jection in the USA

Lethal injection is virtually the universal method of execution in the United States. Of the 1,607 executions in the USA up to the end of 2024, 1,419 have been by lethal injection, including those of 12 women.

Table of Contents

A state-by-state analysis is below – this is kept up to date.

Execution Statistics by State

State	First Used	1982–1999	2000–2025	State	First Used	1982–1999	2000–2025
Alabama	12/02/2002	0	51	Mississippi	07/17/2002	0	19
Arizona	03/03/1993	17	22	Montana	05/10/1995	2	1
Arkansas	06/25/1990	20	10	Nebraska	08/14/2018	0	1
California	02/23/1996	5	6	Nevada	12/06/1985	7	4
Colorado	10/13/1997	1	0	New Mexico	11/06/2001	0	1
Connecticut	05/13/2005	0	1	North Carolina	03/16/1984	13	28
Delaware	03/14/1992	9	6	Ohio	02/19/1999	1	55
Federal*	06/11/2001	0	15	Oklahoma	09/10/1990	19	108
Florida	02/23/2000	0	65	Oregon	09/06/1996	2	0
Georgia	10/25/2001	0	54	Pennsylvania	05/02/1995	3	0
Idaho	01/06/1994	1	2	South Carolina	05/31/1996	19	20
Illinois	09/12/1990	12	0	South Dakota	07/11/2007	0	5
Indiana	07/18/1996	4	14	Tennessee	04/19/2000	0	7
Kentucky	05/25/1999	1	1	Texas	12/07/1982	199	394
Louisiana	03/05/1993	5	3	Utah	08/28/1987	4	1
Maryland	05/16/1994	3	2	Virginia	01/24/1995	48	34
Missouri	01/06/1989	41	59	Washington	10/13/1998	1	2
				Wyoming	01/22/1992	1	0

* Carried out at Terre Haute, Indiana
Total at 03/20/2025: 1,426

Historical Background

Lethal injection was first considered as a means of execution in the USA in 1888 when New York’s J. Mount Bleyer, M.D., suggested it in the Medico-Legal Journal. He argued it would be more humane, cheaper, and strip prisoners of the “hero status” often associated with hangings. He proposed the intravenous injection of six grains of morphine. The idea, however, did not catch on—New York introduced the electric chair instead.

Development of the Modern Protocol

With the resumption of the death penalty in 1977, Oklahoma sought a method to replace its derelict electric chair. A three-drug lethal injection protocol was proposed by Chief Medical Examiner A. Jay Chapman in 1977. It was approved by Dr. Stanley Deutsch, chair of the Anaesthesiology Department at Oklahoma University Medical School, and passed into law the same year.

Deutsch described administering drugs through an IV drip to cause rapid, painless death:

“Having been anaesthetised on several occasions with ultra short-acting barbiturates and having administered these drugs for approximately 20 years, I can assure you that this is a rapid, pleasant way of producing unconsciousness,” he wrote in February 1977.

Although Oklahoma was first to legislate, Texas passed similar legislation later that year and carried out the first execution by lethal injection on December 7, 1982. Charles Brooks was executed for the 1976 murder of second-hand car salesman David Gregory. The execution was reportedly uneventful. Brooks’ girlfriend, Vanessa Sapp, witnessed the procedure. It began at 12:07 a.m. and he was declared dead at 12:16 a.m.

By the end of 2010, Texas had executed 463 inmates by lethal injection.

States Using Lethal Injection

As of January 1, 2020, 29 American states have lethal injection protocols, either as their sole method or as an option alongside traditional methods. These include:

Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, and Wyoming.

Only 32 states had actually carried out executions up to the end of 2010. Although Connecticut and New Mexico have abolished the death penalty, inmates remain on death row in both states. The governors of Colorado, Oregon, and Washington have all imposed moratoriums on executions during their terms in office.

Florida offered lethal injection as an option to electrocution in 1999. Alabama followed suit from July 1, 2002. Nebraska replaced electrocution with lethal injection in 2009.

Many states have retrofitted existing execution chambers to reduce costs. California constructed a new lethal injection suite at San Quentin in 2009, which remains unused. At Washington State Penitentiary in Walla Walla, injections were carried out beneath the gallows trapdoors. In Utah, the same chamber is used for both firing squad and lethal injection executions.

U.S. Federal and Military Executions

Federal Facility at Terre Haute

The U.S. Federal Bureau of Prisons maintains a $300,000 lethal injection facility at Terre Haute, Indiana. Located in a nondescript brick building outside the main compound, the death house includes five viewing rooms around the execution chamber.

The chamber resembles a hospital room, lined with green tiles, and features a gurney with five Velcro restraints and a sink in one corner. Intravenous tubes pass through a small wall opening into the executioner’s room. Only the executioner’s room has one-way glass; all others have two-way windows with curtains. A phone line connects directly to the Justice Department in Washington, and the President retains sole authority to grant last-minute clemency.

A ceiling-mounted camera transmits footage to the executioner’s room to monitor for signs of pain.

Notable Federal Executions

Timothy McVeigh: Executed on June 11, 2001, for the Oklahoma City bombing, which killed 168 people. The intravenous drip that delivered the lethal chemicals went to a catheter in McVeigh’s right leg. The first drug was administered at 8.10 a.m., with the second being given at 8.11 and the final one at 8.13 and he was pronounced dead at 8.14 a.m.
Juan Raul Garza: Executed June 19, 2001, for murder and drug trafficking. He was executed on the same gurney.
Louis Jones, Jr.: Executed March 18, 2003, for rape and murder.

Federal executions resumed in July 2020 with three executions in a single week using pentobarbital sodium:

Daniel Lewis Lee – July 14
Wesley Ira Purkey – July 16
Dustin Lee Honken – July 17

Together, these three men had nine victims. All executions proceeded without complications. An additional five executions were carried out in August and September 2020.

Military Executions

The U.S. military has transitioned from hanging to lethal injection. The execution facility is located in the basement of the military prison at Fort Leavenworth, Kansas, where seven inmates are currently housed.

Overview of Lethal Injection

Lethal injection protocols vary from state to state. Typically, the prisoner is strapped to a gurney (a wheeled hospital-style trolley bed) or a fixed execution table, rather like an operating room table, by leather or webbing straps over the body and legs. Their bare arms are strapped to boards projecting from the sides of the gurney.

Trained technicians then insert a 14-gauge (2.0mm diameter) catheter—the largest commercially available needle—into a vein in each arm, a process that sounds much simpler than it often is. Once the catheters are in place, they are flushed with 10cc of a Heparin solution to prevent clots forming inside the catheter. Then, a 1,000cc bag of saline solution is connected to the catheter ends, and the inmate is either wheeled into the execution chamber or the curtains surrounding it are drawn back to allow the witnesses to see the procedure.

Administration of Drugs

Once the condemned has made any final statement, the prison warden gives the signal for the execution to begin, and the technician(s) begins to manually inject the three chemicals, typically comprising:

2–3 grams of sodium thiopental (C₁₁H₁₇N₂NaO₂S) in 80cc of aqueous solution
50–100mg of Pavulon (the trade name for pancuronium bromide, C₃₅H₆₀N₂O₄)
100 milliequivalents (MEQ) of potassium chloride (KCl) in 50cc of aqueous solution

There is a short interval between each chemical, during which the saline solution continues to flow in the IV line to prevent any chemical reaction that could block it. Typically, the actual injections take from 3 to 5 minutes to complete. The amount of sodium thiopental used is between eight and ten times the amount used for medical anaesthesia.

Texas Drug Quantities

Texas used the three drugs in the following quantities:

120cc of solution containing three grams of sodium thiopental
50cc of solution containing 100 milligrams of pancuronium bromide
70cc of solution containing 140 milliequivalents of potassium chloride

The drugs are administered in this order, sequentially, with intervening saline flushes over a period of approximately five minutes.

Effects and Medical Commentary

All the chemicals used in the U.S. are standard medical drugs. Sodium thiopental is an ultra short-acting barbiturate that causes unconsciousness very quickly if injected into a vein. Pancuronium bromide (Pavulon) is a muscle relaxant that paralyses the diaphragm and thus arrests breathing, while potassium chloride causes cardiac arrest. It is used in cardiac surgery to stop the heart.

In most cases, the inmate is unconscious in less than half a minute after sodium thiopental is administered. Its effects also wear off rapidly, which is why, in surgery, gaseous anaesthetic is used to maintain the unconscious state.

A British medical journal, The Lancet, published an article critical of lethal injection (Volume 365, 4/16/05), which claimed to have identified 21 execution cases where the post-mortem level of sodium thiopental was below that used in surgery, suggesting that consciousness during administration of the other two drugs may have been possible.

However, sodium thiopental is rapidly absorbed by body fat, so testing should be done as soon as possible after death. This was done in the execution of Michael Ross in Connecticut in May 2005. A blood sample taken 25 minutes after death showed 29.6 milligrams per litre of thiopental. A second sample, taken five hours later, showed 9.4 milligrams per litre.

There is no conclusive evidence that an inmate has still been conscious while the second and third drugs were administered. After death, the inmate’s face may show a bluish tinge, a typical consequence of respiratory failure as oxygen levels fall in the bloodstream.

Legal Challenges: Kentucky Case

In the state of Kentucky, condemned inmate Ralph Baze appealed against the use of lethal injection on the grounds that it was a “cruel and unusual punishment,” which is unconstitutional under the Eighth Amendment.

His case was heard by the Supreme Court on January 7, 2008. On April 15, 2008, the Court ruled by a majority of 7–2 that lethal injection does not violate the U.S. Constitution, clearing the way for executions to resume. As a result of the earlier legal delay, there were no executions in the U.S. from September 25, 2007, to May 5, 2008.

The Supreme Court ordered the release of the Kentucky Lethal Injection Protocol. Kentucky uses the same three-drug cocktail that most other states use and has carried out two executions by injection, both of which appeared to go smoothly (Eddie Harper in May 1999 and Marco Alan Chapman in 2008).

Automated Execution Machines

In some states, a fully automated lethal injection machine has been used that runs off a 12-volt battery. It injects the chemicals in the correct order and amount once the catheters are in place. The machine has six syringes activated by mechanical plungers—three with the lethal drugs, and three with harmless saline solution.

Two buttons control the machine—one for the lethal syringes and one for the harmless ones. The two executioners each press a button, and the syringes release the drugs into the IV line.

Multiple Executions

Arkansas and Texas Cases

In Arkansas in 1994, prison officials cited the disruptive impact of executions on staff and other prisoners and the high cost of “rehearsal time” and overtime pay. To reduce both, they conducted multiple executions. Two unrelated executions were carried out on the night of May 11, and three more on August 3 of that year, with 45-minute intervals between them to clear the chamber and replace the equipment.

Texas has also carried out multiple executions. On January 30, 1995, in that state’s first multiple execution in 44 years, 33-year-old Clifton Russell was put to death just after midnight, and Willie Williams, 38, was injected about an hour and a half later. Texas carried out another double execution in 1997 (Dorsie Johnson-Bey and Davis Losada on June 5).

Witness Account

“Witnessing the Execution of David Clayton Hill“ is a first-hand account of a lethal injection written by the inmate’s spiritual advisor and published here at his request.

Ohio’s Lethal Injection Protocols

Romell Broom Case and Changes

After the failed execution of Romell Broom on September 15, 2009, the Ohio Corrections Department adopted a single-injection protocol using 5 grams of sodium thiopental—2.5 times the previous amount. Since the other two drugs were not used, there was no risk of pain as the inmate drifted into coma and death. This mirrors the method used in animal euthanasia.

Intra-Muscular Backup Method

If suitable veins cannot be located, a backup method is employed involving intra-muscular injection of two drugs:

10mg of Midazolam
40mg of Hydromorphone

These are injected into the shoulder, thigh, or buttock. After five minutes, a doctor examines the inmate, and the process may be repeated. Midazolam is an ultra short-acting benzodiazepine with strong anaesthetic properties. Hydromorphone is a morphine derivative and powerful painkiller.

Executions Using New Methods

The first execution using the single dose of sodium thiopental took place on December 8, 2009, when Kenneth Biros was executed at the Southern Ohio Correctional Facility in Lucasville. Biros was pronounced dead 43 minutes after the process began. The drug took about 10 minutes to cause death—2–3 minutes longer than the three-drug process.

Reportedly, Biros’ chest heaved several times, and he moved his head before becoming still. Ten executions using this new protocol occurred without issue through the end of 2010.

Switch to Pentobarbital

On January 25, 2011, Ohio announced a switch to a single dose of pentobarbital sodium after its thiopental supply was depleted. The U.S. manufacturer, Lundbeck Inc., protested its use in executions.

Johnnie Baston was the first person executed with a single 5-gram dose of pentobarbital on March 10, 2011. He was pronounced dead 13 minutes after the injection. About a minute in, he gasped and grimaced, then became still.

Ohio’s second use of pentobarbital was on April 12, 2011, with the execution of Clarence Carter. Again, the process was smooth. However, difficulty locating a vein arose during the May 17 execution of Daniel Lee Bedford. Ohio’s supply of pentobarbital was exhausted with the execution of Harry Mitts Jr. in September 2013.

Execution of Denis McGuire

On January 16, 2014, Ohio executed 53-year-old Denis McGuire using two previously untried drugs: midazolam (a sedative) and hydromorphone (a painkiller), due to unavailability of thiopental and pentobarbital.

It took 25 minutes for McGuire to die—the longest time ever recorded in Ohio. For the first five minutes, he lay motionless, then emitted a loud snort, continuing the sound for several minutes. He also opened and shut his mouth and showed stomach movement. His final movement, a coughing sound, occurred at 10:43 a.m., and he was pronounced dead 10 minutes later.

McGuire’s family intends to sue the state over the incident. At a January 12 court hearing, the state’s expert, Dr. Mark Dershwitz, stated, “I truly don’t know how many minutes it will take the inmate to stop breathing,” and added, “There is no science to guide me on exactly how long this is going to take.”

The Sodium Thiopental Shortage

Illinois-based Hospira Inc. was the sole U.S. supplier of sodium thiopental and suspended production in late 2009 due to problems in obtaining raw materials. Initially, it planned to continue production at its plants in Italy but decided not to resume production on January 22, 2011, after the Italian parliament banned the export of sodium thiopental for lethal injections.

This shortage led to several states having to postpone executions in the fall of 2010, with some obtaining supplies from outside the U.S. Arizona, for example, did so for the execution of Jeffrey Landrigan in October 2010. Their supply came from Archimedes Pharma in the UK, the only licensed manufacturer of sodium thiopental in Britain. However, the British government banned Archimedes from exporting further supplies in November 2010.

Several other states, including California, Georgia, and Tennessee, managed to beat this ban and obtained supplies as well. Archimedes Pharma’s sales agent, Dream Pharma—a licensed pharmaceutical wholesaler—apparently exported sufficient thiopental for 90 executions. Georgia used UK-sourced thiopental for the execution of Emanuel Hammond on January 25, 2011, but its supply was later seized by the DEA, as were supplies in Kentucky and Tennessee (April 1, 2011).

Three Arizona death row inmates filed a lawsuit on February 3 to try and prevent this UK-sourced thiopental from being used, demanding its withdrawal from all four states that had it. As of January 2011, 17 states did not possess any usable sodium thiopental.

Texas announced in mid-March 2011 that it was switching to pentobarbital sodium as the first drug from April 1. Five grams of this will be used in place of the previous 3 grams of sodium thiopental.

Nebraska revealed in January 2011 that it had obtained a supply of 500 grams of sodium thiopental from Kayem Pharmaceuticals in India in December 2010 and that it had been tested by an independent U.S. laboratory to ensure usability. Kayem Pharmaceuticals announced in April 2011 that it was no longer willing to supply sodium thiopental to U.S. correctional institutions.

Kentucky, California, Maryland, and Nebraska are states that have Administrative Procedures Acts requiring any change to their execution protocols to pass through a review procedure and public scrutiny.

Pentobarbital Sodium Replaces Sodium Thiopental

Pentobarbital sodium has been used by Alabama, Arizona, Delaware, Florida, Georgia, Ohio, Mississippi, Oklahoma, South Carolina, Texas, and Virginia to replace sodium thiopental as of September 2011.

Pentobarbital (C₁₁H₁₇N₂NaO₃), trade name Nembutal (manufactured in the U.S. by Lundbeck Inc. in Illinois), is a fast-acting barbiturate that causes a rapid slowdown in central and peripheral nervous system activity and, in large doses, can mimic brain death. It is used by vets to euthanize animals and is also used for human euthanasia. First synthesized in 1928, it is FDA-approved.

Oklahoma’s First Use of Pentobarbital

On December 16, 2010, Oklahoma executed John David Duty for the murder of his cellmate Curtis Wise. Due to the issues obtaining sodium thiopental, Oklahoma used a 5-gram dose of pentobarbital sodium as the first drug administered.

The drugs began to flow at 6:12 p.m., and Duty’s breathing became labored one minute later. At 6:15 p.m., he appeared to stop breathing, and the color began to drain from his face. He was pronounced dead at 6:18 p.m. There were no apparent problems in substituting pentobarbital for thiopental. At this dosage, pentobarbital alone would have been lethal.

Billy Don Alverson was executed on January 6, 2011, and Jeffrey David Matthews followed on January 12—both without apparent problems. Joseph Paul Franklin was executed in Missouri on November 20, 2013, using a single dose of pentobarbital sodium—the first such use in that state.

Texas and Other States Follow Suit

Texas’ first execution using pentobarbital was that of Cary Kerr on April 3, 2011. The drug was administered at 6:10 p.m., and Kerr was pronounced dead at 6:19 p.m. without reported issues.

South Carolina used the same three-drug protocol on May 6 for Jeffrey Motts. He became unconscious in 30 seconds and stopped breathing a minute later. Mississippi executed Benny Joe Stevens on May 10 and Rodney Gray on May 17. Alabama executed Jason Oric Williams on May 19. Arizona used the protocol on May 25 for Donald Edward Beaty. Texas executed Gayland Bradford on June 1, followed by three more executions in June.

Georgia became the eighth state to use pentobarbital when it executed Roy Blankenship on June 23, 2011. This execution did not go smoothly; Blankenship took longer to lose consciousness, though the cause is unknown. Arizona executed Richard Bible without incident on June 30.

That same day, Lundbeck, the manufacturer of pentobarbital, announced a ban on supplying the drug to U.S. correctional facilities.

Subsequent executions included:

Humberto Leal Jr. in Texas (July 7, 2011) – He was pronounced dead ten minutes after the injections began.
Thomas West in Arizona (July 19, 2011) – He executed in Arizona without any problem after a last minute flurry of appeals, centering in part on the use of pentobarbital. He was pronounced dead four minutes after being declared sedated.
Mark Stroman in Texas (July 20, 2011) – He was executed without any problems.
Andrew DeYoung in Georgia (July 21, 2011, videotaped) – This execution was videotaped.
Robert Jackson III in Delaware (July 29, 2011) – He was put to death without any apparent problem at the James T. Vaughn Correctional Center in Smyrna.
Jerry Terrell Jackson in Virginia (August 18, 2011) – This went smoothly and he was pronounced dead after 6 minutes.
Manuel Valle in Florida (September 28, 2011)

Further Expansion of Pentobarbital Use

Idaho conducted its first execution in 17 years on November 18, 2011, executing Paul Ezra Rhoades. The procedure took 22 minutes.

In 2012:

Gary Roland Welch was executed in Oklahoma (January 5)
Arizona used a single dose for Robert Moormann (February 29) and Robert Charles Towery (March 8)
Idaho used a single dose for Richard Leavett (June 12)
Texas executed Yokamon Hearn using a single dose (July 18)

Texas could no longer obtain pancuronium bromide. Virginia’s Department of Corrections announced it would substitute rocuronium bromide for pancuronium in July 2012.

Florida Becomes First to Use Midazolam Hydrochloride

On October 15, 2013, Florida executed 51-year-old William Happ for the rape and murder of Angie Crowley. The sedative midazolam hydrochloride (500mg) was used for the first time in an execution.

The process began at 6:02 p.m. Happ blinked, yawned, and showed movement for several minutes. By 6:08, a prison official stimulated his eyelids and shook him with no response. He was pronounced dead at 6:16 p.m., but appeared to remain conscious longer than others executed with thiopental or pentobarbital.

Midazolam is a short-acting benzodiazepine CNS depressant, typically used for sedation. The hydrochloride salt form is soluble in aqueous solutions. Its formula is C₁₈H₁₃ClFN₃·HCl.

Darius Kimbrough was executed in Florida on November 12, 2013, using the same combination of chemicals. The injection began at 6:01 p.m., and he was pronounced dead at 6:18 p.m. There were no body movements like in Happ’s case.

Oklahoma Tries Midazolam—with Disastrous Results

On April 29, 2014, Oklahoma executed Clayton Lockett using midazolam hydrochloride. The execution began at 6:23 p.m., and it took 10 minutes to declare Lockett unconscious. At 6:34, he moved his mouth; at 6:36, he began convulsing; at 6:37, he tried to sit up and said, “something’s wrong.”

The process was halted at 6:39. Lockett died from a massive heart attack at 7:06 p.m. It appears the vein burst and chemicals were injected into surrounding tissue rather than the femoral vein.

Florida Uses Etomidate for the First Time

On August 24, 2017, Florida used etomidate for the execution of Mark Asay due to issues with midazolam. The formula is C₁₄H₁₆N₂O₂. Etomidate was followed by rocuronium bromide and potassium acetate. The execution began at 6:10 p.m., and Asay was pronounced dead at 6:22 p.m. without apparent suffering.

Nebraska Becomes First State to Use Fentanyl Citrate

On August 14, 2018, Carey Dean Moore became the first person executed with fentanyl. Nebraska’s protocol included diazepam (Valium), fentanyl, cisatracurium besylate (to induce paralysis), and potassium chloride. Diazepam and cisatracurium had not previously been used in executions.

The End of Lethal Injection in the USA?

On July 1, 2011, Lundbeck Inc.’s parent company in Denmark banned the sale of pentobarbital to U.S. state corrections departments. “It adamantly opposes the distressing misuse of our product in capital punishment,” the company stated.

On March 27, 2012, a federal court in Washington, D.C., ordered the FDA to block sodium thiopental imports and instruct states to surrender any foreign-manufactured supplies.

By May 2012, several states (e.g., Missouri, Kansas, Kentucky) lacked the necessary drugs to carry out executions. Others, like Oklahoma, would run out by year’s end. Texas had enough drugs for 23 more executions.

In May 2012, Missouri considered using propofol (Diprivan, formula C₁₂H₁₈O), a short-acting non-barbiturate anesthetic and the drug involved in Michael Jackson’s death. Gov. Jay Nixon halted Allen Nicklasson’s October 23 execution after medical protests and pressure from the European Union. Missouri’s supply came via a U.S. distributor for Fresenius Kabi in Germany.

Lethal Injection in Other Countries

China

Lethal injection is used by China, which is progressively replacing shooting with it, although it is impossible to know how many people have died by this method so far, as execution figures are a state secret there.

An amendment to China’s Criminal Procedure Law in 1996 allowed for executions by lethal injection. Kunming, the provincial capital of Yunnan, was the first Chinese city to adopt lethal injection when two unnamed men were executed on March 28, 1997. Other cities and provinces followed, including Changsha, Shanghai, Guangzhou, Nanjing, Chongqing, Hangzhou, and Shenyang. The next city to adopt lethal injection was Chengdu from March 1, 2008. China’s north-eastern province of Liaoning moved to injection from February 2009. Around half of the 404 Intermediate People’s Courts have now adopted this method. Beijing moved to lethal injection at the beginning of 2010.

During 2003, China introduced a fleet of mobile execution vehicles, converted from large Iveco vans. The windowless execution chamber at the back contains a metal bed on which the prisoner is strapped down. The executioner presses a button that starts an automatic injection process, which can be watched on a video monitor next to the driver’s seat and recorded if required.

Efficiency and cost were apparently the main reasons for the introduction of these vehicles, according to Yunnan officials. One was quoted as saying, “With lethal injection, only four people are required to execute the death penalty: one executioner, one forensic doctor, one member of the court, and one other official. A dozen guards are also required to keep watch around the van.” It is thought that China uses a single large dose of pentobarbital sodium, administered by a mechanical pump through an IV line and catheter.

Thailand

Thailand adopted lethal injection as its sole method and carried out its first executions in December 2003, when four men were put to death in Bang Khwang prison for drug trafficking and murder. Two men were executed there for drug trafficking during 2009.

Vietnam

Vietnam is switching to lethal injection in place of shooting by firing squad from July 2011. In May 2012, Vietnam news announced that the country had been unable to source the necessary drugs and had not carried out any executions by injection, despite having more than 400 on death row, 100 of whom had completed their appeals.

A decree that came into force on June 27, 2013, permitted authorities to use Vietnamese-made chemicals for executions. The first execution by lethal injection was carried out on August 6, 2013, when 27-year-old Nguyen Anh Tuan was put to death in Hanoi for a 2009 robbery/murder. Vietnam has adopted a three-drug protocol using sodium thiopental, pancuronium bromide, and potassium chloride. 596 people remain on death row at this date.

The Philippines

The Philippines decided to use lethal injection to replace the electric chair and carried out its first injection execution on February 4, 1999, when Leo Echegaray was put to death for child rape. A further six men were executed by this method up to the end of 2000, but there have been no executions since, and the Philippines abolished capital punishment in June 2006.

Guatemala

Guatemala also switched to lethal injection after a botched firing squad execution in 1996 and has carried out three executions since then.

The first occurred on February 10, 1998, when 42-year-old Manuel Martinez was put to death for killing four children, their parents, and their aunt in 1995 in a dispute over a small plot of land.

On June 29, 2000, two members of a Guatemalan kidnapping ring were executed in consecutive and televised executions. Amilcar Cetino Perez and Tomas Cerrate Hernandez were members of a notorious kidnap gang believed to be responsible for death threats against the family of President Alfonso Portillo.

Is Lethal Injection the Humane Alternative?

Execution by lethal injection takes much longer from start to finish than any other method—typically 20–30 minutes, depending on the execution protocol and the ease (or otherwise) of locating a vein. For the majority of this time, the inmate receiving a lethal injection is fully aware of what is happening to them and able to experience their execution.

They know that they will be dead at the end of it, and the fear of dying (particularly in front of an audience) and of the unknown is strong in most of us. It is difficult to see, therefore, how it can be considered more humane, as the prisoner is subjected to far more mental anguish over a much longer period.

It is fair to say that injection is much less dramatic than the electric chair or hanging and probably easier for the staff and witnesses, as it looks more like a surgical procedure than an execution. Looking at the Guatemala photo above, it is not obvious that this is an execution rather than a surgical procedure. But does it cause the prisoner less suffering overall?

When all goes well, the only physical pain is the insertion of the catheters. If the person’s veins are easy to find, this can be done in a minute or so. The catheters are connected to the saline drip, and the prisoner is either wheeled into the execution chamber or the curtains drawn back so that they are in full view of the witnesses and journalists.

After they have made their final statement, the injection of the lethal chemicals can begin. They may pass almost instantly from full consciousness into unconsciousness, or they may feel themselves becoming drowsy and know that they are beginning to die.

Rogelio Cannady was put to death by lethal injection in Texas on May 19, 2010. Just before he became unconscious, he told witnesses, “I am going to sleep now. I can feel it – it’s affecting me.” So he was able to feel something, although he did not claim to be in any pain.

Not everyone is of the opinion that death by lethal injection is painless. Dr. Edward Brunner, chairman of the Department of Anaesthesia at Northwestern University Medical School, submitted an affidavit on behalf of death row inmates in Illinois in which he states that lethal injection, “create[s] the substantial risk that prisoners will suffocate or suffer excruciating pain during the three chemical injections but will be prevented by the paralytic agent from communicating their distress.”

The Problems with Injection

The most common problem seems to be where the needle either misses the vein or passes through it. Even for trained medical staff, getting a needle into a vein is not always that easy. I have had it happen to me twice during routine blood work (blood test), where a skilled nurse failed at the first attempt.

This could be easily checked, however, by using a vacuum vial to ensure that blood flows freely after the needle is inserted, as is done when taking a normal blood sample. Missing the vein appears to be what happened in the case of Angel Nieves Diaz in Florida, as described below.

Another problem with lethal injection is the aqueous pressure in the executee’s veins. Veins have an internal pressure (blood pressure) which has to be overcome to allow injection into them. A doctor, when giving a normal intravenous (IV) injection, has to equal and then slightly exceed this pressure. If he produces a pressure that is too great, he will rupture the vein.

The doctor accomplishes this through his training, fingertip dexterity, and experience built up from giving repeated injections. He feels the pressure in the vein against the top of the plunger of the syringe.

In the case of a lethal injection, the volume of fluid required to fill the IV tubes running between the executioner’s cubicle and the prisoner means that the syringes must be of 50–60cc capacity. Syringes of this size are too big to give any real feel to the person administering the injection. Thus, too much pressure can easily be applied and a rupture of the vein may occur. This can happen even in giving a non-lethal injection into good healthy veins in a normal person.

It is not unusual for the inmate to be a former intravenous drug abuser, with delicate, collapsed veins that can stand far less overpressure. This is also true of people who are insulin-injecting diabetics. When a person with normal veins is frightened, their veins contract and become hard to find.

Before insertion of the catheters, a good vein must be located. It is not unusual for a “cut-down operation” to have to be performed to find a usable (not necessarily suitable) vein. This entails a minor surgical procedure on the arm, leg, or groin carried out under local anaesthetic, using a subcutaneously injected dose of Xylocaine or similar local anaesthetic, administered by a technician.

The public is seldom made aware of this, and the witnesses would not typically see any evidence of it during the execution.

To produce a quick and painless death, it is vital that the chemicals are injected into a vein, rather than an artery. Veins carry blood to the heart and arteries away from the heart. The path of the chemicals (particularly the potassium chloride) should be via the quickest route to the heart so as not to prolong the execution.

If an artery is used by mistake instead of a vein, the blood carrying the chemicals has to go the “long way round,” significantly increasing the time taken to stop the heart. The distinction between a vein and an artery is not an easy one to make. Even a doctor can make a mistake!

It is clear from reading reports of executions that the time between commencing the injection and certifying death varies a great deal.

Injections on Film

Sharon Stone’s Last Dance gives a good insight into what goes on, as well as examining many of the issues surrounding capital punishment in a balanced and sensitive way.

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