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Anesthesiology - Capital Punishment protocol.
Expert: Ronald Levy, M.D. - 11/1/2009
Question
I am a student who is conducting a study and producing a research paper on lethal injection as a form of capital punishment. one of my major quarrels and basis for my arguments is that weight and liver conditions aren't typically taken into consideration when calibrating the dosage of Sodium Thiopental. In theory, isn't it possible or even plausible that the condemned inmate may experience some form of pain or awareness(whether it be the feeling of suffocating or experiencing a heart attack,etc.) from administration of the subsequent drugs if the other health factors have not been considered. For instance, and correct me if I am wrong, if the state typically issues a Sodium Thiopental dosage for a man or women who ways 160 lbs but the inmate receiving the drug actually weighs 235 lbs, couldn't that person experience the negatives that i mention earlier? what is the correct dosage/weight ratio to prevent such occurance during lethal injections? I apology for the lengthy inquires but it has been quite difficult to get an honest and unbureaucratic answer for this topic.
Answer
According to what my understanding of the drugs used for capital punishment (and I may be wrong about this) is that the dosages of all the medications (Pentothal, Pancuronium, and Potasssium Chloride) are all given in excess dosages and not actually calculated by the weight of the patient. If it is calculated individually, it is based on the patient's lean body weight and for anesthesia is 3-5 mg/kg. I would imagine that, because of the fear that they are underdosing, they would tend to overdose (there would be no reason not to as the goal is to execute the person). They would never feel suffocating because the Pentothal works too quickly and even if it were underdosed and the patient moved, they wouldn't actually remember suffering (if they were to wake up). The liver issue is not important as that is related to metabolism and would be important for waking up. Other health factors would only work to kill him faster which, in the end, is the goal. Without taking sides in this issue, the people who are against capital punishment use this "patient suffering" line of attack because of the 7th amendment prohibition against cruel and unusual punishment. The fact is that the prisoner is not feeling anything and death by injection is actually the least painful of all the current methods currently employed.
Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston
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