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US court upholds use of sedative in executions

BMJ 2015; 351 doi: (Published 01 July 2015) Cite this as: BMJ 2015;351:h3599
  1. Michael McCarthy
  1. 1Seattle

In a 5-4 decision the US Supreme Court ruled on 29 June that the sedative midazolam can be used in the controversial three drug execution protocol adopted by the state of Oklahoma.1 Although the ruling was made largely on technical issues, several justices used the decision to argue for and against the constitutionality of capital punishment.

In 1997 Oklahoma adopted a lethal injection protocol that involved the intravenous administration of the barbiturate sodium thiopental to induce unconsciousness, followed by a paralytic agent to inhibit musculoskeletal movements and to paralyze the diaphragm, causing asphyxiation, as well as an infusion of potassium chloride to induce cardiac arrest.

Supporters of the protocol argued that, by rendering prisoners unconscious, the barbiturate shielded them from the terror of asphyxiation and the searing pain caused by the infusion of a high dose of potassium chloride.

However, under pressure from death penalty opponents, drug companies began refusing to provide firstly sodium thiopental and later another barbiturate, pentobarbital; and, in 2011, the European Commission expanded its ban on the export of products that could be used in executions or torture to include these barbiturates. Unable to obtain either drug, Oklahoma decided to use midazolam at 500 …

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