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December 19, 2007

Lethal Injection and Physicians: State Law vs Medical Ethics

Author Affiliations

Author Affiliations: Ethics Group, American Medical Association, Chicago, Illinois (Mr Black); and Institute of Human Values in Health Care, Medical University of South Carolina, Charleston (Dr Sade). Dr Sade is a former chair of the AMA Council on Ethical and Judicial Affairs.

JAMA. 2007;298(23):2779-2781. doi:10.1001/jama.298.23.2779

Legal execution by lethal injection has made national headlines during the past 2 years because prisoners have argued that it poses an unnecessary risk of pain as currently performed and therefore constitutes unconstitutional cruel and unusual punishment. The most widely used method of lethal injection, developed by a physician,1 involves the intravenous infusion of large doses of sodium thiopental to induce deep sleep, pancuronium bromide as a paralyzing agent, and potassium chloride for cardioplegia. Lethal injection was adopted as a means of execution because it seemed more humane than other methods, but it is unclear what consideration was given to the selection of execution personnel, the skills they needed, and the training they might require. Recent court challenges have revealed that drug dosages are not uniform among the states, so wide disparities in levels of sedation may occur, and some inmates may have experienced considerable pain after potassium chloride infusion.2,3

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