The execution of Christa Pike, which was carried out by lethal injection in Tennessee last evening, was not the first time that the injection process did not go as planned, but it happened repeatedly in the same state this year.
“The number of people surviving executions has certainly increased, as states have more difficulty implementing executions by lethal injection,” said Austin Sarat, a professor of jurisprudence and political science at Amherst College who has written several books on the death penalty.
Over the past decade and a half, pharmaceutical companies have restricted the use of their products in executions, and before that major medical groups, including the American Medical Association and the American Nurses Association, opposed their members' participation in executions.
The result is “a Frankenstein version of the medical model,” said Corinna Barrett-Lane, a law professor at the University of Richmond School of Law and author of the 2025 book Secrets of the Killing State: The Untold Story of Lethal Injection.
Line added to CNN that the matter is “a highly sensitive procedure prone to errors, carried out by untrained people,” using “medicines purchased on the black market, and in secret ways. It is a disastrous recipe from the beginning.”
According to Sarat's data, lethal injection executions were carried out incorrectly in about 7% of cases between 1890 and 2010. The Death Penalty Information Center published its data. An execution gone wrong means that the process does not go as planned, delaying the execution and causing unnecessary pain, and sometimes horrific results. In contrast, the percentage reached 3.2% when all methods of execution were taken into account combined.
The failure rate in lethal injection executions has been rising since 2010, approaching 8%, including "a series of cases in which, like Pike, people have survived lethal injection," Sarat said.
Sarat attributes this increase to “the difficulties facing drug suppliers.”
Lethal injection was developed in 1977 in Oklahoma as an alternative that seemed less brutal than hanging, firing squads, gas chambers, and the electric chair, and was first used in 1982 in Texas. The original protocol relied on three drugs: sodium thiopental for anesthesia, pancuronium bromide to cause paralysis, and potassium chloride to stop the heart, in doses much higher than usual medical uses.
In 2010, pharmaceutical companies were subjected to pressure from the British human rights organization Reprieve to stop exporting these drugs to the United States for use in carrying out death sentences. Although some companies initially objected, restrictions were later imposed on its use, the UK and Europe implemented export controls, and US pharmaceutical companies followed suit.
"Pharmaceutical companies started saying, 'We don't want this negative publicity,'" Sarat said.
This has led to a shortage of drugs used in lethal injection, prompting states to look for alternative sources, including pharmacies that compound the drugs, according to Lane. These pharmacies make medications tailored to patients' needs, but they are not regulated by the US Food and Drug Administration in the same way as traditional pharmaceutical companies.
In 2015, the Coalition for Drug Compounding announced that it discourages the compounding of lethal injection drugs, while acknowledging the right of the individual practice to make the decision to dispense the drug based on the recipient’s personal, moral, and religious beliefs. The group's position was based on calling for a national debate about the right of pharmaceutical companies to restrict the use of their FDA-approved products in accordance with their values.
Some pharmacies that agreed to provide medications to death row executioners were found to have a "very poor track record," Line said. This may lead to medications being provided in the incorrect concentration or being stored incorrectly, which may affect their effectiveness.
Even before the first execution by lethal injection was carried out, the American Medical Association prohibited doctors from participating in executions, and this prohibition remains enshrined in its Code of Medical Ethics. The American Nurses Association has also emphasized since the early 1980s that nurses should not assume any role in executing death sentences, and expanded its position in 2016 to include opposition to the death penalty in general. In 2010, the National Association of Emergency Medical Technicians declared its strong opposition to emergency medical personnel participating in executions.
The identity of people administering lethal injection drugs is often shrouded in secrecy, Line said. A “medical team” may insert intravenous needles, while another team administers medication, and in some places its members may be prison guards who are not medical specialists.
Inability to insert an IV is one of the most common reasons for failure in lethal injection executions, according to the Death Penalty Information Center. That's what happened in May in Tennessee, when Tony Carthers' execution was halted after officials struggled for more than an hour to find a vein, and the state's governor granted him a one-year reprieve.
The original lethal injection protocol, established in 1977, was changed due to problems with drug supply and failure to carry out executions. In Pike's case, she was given two doses of just one drug, pentobarbital, and remains unconscious in a Nashville-area hospital, according to her attorney.
It is not yet clear why the operation failed. Possibilities include the drug getting into the tissues instead of the vein, its effectiveness being less effective, or people responding differently to the medications, as well as using one drug instead of three, Line said.
As the problems of lethal injection increased, American states began turning to alternative methods. The US Department of Justice said in April that it would expand execution methods to include execution by firing squad, while in 2024 Alabama will begin using nitrogen hypoxia.
Since the end of the 19th century, the United States has been seeking a method of execution that is “safe, reliable and humane,” Sarat said, adding: “There is no such method.”
