Giz Explains: How Lethal Injection Works

How Lethal Injection Works

Virtually all of the 32 American states that allow the death penalty rely on a deadly chemical cocktail to slowly and quietly kill the condemned. But America has found itself running dangerously low on sodium pentothal, the injection's primary ingredient, after the only US supplier stopped making it. So how are they supposed to kill the 3000-plus inmates currently on Death Row? Guillotine? Actually, the doctor who developed lethal injections in the first place thinks it might be more humane.

Whether you personally agree with the practice or not, capital punishment has long been a fundamental component of government. From the founding of the earliest city-states, the rule of law has been built on the state-sanctioned execution of a society's most heinous transgressors. While the method of execution has changed over the millennia, its message remains the same: government — and only government — has the right to take the lives of its citizens.

But while the number of nations that maintain this stance has shrunk to just 20 — 100 others, 51 per cent of the world total, have sworn off the practice — America remains steadfast in its use of the death penalty. According to the most recent records available from the US Department of Justice, some 3175 inmates in 32 states and throughout the federal prison system are on Death Row. Since 1977, when the death penalty was reinstated at the federal level, more than 1200 inmates have been executed, with 43 put to death in 2012 alone. Only China (2000), Iran (314), Iraq (189) and Saudi Arabia (90) executed more people last year than we did.

How Lethal Injection Works

How Lethal Injection Got Its Start

Between death by electrocution, hanging, firing squad, gas chamber and beheading, capital punishment has always been a dirty, brutal affair. Lethal injection has risen to prominence and become the near-exclusive method of execution in America, due to its reputation of being less painful and more humane than other methods.

The concept was originally proposed in 1888 by New York doctor Julius Mount Bleyer, though his idea never came to fruition. It wasn't until 1977 that an Oklahoma state medical examiner named Jay Chapman devised the current three-drug cocktail, known as Chapman's Protocol. This method first injects an ultra-short-acting barbiturate in combination with a pair of chemical paralytics, which suppress respiratory and cardiac functions. The protocol was quickly adopted by Oklahoma, then Texas. In 2004, 38 of the 39 states that maintained the death penalty used Chapman's Protocol. The practice has also spread abroad, becoming the preferred method utilised by China, Thailand, Guatemala and Taiwan.

How Lethal Injection Works

The Procedure

After an inmate's appeals have been exhausted, an execution order is ordered by the court and the date of execution is set. In the weeks preceding the date, in California at least, the inmate is interviewed by a number of prison staff including psychiatrists, clergy, and social workers who generate pre-execution reports based on their interactions. Additional sanity review requests can be filed at that time as well. In the days and hours leading up to the scheduled execution, the inmate is allowed priority visiting rights for family, spiritual advisers and legal representation, given a fresh pair of cloths and EKG monitor, his last meal, and last rites before being ushered into the execution chamber and strapped to a gurney.

IV lines are inserted into two usable veins (one as a backup), and a slow saline drip is started. Once the inmate is given the opportunity for some last words to the witnesses seated adjacent to the execution chamber, the warden issues the execution order and the process begins.

Chapman's Protocol relies on a trio of powerful drugs, each individually lethal in its administered dose — and even more so when used together. Five grams (14 times the .35g recommended dosage) of sodium pentothal is administered first. This fast-acting barbiturate is typically used as an anaesthetic for medically inducing comas, and will typically render the condemned inmate unconscious within 10 seconds.

Following a saline flush of the IV line, 100mg of Pancuronium bromide is injected next. This drug is a non-depolarising muscle relaxant that blocks the action of a specific muscle receptor site that prevents the fibre from contracting, effectively paralysing the inmate and arresting his breathing. After a final IV flush, the inmate receives an injection of 100mEq of potassium chloride. Potassium is an electrolyte used by our bodies use to help transmit electrical signals among our neurons and muscles. While sodium and chloride, the other two primary electrolytes, exist primarily in our extra-cellular fluid, 98 per cent of the potassium in our bodies resides within our cells.

That said, when someone then injects large amounts of potassium into your bloodstream, it throws off the body's electrolytic balance and causes hyperkalemia. This condition lowers the resting electrical potential of the heart muscle cells, preventing them from repolarising and refiring — effectively stopping the heart and inducing cardiac arrest. Once the EKG registers asystole, a physician will inspect the inmate and declare an official time of death.

How Lethal Injection Works

Building a Better Killing Machine

This three drug cocktail, though touted as more humane than other execution methods, isn't without its detractors. A number of studies have intimated that, if the anaesthesia is inadequate, inmates would be aware and suffering as their hearts and lungs stop functioning.

The three-drug mix can also be difficult to administer if the inmate has severe cardiovascular degeneration. After the failed execution attempt of convicted kidnapper/rapist/murderer Rommell Broom, the Ohio state penal system dropped the Pancuronium and potassium entirely and began simply injecting condemned inmates with 5g of Sodium thiopental only, still enough to kill them. A number of other states have since also switched to the single drug regimen.

The problem with the Ohio protocol, as the single drug method is known, is that the only American company that manufactures it, Hospira, recently moved its headquarters to Italy. Under Italian law, the company was barred from exporting the chemical to the US unless it could prove that it would not be used in lethal injections — and thus, the supply of sodium thiopental in America is dwindling. The 11 states that continue to use this method have begun looking into using Pentobarbital, the stuff vets use to euthanise animals, as an alternative.

Ironically, even Dr Chapman himself is in favour of discontinuing the use of his protocol. As he told CNN in 2007, "The simplest thing I know of is the guillotine and I'm not at all opposed to bringing it back. The person's head is cut off and that's the end of it." That's actually not an unreasonable concept. A guillotine is nearly instant and guaranteed to work the first time. Plus, it conveniently sidesteps the entire Hippocratic Oath quagmire that has plagued medical personnel's involvement with lethal injection — anybody can operate a guillotine, but not everybody can administer an IV. [How Stuff Works - Wiki - CDCR - Al Jazeera - Slate]

Pictures: Maxx-Studio, AP Images


    One would think they could solve the problem of someone being alive with all those guns they already have

      agreed - i know people survive gunchot wounds to the head, but surely if they used something like a shotgun or something - maybe a barrett?

      im not trying to be morbid, but maybe death by hanging or guillotine may be an alternative.

        Re surviving gunshot wounds to the head, it all depends on which part of the brain is hit. Hit the right spot, and certain functions stop and the individual dies. Hit the wrong spot and...well, anything from surviving with little to no side effects to surviving with serious disabilities, to even death could happen. Not too long ago on the news there was a young man who got a metal pole through the head. He survived with few (if any) side effects. Shooting someone in the head isn't a very reliable form of execution. Firing squad in general is also even more inhumane than beheading, considering the executioners aim for the body in general.

          I think death by a gunshot to the head has less to do with what part of the brain gets hit and more to do with the massive exit wound the bullet creates as it leaves your skull. I presume the metal pole was travelling significantly slower than a bullet, so any damage would've been localised to the immediate area around the pole.

            I can't comment on the person Soulless was referring to, but it sounds very similar to a very famous case study where Phineas Gage had a railway spike get shot through his head.

            Seeing as it happened in 1848 I wouldn't exactly call it recent, it was shot through his head as the result of an explosive so not exactly what you'd consider slow.

            He recovered almost perfectly, with the caveat that his entire personality was fundamentally changed. Well worth reading up on if you're interested, just google his name.

          it would be a bloody (dual use of the word) mess to clean up too.

          reading further down the page of comments - i wonder why they dont use the oxygen deprivation method?

          maybe because of the panic one would go through, but then i guess anyone on death road could have a panic attack knowing they were about to meet their end.

          in some sense - im not really up for intentionally putting people in harmful situations, but sometimes you almost wonder if its a fitting end for the people who are on death row, that they have a not so pleasant death.

          i dont like the idea of it myself - i guess the US government has some form of moral decency in regard to the matter.

          unfortunately i cant say the same for some of the eastern and middle-eastern countries.
          beheadings and stonings.... thats a little messed up in my mind, but i also understand its a cultural and historical thing.

      The lethal injection is an extremely efficient way to kill a human being. Guns are too messy and not guaranteed to work. The problem in the US is that the IV is not administered by a medical professional as it goes against the oath they take before before becoming doctors (I think it's the hypocritical oath argument or something).

      With the guillotine and firing squad etc., you'll have organisations like Amnesty International up in arms abut human rights violations and the overall morbidity of the executions.

        It's the Hippocratic Oath, though I suppose one could call it the "hypocritical oath" instead, depending on your stance on capital punishment.

          Haha thanks for the correction. I've never actually seen it spelt before. I've only heard it being called that by pronunciation and I thought they were referring to killing another being hypocritical to a doctor's practice.

          Always nice to learn something new!

            I think it's called the Hippocratic Oath, because it is believe to have been written by Hippocrates.

    "... the rule of law has been built on the state-sanctioned execution of a society’s most heinous transgressors." Trouble is, the state all too often executes the wrong person. How many death row inmates have been shown to be innocent of the crime they were accused of now? The police are not always appropriately diligent in their work, legal representation is sometimes very inadequate.

      Exactly. Unfortunately there have and probably always will be innocent people on death row. While I do believe the guilty need to pay for their crimes, I can't help but feel sorry for those who don't deserve to be there. It's one of the reasons I'm divided on the whole thing. How can people allow executions to happen when there's a chance that some of the condemned are innocent? How is it ok to make them suffer just so the guilty can be brought to justice?

    In regards to using a guillotine, I've read that that it's possible for the head to live for a few seconds after it's removed from the body. Supposedly it's also possible for people to even be aware of what's happened after they've been beheaded. If this is indeed true, it may not be quite as humane as expected. Though I suppose there's no real "humane" way of killing someone... :/

    Anyway, interesting article. I had heard something about the US running low on one of the drugs required, but didn't take too much notice. I'm surprised someone else hasn't picked up the production of it, or are the rights to make it owned by that one company?

      Yeah I've always read similar, I think it may be greatly exaggerated though.

      In reality the blood loss to the head and brain would be very quick, if anything there would be a short glimpse of vision but I'd say that would fade rapidly once the blood drained from the brain.

      Simple fix to that, turn the lights off?

      I've always wondered why carbon dioxide, or oxygen depletion wasn't an option. If you run out of oxygen gradually, don't you just fall asleep, comatose, and then die?

        Given that Giz cited How Stuff Works for this story, I should probably point to their article on decapitation:

        In particular:

        Hillman also goes on to point out that the so-called painless guillotine is likely anything but. He states that "death occurs due to separation of the brain and spinal cord, after transection of the surrounding tissues. This must cause acute and possibly severe pain." This is one of the reasons why the guillotine, and beheading in general, is no longer an accepted method of execution in many countries with capital punishment.

        This is how they cull all the chickens that we eat every single day.

        I dont understand why this simple procedure isnt done just about everywhere - have a locked down room drain the oxygen out with carbon dioxide - patient falls aleep and comatises, patient dies - Job complete.

        Carbon dioxide overdose is a very painful, gagging death. Oxygen deprivation however is painless (you go dizzy, then faint). Using nitrogen has been investigated but never practiced.

      see Stephen King's "The Breathing Method" from "Different Seasons"

      I highly doubt that death by guillotine is completely painless. Wikipedia also cites that some doctors say that the human head will live for up to 15 minutes after decapitation.

      I'm sure there are loads of different ways to kill people painlessly. I find it absurd that this doctor Chapman would think that this is an appropriate alternative. It's the 21st century, surely there's a more civilized way than cutting a man's head off.

    Send them to the Predator planet.

    ...with 43 put to death in 2012 alone. Only China (2000), Iran (314), Iraq (189) and Saudi Arabia (90) executed more people last year than we did.

    That sentence right there, the comparison to those countries........ouch

    I do know Japan still executes as well.

    Well.........apparently wikipedia says Japan hangs its inmates

      Are you mates with Scott Morrison or what?

        I don't get it, I just mentioned what Japan does because it was an article on executions....

        what does the Immigration Minister have to do with it?

        ohhh is it because I used wikipedia as a quick source of information?
        albeit not a hugely reliable source, but good enough for an online blogging site...

        if that is the case, it wasn't funny, only because it took me so long to realise haha

    I don't think there's really a comfortable way to die. A split second of excruciating pain as your head is severed is still only a split second. I wouldn't say I agree with capital punishment in the first place but I think if you're going to enforce it you have to accept the fact that you're inflicting pain on another human. Make it fast.

    Perhaps they could use prison labour to manufacture the poisons?

    Why are we not using lasers for this sort of stuff?

      You can't seriously think we have lasers that are powerful enough to kill instantly rather than by causing painful death by having massive external and internal burns.

      frickin' sharks with frickin' las.... oh, screw this.

    Well you can always rely on Americans to come up with creative ways to take a life.

      How is lethal injection creative? Now killing someone by dropping them in a pool of sharks while wearing a bacon suit, that would be creative.

    I never understood why they couldn't execute a prisoner who is feeling sick and I never understood why the needle has to be sterile either...

      I don't think it "has" to be sterile per se. They just use sterile needles because, well, there isn't a factory that makes the non-sterile-for-lethal-injection kind.

      The needle is sterile in case the person administering the procedure accidentally sticks themselves if the prisoner flinches or similar.

        A fair point... but not executing a prisoner who isn't feeling well still perplexes me?

      To cover their arses in case the condemned has to be revived (for example, a stay of execution). Up to a point, it's possible to undo things and revive the person (though I'm not sure on the exact details or specifics). Sterilizing the needles is simply to prevent the condemned from getting sick from a dirty needle and then suing the state if they are given a stay of execution.

    executed more people last year than we did.


    Copy paste job again?

      The story was clearly written by an American.

      Is there something wrong with that?

        short answer: yes

        only in the sense that this is the Australian arm of Giz, some actual editing would be nice every now and again.

          I found the article quite interesting as an Australian.

            as did i, but a lot of the copy/paste journalism is fine, just a quick read through and edit would be nice to see. and maybe even a reference to other materials where it was taken from if applicable.

    what about the thingy they use for euthanasia apparently peaceful painless and usually a smile on the face too. Something that Doctor Nicaragua advocated...

    I would like to point out that for the crimes that some of these individuals committed a quick painless and humane death may have been something they did not afford their victims...(of course you can also get executed for speaking your mind in some countries)


      morphine can make you feel terrible too - I know when I had it for an injury I got a wave of 'pressure' (feeling as though I was compressed in the bed and restricted around the chest, not being able to breathe properly) and then profound nausea lasting about 30 minutes....

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