ban on “cruel and unusual punishments,” because of the risk that the protocol's ...
[98]
Baze v. Rees - Oyez
Jan 7, 2008 · In a 7-2 decision with four concurrences and a dissent, the Court held that Kentucky's lethal injection scheme did not violate the Eighth Amendment.
[99]
BAZE v. REES - Supreme Court - Law.Cornell.Edu
Apr 16, 2008 · The court affirmed that Kentucky's lethal injection protocol, using three drugs, does not violate the Eighth Amendment's ban on cruel and ...<|separator|>
[100]
Glossip v. Gross | 576 U.S. 863 (2015)
Glossip v. Gross: A death row inmate seeking an injunction under the Eighth Amendment against the use of a certain execution method must show that the risk ...
[101]
Glossip v. Gross | Oyez
5–4 decision for Gross majority opinion by Samuel A. Alito, Jr. ... No. Justice Samuel A. Alito, Jr. delivered the opinion of the 5-4 majority.
[102]
Bucklew v. Precythe | Oyez
Nov 6, 2018 · According to Bucklew, lethal injection would likely cause him to hemorrhage during the execution, potentially choking on his own blood.” As ...
[103]
Bucklew v. Precythe | 587 U.S. ___ (2019)
Bucklew v. Precythe: Supreme Court rejects a claim that ... ” Missouri plans to execute Bucklew by lethal injection using a single drug, pentobarbital.
[104]
https://www.supremecourt.gov/opinions/25pdf/25a457_8nka.pdf
[105]
The state of the death penalty - SCOTUSblog
Sep 30, 2025 · The Biden administration in 2021 imposed a three-year moratorium on federal executions to assess the use of the death penalty in federal cases.
[106]
Countries with Death Penalty 2025 - World Population Review
The one other form of execution that Chinese officials can legally invoke is death by lethal injection, which is seen as more humane and painless than a gunshot ...Countries that Permit the... · Death Sentence Data are...
[107]
Death Penalty - Amnesty International
At the time of writing Iran has executed at least 122 of them since 1990. Execution Methods used in 2024. Beheading; Hanging; Lethal injection; Shooting ...Global: Recorded executions... · Your Questions Answered · Universal Declaration
[108]
International | Death Penalty Information Center
While international law does not prohibit the death penalty, most countries consider it a violation of human rights. The use of the death penalty worldwide is ...
[109]
[PDF] The Death Penalty under International Law: A Background Paper to ...
This paper aims to outline the status of the death penalty under international law. ... However, the use of lethal injection remains legal at international law at ...
[110]
Key facts - Penal Reform International
In 2021, Amnesty International recorded 579 executions in 18 countries, an increase of 20% from the 483 recorded in 2020, which represented a record low number ...
[111]
The death penalty: an impossible punishment - ELEOS
Oct 10, 2023 · While IHRL remains unsettled as to the status of lethal injection when administered 'properly', the risk of technical failures and botched ...
[112]
United States: UN experts horrified by Kenneth Smith's execution by ...
Jan 30, 2024 · GENEVA (30 January 2024) – UN experts* today unequivocally condemned the execution of Kenneth Eugene Smith in Alabama, in the United States, ...Missing: lethal | Show results with:lethal
[113]
https://www.ibanet.org/medias/Deathpenalty-Paper.pdf?context=bWFzdGVyfEhSSS1yZXBvcnRzfDE1NjM3NlxhcHBsaWNhdGlvbi9wZGZ8YURZekwyaG1NeTg0T0RBd05qZ3pORGt4TXpVNEwwUmxZWFJvY0dWdVlXeDBlVjlRWVhCbGNpNXdaR1l8NGEzOWJiMTI1Yzk5YWI0YjJiZmM5ZGU1MzY4OWMwNzNiNjNmMTFlOTIyOGE2OGNkZmQ5NmU2MWFmZGYxNWQzMw&attachment=true
[114]
Human Rights and U.S. Executions - Death Penalty Information Center
Issues with Lethal Injection and the International Response · Lethal injection as a method of execution was introduced in the United States by Oklahoma in 1977 ...
[115]
[PDF] Whether the Food and Drug Administration Has Jurisdiction over ...
May 3, 2019 · Drugs intended for use in lethal injection that were FDA- approved only for other uses would also be misbranded because their. FDA-approved ...
[116]
FDA Issues Final Order Refusing to Release Illegally Imported ...
Apr 24, 2017 · FDA Issues Final Order Refusing to Release Illegally Imported Lethal-Injection Drugs to States | Death Penalty Information Center.Missing: challenges | Show results with:challenges
[117]
New Paper Calls Upon States to Cease Experimenting with Lethal ...
May 5, 2014 · The paper argues that state Departments of Corrections are violating U.S. Food and Drug Administration (FDA) investigational new drug ...Missing: challenges | Show results with:challenges
[118]
[PDF] Reviewing Refusal: Lethal Injection, the FDA, and the Courts
First, a state must surmount the challenge of showing that a valid prescription order can even exist for something like compounded lethal drugs. Federal ...
[119]
States Try to Obscure Execution Details as Drugmakers Hinder ...
Mar 30, 2023 · Pharmaceutical companies have put the brakes on many states' ability to execute prisoners using lethal injections.
[120]
Lethal Injection Secrecy Laws - The Marshall Project
Only 4 states are currently carrying out lethal injections, and 10 are considering other methods. Analysis • 04.12.2016
[121]
Broader Implications of Eliminating FDA Jurisdiction Over Execution ...
We argue that it was a grave mistake for the OLC to take the position that the FDA lacks jurisdiction over execution substances.
[122]
Virginia's Proposed Lethal Injection Secrecy Law - Petrie-Flom Center
Apr 13, 2016 · At least fourteen states have passed or tried to pass rules keeping the names of lethal injection suppliers confidential. ... state to supply ...
[123]
Secrecy laws, low regulation and 'gray markets' mean Tennesseans ...
Mar 5, 2025 · Secrecy laws, low regulation and 'gray markets' mean Tennesseans know very little about the state's lethal injection drugs. By Catherine Sweeney.<|separator|>
[124]
[PDF] Respecting Corporate Contracts: State-by-State Risk Index
May 7, 2024 · "The South Carolina secrecy law not only compromises the safety and quality of medicines, including drugs used in lethal injections; it also.
[125]
State execution secrecy laws are anti-free market and at odds with ...
Jun 21, 2024 · Such statutes remove transparency from execution protocols, personnel, products, and suppliers.
[126]
Secrecy Clouds Arizona's Lethal Injection Protocol as the State ...
Mar 17, 2025 · Secrecy Clouds Arizona's Lethal Injection Protocol as the State Restarts Executions. The decision by Democratic Governor Katie Hobbs to ...
[127]
ACLU of South Carolina challenges death penalty secrecy law
Jan 29, 2025 · The new federal lawsuit challenges the constitutionality of the 2023 secrecy statute that forbids the publication of information about the procurement of ...<|separator|>
[128]
What's at Stake in the Lethal Injection Arguments - NPR
Jan 7, 2008 · Why do most states use lethal injection to carry out the death penalty? Because it was considered a more humane way of executing the condemned.
[129]
Lethal Injection on Trial: An Analysis of the Arguments Before the ...
Dec 19, 2007 · Finally, Kentucky argues that its method of lethal injection is humane and highly unlikely to cause condemned inmates pain or discomfort.
[130]
[PDF] Baze-d and Confused: What's the Deal with Lethal Injection?
After further consultation between Dr. Chapman and state prison officials, Okla- homa became the first state to adopt a three-drug lethal injection pro- tocol— ...<|separator|>
[131]
Methods of Execution - Death Penalty Information Center
Lethal injection is the most widely-used method of execution, but many states authorize other methods including electrocution, lethal gas, and firing squad.Lethal Injection · Execution Method Descriptions · Authorized Methods by State
[132]
Lethal Injection and the False Promise of Humane Execution
This chapter traces the early history of lethal injection, focusing specifically on its first serious consideration in New York at the end of the 19th century.
[133]
Inadequate anaesthesia in lethal injection for execution - PubMed
Methods of lethal injection anaesthesia are flawed and some inmates might experience awareness and suffering during execution.
[134]
The Cruel and Unusual Execution of Clayton Lockett - The Atlantic
Jun 15, 2015 · The untold story of Oklahoma's botched lethal injection—and America's intensifying fight over the death penalty.<|separator|>
[135]
Capital Punishment - AMA Code of Medical Ethics
And, when the method of execution is lethal injection: Selecting injection sites. Starting intravenous lines as a port for a lethal injection device.Missing: UN | Show results with:UN
[136]
The role of anaesthesiologists in lethal injection: a call to action - PMC
The California protocol called for an injection of a three-drug cocktail: thiopental, a barbiturate intended to render the inmate unconscious; pancuronium, a ...Missing: mechanism | Show results with:mechanism<|separator|>
[137]
Physician Participation in Capital Punishment - JAMA Network
The Oath of Hippocrates has historically been interpreted as prohibiting physician participation in executions. The Oath states in part:I will use treatment to ...
[138]
Statement on Physician Nonparticipation in Legally Authorized ...
The ASA believes capital punishment is not medicine, and that physicians, especially anesthesiologists, should not participate in executions, as it is not the ...
[139]
Professional association policies - Lethal Injection Information Center
4) ASA continues to agree with the position of the American Medical Association on physician involvement in capital punishment. ASA strongly discourages ...
[140]
Should Physicians Participate in State-Ordered Executions?
Even though proponents of execution by lethal injection ... A modest proposal for the medical profession to introduce humane and civilized executions.
[141]
When Law and Ethics Collide — Why Physicians Participate in ...
Mar 23, 2006 · The ruling ordered that the state have a physician, specifically an anesthesiologist, personally supervise the execution, or else drastically ...<|separator|>
[142]
Physician participation in capital punishment: A question of ... - NIH
This article argues that it is unethical for physicians within the role as medical professional to participate in capital punishment.
[143]
AMA to Supreme Court: Doctor participation in executions unethical
Aug 22, 2018 · The AMA Code of Medical Ethics says physicians shouldn't opine on which execution method would most reduce physical suffering.
[144]
Federal Execution-Drug Supplier Says It Will No Longer Produce ...
Jul 2, 2024 · Federal Execution-Drug Supplier Says It Will No Longer Produce Pentobarbital for Executions · Connecticut-based company Absolute Standards, which ...
[145]
Activist on mission to ban companies from facilitating executions
Feb 28, 2025 · Pharmaceutical companies that manufacture drugs used in lethal injections have largely refused to supply them for executions, citing ethical ...<|separator|>
[146]
EU imposes strict controls on 'execution drug' exports - BBC News
Mar 5, 2012 · EU imposes strict controls on 'execution drug' exports ... The European Commission has imposed strict controls on the export of drugs used to ...
[147]
Danish Company Blocks Sale of Drug for US Executions
Jul 1, 2011 · Reprieve, a human rights group in London that has led in the movement to stop European companies from selling lethal injection drugs to the ...
[148]
Europe's moral stand has U.S. states running out of execution drugs ...
Feb 18, 2014 · "The lethal injection that they are using now in certain states has never been tested, verified, let alone been approved for executions," said ...
[149]
Explainer: Is there a lethal injection drug shortage in the U.S.?
Jan 25, 2024 · “With Pfizer's announcement, all FDA-approved manufacturers of any potential execution drug have now blocked their sale for this purpose,” Maya ...
[150]
LETHAL INJECTION: Shortage of Drugs Leaves Texas Unsure ...
The Texas Department of Criminal Justice announced its remaining supply of pentobarbital, used for lethal injections, expires in September, and it is unsure ...
[151]
How the Trump administration secured a secret supply of execution ...
Jul 10, 2020 · The difficulty in procuring execution drugs has forced states and the U.S. government to get their supplies of the drug from compounding ...Missing: disruptions | Show results with:disruptions
[152]
Texas secretly purchased execution drugs from local pharmacy, Rite ...
Jul 10, 2024 · The state of Texas, blocked from purchasing lethal injection drugs by major pharmaceutical companies that refuse to participate in executions, ...Missing: disruptions | Show results with:disruptions
[153]
Braun says Indiana is out of execution drugs, signals willingness to ...
Jun 4, 2025 · Indiana has exhausted its supply of lethal injection drugs after carrying out two executions in the past six months, Gov. Mike Braun said.
[154]
New records show Trump's DOJ rushed a no-bid contract for lethal ...
Dec 3, 2020 · New records show Trump's DOJ rushed a no-bid contract for lethal injection drugs. The Trump administration was in such a rush to execute people ...Missing: sourcing disruptions
[155]
[PDF] THE SUPPLY-SIDE ATTACK ON LETHAL INJECTION AND THE ...
Mar 3, 2015 · State has refused to disclose “not only the source of the drug or drugs to be used in their executions but also the identity of the drug or ...Missing: sourcing disruptions
[156]
How the Drug Shortage Has Slowed the Death-Penalty Treadmill
Apr 12, 2016 · Only four states are currently carrying out lethal injections. Texas, Missouri, and Georgia use a single drug, pentobarbital (Georgia is set to ...
[157]
Executions by Race and Race of Victim
Race of Victims Since 1976. (Victims of Executed Prisoners). Native American or Alaskan Native (0.3%). Other (0.3%). Asian (1.6%). Latino/a (7%). Black (15%).
[158]
[PDF] An Empirical Study of the Effects of Racial Bias on Capital ...
Feb 22, 2022 · These mock jurors were 18.3% to 18.4% more likely to sentence a Black defendant to death than a White defendant ceteris paribus. 35 Monte Carlo ...
[159]
[PDF] Race and the Death Penalty: an Empirical Assessment of First ...
This Article builds upon these theoretical underpinnings by analyzing “death-eligible” murder convictions in Tennessee between. 1977 and 2007. Its objective is ...
[160]
Race and the Death Penalty | Capital Punishment in Context
Only 5% of Georgia killings result in a death sentence; yet, when more than 230 non-racial variables are controlled for, the death-sentencing rate is 6% higher ...Race And Jury Selection · Race Of The Victim · Race Of The Defendant
[161]
Race and the Death Penalty by the Numbers
Race of Defendants Executed in the U.S. Since 1976 ; Other 0.2% ; Asian 0.4% ; Native American or Alaskan Native 1.3% ; Latino/a 8% ; Black 34%.
[162]
Drug Shortage Disrupts Lethal-Injection Mix - ABC News
Mar 16, 2011 · ... change its three-drug protocol. Effective immediately, pentobarbital will now be substituted for sodium thiopenthal, officials said. Both ...
[163]
Challenges to Lethal Injection Protocols Continue
Mar 1, 2013 · Several states have reacted to the shortage of sodium thiopental by switching to a single-drug protocol, most commonly using large doses of pentobarbital.
[164]
The End of the Open Market for Lethal-Injection Drugs
May 21, 2016 · In 2012, Missouri replaced its three-drug protocol for lethal injections with a one-drug protocol, using propofol. ... of the drugs that the state ...<|control11|><|separator|>
[165]
The Emergence of Second-Generation Lethal Injection Protocols
Oct 2, 2017 · Drug shortages, induced in part by manufacturers under pressure by death penalty opponents and governments opposed to capital punishment, have ...
[166]
"Lethal Injection Chaos Post-Baze" by Deborah W. Denno
In the six years after Baze, legal challenges to lethal injection soared as states scrambled to quell litigation by modifying their lethal injection protocols.
[167]
Pharmaceutical Firms Against Lethal Injection and the Ramifications
This article will discuss how it is morally impermissible for Big Pharma to deny the State, and hence its prisoners, access to lethal injection drugs.Missing: sourcing | Show results with:sourcing
[168]
Nitrogen Suffocation | Equal Justice Initiative
In 2015, Oklahoma became the first state to adopt a measure allowing prison staff to use nitrogen gas to execute people after the botched lethal injection ...
[169]
Nitrogen Hypoxia - Death Penalty Information Center
On January 25, 2024, Alabama executed Kenneth Smith using nitrogen hypoxia, a first in American history. Though state attorneys had assured courts that the ...
[170]
Alabama carries out second nitrogen gas execution in US - BBC
Sep 26, 2024 · The US state of Alabama has executed Alan Eugene Miller - the second American ever put to death by inhaling nitrogen gas.
[171]
https://www.theguardian.com/us-news/2025/oct/23/alabama-execution-nitrogen-gas-anthony-boyd
[172]
United States: Experts call for urgent ban on executions by nitrogen ...
Nov 20, 2024 · We reiterate our call for an urgent ban on execution by nitrogen asphyxiation, which is clearly prohibited under international law.
[173]
Map Shows US States Allowing Firing Squad Executions - Newsweek
Mar 10, 2025 · Along with South Carolina, Idaho, Mississippi, Oklahoma and Utah authorize the firing squad as a method of execution. Read More. U.S.. Donald ...
[174]
Idaho House widely passes bill to make firing squad main execution ...
Feb 6, 2025 · Skaug's bill this year would make lethal injection the alternative execution method. If passed into law, the bill would take effect July 1, 2026 ...
[175]
Authorized Methods by State | Death Penalty Information Center
Authorized Methods by State ; Utah, Authorizes the use of the firing squad if lethal-injection drugs are unavailable or if lethal injection is held to be ...
[176]
Is the Firing Squad a More Humane Method of Execution?
Mar 20, 2025 · Introduced in 1977 as a supposedly more humane method, lethal injection has faced multiple problems from its inception. The three-drug ...
[177]
Lethal injection, firing squad and nitrogen gas: A look at U.S. ...
Mar 23, 2025 · States have used five different execution methods: lethal injection, electrocution, lethal gas, firing squad and hanging. Here's a look at how the US executes ...