Editing Lethal injection (section)

==Procedures==

===Procedure in the United States===
In the United States, the typical lethal injection begins with the condemned person being strapped onto a [[gurney]]; two [[intravenous]] cannulas ("IVs") are then inserted, one in each arm. Only one is necessary to carry out the execution; the other is reserved as a backup in the event the primary line fails. A line leading from the [[Intravenous therapy|IV line]] in an adjacent room is attached to the prisoner's IV and secured so that the line does not snap during the injections.

The arm of the condemned person is swabbed with [[ethanol|alcohol]] before the cannula is inserted.<ref>{{Cite web |last=Adams |first=Cecil |date=1991-08-09 |title=When someone is executed by lethal injection, do they swab off the arm first? |url=https://www.straightdope.com/21341822/when-someone-is-executed-by-lethal-injection-do-they-swab-off-the-arm-first |access-date=2022-05-29 |website=The Straight Dope |language=en}}</ref> The needles and equipment used are sterilized. Questions have been raised about why these precautions against infection are performed despite the purpose of the injection being death. The several explanations include: cannulae are sterilized and have their quality heavily controlled during manufacture, so using sterile ones is a routine medical procedure.<ref>{{cite web|url=http://www.madehow.com/Volume-3/Syringe.html|title=How syringe is made – material, production process, manufacture, making, history, used, processing, parts|website=www.madehow.com|language=en|access-date=2018-04-21|url-status=dead|archive-url=https://web.archive.org/web/20171117072339/http://www.madehow.com/Volume-3/Syringe.html|archive-date=November 17, 2017|df=mdy-all}}</ref><ref name=":0">{{Cite news|url=https://gizmodo.com/why-proper-sterlization-procedures-are-used-during-leth-1542022939|title=Why Proper Sterlization Procedures Are Used During Lethal Injections|last=TodayIFoundOut.com|first=Daven Hiskey -|work=Gizmodo|access-date=2018-04-21|language=en-US|url-status=live|archive-url=https://web.archive.org/web/20180422062743/https://gizmodo.com/why-proper-sterlization-procedures-are-used-during-leth-1542022939|archive-date=April 22, 2018|df=mdy-all}}</ref> Secondly, the prisoner could receive a [[stay of execution]] after the cannulae have been inserted, as happened in the case of [[James Autry]] in October 1983.<ref name=":0" /><ref name=":1">{{Cite news|url=http://mentalfloss.com/article/26514/why-do-they-use-sterile-needles-lethal-injections|title=Why Do They Use Sterile Needles for Lethal Injections?|date=2010-11-30|access-date=2018-04-21|language=en|url-status=dead|archive-url=https://web.archive.org/web/20180422063142/http://mentalfloss.com/article/26514/why-do-they-use-sterile-needles-lethal-injections|archive-date=April 22, 2018|df=mdy-all}}</ref> Third, use of unsterilized equipment would be a hazard to the prison personnel in case of an accidental needle stick injury.<ref name=":1" />

Following connection of the lines, [[Saline (medicine)|saline]] drips are started in both arms. This, too, is standard medical procedure: it must be ascertained that the IV lines are not blocked, ensuring the chemicals have not precipitated in the IV lines and blocked the needle, preventing the drugs from reaching the subject. A [[Electrocardiography|heart monitor]] is attached to the inmate.<ref name=":2">{{Cite news|url=https://mundoestranho.abril.com.br/ciencia/como-e-uma-execucao-por-injecao-letal/|title=Como é uma execução por injeção letal?|work=Mundo Estranho|access-date=2018-04-21|language=pt-BR|url-status=dead|archive-url=https://web.archive.org/web/20180422062657/https://mundoestranho.abril.com.br/ciencia/como-e-uma-execucao-por-injecao-letal/|archive-date=April 22, 2018|df=mdy-all}}</ref>

In most states, the intravenous injection is a series of drugs given in a set sequence, designed to first induce [[unconsciousness]] followed by death through [[paralysis]] of respiratory muscles and/or by [[cardiac arrest]] through [[depolarization]] of [[cardiac muscle]] cells. The execution of the condemned in most states involves three separate injections (in sequential order):
#[[Sodium thiopental]] or [[pentobarbital]]:<ref name=wsj>{{cite news |url=https://www.wsj.com/articles/SB10001424052702304584004576419092675627536 |title=Lundbeck Seeks to Curb Use of Drug in Executions |newspaper=The Wall Street Journal |date=July 1, 2011 |access-date=July 3, 2011 |first1=Jeanne |last1=Whalen |first2=Nathan |last2=Koppel |url-status=live |archive-url=https://web.archive.org/web/20160102085205/http://www.wsj.com/articles/SB10001424052702304584004576419092675627536 |archive-date=January 2, 2016 |df=mdy-all }}</ref> ultra-short-action barbiturate, an anesthetic agent used at a high dose that renders the person unconscious in less than 30 seconds. Depression of respiratory activity is one of the characteristic actions of this drug.<ref name="THIOPENTAL SODIUM">{{cite web |url=http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=48745 |title=THIOPENTAL SODIUM |date=April 2010 |access-date=November 20, 2013 |url-status=live |archive-url=https://web.archive.org/web/20131203021853/http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=48745 |archive-date=December 3, 2013 |df=mdy-all }}</ref> Consequently, it will—even in the absence of the following two drugs—cause death due to lack of breathing, as happens with overdoses of [[opioid]]s.
#[[Pancuronium bromide]]: non-depolarizing muscle relaxant, which causes complete, fast, and sustained paralysis of the [[Striated muscle tissue|striated]] [[skeletal muscle]]s, including the [[diaphragm (anatomy)|diaphragm]] and the rest of the respiratory muscles; this would eventually cause death by [[asphyxia]]tion.
#[[Potassium chloride]]: a [[potassium]] salt, which increases the [[Hyperkalemia|blood and cardiac concentration of potassium]] to stop the heart via an [[Heart arrhythmia|abnormal heartbeat]] and thus cause death by [[cardiac arrest]].
[[File:SQ Lethal Injection Room.jpg|thumb|right|250px|Execution room in the [[San Quentin State Prison]] in California]]
The drugs are not mixed externally to avoid [[precipitation (chemistry)|precipitation]]. A sequential injection is also key to achieve the desired effects in the appropriate order: administration of the pentobarbital renders the person unconscious; the infusion of the pancuronium bromide induces complete paralysis, including that of the lungs and diaphragm rendering the person unable to breathe.

If the person being executed were not already completely unconscious, the injection of a highly concentrated solution of potassium chloride could cause severe pain at the site of the IV line, as well as along the punctured vein; it interrupts the electrical activity of the heart muscle and causes it to stop beating, bringing about the death of the person being executed.

The intravenous tubing leads to a room next to the execution chamber, usually separated from the condemned by a curtain or wall. Typically, a prison employee trained in [[venipuncture]] inserts the needle, while a second prison employee orders, prepares, and loads the drugs into the lethal injection syringes.{{Citation needed|date=November 2022|reason=No source}} Two other staff members take each of the three syringes and secure them into the IVs. After the curtain is opened to allow the witnesses to see inside the chamber, the condemned person is then permitted to make a final statement. Following this, the warden signals that the execution may commence, and the {{not a typo|executioner(s)}} (either prison staff or private citizens depending on the jurisdiction) then manually inject the three drugs in sequence. During the execution, the condemned's cardiac rhythm is monitored.

Death is pronounced after cardiac activity stops. Death usually occurs within seven minutes, although, due to complications in finding a suitable vein, the whole procedure can take up to two hours, as was the case with the execution of [[Christopher Newton (criminal)|Christopher Newton]] on May 24, 2007. According to state law, if a [[physician]]'s participation in the execution is prohibited for reasons of [[medical ethics]], then the death ruling can be made by the state [[medical examiner]]'s office. After confirmation that death has occurred, a [[coroner]] signs the condemned's death certificate.
[[File: National Museum of Crime and Punishment - Delaware lethal injection machine (2868729627).jpg|thumb|right|The Control Module of the lethal injection machine formerly installed in the [[James T. Vaughn Correctional Center]], Delaware. On display in the [[National Museum of Crime & Punishment]], Washington, D.C. (2009)]]

[[Missouri]] and, before the abolition of capital punishment, [[Delaware]], uses or used a lethal injection machine designed by [[Massachusetts]]-based [[Fred A. Leuchter]] consisting of two components: the delivery module and the control module. The delivery module is in the execution chamber. It must be pre-loaded with the proper chemicals and operates the timing of the dosage. The control module is in the control room. This is the portion which officially starts the procedure. This is done by first arming the machine, and then with station members simultaneously pressing each of their buttons on the panel to activate the delivery. The computer then deletes who actually started the syringes, so the participants are not aware if their syringe contained saline or one of the drugs necessary for execution (to assuage guilt in a manner similar to the [[Execution by firing squad#Blank cartridge|blank cartridge]] in [[execution by firing squad]]).

The delivery module has eight syringes. The end syringes (i.e., syringes 7 and 8) containing saline, syringes 2, 4 and 6 containing the lethal drugs for the main line and syringes 1, 3 and 5 containing the injections for the backup line. The system was used in New Jersey before the abolition of the death penalty in 2007. Illinois previously used the computer, and Missouri and Delaware use the manual injection switch on the delivery panel.<ref>{{cite web |url=http://www.angelfire.com/fl3/starke/injection.html |title=FRED A |url-status=dead |archive-url=https://web.archive.org/web/20081204004157/http://www.angelfire.com/fl3/starke/injection.html |archive-date=December 4, 2008}}</ref>{{citation needed|date=August 2014|reason=21-months-dead link to low-rent, presumably blog-prone provider}}

Eleven states have switched, or have stated their intention to switch, to a one-drug lethal injection protocol. A one-drug method is using the single drug [[sodium thiopental]] to execute someone. The first state to switch to this method was Ohio, on December 8, 2009.<ref name="state by state">{{cite web |url=http://www.deathpenaltyinfo.org/state-lethal-injection |title=State by State Lethal Injection |work=Death Penalty Information Center |access-date=March 19, 2016 |url-status=dead |archive-url=https://web.archive.org/web/20150403093930/http://www.deathpenaltyinfo.org/state-lethal-injection |archive-date=April 3, 2015 |df=mdy-all }}</ref>

In 2011, after pressure by activist organizations, the manufacturers of pentobarbital and sodium thiopental halted the supply of the drugs to U.S. prisons performing lethal injections and required all resellers to do the same.<ref name=wsj/>

===Procedure in China===
{{Further|Execution van}}

In the past, the [[People's Republic of China]] executed prisoners primarily by [[Execution by shooting|means of shooting]]. In recent years, lethal injection has become more common. The specific lethal injection procedures, including the drug or drugs used, are a state secret and not publicly known.<ref>{{cite web |url=http://law.fordham.edu/faculty/19974.htm |title=Drug shortage throws US executions into disarray |first=Lucile |last=Malandain |work=Agence France-Press |date=October 24, 2010 |access-date=March 13, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20101216013209/http://law.fordham.edu/faculty/19974.htm |archive-date=December 16, 2010 |df=mdy-all }}</ref>

Lethal injection in China was legalized in 1996. The number of shooting executions slowly decreased; and, in February 2009, the [[Supreme People's Court]] ordered the discontinuation of [[Execution by firing squad|firing squads]] by the following year under the conclusion that injections were more humane to the prisoner. It has been suggested that the switch is also in response to executions being horrifying to the public. Lethal injections are less expensive than firing squads, with a single dose costing 300 [[yuan (currency)|yuan]] compared to 700 yuan for a shooting execution.<ref name="asiatimes20091216">{{cite news |url=http://www.atimes.com/atimes/China/KL16Ad01.html |archive-url=https://web.archive.org/web/20091218062406/http://www.atimes.com/atimes/China/KL16Ad01.html |url-status=unfit |archive-date=December 18, 2009 |title=China injects 'humanity' into death sentence |work=[[Asia Times Online]] |first=Cristian |last=Segura |date=December 16, 2009 |access-date=October 18, 2016}}</ref>

=== Procedure in Vietnam===
Prior to 2013, shooting was the primary method of execution in [[Vietnam]]. The use of lethal injection method was approved by the government in 2010, adopted in 2011, and then started being used in 2013.<ref name=":3">{{cite web|url=http://english.vietnamnet.vn/fms/society/172369/vietnam-to-build-five-more-lethal-injection-venues.html|title=Vietnam to build five more lethal injection venues – News VietNamNet|last=vietnamnet.vn|website=english.vietnamnet.vn|access-date=2018-04-21|url-status=live|archive-url=https://web.archive.org/web/20180422064044/http://english.vietnamnet.vn/fms/society/172369/vietnam-to-build-five-more-lethal-injection-venues.html|archive-date=April 22, 2018|df=mdy-all}}</ref><ref name=":4">{{cite web|url=https://www.deathpenaltyworldwide.org/country-search-post.cfm?country=Vietnam#f10-1|title=The Death Penalty in Vietnam|website=www.deathpenaltyworldwide.org|language=en|access-date=2018-04-21|url-status=live|archive-url=https://web.archive.org/web/20170914020718/http://www.deathpenaltyworldwide.org/country-search-post.cfm?country=Vietnam#f10-1|archive-date=September 14, 2017|df=mdy-all}}</ref> Urges to adopt other methods than lethal injection to replace the shooting execution began earlier, in 2006, after concerns of the mental state of the firing squad members after executions.<ref name="pri20140507" />

The drugs used consist of [[pancuronium bromide]] (paralytic), [[potassium chloride]] (cardiotoxin), and [[sodium thiopental]] (anesthetic).<ref name=":4" /> The production of these substances, however, is low in Vietnam. This led to drug shortages and to considering using other domestic poisons or the readoption of shootings.<ref name="pri20140507" /><ref name=":4" />

The first prisoner in Vietnam to be executed by lethal injection, on August 6, 2013, was 27-year-old Nguyen Anh Tuan, arrested for murder and robbery.<ref>{{cite web|url=http://www.dw.com/en/vietnam-executes-by-lethal-injection-despite-protest/a-17000124|title=Vietnam executes by lethal injection despite protest {{!}} DW {{!}} 06.08.2013|last=(www.dw.com)|first=Deutsche Welle|website=DW.COM|language=en|access-date=2018-04-21|url-status=live|archive-url=https://web.archive.org/web/20180422063456/http://www.dw.com/en/vietnam-executes-by-lethal-injection-despite-protest/a-17000124|archive-date=April 22, 2018|df=mdy-all}}</ref> Between 2013 and 2016, 429 prisoners were executed by this method in the country.<ref name=":3" />