Lethal Injection Failures Raise New Questions About Execution Protocols
Goldlaner.com – The unsuccessful execution of Christa Pike in Tennessee on Wednesday night has renewed attention on a method of capital punishment that was designed to appear more clinical and less violent than earlier forms of execution. Pike’s case was not Tennessee’s first lethal-injection failure, nor was it the state’s first such incident this year.
Problems with executions have become more visible as states struggle to obtain drugs and carry out protocols that depend on medical-style procedures without broad participation from medical professionals. Austin Sarat, an Amherst College professor of jurisprudence and political science, has studied capital punishment extensively and says the number of people surviving attempted executions has risen as lethal injection has become harder to administer.
The incidence of people surviving executions has certainly increased as states have encountered more difficulties with lethal injection.
The procedure was originally promoted as an alternative to hanging, firing squads, gas chambers and electrocution. Yet its implementation has increasingly revealed the practical complications behind its calm-looking appearance: identifying usable drugs, establishing reliable supply chains, preparing the compounds properly and finding personnel able to conduct a delicate intravenous process.
A procedure modeled on medicine, without the same safeguards
Corinna Barrett Lain, a University of Richmond School of Law professor and author of the 2025 book Secrets of the Killing State: the Untold Story of Lethal Injection, describes the modern system as an uneasy imitation of medical practice. Major organizations including the American Medical Association and American Nurses Association have long opposed or restricted member participation in executions.
It’s a highly delicate, error-prone procedure that is done by people who are not trained.
Lain has also warned that execution teams may be using drugs acquired outside conventional pharmaceutical channels. In her view, the combination of limited oversight, uncertain sourcing and complex administration creates significant risks from the outset.
Drugs that are bought on the black market, under the table. It’s a recipe for disaster from the start.
A botched execution does not necessarily mean the person survives. The term generally refers to an execution that fails to unfold as intended, producing delays, avoidable pain or disturbing outcomes. Sarat’s research, published by the Death Penalty Information Center, found that lethal injections were botched about 7% of the time from 1890 through 2010. Across all execution methods during that period, the rate was 3.2%.
Since 2010, Sarat has said the failure rate for lethal injections has moved closer to 8%. That period has included multiple instances in which people survived attempted lethal injections, including Pike. He connects the increase largely to mounting problems involving drug suppliers.
How drug shortages reshaped executions
Oklahoma developed lethal injection in 1977 while officials sought an execution method that would seem less brutal than the alternatives then in use. Texas carried out the first lethal injection five years later. The early three-drug procedure used sodium thiopental as an anesthetic, pancuronium bromide as a paralytic and potassium chloride to stop the heart. The quantities used were far above ordinary medical doses.
That system began to change sharply in 2010. Reprieve, a UK human rights organization, led a campaign aimed at preventing European companies from sending drugs to the United States for use in executions. Some pharmaceutical businesses initially argued that they could not fully control how products were distributed after sale to American suppliers and stressed the drugs’ legitimate medical uses.
Over time, however, manufacturers imposed restrictions. Export controls in the United Kingdom and Europe added another obstacle, while US drugmakers later adopted similar limits. Sarat said companies increasingly sought to avoid the reputational harm associated with having their medical products tied to executions.
Drug companies began to say, ‘We don’t want this negative publicity.’
The resulting shortages pushed states to search for replacement supplies, including from compounding pharmacies. These pharmacies commonly prepare customized medications for individual patients, such as people who cannot use a standard drug because of an allergy. They do not face the same form of US Food and Drug Administration regulation applied to conventional drug manufacturers.
Concerns over compounded drugs
As states turned more often to compounders, questions emerged over potency, handling and quality control. Lain has said that some pharmacies willing to provide drugs for executions had deeply troubling records. A drug that is not mixed at the intended strength, or that has been stored improperly, may not work as anticipated during an execution.
Horrible, just horrible histories.
In 2015, the Alliance for Pharmacy Compounding discouraged the preparation of drugs for lethal injection. Its position did not rest on an explicitly moral objection to capital punishment. Instead, the organization called for a national discussion about whether a manufacturer can limit use of FDA-approved products to purposes consistent with its corporate values. At the same time, it recognized that individual practitioners could make dispensing decisions based on personal ethical or religious beliefs.
Pike’s survival places those concerns in immediate focus. An execution protocol involves more than a written sequence of drugs. It depends on the quality of the substances, the reliability of the equipment, the ability to establish intravenous access and the judgment of the people carrying it out. When any one of those elements breaks down, the consequences can include a prolonged and traumatic event for the person being executed, witnesses, prison staff and victims’ families.
The broader debate is likely to continue as states confront shrinking drug access and legal challenges involving execution practices. Lethal injection was introduced with the promise of a more controlled process. Decades later, its growing record of failures has left that promise under sustained scrutiny.
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