Lethal Injection and Physicians

EGAL EXECUTION BY LETHAL INJECTION HAS MADE NAtionalheadlinesduringthepast2yearsbecauseprisoners have argued that it poses an unnecessary risk of pain as currently performed and therefore constitutesunconstitutionalcruelandunusualpunishment.The most widely used method of lethal injection, developed by aphysician, 1 involvestheintravenousinfusionoflargedoses of sodium thiopental to induce deep sleep, pancuronium bromide as a paralyzing agent, and potassium chloride for cardioplegia. Lethal injectionwas adopted as a means of execution because it seemed more humane than other methods, but it is unclear what consideration was given to the selectionofexecutionpersonnel,theskillstheyneeded,and thetrainingtheymightrequire.Recentcourtchallengeshave revealedthatdrugdosagesarenotuniformamongthestates, sowidedisparitiesinlevelsofsedationmayoccur,andsome inmates may have experienced considerable pain after potassium chloride infusion. 2,3 The legal challenges have also publicly exposed the participation of physicians in executions. 4,5 A number of states suspendedexecutionstoreexaminetheirmethods 6 andhave considered escalating the role of physicians to meet constitutionalchallenges.Theseeventshaveraisedquestionsabout theeffectofprofessionalethicalstandardsonphysicianparticipation in capital punishment and about the response of the medical profession to known instances of physician involvement in executions.