How are execution drugs supposed to work?

http://www.theguardian.com/world/2014/jul/24/execution-drugs-how-are-they-supposed-to-work

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Seven states have killed 26 men in 2014, including Joseph Wood, whose prolonged execution – "gasping and snorting" for almost two hours – is the third botched delivery of capital punishment this year.

Wood's execution on Wednesday night follows Dennis McGuire's in Ohio in January and Clayton Lockett's in Oklahoma in April. Each execution stretched well past the intended duration of about 10 minutes: an hour and 58 minutes, 26 minutes, and 43 minutes respectively. Witnesses described visible distress and abnormal bodily reactions from all three men: Wood "gasped and snorted more than 600 times", "gulped like a fish" and his stomach became strangely distended; McGuire "made snorting and choking sounds … heaved and clenched his fist"; and Lockett "struggled violently, writhing and groaning".

Arizona and Oklahoma have ordered investigations, but also defended the execution protocol, and Arizona governor Jan Brewer said "by eyewitness and medical accounts he did not suffer." All were meant to be sedated, and all were executed under new drug and injection protocols, put in place to circumvent shortages of lethal drugs and to protect new drug providers with secrecy.

State prison officials face boycotts from drug providers, a mandate to execute convicts who have been sentenced to death, and a prohibition in the constitution's eighth amendment against inflicting "cruel and unusual punishment".

After the courts determine suspects' guilt, the states must either find a way to navigate legal hurdles to execute the convict, or they must change their policy on the death penalty – a course most governors and lawmakers shy from doing. Absent that, death penalty states have followed a road of untested drug combinations and secret sources.

The drugs

In Arizona, officials used on Wood the same two-drug combination of midazolam-hydromorphone that Ohio used to kill McGuire. David Waisel, an associate professor of anaesthesia at Harvard Medical School, testified ahead of McGuire's death, and warned the court in a nine-page declaration that the dose of midazolam, the sedative, was too low to induce anaesthesia. While waiting for the drugs to take effect, the inmate would be aware of a suffocating sensation known as "air hunger".

Waisel wrote to the court: "In light of the insufficient dose of midazolam, it is substantially likely that McGuire [is at] substantial, palpable, objectively intolerable risk of experiencing the agony and horrifying sensation of unrelenting air hunger. … It is substantially likely that McGuire will remain awake and actively conscious for up to five minutes, during which he will increasingly experience air hunger as the drugs suppress his ability to breathe."

Midazolam, a sedative often given to patients before surgery, is commonly known as Versed, and was also used in the three-drug combination that Oklahoma used to execute Clayton Lockett. The drug's side effects can include breathing problems and cardiac arrest and overdoses can reduce a person's heart rate. Arizona, Oklahoma and Ohio used varying amounts of the sedative, but all were higher than safely prescribed dosages.

Hydromorphone, the second drug in the Wood and McGuire executions, is a painkiller that changes the way the brain and nervous system respond to pain, and at high doses can stop the heart and respiratory system.

Arizona has said it used federally approved medicines, and implied licensed manufacturers had provided them. The Guardian's Ed Pilkington previously reported that the only two midazloam manufacturers in the US have major distribution loopholes. Florida also uses the drug, at much higher dosages.

Vecronium bromide and potassium chloride, the two other drugs in Oklahoma's lethal injection, are a muscle relaxant and a drug for potassium deficiency, respectively, but potassium chloride is used by executioners to stop the heart. Verconium bromide can cause breathing difficulties.

Why don't they use other methods?

Alex Kozinski, the chief judge on a federal appeals court, argued that the use of medical drugs meant to help sick people is an "enterprise doomed to failure". He previously told the Guardian that such a process was "complicated" and "not designed for executions … It's hard to watch these executions and not realize that these blunders are bound to happen."

Kozinski argues that death penalty states should return to using the firing squad: “The firing squad strikes me as the most promising. Eight or 10 large-caliber rifle bullets fired at close range can inflict massive damage, causing instant death every time. Sure, firing squads can be messy, but if we are willing to carry out executions, we should not shield ourselves from the reality that we are shedding human blood. If we, as a society, cannot stomach the splatter from an execution carried out by firing squad, then we shouldn’t be carrying out executions at all.”

The prohibition on cruel and unusual punishment also led a federal judge, Cormac Carney, to argue that because an inmate faced "complete uncertainty as to when, or even whether" he would be executed, California had violated the constitution. California's system has twice the national delay for inmates on death row.