Arizona inmate Joseph Rudolph Wood took nearly two hours to die. Even as botched executions are becoming more common as states are scrambling to get the lethal drugs they need to execute inmates, Wood’s execution stretched on for much longer than usual. Although state officials maintain he did not suffer, the incident has put the spotlight back on one controversial drug that may not effectively numb death row inmates.
The Arizona corrections department has been reassuring the public that Wood’s execution was humane, saying he was in “deep sedation” throughout. “There was no gasping or snorting. Nothing. He looked like he was asleep,” Stephanie Grisham, a spokeswoman for the Arizona attorney general’s office, told the Washington Post.
Although it’s too early to tell exactly what happened — there will be a full investigation to glean more information about how exactly the drugs operated in Wood’s body — there is one common thread running through several recent examples of botched executions. In Ohio, Oklahoma, and now Arizona, state officials have been using a short-acting sedative named midazolam to numb inmates while the other drugs intended to shut down their systems flow through their veins.
Midazolam is typically used before a surgery to make patients feel sleepy and relaxed, but, according to The Pharmacological Basis of Therapeutics, it’s not technically a “true general anesthesia” because it allows awareness to persist. That means it’s possible it won’t effectively anesthetize the effects of the other lethal drugs given to inmates. On top of that, since midazolam is usually administered in smaller doses for short time periods, doctors aren’t exactly sure what dosage to use for executions, or what a significantly higher dosage will do to the human body.
“It’s uncharted territory,” David Waisel, an anesthesiologist at Boston Children’s Hospital who has testified against untested lethal injection cocktails, told the Wall Street Journal after issues with Oklahoma’s latest execution made national headlines. “States literally have no idea what they’re doing to these people.”
Plus, since midazolam typically isn’t used in situations where the subject won’t wake up, states haven’t agreed on a standard dosage for executions. Arizona’s rules call for 50 milligrams of midazolam, followed by an injection of a second drug to stop the respiratory system and the heart. Meanwhile, Oklahoma used 100 milligrams for a botched execution that lasted 45 minutes, and Ohio used just 10 milligrams for one that took 25 minutes.
In all three instances, witnesses say the inmates appeared to be gasping for breath. According to the lawyers for Dennis McGuire, the Ohio inmate who received 10 milligrams of midazolam, the experimental combination of the sedative and the second heart-stopping drug could have subjected him to “air hunger,” the feeling of suffocation due to the insufficient flow of air into his lungs. Nonetheless, Arizona used the same exact two drugs to execute Joseph Rudolph Wood.
At least some legal experts say that the states using midazolam may be violating the Eighth Amendment to the U.S. Constitution, which prohibits cruel and unusual punishment. But that hasn’t stopped them from seeking it out. While just four states — Florida, Oklahoma, Ohio, and Arizona — have used midazolam for this purpose so far, additional states are interested in following suit as they’re struggling to get their hands on thiopental and pentobarbital, the more powerful barbiturates typically used to anesthetize condemned individuals.
The issue is complicated by the fact that qualified medical professionals aren’t always involved in administering lethal drugs, or willing to assist states with coming up with effective cocktails. The American Society of Anesthesiologists discourages their members from participating in executions; the organization’s official policy on the subject states that “execution by lethal injection has resulted in the incorrect association of capital punishment with the practice of medicine, particularly anesthesiology.”
When ThinkProgress reached out to several professional anesthesiologists to clarify whether Wood received an effective combination of drugs to prevent him from experiencing pain, they declined to comment. “We have no experts in lethal injection. Many physicians in the field of anesthesiology find ethical objections to even the idea of becoming an expert in this area of the criminal justice system,” one doctor replied via email. “Yes, they are using ‘our drugs’, but with a different purpose and intent.”
Because of the issues swirling around lethal injections, and the difficulty that states have encountered in their attempts to administer the drugs in a completely painless way, some doctors advocate resorting to alternate methods of execution — like firing squads, hanging, and even the guillotine. Although those methods may appear to be more gruesome, medical professionals point out they may actually be harder to mess up.