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Since the death penalty was reinstated in 1976, nearly 1500 men, women, children, and mentally ill people have been shot, hanged, asphyxiated, lethally injected, and electrocuted by States and the federal government. In over 75 percent of the cases resulting in execution since 1976, the victim was white, although only 50 percent of murder victims nationwide are white. The vast majority of executions in America (81 percent) have been carried out by Southern states.

Lethal injection is the primary method of execution used by states and the federal government. States use a variety of protocols using one, two, or three drugs. The three-drug protocol uses an anesthetic or sedative, typically followed by pancuronium bromide to paralyze the inmate and potassium chloride to stop the inmate’s heart. The one- or two-drug protocols typically use a lethal dose of an anesthetic or sedative.

In recent years, traditional lethal injection drugs like pentobarbital have become unavailable because manufacturers will not sell them for use in executions. States are responding to a declining supply of lethal injection drugs by engaging in illegal drug imports and sales, buying drugs from largely unregulated compounding pharmacies, and conducting experiments on prisoners by injecting them with never-before-tried quantities and combinations of drugs. Many states have passed or tried to pass secrecy laws to shield them from disclosing to the courts, the prisoners or their lawyers, the media, or the public the source or composition of the drugs or the details of the execution protocols.

Experimental protocols shrouded in secrecy resulted in the dramatically botched executions of three men in the first seven months of 2014 alone. On January 16, Dennis McGuire struggled, made guttural noises, gasped for air and choked for about 10 minutes before being declared dead after Ohio subjected him to a never-before-used two-drug execution method. Oklahoma botched the April 29 execution of Clayton Lockett, who grimaced and writhed on the gurney, clenching his jaw and appearing to be in pain, until officials closed the curtain, called off the execution, and then declared Mr. Lockett dead of an apparent heart attack. Arizona's execution of Joseph Wood in July using a secret experimental drug protocol took more than two hours, during which witnesses reported that he gasped and snorted more than 600 times.

Alabama has executed 66 people since 1976. It consistently has the nation’s highest per capita execution rate. Since 2010, Alabama has executed two “volunteers” whose mental illness led them to give up their available appeals; three people whose their juries or sentencing judge believed they should be sentenced to life imprisonment; and an intellectually disabled man who was not allowed to present evidence that would have proved he should have been exempt from execution. Evidence persists that cruelty and inhumane suffering may accompany executions carried out by lethal injection in Alabama. The State killed one man using a secret combination of drugs after the State of Alabama’s illegally-purchased drugs were confiscated by the DEA; in 2016, Ronald Bert Smith in Alabama clenched his fists and raised his head, then heaved, gasped, and coughed while struggling to breathe for 13 minutes after the lethal drugs were administered; and in 2019, witnesses observed disturbing evidence that Michael Brandon Samra struggled on the gurney before he died.