The Medical Aspect of Execution

  1. What do you all think of all the medical snafus in State sanctioned Capital Punishment? Who are the people in charge of this and why can't they get their act together? Is it that hard to humanely kill a person?

    The euthanasia proponents seem to think it's easy and humane. My vet did a compassionate and competent job with my dog. Why can't the executioners get it right?
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  2. 69 Comments

  3. by   Boomer MS, RN
    I've wondered about this too. My latest thoughts are that the people who are willing to be involved and/or employed by the facility may not be very skilled at obtaining IV access. But what really stumps me is how difficult it seems, from the news reports, to kill someone humanely. For example, why not give some versed first, a huge dose of morphine or another narcotic, maybe a huge dose of a barbiturate and finally a paralytic or even propofol? I suppose if no one could get IV access, any other option such as central line, which requires an MD, would not be feasible or even possible in that environment. Last evening on 60 Minutes a judge on the 9th Circuit Court stated that a firing squad was more humane than death by meds IV. Cannot agree with that opinion.
    Last edit by Boomer MS, RN on Apr 24 : Reason: added thoughts
  4. by   ~Mi Vida Loca~RN
    Ok I must have missed something, (I'll admit though I never watch the news anymore) has something been happening recently regarding bad executions??
  5. by   Sour Lemon
    Quote from Emergent
    What do you all think of all the medical snafus in State sanctioned Capital Punishment? Who are the people in charge of this and why can't they get their act together? Is it that hard to humanely kill a person?

    The euthanasia proponents seem to think it's easy and humane. My vet did a compassionate and competent job with my dog. Why can't the executioners get it right?
    There are occasional problems with pets, too ...but in difficult circumstances, the euthanasia solution can be injected directly into the heart. That always works.
  6. by   Emergent
    Quote from ~Mi Vida Loca~RN
    Ok I must have missed something, (I'll admit though I never watch the news anymore) has something been happening recently regarding bad executions??
    I read that Arkansas is fixing to execute some bad guys, 2 in one day. Their killing meds are due to expire.
  7. by   Boomer MS, RN
    Quote from Emergent
    I read that Arkansas is fixing to execute some bad guys, 2 in one day. Their killing meds are due to expire.
    Just saw this on ABC news: US judge temporarily blocks 2nd Arkansas execution - ABC News
  8. by   ~Mi Vida Loca~RN
    Thanks for giving me some directions, I will go check it out.
  9. by   RiskManager
    One of the problems lately has been the pharmaceutical manufacturers do not want their drugs used in executions. This is making it more difficult to come up with a drug cocktail that humanely executes the prisoner. The hard part is the deep sedation/anesthesia so that the prisoner feels no pain or terror while the vecuronium paralyzes respiration and the potassium chloride stops the heart. I have done some consulting in correctional healthcare, and I found out that many prisoners have very difficult venous access due to years of IV drug use, including while in prison. It is hard to find someone to do a cut-down while the prisoner is on the execution gurney.

    For reasons unclear to me, we don't just use a large overdose of an opiate to execute people. I have thought that a humane method that can be used by medically-unskilled people is nitrogen asphyxiation: the sedated prisoner is in an airtight room, and the room air is replaced with nitrogen. The prisoner drifts off to sleep and dies by anoxia. Turn on the vent fans and open the vents to flush the nitrogen out and replace it with room air, and there is no safety hazard to the staff.

    PS: after a documentary on PBS, I read the execution protocol of the state of Missouri, if I recall correctly. I thought it was interesting that protocol called for alcohol swabbing of the skin prior to placing the IV access. You probably would not be too worried about infection control at that time, barring any last-minute reprieves. I wonder if they did that to maintain the medical aspects of the procedure, to make it easier on the staff and prisoner.
  10. by   ~Mi Vida Loca~RN
    I am assuming we don't just give a large dose of opiates because there is no guarantee to that, it's not going to usually instantly kill unless they play around with different dosages and who is going to be the test subjects on that? Everyone metabolizes things so different. I have seen someone take 500mg of Oxycodone within an hr all that happened was they woke up with a massive headache. Their hope was to die. They did it again with 600mg and 30 of ambien and alcohol along with phenergan and zofran. They woke up the next day again.

    But then I have seen someone take 15 5/325 percocet and die.

    Same with IV stuff. Seen so much given you would expect them to die but they don't, meanwhile you give a regular dose to someone else and they need narcan.

    Just way too many variables.

    I would wonder what about the coctails given for assisted suicide patients, from the studies and documentaries I have seen, they seem to go well. But again they are already on the edge of death and it's also oral medication which I am assuming a inmate isn't going to take willingly.
  11. by   Boomer MS, RN
    Now I see that the second inmate was executed after all. Rare double execution carried out for Arkansas inmates - CBS News

    Interesting comments here. I can understand that pharmaceutical companies might not or would not want their drugs used for executions. And I know well as a former ER nurse that IV access can be challenging. And that may be part of the problem, as I stated above, that the best at starting IVs may not be working in a prison environment. But as Emergent asked, why can't it be done in a humane manner? I figured if you gave mega doses of the drugs that respirations would cease and the heart would stop. Why couldn't the prison PTB consult with a pharmacist, anesthesiologist, nurse anesthetist, critical care MD, or Hospice provider? Now you've got me thinking more and more about this...Looking forward to more input here.
  12. by   akulahawkRN
    From my understanding, it's pretty well known how to euthanize people reliably, quickly, and painlessly. The problem is at the minimum two-fold: One is that various medication manufacturers don't want their name/brand associated with euthanasia. The other is that because people are involved, politics are also involved. Politicians and Judges sometimes get involved in these matters, basically to the point of directing what medications may and may not be used in carrying out a death sentence. Possibly third in all this is some people just don't respond in an expected manner to the medications used, even when all of them are used in doses that would be expected to be lethal on their own as a single agent.

    At the risk of sounding cold, cruel, and possibly heartless, this is also why there used to be several different methods of execution available. If one method didn't work, another likely would.
  13. by   MunoRN
    Oklahoma, which one of the state's that had some embarrassing episodes with executions, recently legalized the use of nitrogen asphyxiation for executions, I don't know why they haven't switched to that. Asphyxiation, commonly using nitrogen, using some sort of apparatus that still allows carbon dioxide to be expelled normally is a relatively pleasant way to go, it's a popular way for those intentionally ending their lives due to medical conditions to die.

    Oklahoma recently produced a report on a botched execution which described a keystone cops sort of scenario relating to IV access to administer the drugs. A paramedic made the first attempt at access and was able to get an 18 guage in the AC with good flash, but he did not have any tape or dressing ready to go, so he left to find some, by the time he found some tape the IV was no longer in place. He then made numerous other failed attempts at which point the physician attempted a subclavian central line access, but had no ultrasound so couldn't get it correctly into the vein, an EJ was attempted and failed, finally the physician decided to place a femoral line, but with a 1.5 inch peripheral IV, there was another central line kit available for use but it did not occur to the physician that this would be better for femoral access. The femoral line was described as "positional" but working, the site was covered to maintain privacy and the execution drugs were infused, and for some reason the drugs were working but not very well and was basically obvious distress someone checked the IV site and there was a large infiltration, he was eventually moved to another room and died later.

    As it turns out, there was no apparent puncture to the femoral vein, the IV placed there was only infusing into the subcutaneous tissue, although it is surprising that a fair amount of the drugs did make it's way into circulation through capillary absorption.
  14. by   twss2323
    If IV access is such a huge issue, which I understand given most of these individuals likely have a past history of drug use; I wonder if there's a way to do something IM or subQ. Yeah, it doesn't work as fast, but give the sedative, let it start working, then give the next drug.

    I've always thought a giant dose of insulin might not be too bad of a way to go. There's gotta be other routes of administration of drugs.

    The nitrogen method is interesting, and seems like it would totally eliminate the IV issue. I wonder why it isn't more widely used.

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