Is lethal injection humane?

Editor's note: This report originally ran in the Q section on April 4, 2004.

Lethal injection became the favored way to execute criminals in the United States because it looks peaceful and clinical -- and, if done right, it's painless.

Partly because lethal injection is considered so humane, North Carolina made it the state's only execution method in 1998. Lethal injection also avoids exposing prison workers to poisonous vapors as the gas chamber had.

Now, doctors and death-penalty critics warn that lethal injection can deliver a hidden torture worse than other ways of putting killers to death, such as hanging, electrocution, firing squad or lethal gas. They claim inmates can die awake and in pain but unable to alert witnesses because they are paralyzed.

Lawsuits challenging the constitutionality of lethal injection are the latest turn in the death-penalty debate. Suits have been filed not only in North Carolina but also in states such as South Carolina, Virginia, Tennessee, Georgia, Louisiana, Texas, Ohio, Pennsylvania and New York. Lawyers for death row inmates argue that what might seem to be the most civilized form of execution actually is cruel and unusual punishment -- and therefore forbidden by the U.S. Constitution.

An appeals court in New Jersey recently stopped lethal injections there on the grounds that insufficient medical knowledge supports the method.

And the U.S. Supreme Court heard arguments Monday in an Alabama case raising a related question: Is lethal injection humane when prison personnel have to cut into an inmate to find a vein for injecting the drugs? Sometimes that is necessary for obese inmates or for drug addicts. A victory by the Alabama inmate could invite more challenges to lethal injection, which 37 states, the federal government and the military use. A ruling is expected by June.

"Until recently, there was no incentive for states to review what they're doing," said Fordham University law professor Deborah Denno, who has studied execution methods. "An awful lot more attention is going to be paid to how we execute people. I think states are going to have to make changes."

First-degree murder is punishable by death in North Carolina. Four women and 187 men are on death row at Raleigh's Central Prison.

North Carolina's way

Like most states, North Carolina uses a trio of drugs: the anesthetic sodium pentothal to put the inmate to sleep, potassium chloride to stop the heart and pancuronium bromide to paralyze and suffocate the prisoner. The drugs are administered one after another fairly quickly.

Critics of the method say the anesthetic might not put the inmate fully to sleep or could wear off too soon, causing the inmate to die in agony, terrified and aware he's dying. The paralyzing drug prevents the inmate from so much as frowning or lifting an eyelid -- so it could hide excruciating pain and terror caused by the suffocation and the drug- induced heart attack, critics say.

If the paralyzer weren't used, doctors say, there would be little question as to whether the anesthesia was working because the inmate could express pain.

For similar reasons, veterinarians aren't supposed to use paralyzers to euthanize animals. And they're discouraged from using sodium pentothal as an anesthetic because it can wear off.

A further concern is that nonmedical prison personnel must administer the lethal chemicals because doctors and nurses aren't supposed to help kill people.

Doctors disagree

In a pending lawsuit filed by North Carolina death row inmate George Franklin Page, Dr. Philip Boysen, chairman of anesthesiology at UNC-Chapel Hill's medical school, said in an affidavit that North Carolina's lethal-injection procedure invites disaster.