US: Nevada plans execution with never-used-before drug cocktail

[JessFR]

^^I can understand your opposition to the death penalty but how are we supposed to know whether a deadly cocktail will be truly painless for someone? Obviously we can't take it ourselves, i think the new cocktail of a powerful opiate and a powerful benzos is about the most peaceful death one could hope for.

Apart from the fact that it simply doesn't make any sense for someone under a massive influence of benzos or opioids to be in conscious pain. People have both accidentally and intentionally experienced such overdoses of a similar nature only to be revived by medical intervention, and generally report no awareness of anything.

The only thing used to justify this belief is witnesses claiming to see people gasping for air or shaking or various other involuntary actions that we already know as a well established medical fact of dying are involuntary behaviors that in no way indicate consciousness.

So, plenty of excellent and virtually irrefutable evidence that it's not the case, vs the ignorant assumptions of people with zero medical knowledge, many of whom have a clear agenda to want it to turn out to be painful for political reasons.

It's the dishonesty of it that I hate. I'm all for getting rid of the death penalty. But for good reasons like that we can't trust the state to always get it right (my argument) , or that it's morally unacceptable for the state to take someone's life in cold blood for any reason (not my argument, but I can respect it).

 

[Captain.Heroin]

Apart from the fact that it simply doesn't make any sense for someone under a massive influence of benzos or opioids to be in conscious pain. People have both accidentally and intentionally experienced such overdoses of a similar nature only to be revived by medical intervention, and generally report no awareness of anything.

The only thing used to justify this belief is witnesses claiming to see people gasping for air or shaking or various other involuntary actions that we already know as a well established medical fact of dying are involuntary behaviors that in no way indicate consciousness.

So, plenty of excellent and virtually irrefutable evidence that it's not the case, vs the ignorant assumptions of people with zero medical knowledge, many of whom have a clear agenda to want it to turn out to be painful for political reasons.

It's the dishonesty of it that I hate. I'm all for getting rid of the death penalty. But for good reasons like that we can't trust the state to always get it right (my argument) , or that it's morally unacceptable for the state to take someone's life in cold blood for any reason (not my argument, but I can respect it).

Well said. Thank you for clarifying your position.

 

[34-dihydroxyphen]

Y’all are insane

You feel nothing but bliss when put under with fentanyl and midazolam.

Very humane. Pain free. It’s like you get the urge to go to sleep, and you do. And that’s it.

For my wisdom teeth surgery, I was put under with a combination of midazolam, Demerol, and Propofol. For whatever reason, this combo wasn't strong enough for me, so I was essentially awake and screaming for the entire surgery, no matter how much extra midazolam they kept shooting me with. Despite the presence of both an opioid and a benzo in high doses, the state of mind I was in was far from bliss.

If the midazolam doesn't knock you out, then I imagine the introduction of the paralytic agent and the potassium chloride feels quite unpleasant.

 

[JessFR]

Well, of those only Demerol is an analgesic. But I do actually agree that a midazolam based lethal injection is far from ideal. But that's a long way from saying it's painful. There's no reason it should be painful given that such high doses should still result in unconsciousness and amnesia, and potassium just stops the heart.

But regardless, that's not really my point. People were making the argument it was painful when it was barbiturates and fentanyl too. It's all made up to begin with. In the very unlikely even that any lethal injection cocktail has ever been painful, then the people saying that were correct for all the wrong reasons. My point is that the argument is totally dishonest and has nothing to do with reality one way or the other.

But yes, midazolam isn't ideal. Ideal would be switching back to barbs, but for dubious reasons thats been problematic.

There are actually other good painless options, like nitrogen gas. But as I've been saying, the problem is the method doesn't have to just be painless in reality. It has to be painless in reality, AND appear painless to witnesses. How painful or disturbing it looks to the witnesses is the primary consideration because it's all political bs.

If it weren't, we'd have lots of options for painless execution. Shooting them, various drugs for lethal injection, gasses like nitrogen to cause oxygen displacement and hypoxia without the unpleasent sensation of suffocating. But all of those look unpleasent or disturbing to witnesses. That's the main reason we include a paralytic to start with. It's not needed to kill them. It's needed make it look peaceful. It's peaceful for them regardless. But the witnesses perception is the primary consideration. It's all dishonest political bs.

My preference would be to do away with the death penalty since we are clearly too corrupt and incompetent to use it properly. But if we do have it, it should be painless and quick, and the determination of that should be based on medical science, not the lies and imaginations of witnesses for political reasons.

 

[falsifiedhypothesi]

^ I appreciate the sentiment of a quick an painless death based on medical science but do we have a lot of studies about euthanizing humans in a quick and painless way? I'm not attacking your position, it's an honest question.

 

[JessFR]

Well obviously you can't determine how to painlessly kill people by comparing groups of peoples experiences using multiple methods. We have to take what we know about the drugs pharmacology and the non lethal subjective experiences and make an educated inference.

We probably can't do a traditional study about euthanizing people. But I'd say we can make a more than sufficient determination with what we already know about human biology and the pharmacodynamics of various drugs.

Even if it's imperfect it's still worlds ahead of just going by the subjective reaction of ignorant people.

We can also apply what we know from animal euthanasia. In fact I'm pretty sure we already have. I suspect a lot of this research has already been done. It's likely just that people haven't paid attention to it.

We do scientific research on important questions like these all the time only for it to be totally ignored at the policy creation stage and instead making decisions based on the foolish and ignorant political attitudes of the public.

And as I mentioned before and just alluded to, I suspect the ideal is to simply use the same method we've long used for animals. Which is a pentobarbital overdose. It's not exactly an irresponsible presumption to believe that the condemned individual won't suffer if they're entirely unconscious for their death. There are other options though if we weren't worrying about people's perceptions.

But that's the whole point, we are. We'd have lots of good options we're that not the case.

Once you take the politics out of it, this really isn't a difficult question. We have long perfected how to literally cut people open and take their organs out and have them experience no pain until they wake up. All we need to painlessly kill them is to just extent that and have them not wake up again.

 

[34-dihydroxyphen]

Well, of those only Demerol is an analgesic. But I do actually agree that a midazolam based lethal injection is far from ideal. But that's a long way from saying it's painful. There's no reason it should be painful given that such high doses should still result in unconsciousness and amnesia, and potassium just stops the heart.

But regardless, that's not really my point. People were making the argument it was painful when it was barbiturates and fentanyl too. It's all made up to begin with. In the very unlikely even that any lethal injection cocktail has ever been painful, then the people saying that were correct for all the wrong reasons. My point is that the argument is totally dishonest and has nothing to do with reality one way or the other.

But yes, midazolam isn't ideal. Ideal would be switching back to barbs, but for dubious reasons thats been problematic.

There are actually other good painless options, like nitrogen gas. But as I've been saying, the problem is the method doesn't have to just be painless in reality. It has to be painless in reality, AND appear painless to witnesses. How painful or disturbing it looks to the witnesses is the primary consideration because it's all political bs.

If it weren't, we'd have lots of options for painless execution. Shooting them, various drugs for lethal injection, gasses like nitrogen to cause oxygen displacement and hypoxia without the unpleasent sensation of suffocating. But all of those look unpleasent or disturbing to witnesses. That's the main reason we include a paralytic to start with. It's not needed to kill them. It's needed make it look peaceful. It's peaceful for them regardless. But the witnesses perception is the primary consideration. It's all dishonest political bs.

My preference would be to do away with the death penalty since we are clearly too corrupt and incompetent to use it properly. But if we do have it, it should be painless and quick, and the determination of that should be based on medical science, not the lies and imaginations of witnesses for political reasons.

My point is that for a wide variety of reasons (liver enzymes, neurological differences, endocrine irregularities), certain individuals may process or metabolize specific drugs very differently than the standard population. In the case of my wisdom tooth surgery, I sure as fuck didn't process at least one of the drugs given to me the way everybody else does; or rather, the way anybody does, in my case. The particularly surgeon I went to prided his office on having a kick ass anaesthesia cocktail, and while they have had people wake up before, I was the only one to ever keep waking up/remain awake and then casually walk off the operating table afterwards in the entire history of their practice.

My counterpoint to Captain.Heroin being that the euphoric, analgesic and anti-anxiolytic of these drugs was not enough to counteract the pain, fear, and dysphoria associated with being awake while somebody drills the impacted wisdom teeth growing beneath my gums to fine dust, from crown to root, and then vacuums my powdered dentia out of from a fine incision made in my rear gumline.

The paralytic agent is supposedly really unpleasant. There have been cases, IIRC, where individuals were given the first two stages (sedative + paralytic), but not the third for whatever reason, who also happened to not be fully sedated into unconsciousness by whatever barbituate/benzo was used, and reported that it was pretty fucking excruciating. (I should probably fact check these stories to make sure my info/memory are serving me right, but laziness).

The point isn't that it's painful, the point is that it is potentially extremely painful because the process is flawed in that dosage is calculated based on mg/kg data for the standard population, completely failing to account for the fact that some individuals do not react to the drug normally; because a person can only be executed once, there are no second chances to adjust the dosage the next time around if the first one doesn't go so well for them. Additionally, those who weren't sedated properly aren't able to communicate their experience after stages two and three are implemented, so we have no idea how frequently this actually occurs.

I also agree that the state should not enforce a death penalty. Aside from the fact that there is no guaranteed painless or "humane" way to murder somebody, the entire death row process one has to endure in this country is more Kafkaesque than most Kafka. A legal process in a civilized society should not be so cruel and dehumanizing as to make me sympathize with an unrepentant multiple child rapist and murderer; if the clash between him and the system of justice he is ensnared in leaves him looking like the lesser of two evils, then that system is not just.

 

[JessFR]

I really don't think you can compare surgery anesthesia to the death penalty the way you're doing.

With surgery, there's both an upper and lower limit when you're talking about dose. Too little and you aren't fully unconscious. Too much and you might die. Obviously this will always air on the side of you waking up than dying.

The death penalty is totally different, death is the end goal. There isn't really a "too much". And while different people do metabolize drugs differently. There's pretty much nobody on earth that won't be rendered unconscious and quickly dead from a massive barbiturate and potassium overdose.

And as for those claims you made. Apart from the fact that as you said, they might be misremembered, even if they aren't, once again there's a strong incentive for both the condemned, their supporters, and anti death penalty advocates to lie about it.

It is true however that there have likely been instances of botched lethal injection procedures that resulted in pain, with or without death as an end result. But this is likely a result of poor procedures stemming from the political dishonesty going on to start with. As ive been saying. The sole aim has been that it appear painless to witnesses. Which means we haven't always been making decisions based on what would result in the most painless death.

Then you have the European companies who decide or have been made to decide not to supply the best drugs to use for lethal injection, resulting in mistakes as new protocols are developed, which is then used to further justify having refused to provide them.

I have two primary points here. One being that we absolutely could kill people painlessly and reliably with lethal injection so long as we were smart about it and stopped trying to placate dishonest politics.

And two, that the politics surrounding it IS indeed dishonest. In the case of your post, as best I can tell, you're suggesting we can't reliably kill people painlessly with drugs. And I see no evidence of that and plenty of reason to think it's bullshit.

Nobody pumped full of barbiturates painkillers and potassium is gonna have an "unusual reaction" where they experience a slow drawn out death. It's total bullshit.

Really, if our goal is a painless, quick death. With no risk of problems caused by say, drug tolerance (which is by far the most plausible concern here), there's an obvious solution...

We strap them to a chair, place a shotgun to the back of their head. Pull the trigger. Or automate it with a machine since that could be legitimately traumatic for the executioner. Just to be extra double 110% sure we could flood the room with nitrogen too. It's totally doable.

The painless death part isn't a problem. The witnesses and politics are the problem.

 

[34-dihydroxyphen]

I really don't think you can compare surgery anesthesia to the death penalty the way you're doing.

With surgery, there's both an upper and lower limit when you're talking about dose. Too little and you aren't fully unconscious. Too much and you might die. Obviously this will always air on the side of you waking up than dying.

The death penalty is totally different, death is the end goal. There isn't really a "too much". And while different people do metabolize drugs differently. There's pretty much nobody on earth that won't be rendered unconscious and quickly dead from a massive barbiturate and potassium overdose.

And as for those claims you made. Apart from the fact that as you said, they might be misremembered, even if they aren't, once again there's a strong incentive for both the condemned, their supporters, and anti death penalty advocates to lie about it.

It is true however that there have likely been instances of botched lethal injection procedures that resulted in pain, with or without death as an end result. But this is likely a result of poor procedures stemming from the political dishonesty going on to start with. As ive been saying. The sole aim has been that it appear painless to witnesses. Which means we haven't always been making decisions based on what would result in the most painless death.

Then you have the European companies who decide or have been made to decide not to supply the best drugs to use for lethal injection, resulting in mistakes as new protocols are developed, which is then used to further justify having refused to provide them.

I have two primary points here. One being that we absolutely could kill people painlessly and reliably with lethal injection so long as we were smart about it and stopped trying to placate dishonest politics.

And two, that the politics surrounding it IS indeed dishonest. In the case of your post, as best I can tell, you're suggesting we can't reliably kill people painlessly with drugs. And I see no evidence of that and plenty of reason to think it's bullshit.

Nobody pumped full of barbiturates painkillers and potassium is gonna have an "unusual reaction" where they experience a slow drawn out death. It's total bullshit.

I didn't mean to suggest that we couldn't reliably kill people painlessly with drugs; however, the form of lethal injection we practice universally in this country is the midazolam+paralytic+potassium chloride method. I'm not concerned with hypothetical lethal injection methods that could be used -- I'm concerned with Lethal Injection as it is practiced in the US.

I believe the dosage of midazolam given is not that much greater, or even greater at all, as the dosage used in anaesthesia, as its purpose is not to kill the patient, but rather to render them unconscious for the portion that does. Benzodiazepines are extremely difficult to OD on when taken alone, so if the midazolam is in any way intended to kill the patient, then they are doing it wrong.

The relevance of the wisdom tooth surgery therefore being that at least one person in this thread is able to claim an atypical response to what was most likely the midazolam. I know for a fact I process Demerol normally, if you catch my drift, while the Propofol was probably what kept me asleep for the first 15-30 minutes of the operation. Point being, if the dosages are similar, and I end up on death row, I will most likely be awake for my own execution.

While my case was extreme, plenty of people do wakeup the one time during this kind of dental surgery, where midazolam+Demerol is a pretty standard combination. It could just be that going purely by mg/kg is not an extremely effective means of predicting how midazolam will effect an individual with any certainty. This is fine in dental surgery, where additional midazolam can be given if the initial dose wasn't enough, but is unacceptable for a process such as lethal injection.

But yeah, our supposedly "humane" lethal injection method doesn't even come close to resembling the method a euthanasist would choose. There absolutely has to be a method of killing people using drugs that is painless; there are too many good drugs out there for that not to be the case.

The idea of swapping fentanyl in for midazolam, by the way, is fucking barbaric. Are any of the people who come up with this shit even remotely educated in a science such as psychiatry or pharmacology? While I am a former opioid addict, I have never myself experienced an OD, but from what I understand, it isn't just a straight lapse into unconsciousness, correct? I mean, even if unconsciousness does eventually occur, I have heard it described as more of a slow lapse from consciousness to semi-consciousness, and eventually into full unconsciousness if it progresses far enough, but only after a long period of time. Somebody with more experience can correct me if I am wrong.

I know for a fact that an opioid is not a suitable replacement for a benzo, however. I also know that opioids make for a terrible euthanasia agent, both because it is difficult to find a dosage that will reliably kill someone, and because death by opioid os apparently not as pleasant as it might seem to somebody who has been in a nod before.

The fact that a state not only considered, but approved this, and that it was only blocked because the pharmaceutical company who supplied the fentanyl did not want the good name of their product tarnished by its having killed someone is just further evidence that we live in a world gone completely mad.

 

[JessFR]

Well, as I mentioned earlier, I have reservations about the midazolam choice too. I'm not sure what the current most frequently used method is, but it used to be that unconsciousness was largely induced with a barbiturate until the supply problem started. And it certainly a much better choice.

What frustrates me is that this argument of "agonizing death" by lethal injection well predates the current supply problem. It's totally disingenuous. And we would have other options if we weren't worrying about how or looks for the witnesses. My point being simply that we increase the risk of an unpleasant death by focusing on the ignorant perception of the experience by ignorant witnesses.

I've fortunately never experienced a serious opioid overdose myself, but I've yet to hear any examples of such experiences being particularly unpleasant, prior to the medical intervention to keep them alive that is. But ideally we shouldn't be using opioids or benzos for this purpose.

If for no other reason than that they're both widely used recrationally, and so have a much higher risk of failing due to substantial tolerance. So you won't get any argument from me there. What pisses me off is that how painful or unpleasant it is or isn't in reality seems to have very little relation to the arguments used politically. Which in my experience are all based around the testimony of witnesses which is totally unreliable.

Just as a little off topic comment though about your experience, as I recall propofol is metabolized pretty quickly. If it's not being continually administered with the dosage monitored, it's not surprising that the patient could wake up. But it depends on how long anasthesia is required. But that's why we have anesthesiologists of course.

Propofol was another one I thought about briefly for the death penalty, but as I recall, only two companies make it, and I'm pretty sure it's fairly complicated to manufacture. So it likely has supply issues too.

Really you'd think we could find some other way to source barbiturates. They're the one of the only drugs we already manufacture in preparations for the sole and singular purpose of causing death. Like lethabarb for example.

 

[Limpet_Chicken]

Propofol is pretty simple, its just a dialkyl phenol, with the phenolic group in between a pair of isopropyl groups both located ortho to the phenolic -OH.

Shit, I've seen kilos of 2,6-diisopropylphenol sold on that major auction site, probably for some chemical use, and that gave me quite the laugh...fucking kilos of propofol on the open market like that. I didn't buy any mind you, unless I wanted it for making something else, I wouldn't want that kind of thing around, its pretty notorious for knocking off light-fingered anaesthetists, as I recall. Supply issues for something like that, I can't see it. And if its going to be used for murder, doesn't really make much difference if its industrial or medical grade at the end of the day does it?

 

[S.J.B.]

And if its going to be used for murder, doesn't really make much difference if its industrial or medical grade at the end of the day does it?

Practically, no, but getting back to Jess's point about perceptions, it would probably look bad if the state couldn't get "pharmaceutical-grade death drugs" so had to resort to "injecting the prisoner with industrial chemicals."

 

[Limpet_Chicken]

Might as well say an axe murderer looks bad because their axe was rusty.

 

[JessFR]

Propofol is pretty simple, its just a dialkyl phenol, with the phenolic group in between a pair of isopropyl groups both located ortho to the phenolic -OH.

Shit, I've seen kilos of 2,6-diisopropylphenol sold on that major auction site, probably for some chemical use, and that gave me quite the laugh...fucking kilos of propofol on the open market like that. I didn't buy any mind you, unless I wanted it for making something else, I wouldn't want that kind of thing around, its pretty notorious for knocking off light-fingered anaesthetists, as I recall. Supply issues for something like that, I can't see it. And if its going to be used for murder, doesn't really make much difference if its industrial or medical grade at the end of the day does it?

That's not the problem, the problem is it isn't very water soluble. So it has to be made into a water oil emulsion for IV use, and not many companies produce it. As I said, only 2 that I know of.

Might as well say an axe murderer looks bad because their axe was rusty.

Yes, it is stupid. But people are stupid. It's also stupid that people always call the use of ketamine on people using "horse tranquilizers". But people are dumb and totally ignorant of chemistry, and perception matters.

 

[Captain.Heroin]

For my wisdom teeth surgery, I was put under with a combination of midazolam, Demerol, and Propofol. For whatever reason, this combo wasn't strong enough for me, so I was essentially awake and screaming for the entire surgery, no matter how much extra midazolam they kept shooting me with. Despite the presence of both an opioid and a benzo in high doses, the state of mind I was in was far from bliss.

If the midazolam doesn't knock you out, then I imagine the introduction of the paralytic agent and the potassium chloride feels quite unpleasant.

Some people are conscious during surgery because they're trying to not kill you with the anesthesia. Demerol is an incredibly weak opiate and I'm surprised they wouldn't have put morphine or fentanyl in instead.

 

[Captain.Heroin]

Also, the sensation of needing to breathe and you can't, isn't pleasant but it isn't particularly painful (i.e. the wind's knocked out of you).

 

[JessFR]

Also, the sensation of needing to breathe and you can't, isn't pleasant but it isn't particularly painful (i.e. the wind's knocked out of you).

It doesn't matter since they're not conscious to experience it anyway.

 

[34-dihydroxyphen]

Some people are conscious during surgery because they're trying to not kill you with the anesthesia. Demerol is an incredibly weak opiate and I'm surprised they wouldn't have put morphine or fentanyl in instead.

Midazolam/Demerol is a pretty standard combination for most dental surgeries due to its overall safety record, but stronger anaesthesias are obviously used when cutting into the actual body. According to the team that did the surgery themselves, I should have been asleep. But I was only anomalous in that they were unable to reliably knock me back out; waking up once is a common occurrence. Which is why this particular anaesthesia is generally considered appropriate for dental surgery, but not an appendix removal, and certainly not a lethal injection.

Point being, if people wake up from dental surgeries involving midazolam all the time, then it only follows that they may wake up during lethal injections, as well. That the drug works very differently on different people, and that it can't be reliably dosed on a mg/kg level unless you are immediately able to address an underdose with additional midazolam; and in my rare case, it proved unreliable as an anaesthetic at all.

 

[Captain.Heroin]

They don't need to keep you under for a long period of time to administer the other drugs in the cocktail, though. It would take maybe 1, 3, or 5 minutes tops.

I believe midazolam would last at least 5 minutes even in the event of a super-metabolizer, etc. unless someone had a bizarre tolerance to the drug from lifelong abuse.

Sekio, or any other pharmacology know-it-alls want to jump in here?

 

[JessFR]

Ultimately, it's the potassium that will likely result in the prisoners death. It'll stop the heart which will result in death very quickly. So, all we need is for them to be unconscious for maybe 10 minutes tops.

But again this depends on if you're worried about what the witnesses see. If that's a concern things get much more complicated.

I think this discussion might benefit if it were clearer what's actually being discussed though. Are we talking about the hypothetical ideal lethal injection? If the current methods are potentially unpleasant? If ALL methods are potentially unpleasant. Does witness experience matter or should it matter? I'm finding it hard to follow where a lot of posts here are actually coming from.