lethal injection
The Oklahoma State Penitentiary in McAlester is home to the state's execution chamber. (Michael Duncan)

As Oklahoma plans to start 2022 with another execution, it is time for a sober reassessment of the broken practice of lethal injection.

As an emergency physician born and raised in Oklahoma, I am deeply troubled by our state’s insistence on using life-saving medicines to end lives. The American Society of Anesthesiologists has noted, “Although lethal injection mimics certain technical aspects of the practice of anesthesia, capital punishment in any form is not the practice of medicine.” Numerous other medical associations have issued similar statements, and physicians do not actually administer Oklahoma’s lethal injections.

The Oklahoman recently reported that the state does, however,  pay a physician $15,000 per execution — and thousands more for pre-execution training sessions — to perform duties such as helping with IV placement, performing a consciousness check and verifying death. This amount rivals what many doctors make in a month for taking care of patients, highlighting the absurdity of this perversion of medicine.

Yet lethal injection is carried out by our state, on the behalf of citizens like you and me, under the false guise of medicine and humane treatment. In reality, lethal injection has nothing to do with medicine and is designed to obscure the inhumanity of what is really going on.

Lethal injection is not a medical procedure

In 1977, Oklahoma became the first state to adopt lethal injection as its means for execution, under the deeply mistaken belief that, because the procedure mimics anesthesia, it would produce a more humane execution.

When designing this method, no appropriate medical professionals were involved — it was cobbled together by a legislator and coroner with curbside opinions from an anesthesiologist. The Oklahoma Medical Association refused to participate in the venture, as it would violate the profession’s code of ethics.

The three-drug cocktail used in Oklahoma consists of a sedative to induce a coma, a paralyzing drug that causes suffocation and a high dose of potassium to stop the heart.

Both in anesthesia and emergency medicine — my speciality — we use sedative and paralytic drugs for the very different purpose of keeping patients alive during surgery or other medical interventions. Such drugs are used routinely and successfully in hospitals across the county and are a cornerstone of modern medicine and critical care.

However, the use of these drugs in medicine is also evidence-based. Lethal injection, meanwhile, is based on conjecture and experimentation. Oklahoma’s protocol calls for one of the drugs to be used in a quantity nearly 100 times larger than the amount used medically. There is no research on how this affects the human body, and the side effects may be severe. Furthermore, there is no known effective dose of potassium to stop a heart, since it is unstudied in humans, which means death likely results from a paralyzed suffocation in many cases.

The evidence we do have — from autopsies and witness accounts — suggests death by lethal injection is slow and distressingly painful, even in those instances, such as Bigler Stouffer’s execution on Dec. 9, in which there are no visible complications.

Autopsy reports of more than 200 prisoners executed by lethal injection show that their lungs filled with fluid and blood, which would cause a feeling of drowning, suffocation, panic and terror — something that was witnessed at the 2014 of Joseph Wood in Arizona, during which he reportedly “gulped” and “gasped” more than 600 times in the two hours it took him to die.

The so called “consciousness check” the state-paid physician performs is a pure act for show. There would be no point making a determination of consciousness for a patient given paralytic drugs, which would render any physical examination findings irrelevant. The lethal injection drug combination is perfect for creating a state in which one would be fully conscious but physically unresponsive.

Lethal injection can present the image of a pain-free death while actually causing hidden agony.

Too much room for error

What’s worse is that the suffering described above is a best-case scenario, when lethal injection goes exactly as planned — which is by no means always the case.

Among all execution methods used in the U.S., lethal injection has the highest rate of botched executions, and it can go wrong regardless of which drugs are used.

One risk is that injection executions can involve prolonged and painful attempts at IV insertion by non-medical executioners, resulting in arterial or bladder puncture. And if an IV is misplaced when the injection is administered, the release of the drugs will be slow and torturous. Meanwhile, issues with the sedative can cause patients to feel the release of the drugs as they burn through their veins, causing people to writhe in pain, gasp for air, and die with their eyes open.

Oklahoma is no stranger to botched executions. Clayton Lockett infamously died of a heart attack in 2015 after half an hour of pain caused by a misplaced IV. More recently, John Grant reportedly convulsed multiple times and vomited during an execution that the Oklahoma Department of Corrections later said had proceeded “without complication.”

These incidents show how the process is broken and is not working on any medical level. Lethal injection is widely considered unethical by medical professional societies and pharmaceutical companies. In fact, many pharmaceutical suppliers do not want their lifesaving drugs to be used to kill prisoners and have prohibited the sale of their medicines for this purpose.

And yet Oklahoma persists in killing people using this method.

We have had more 40 years of the lethal injection experiment, and science has shown us that it has failed. It is time for our elected officials to acknowledge this failure and end the practice of lethal injections for good.