Background\r\nLethal injection for execution was conceived as a comparatively humane alternative to\r\nelectrocution or cyanide gas. The current protocols are based on one improvised by a medical\r\nexaminer and an anesthesiologist in Oklahoma and are practiced on an ad hoc basis at the\r\ndiscretion of prison personnel. Each drug used, the ultrashort-acting barbiturate thiopental, the\r\nneuromuscular blocker pancuronium bromide, and the electrolyte potassium chloride, was\r\nexpected to be lethal alone, while the combination was intended to produce anesthesia then\r\ndeath due to respiratory and cardiac arrest. We sought to determine whether the current drug\r\nregimen results in death in the manner intended.\r\nMethods and Findings\r\nWe analyzed data from two US states that release information on executions, North Carolina\r\nand California, as well as the published clinical, laboratory, and veterinary animal experience.\r\nExecution outcomes from North Carolina and California together with interspecies dosage\r\nscaling of thiopental effects suggest that in the current practice of lethal injection, thiopental\r\nmight not be fatal and might be insufficient to induce surgical anesthesia for the duration of\r\nthe execution. Furthermore, evidence from North Carolina, California, and Virginia indicates\r\nthat potassium chloride in lethal injection does not reliably induce cardiac arrest.\r\nConclusions\r\nWe were able to analyze only a limited number of executions. However, our findings suggest\r\nthat current lethal injection protocols may not reliably effect death through the mechanisms\r\nintended, indicating a failure of design and implementation. If thiopental and potassium\r\nchloride fail to cause anesthesia and cardiac arrest, potentially aware inmates could die through\r\npancuronium-induced asphyxiation. Thus the conventional view of lethal injection leading to\r\nan invariably peaceful and painless death is questionable.
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