The Supreme Court ruled 5-4 on June 29 against three death row inmates, saying that the controversial use of the sedative midazolam hydrochloride for lethal injections does not violate the Eighth Amendment prohibition against cruel and unusual punishment.
Historically, the standard lethal injection protocol involved three compounds administered to the convict in sequence. The first was thiopental sodium, an anesthetic that depresses central nervous system activity and would render the condemned person unconscious. It was followed by pancuronium bromide, which inhibits muscle contraction and stops breathing. The final compound was potassium chloride, an electrolyte that stops the heart.
In recent years, states have found it difficult to obtain thiopental or first-choice substitute pentobarbital. Consequently, some states have turned to midazolam hydrochloride, the drug at the center of the Supreme Court case.
Midazolam is a benzodiazepine, similar to diazepam and lorazepam. It is commonly used medically as a sedative or to treat anxiety, not as a surgical anesthetic. The Food & Drug Administration currently lists seven approved manufacturers of injectable midazolam products. Those companies are based in the U.S., the European Union, or India.
In three executions involving midazolam last year, prisoners showed signs of consciousness, including writhing and gasping, according to eyewitness reports.
For lethal injection to be considered humane, the person being executed must be adequately anesthetized before the remaining two compounds are administered. If the prisoner is not unconscious, then he or she would experience suffocation from the pancuronium and burning from the potassium chloride. Pancuronium’s paralytic effects mean that after the compound is administered, it becomes difficult to tell whether a person is adequately anesthetized.
The inmates who filed the case “failed to establish that any risk of harm was substantial when compared to a known and available alternative method of execution,” wrote Justice Samuel Alito for the majority, joined by Chief Justice John Roberts along with Justices Antonin Scalia, Anthony Kennedy, and Clarence Thomas.