"WORSE THAN DEATH" EXPERIENCE
By ADAM LIPTAK
NASHVILLE, Oct. 1 - At the Riverbend Maximum Security Institution here, through a set of double doors next to
several vending machines, a gurney stands ready to deliver prisoners to their executions by lethal injection. Just about every aspect of the death penalty provokes acrimonious debate, but this method of killing, by common
By ADAM LIPTAK
NASHVILLE, Oct. 1 - At the Riverbend Maximum Security
Institution here, through a set of double doors next to
several vending machines, a gurney stands ready to deliver
prisoners to their executions by lethal injection.
Just about every aspect of the death penalty provokes
acrimonious debate, but this method of killing, by common
consensus, is as humane as medicine can make it. People who
have witnessed injection executions say the deaths appeared
hauntingly serene, more evocative of the operating room
than of the gallows.
But a growing number of legal and medical experts are
warning that the apparent tranquillity of a lethal
injection may be deceptive. They say the standard method of
executing people in most states could lead to paralysis
that masks intense distress, leaving a wide-awake inmate
unable to speak or cry out as he slowly suffocates.
In 2001, it became a crime for veterinarians in Tennessee
to use one of the chemicals in that standard method to
The chemical, pancuronium bromide, has been among those
specified for use in lethal injections since Oklahoma first
adopted that method of execution in 1977. Only now, though,
is widespread attention starting to focus on it.
Spurred by a lawsuit by a death row inmate here, advances
in human and veterinary medicine, and a study last year
that revealed for the first time the chemicals that many
other states use to carry out executions, experts have
started to question this part of the standard lethal
Pancuronium bromide paralyzes the skeletal muscles but does
not affect the brain or nerves. A person injected with it
remains conscious but cannot move or speak.
In Tennessee and about 30 other states, the chemical is
used in combination with two others. The other chemicals
can either ease or exacerbate the suffering the pancuronium
bromide causes, depending on the dosages and the expertise
of the prison personnel who administer them.
A judge here recently found that pancuronium bromide,
marketed under the trade name Pavulon, has "no legitimate
"The subject gives all the appearances of a serene
expiration when actually the subject is feeling and
perceiving the excruciatingly painful ordeal of death by
lethal injection," the judge, Ellen Hobbs Lyle, wrote,
describing the worst-case scenario. "The Pavulon gives a
false impression of serenity to viewers, making punishment
by death more palatable and acceptable to society."
A simpler and more humane alternative to the three-chemical
combination, many experts agree, is the method usually used
in animal euthanasia: a single lethal dose of a barbiturate
called sodium pentobarbital.
Dr. Sherwin B. Nuland, who teaches medicine at Yale and
wrote "How We Die" (Knopf, 1994) said he was baffled to
hear that pancuronium bromide was used in executions.
"It strikes me that it makes no sense to use a muscle
relaxant in executing people," he said. "Complete muscle
paralysis does not mean loss of pain sensation."
Dr. Nuland, who described himself as a cautious supporter
of the death penalty, said a humane death could be achieved
in other ways, including by using the other two chemicals
in the standard method, without the pancuronium bromide.
The challenge to the use of pancuronium bromide was brought
in chancery court here by Abu-Ali Abdur'Rahman, who is on
death row for a 1986 murder. Judge Lyle wrote that the use
of the chemical "taps into every citizen's fear that the
government manipulates the setting and gilds the lily." But
despite her misgivings, she ruled that the use of the drug
did not violate the Constitution's ban on cruel and unusual
punishment, because it was widely used and because "there
is less than a remote chance that the prisoner will be
subjected to unnecessary physical pain or psychological
The case is on appeal.
Mr. Abdur'Rahman, 52, is being held at the Riverbend
prison, along with 92 other death row inmates. He is short
and slight, and his long beard has turned gray. He spoke to
a visitor through thick glass.
"They're saying I'm less than an animal," Mr. Abdur'Rahman
said. "The poison they put into our veins needs to be
challenged. Had my attorneys not researched this, I doubt
very much it would have come to light."
The American Veterinary Medical Association condemns
pancuronium bromide when it is the sole chemical used or
when it is used in combination with the usual animal
euthanasia drug, sodium pentobarbital. That is because, an
association report in 2000 said, "the animal may perceive
pain and distress after it is immobilized."
Lethal injection is now the dominant way Americans are
executed. It is used in all 38 states that have the death
penalty except Nebraska, which uses electrocution. In 10
states, prisoners may choose between lethal injection and a
second method, including hanging, firing squad,
electrocution and lethal gas.
In most methods of lethal injection, pancuronium bromide is
the second drug in a three-chemical sequence.
The first is sodium thiopental, a so-called
ultra-short-acting barbiturate. It can be effective for
only minutes. In surgery, it is used to induce rather than
maintain anesthesia. Doctors like it because patients who
encounter immediate complications awaken quickly enough to
The third is potassium chloride, which stops the heart and
causes excruciating pain if the prisoner is conscious.
"It would basically deliver the maximum amount of pain the
veins can deliver, which is a lot," Dr. Mark J. S. Heath,
an anesthesiologist who teaches at Columbia, testified at a
hearing for Mr. Abdur'Rahman.
One problem with the combination of chemicals, Dr. Heath
said in an interview, is that the sodium thiopental could
be inadequate or wear off. That would leave the prisoner
conscious, paralyzed, suffocating and subject to extreme
pain from the potassium chloride.
"You're in a chemical tomb," he said.
The possibility of
improper doses or sequences and of bungled injections is
increased, Dr. Heath said, because doctors may not take
part in executions under most codes of medical ethics.
The reason for pancuronium bromide in the standard lethal
injection method is not well understood. Judge Lyle found
that Tennessee's method "was developed simply by copying
the same method used in some 30 other states."
Deborah W. Denno, a law professor at Fordham University who
published a study of the chemicals used in lethal
injections last year, said that assembling information for
it was difficult.
"The process has been so hidden," said Professor Denno, who
described herself as an opponent of the death penalty.
Four states said their protocols for lethal injection were
confidential; three said they had none. Except for New
Jersey, which does not use pancuronium bromide, all 28
states that supplied Professor Denno with information used
the same three-chemical combination. So does the federal
"The idea of even having a lethal injection protocol
specifying exact chemicals is a very recent phenomenon,"
Professor Denno said, "and that's only because prison
officials have been pressed to provide them. Nobody really
knew what chemicals were being used."
The earliest protocol, in Oklahoma, was based on advice
solicited by a state senator from a professor in the
state's medical school. The professor, Stanley Deutsch,
recommended an ultra-short-acting barbituate and a
neuromuscular blocking drug like pancuronium bromide.
"I can assure you that this is a rapid, pleasant way of
producing unconsciousness," Dr. Deutsch wrote in 1977.
In a recent interview, Dr. Deutsch stood by his initial
finding, saying his method does not cause suffering. "They
use such a massive amount of the penthothal that I don't
think there is any chance that people will awaken," he
Other states, typically acting through their corrections
departments and individual prison wardens, apparently
copied Dr. Deutsch's advice without subjecting it to
independent medical scrutiny.
The prison warden who developed Tennessee's method, for
instance, testified that he did not consult with anyone
with a medical or scientific background. The warden, Ricky
J. Bell, declined to be interviewed.
A spokeswoman for the Tennessee attorney general also
declined to comment and directed a reporter to the state's
legal papers. They do not defend the use of pancuronium
bromide beyond noting that it is widely used and so should
not be considered cruel and unusual punishment under the
The state's legal papers also argued that the ban on
pancuronium bromide in pet euthanasia does not apply to Mr.
Abdur'Rahman because he is not a "nonlivestock animal,"
which the law says includes pets, captured wildlife, exotic
and domesticated animals, rabbits, chicks, ducks and
Carol Weihrer, who underwent eye surgery in 1998, testified
for Mr. Abdur'Rahman at the hearing in May. Anesthesia was
administered before the surgery, as was pancuronium bromide
to immobilize the eye. But the anesthesia was ineffective.
Ms. Weihrer testified that the experience was terrifying
and torturous. She could not, she said, communicate that
she was awake.
"I remember using every ounce of my strength to try to
move," she said.
The surgery went on for hours. She did not suffocate
because she was on a respirator.
Ms. Weihrer called the experience "worse than death."
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