The Emergence of Second-Generation Lethal Injection Protocols: A Brief History and Review

Daniel R. Malcom, Frank Romanelli

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


The history of capital punishment in the United States is long and controversial. In many cases, lethal injection has brought medical personnel, ethically and professionally charged with preserving life, into the arena of assisting the state in taking life. U.S. Supreme Court decisions, including Baze v. Rees (2008) and Glossip v. Gross (2015), have evaluated and condoned lethal injection protocols. Despite the judicial validation of some midazolam-containing protocols, controversy exists about the level of unconsciousness provided due to the ceiling effects of the drug. Drug shortages, induced in part by manufacturers under pressure by death penalty opponents and governments opposed to capital punishment, have forced states to sometimes use creative means to obtain medications for use in lethal injection, even proposing to allow inmates to supply their own drugs for use in execution. Others have resorted to using compounding pharmacies and enacting tougher execution secrecy laws to protect the identities of those involved in the process. Professional organizations representing health care team members, including nursing, medicine, and pharmacy, among others, have roundly denounced the medicalization of capital punishment. Legal challenges continue to mount at all levels, leading to an uncertain future for lethal injection.

Original languageEnglish
Pages (from-to)1249-1257
Number of pages9
Issue number10
StatePublished - Oct 2017

Bibliographical note

Publisher Copyright:
© 2017 Pharmacotherapy Publications, Inc.


  • capital punishment
  • hydromorphone
  • lethal injection
  • midazolam
  • pentobarbital
  • propofol

ASJC Scopus subject areas

  • Pharmacology (medical)


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