Editing Lethal injection (section)

====Research====
In 2005, [[University of Miami]] researchers, in cooperation with the attorney representing death-row inmates from [[List of death row inmates in the United States#Virginia|Virginia]], published a research letter in the medical journal ''[[The Lancet]]''. The article presented protocol information from Texas, Virginia, and North and South Carolina which showed that executioners had no anesthesia training, drugs were administered remotely with no monitoring for anesthesia, data were not recorded, and no peer review was done. Their analysis of toxicology reports from Arizona, Georgia, North and South Carolina showed that ''post mortem'' concentrations of thiopental in the blood were lower than that required for surgery in 43 of 49 executed inmates (88%), and that  21 (43%) inmates had concentrations consistent with awareness.<ref>{{cite journal |title=Inadequate anaesthesia in lethal injection for execution |first1=Leonidas G |last1=Koniaris |first2=Teresa A |last2=Zimmers |first3=David A |last3=Lubarsky |first4=Jonathan P |last4=Sheldon |journal=Lancet |date=April 16, 2005 |volume=365 |issue=9468 |pages=1412–1414 |url=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)66377-5/abstract |doi=10.1016/S0140-6736(05)66377-5 |pmid=15836890 |s2cid=31192408 |url-status=dead |archive-url=https://web.archive.org/web/20130729013249/http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2966377-5/abstract |archive-date=July 29, 2013 |df=mdy-all |access-date=November 29, 2012 |url-access=subscription }}</ref><ref>{{cite journal |title=Inadequate anaesthesia in lethal injection for execution |first1=Leonidas G |last1=Koniaris |first2=Teresa A |last2=Zimmers |first3=David A |last3=Lubarsky |first4=Jonathan P |last4=Sheldon |journal=Lancet |date=April 16, 2005 |volume=365 |issue=9468 |pages=1412–14 |url=http://www.atypicaljoe.com/archives/LancetInadAnesth.pdf |archive-url=https://web.archive.org/web/20061030122123/http://www.atypicaljoe.com/archives/LancetInadAnesth.pdf |archive-date=October 30, 2006 |doi=10.1016/S0140-6736(05)66377-5 |pmid=15836890|url-status=usurped |s2cid=31192408 }}</ref> This led the authors to conclude that a substantial probability existed that some of the inmates were aware and suffered extreme pain and distress during execution. The authors attributed the risk of consciousness among inmates to the lack of training and monitoring in the process, but carefully made no recommendations on how to alter the protocol or how to improve the process. Indeed, the authors conclude, "because participation of doctors in protocol design or execution is ethically prohibited, adequate anesthesia cannot be certain. Therefore, to prevent unnecessary cruelty and suffering, cessation and public review of lethal injections is warranted".

Paid expert consultants on both sides of the lethal-injection debate have found opportunity to criticize the 2005 ''Lancet'' article. Subsequent to the initial publication in the ''Lancet'', three letters to the editor and a response from the authors extended the analysis. The issue of contention is whether thiopental, like many lipid-soluble drugs, may be redistributed from blood into tissues after death, effectively lowering thiopental concentrations over time, or whether thiopental may distribute from tissues into the blood, effectively increasing ''post mortem'' blood concentrations over time. Given the near absence of scientific, peer-reviewed data on the topic of thiopental ''post mortem'' [[pharmacokinetics]], the controversy continues in the lethal-injection community and, in consequence, many legal challenges to lethal injection have not used the ''Lancet'' article.

In 2007, the same group that authored the ''Lancet'' study extended its study of the lethal-injection process through a critical examination of the pharmacology of the barbiturate thiopental. This study – published in the online journal ''PLOS Medicine''<ref>{{cite journal |title=Lethal Injection for Execution: Chemical Asphyxiation? |doi=10.1371/journal.pmed.0040156 |pmid=17455994 |pmc=1876417 |volume=4 |issue=4 |journal=PLOS Medicine |page=e156 |df=mdy-all |year = 2007|last1 = Zimmers|first1 = Teresa A.|last2=Sheldon |first2=Jonathan |last3=Lubarsky |first3=David A. |last4=López-Muñoz |first4=Francisco |last5=Waterman |first5=Linda |last6=Weisman |first6=Richard |last7=Koniaris |first7=Leonidas G. |doi-access=free }}</ref> – confirmed and extended the conclusions made in the original article and goes further to disprove the assertion that the lethal-injection process is painless.

To date, these two studies by the University of Miami team serve as the only critical peer-reviewed examination of the pharmacology of the lethal-injection process.