Lethal injection causes severe pain and severe respiratory distress with associated sensations of drowning, asphyxiation, panic, and terror in the overwhelming majority of cases, a new report from NPR found.
NPR reviewed more than 200 autopsy reports from executions in nine states between 1990 and 2019. The investigation found evidence of pulmonary edema in 84% of the cases. Pulmonary edema occurs when the lungs fill up with fluid, and it can induce the feeling of suffocation or drowning.
The evidence explains why multiple men have gasped for air after their executions began, NPR reports.
The NPR study expands on evidence first uncovered in 2016, when Emory University Hospital anesthesiologist Dr. Joel Zivet and anatomical pathologist Mark Edgar found pulmonary edema in about three-quarters of more than three dozen autopsy reports they reviewed.
In some cases, they also found froth and foam in the airways, which indicates that the person was still alive and trying to breathe as their lungs filled with fluid.
Froth and foam also showed that the first drug given during a lethal injection was causing the pulmonary edema, because the second drug in most protocols is a paralytic that stops the person’s breathing.
NPR’s findings of pulmonary edema were similar not only across the states but also across different drug protocols. Investigators have found high rates of pulmonary edema in people executed with midazolam, pentobarbital, and sodium thiopental.
That’s because pulmonary edema develops during lethal injection as a result of quickly pushing extremely high doses of intravenous drugs, which directly damages the lungs, doctors told NPR.
NPR also reports that doctors have raised serious concerns that many people are not being properly anesthetized—which means they’re feeling the pain and suffocation caused by pulmonary edema as well as the tortuous burning of potassium chloride, the third drug in most lethal injection protocols. And in many cases, it’s impossible to tell that they’re experiencing severe pain because they’re paralyzed. Eighteen states use a paralytic as the second step in their lethal injection protocol.
Midazolam is especially problematic because it’s not an anesthetic. As one of its inventors testified, midazolam induces drowsiness or sleep but it doesn’t stop a patient from feeling pain. Multiple people executed in recent years using midazolam have shown signs of pain—gasping, heaving against restraints, choking, and coughing.
In 2014, Joseph Wood gasped and snorted for nearly two hours before he died; that same year, in Oklahoma, Clayton Lockett writhed on the execution table for 33 minutes before he died of a heart attack.
Evidence of pulmonary edema has been presented to federal courts in a number of states, including Georgia, Arkansas, Missouri, Tennessee, and Ohio.
Last year, a federal court in Ohio ruled that this evidence met the Supreme Court’s standard for cruel and unusual punishment because it “certainly or very likely causes severe pain and needless suffering.” That decision was overturned on appeal, but Ohio Gov. Mike DeWine has put executions on hold due to concerns about pulmonary edema and a drug shortage.
The Supreme Court has not yet ruled on whether the pain associated with pulmonary edema violates the Eighth Amendment.