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Lethal injection is a method of capital punishment. It gained popularity in the twentieth century as a supposedly humane form of execution meant to supplant methods such as electrocution, hanging, firing squad, gas chamber, or decapitation.
After the condemned is secured on the execution table, two IV catheters are inserted, one in each arm. Only one is used for the execution, the other is reserved as a backup in case the primary IV fails for some reason.
The injection is intravenous and is usually a mix of compounds, designed to induce rapid unconsciousness followed by death through muscular paralysis of the lungs and/or by inducing cardiac depolarization. In the US, sodium thiopental is the common agent to bring unconsciousness, with suxamethonium chloride, pancuronium bromide or tubocurarine chloride as the paralysing drug (muscle relaxant), potassium chloride to cause cardiac arrest or one of each kind. Death usually results within five minutes, although the entire procedure can take up to 45 minutes. The individual drugs are not mixed externally as that can cause them to precipitate; they are usually injected in sequence through one or two intravenous tubes.
The IV tubing leads to a room adjacent to the execution chamber, where a licensed doctor or nurse administers the injections. Some doctors object to participating in executions, claiming that it violates their Hippocratic oath. However there is always a physician present (even if not actively participating in the administration of lethal drugs) to officially declare the prisoner dead.
The actual execution of a victim involves 3 separate injections:
- The victim is put to sleep by injection. (Sodium thiopental, in a dose high enough to cause death itself)
- All movement of the muscles except the heart cease function. (Pancuronium/Tubocurarine - involuntary muscle paralysis, collapse of the diaphragm)
- The heart stops beating, thus the victim's death. (Potassium chloride - cardiac arrest)
Hitler's personal doctor, Karl Brand , was the first to suggest killing disabled people by injecting them a lethal dose of poison, as part of the T-4 Euthanasia Program, where lethal injection was adopted as one of several methods. At the Auschwitz concentration camp, SS personnel killed prisoners that were ill or that had been sentenced to death by injection of phenol and other poisons.
The United States was thus, strictly speaking, only the second nation to experiment with lethal injection as a means of execution, using it first on December 7, 1982. The concept had been proposed in 1888 by J. Mount Bleyer in New York, but was not approved. It was also rejected by the British Royal Commission on Capital Punishment (1949-1953) after pressure from the British Medical Association. Texas was the first state to adopt lethal injection after the idea was revived in the US in February 1977 by Dr. Stanley Deutsch in Oklahoma. Oklahoma followed Texas's lead that same year. Since then, the majority of US states using capital punishment prefer to use lethal injection.
The practice extended outside the US when it was adopted by the People's Republic of China in 1997, Guatemala in 1998 and the Philippines in 1999. A number of other countries have adopted the method in law but not in practice.
The staff that inserts the needle into the arm and inject the drugs are not medical professionals, as performing a medical procedure to kill the "patient" would seem to violate the Hippocratic Oath. In the United States, the code of ethics of the American Medical Association forbids doctors or nurses from taking part in lethal injection procedures.
Is lethal injection painless?
The concern has been raised that execution by lethal injection is not actually humane. It has been argued that the short-term anaesthetic may wear off while the paralysing agent continues to paralyze the prisoners and that they die an agonizing death through slow suffocation while fully conscious. For this reason, the use of paralysing agents for the veterinary killing of animals has been made illegal in at least one state — Tennessee. However, the use of these agents for killing human beings continues.
On occasion, there have also been difficulties inserting the delivery needles, sometimes taking over half an hour to find a suitable vein. Certain executions have also been marked by a surprisingly violent reaction to the injected drugs. For example, when Oklahoma executed Robyn Lee Parks in 1992, Parks gasped and gagged for nearly ten minutes until his death.
Concerned about this sort of problem, Fred A. Leuchter designed an automated machine that releases the drugs at a rate depending on the recipient's bloodstream. He also proposed a more comfortable chair, like those at a dentist's office, and a television or some sort of entertainment to watch while the drug takes effect. His injection machine was purchased by several US states.
In 2005, University of Miami researchers reported in the medical journal The Lancet that they believed in 43 out of the 49 execution they investigated, the levels of thiopental in the blood was lower than that required for surgery. This has lead them to believe that the prisoners were fully aware of what was happening to them.  
- International Herald Tribune story: "A warning on lethal injections"
- Wired News: Searching for Humane Execution Machines
- Court TV: "Lethal injection--the humane alternative?"
- BBC News report: Prisoners 'aware' in executions
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