Lethal Injection Is Not Humane

T his month's issue of PLoS Medicine contains a research article on three protocols used in lethal injection, the current method of execution for most US states. Despite the British Royal Commission on Capital Punishment advising against lethal injection half a century ago [1], the United Nations General Assembly affi rming the desirability of abolishing the death penalty in 1971, and the European Union explicitly banning the death penalty in all circumstances [2], execution—predominantly by lethal injection—is still practiced in many countries. During 2005 at least 2,148 people were executed in 22 countries in cases recorded by Amnesty International; the actual numbers were certainly higher. The majority of these executions took place in China, where fl eets of mobile execution vans have been deployed to facilitate prompt, low-profi le executions by lethal injection. Iran, Saudi Arabia, and the US together with China accounted for 94% of executions in 2005 [3]. Following its introduction to the US in 1982, lethal injection became the primary method of execution there, largely replacing execution by hanging, fi ring squad, gas chamber, and electrocution. Each of these older methods has come to be seen as inhumane or excessively violent by most states, but each remains an option in a handful of others. Of the 53 executions in the US in 2006, all but one (an electrocution) were carried out using lethal injection [4]. In recent months, concerns over botched lethal injections have put the method on hold in a dozen or so of the 36 US states that have the death penalty. Following a particularly agonizing execution in December 2006, the US District Court ruled that California's lethal injection protocol was unconstitutional. The governors of Florida and Tennessee suspended executions pending review of their states' lethal injection protocols. A court ruling in December 2006 suspended Maryland's executions, and New Jersey is considering an outright ban on its death penalty following a 2004 court order requiring the state to justify its lethal injection process. Executions are on hold in several other states pending legal proceedings [4]. In this context, the editors of PLoS Medicine believe it is timely to publish a research article reporting shortcomings of lethal injection protocols. Strictly speaking, this article has little to do with medicine. Execution by lethal injection, even if it uses tools of intensive care such as intravenous tubing and beeping heart monitors, has the same relationship to medicine that …