Lethal Injection: Time for the Chop
On 29th April 2014, Clayton Lockett, 38, was executed by lethal injection in Oklahoma for the heinous crimes he committed fourteen years earlier.
That evening, he was escorted to the execution chamber and placed on the table. An intravenous line was inserted in his groin.
At 6.23pm, he was given midazolam, a sedative intended to render him unconscious. He should normally have lost consciousness within a minute or two. Seven minutes later, a doctor declared that Mr Lockett was still conscious. After a further three minutes, the doctor checked again and declared him unconscious. It is unclear what criteria he used to come to this conclusion, but the events that followed indicate that Mr Lockett was still partially conscious. Vecuronium was then administered to paralyse his muscles, followed by potassium chloride to stop his heart.
According to Katie Fretland, a journalist who witnessed the execution, Mr Lockett then “lurched forward against his restraints, writhing and attempting to speak. He strained and struggled violently, his body twisting, and his head reaching up from the gurney” and said the word “Man”.
The doctor examined Mr Lockett and found that the vein had “blown”. This means that the intravenous line was probably not located correctly in the vein, and that the injected drugs were not delivered into Mr Lockett’s bloodstream. Instead, the drugs went into the tissues of his groin, where they were absorbed into his system much more slowly.
After discussion between the prison doctor, warden and director, the execution attempt was stopped. At 7.06pm, 43 minutes after the administration of midazolam, Mr Lockett was pronounced dead. He probably suffered a cardiac arrest brought on by the gradual action of the lethal drugs. During those 43 minutes, Lockett is likely to have been partly conscious, and slowly suffocated due to his weakened muscles. Eventually his body – and his heart – ran out of oxygen.
Mr Lockett’s case reveals that the controlled killing of a young, healthy man with drugs is no easy task. It requires skill and expertise. It is also a reminder of the violent nature of the act of execution.
The botched execution of Mr Lockett is unlikely to change the minds of many people on the morality of the death penalty. Those in favour will continue to support the practice, and those against will see this as yet another reason to abolish it. Yet, most people agree that if executions are carried out they should be conducted humanely. This incident casts doubt on the appropriateness of lethal injection.
In recent times, doctors have reflected on the most gentle and effective ways to kill people in the context of end-of-life care. In Oregon, for example, the Death with Dignity Act allows terminally ill persons to end their lives by taking an oral dose of a barbiturate. A similar system could be devised for death row inmates, giving them the freedom to choose when to ingest the lethal cocktail, within a given period. The doomed inmate, once offered the drugs, would retain some autonomy on when to die.
If the inmate refused to kill himself, he would be guillotined.
It was a doctor, Dr Joseph-Ignace Guillotin, who suggested the use of the guillotine during the French Revolution. Although Dr Guillotin himself was against the death penalty, his goal was to make the process as swift and painless as possible. Dr Guillotin made his suggestion before the advent of modern anaesthesia and pharmacology but medically the guillotine has advantages. The sudden severing of the spinal cord causes immediate unconsciousness. It also leaves organs intact, which could be used – with prior consent – to save the lives of others through transplantation.
From a practical perspective, it is cheap, quick, effective, and requires little skill. Currently, many medical associations (including the American Medical Association) and codes of ethics prohibit doctors’ involvement in executions. With the guillotine, no medical involvement would be necessary.
Lethal injection, the preferred method in many jurisdictions, is the aesthetic choice, rarely offending the sensitivities of the viewers. It is, however, a technical procedure that is prone to failure. Some of the condemned have a history of intravenous drug use, rendering their veins difficult to find.
The guillotine is a pragmatic but bloody option. In Reflections on the Guillotine, Albert Camus told the story of his father, who woke early one morning to witness the execution by guillotine of a murderer who had slaughtered an entire family, including children. His father believed decapitation to be too mild a punishment for this monster. On his return home from the public execution, pale as a ghost, he lay on the bed and vomited. Camus described the ritual act of execution as ‘horrible indeed if it manages to overcome the indignation of a simple, straightforward man and if a punishment he considered richly deserved had no other effect in the end than to nauseate him.’ He concluded that, far from bringing peace and order into society, the execution represented a new murder which added another blot to the first one.
Cutting a person’s neck is more graphic than lethal injection but, if the public favours capital punishment, it must confront the true nature of the act. It is the premeditated killing of a human being who does not want to die. If the sight of a severed head or the sound of falling blade awakens people to the violence of the act, then that is a good thing. Stopping the heart and causing havoc to the internal organs does not make the execution any less brutal. The brutality is simply hidden from view.
The case of Clayton Lockett reminds us that, for all the disagreements on the issue of capital punishment, one point is beyond dispute: the most effective way to avoid botched executions is not to execute people.
by Daniel K. Sokol: a barrister and medical ethicist in London, England
and Aidan O’Donnell : a consultant anaesthetist in Waikato, New Zealand