In June of this year the Supreme Court handed opponents of the death penalty a crushing defeat. Contrary to all medical evidence, the Supremes ruled, five to four, that the use of midazolam in lethal injection executions did not violate the Eighth Amendment against cruel and unusual punishment. A team of Federal Public Defenders, buttressed by three stellar experts, had sued Oklahoma's Attorney General in Glossip vs. Gross on behalf of the state's death row inmates, who were facing an agonizing fate if the high court did not intervene. At least one of the plaintiffs may be dead by the time you read this article.
The Supreme Court Sees No Cruelty in Controversial Execution Drug
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Midazolam occupies a place on the World Health Organization [WHO] Model List of Essential Medicines, a pharmacopeia of the most important drugs needed by a modern healthcare system. Specifically, midazolam is classified as a preoperative medication and a sedative; it is also used in noxious but not particularly painful procedures like endoscopies and colonoscopies. Executions are not one of WHO's indications, but death penalty states across America are scrambling to incorporate midazolam in execution protocols.
Since the Supreme Court lifted its moratorium on executions in 1976, 1202 men and women have been killed with a three-drug cocktail devised by an Oklahoma medical examiner, A.. Jay Chapman, MD, as a more humane way of dispatching miscreants (and an unknown number of innocent prisoners) than the electric chair, the gas chamber, or the firing squad. Chapman's brew, served up by catheters placed in the veins, consists of an anesthetic, a drug to paralyze the skeletal muscles including those of breathing (pancuronium bromide or a related drug) and a drug to stop the heart (potassium chloride).
Without an anesthetic to put the condemned person in a profound sleep, Chapman's cocktail would be worthy of Torquemanda, Spain's Grand Inquisitor because the paralytic would create a sensation of suffocation and the potassium chloride would make the condemned person feel as if his whole body were on fire. I made three attempts to interview Chapman for his opinion on the use of midazolam but he did not return my calls.
Until 2010 the anesthetic in the Chapman cocktail was thiopental, an ultra-short-acting barbiturate. At that point, the sole manufacturer of thiopental, a Illinois-based generic house (Hospira), ran out of raw materials and decided to get out of the execution business rather than import the ingredients. Some states had enough thiopental on hand to continue the killing for several more years; other states switched to pentobarbital, another powerful barbiturate. Execution states whose cup runneth over shared these anesthetics with states whose supplies were depleted, but ultimately everybody ran out of thiopental and pentobarbital. Hospira was out of the running and the Danish pharmaceutical firm of Lundbeck cut off access to pentobarbital when it found out that its product was being used for executions. The death penalty states sought a new anesthetic and ultimately settled on midazolam.
Midazolam is not a barbiturate; it is a benzodiazepine like Valium, Klonopin, and Xanax, but with a much shorter duration of action. So far there have been five executions with midazolam, all botched. To find out why, I talked first with Jonathan Groner, MD, a practicing pediatric surgeon and Professor of Clinical Surgery at Ohio State University's medical school. Dr. Groner told me that he uses midazolam all the time to quickly calm children before taking them up to the O.R. Not only is midazolam a rapid-acting sedative, it is also an anamnestic - that is, an agent that erases the memory of being prepared for surgery. Dr. Groner emphasized that midazolam is not an analgesic (a pain killer) and it is not an anesthetic, in contrast to thiopental and pentobarbital. The suffocating sensation of the paralytic and the excruciating pain of potassium chloride would surely awaken the condemned...assuming the midazolam had not already begun to wear off. Dr. Groner told me that he was an abolitionist since the 1990s and deplored the "medicalization" of capital punishment.
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