That decline is mirrored in the US. Hanging was the most common form of capital punishment in the US until the s. Then, the electric chair became the most widespread method. In , the first execution by lethal injection was carried out by the state of Texas, after which it gradually replaced the electric chair across the nation. Today, other methods are very rarely used. Only Utah occasionally executes individuals by firing squad — the last time was in Perhaps surprisingly, though, there is still no consensus on the exact combination of drugs and dosages to use for the lethal injection.
The drug midazolam — a sedative used by several states to cause unconsciousness — has proved so controversial that, in , Alabama inmate Thomas D Arthur asked to be executed by firing squad. The Supreme Court denied the appeal, and Arthur was executed by lethal injection in May In Arkansas, the lethal injection comprises three chemicals: midazolam, to sedate; vecuronium bromide, to paralyse the muscles; and potassium chloride, to stop the heart.
Each of these is delivered at a dose that could theoretically kill the inmate; however, each drug has drawbacks. At the time of execution, the inmate is strapped to a gurney, and IV tubes are inserted into both arms.
The Arkansas procedure uses two IV sites. This is partly to protect against 'vein failure'. The first drug given to the inmate is midazolam, a sedative, which is administered to render the inmate unconscious and prevent them from feeling any suffering. Midazolam is a benzodiazepine. At low doses it has an anti-anxiety effect. At around 10mg, it knocks the inmate unconscious.
On death row in Arkansas, the dose is mg. The drug travels up the arm via the bloodstream to the brain. Within seconds, the inmate starts to black out. It has been alleged, however, that some inmates who received midazolam have appeared to regain consciousness mid-execution. The three-drug sequence used today in lethal injections was developed almost three decades ago and then, over the following two decades, was adopted by all but one of the death penalty states. Today, I would have just not been so specific in my drug language in the protocols, so that corrections officials could use the best agents of their time.
Over the years, states have tinkered with certain relatively insignificant aspects of their death penalty procedures, for example, addressing how an inmate is brought into the execution chamber, whether to pay their executioners in cash or by check, how to accommodate media access, what type of catheter to use, and what time of day the execution will take place. There are a few exceptions. Jeffrey Beard, secretary of the Pennsylvania Department of Corrections, told Human Rights Watch that one of the options under consideration is the use of a brain monitor to assess the effect of the anesthesia before the other two drugs are administered.
In prior and ongoing litigation, states have not offered to change their drug protocols or methods of administration. Mark Dershwitz, Reid v. Johnson , No. And those of us who routinely use pancuronium in our practice, take great pains to make sure that none of our patients are awake and paralyzed at the same time.
In , when New Jersey's lethal injection statute was passed, a doctor at the NJDOC warned the NJDOC assistant commissioner that he had "concerns in regard to the chemical substance classes from which the lethal substances may be selected. Who knew what the future was going to bring?
See also Affidavit of Dr. Kevin Concannan, D. Beck, et al. Dunn, Jr. Also, Human Rights Watch telephone interview with a physician who consulted with the state legislator and served on the state medical ethics board and asked to remain anonymous due to the sensitivity of the issue in Oregon , Portland, Oregon, March 6, Baselt, Ph.
Dershwitz: Well yes. For instance, if the pancuronium was the first drug given and the person were conscious when experiencing paralysis, they would have no motor or mechanical way of communicating their displeasure. Because of the routine use of neuromuscular blocking agents also called paralytics during general anesthesia, the patient is often unable to communicate with the surgical team if this occurs. Cain , Case No.
Laws Causes and Risks. Warning Signs of Heart Failure. Diagnosing Heart Failure. Treatment Options. Tools and Resources. Heart Failure Personal Stories. What is hyperkalemia? You may be at risk for hyperkalemia because of: Chronic kidney disease Diabetes Congestive heart failure Medications that disrupt potassium balance, such as certain blood pressure lowering drugs Less common causes can include: Massive injury resulting in muscle damage Burns over large parts of the body High-volume blood transfusions HIV and certain other infections Alcoholism or heavy drug use that breaks down muscle fibers, releasing potassium In some cases, multiple factors may be involved or the cause is never clearly identified.
How is it diagnosed? Can it be prevented? These may include: asparagus, avocados, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, cooked spinach oranges and orange juice, nectarines, kiwifruit, bananas, cantaloupe, honeydew, prunes and raisins or other dried fruit. If you are on a low-salt diet, avoid taking salt substitutes. How is hyperkalemia treated? For people with heart failure There are some drugs that heart failure patients take that are associated with hyperkalemia.
Last Reviewed: Oct 31,
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