Intended for healthcare professionals

Feature Feature

The slow death of lethal injection

BMJ 2014; 348 doi: (Published 29 April 2014) Cite this as: BMJ 2014;348:g2670
  1. Owen Dyer, freelance journalist, Montreal
  1. owen_dyer{at}

The medicalization of execution was once seen as the solution to death penalty concerns. Instead it has only spawned new legal challenges, says Owen Dyer, and a tightening drugs embargo that now seriously threatens US states’ ability to continue capital punishment

“Please—Please—Please HELP . . . this system failure—a mistake—1 carton of 20 vials—is going to affect thousands of Americans.” This email, sent last November from a Louisiana pharmaceutical distributor to Missouri’s department of corrections, eventually persuaded Missouri to relent and return the propofol it had bought against the wishes of the drug’s German manufacturer Fresenius Kabi. Missouri’s governor Jay Nixon ordered the department to find other execution drugs, and the US narrowly escaped a catastrophic embargo of its most important anesthetic. American hospitals will continue to have access to the drugs they need to do their job. But American executioners may not, in the face of a remarkably unanimous refusal to sell from both European and US drug makers.

It is now three years since an EU ban effectively deprived the US of sodium thiopental, the key drug in the three drug protocol used in most executions since lethal injection began in 1982.

States have been forced to adopt desperate and sometimes disreputable methods to carry out scheduled executions. Prison authorities have bought drugs using employees’ credit cards, and submitted prescriptions under employees’ names. Louisiana declared itself ready to execute a prisoner, only to have a court subpoena reveal that its drugs were expired.1

Kentucky, Tennessee, and Georgia had to hand over their supplies of sodium thiopental to the Drug Enforcement Administration after it emerged that they had been illegally imported. At least two US states, Georgia and Arizona, purchased unapproved sodium thiopental from Dream Pharma, a UK distributor that operates out of the back of a …

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