Why botched lethal injections are becoming more common

Growing Problems With Lethal Injection Put Execution Procedures Under New Scrutiny

Earthguardiansonline.com – Christa Pike’s failed execution in Tennessee on Wednesday night has intensified concern over the reliability of lethal injection, a method once presented as a more clinical alternative to older forms of capital punishment. The incident was not Tennessee’s first lethal-injection failure, and it was not the state’s only such case this year.

For decades, states have relied on lethal injection while facing escalating obstacles: limited access to drugs, pressure on pharmaceutical suppliers, legal disputes over secrecy and a shortage of qualified medical professionals willing to take part. Those difficulties have made a procedure designed to appear controlled increasingly vulnerable to delay, error and suffering.

“The incidence of people surviving executions has certainly increased as states have encountered more difficulties with lethal injection,” said Austin Sarat, a professor of jurisprudence and political science at Amherst College.

Sarat, who has written extensively on capital punishment, has tracked execution failures over time. His data, published by the Death Penalty Information Center, found that lethal injections went wrong roughly 7% of the time from 1890 through 2010. Across every execution method combined, the failure rate was 3.2%.

Since 2010, Sarat said, the rate for lethal injection has moved closer to 8%. That period has included several cases in which prisoners survived attempted injections, as Pike did. A botched execution is one that fails to unfold as intended, potentially producing long delays, unnecessary pain or disturbing physical consequences.

A Method Built on a Medical Appearance

Lethal injection originated in Oklahoma in 1977, when officials were searching for an execution method that seemed less visibly violent than hanging, firing squads, gas chambers or the electric chair. Texas carried out the first lethal injection five years later.

The original three-drug process called for sodium thiopental, an anesthetic, followed by pancuronium bromide, a paralytic drug. Potassium chloride was then used to stop the heart. The drugs were administered in amounts far above ordinary medical doses.

Its medical-style design, however, has always faced a basic contradiction: the professionals most associated with administering drugs and monitoring patients have generally opposed involvement in executions. Major medical organizations, including the American Medical Association and the American Nurses Association, have opposed or barred member participation for many years.

That leaves states trying to conduct a technically sensitive procedure without the same professional framework, training standards or clinical oversight expected in ordinary health care. 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, described the result as a distorted imitation of medicine.

It is a “Frankenstein version of the medical model,” Lain said.

She characterized lethal injection as a delicate process with substantial room for failure when it is performed by people without appropriate training and with drugs obtained through irregular channels.

“It’s a highly delicate, error-prone procedure that is done by people who are not trained,” Lain said, adding that the drugs can be obtained “on the black market, under the table. It’s a recipe for disaster from the start.”

Drug Restrictions Changed the Landscape

The pressure on state execution systems became especially pronounced around 2010. Pharmaceutical companies that manufactured drugs for medical treatment faced campaigns urging them to prevent those products from being used in executions. Reprieve, a United Kingdom-based human rights organization, led an effort aimed at stopping European companies from exporting execution drugs to the United States.

Some companies initially argued that they could not fully control where products went after sale to American distributors. They also stressed that the medications served important health-care purposes. Over time, though, companies adopted distribution restrictions. The United Kingdom and European authorities imposed export controls as well, and American drugmakers later took similar steps.

“Drug companies began to say, ‘We don’t want this negative publicity,’” Sarat said.

Those decisions reduced the available supply of drugs once commonly used in lethal injection protocols. States then looked for alternatives, including compounding pharmacies.

Compounding pharmacies generally prepare customized medications for individual patients, such as people who cannot use a standard commercial formulation because of an allergy or another specific need. They do not face the same Food and Drug Administration regulatory structure that applies to conventional pharmaceutical manufacturers.

In 2015, as more states turned to compounders, the Alliance for Pharmacy Compounding discouraged the production of lethal-injection drugs. The organization nevertheless recognized that individual practitioners could make their own decisions based on ethical, religious and personal beliefs.

The group framed its position around a broader policy question: whether a pharmaceutical manufacturer should be able to limit FDA-approved products to uses consistent with its corporate values. That dispute highlights a central tension in lethal injection policy. States seek a dependable means to carry out lawful sentences, while drug companies and health-care professionals may reject any role in the process.

Why Supply Questions Matter

The origin, handling and potency of execution drugs can directly affect how an injection performs. Lain said some compounding pharmacies that supplied execution drugs had deeply troubling records. Drugs may be improperly stored, produced at an incorrect strength or otherwise fail to work as expected.

Those risks are especially consequential in an execution setting, where there is no opportunity to simply postpone treatment, reassess a patient and correct a medication error in the way a hospital normally would. When an execution protocol breaks down, the result can raise immediate questions about pain, competence and whether the state can safely proceed.

Pike’s survival places those questions at the center of the next phase of her case. It also underscores a wider reality for death-penalty states: lethal injection has become harder to carry out precisely because the medical and pharmaceutical systems on which it depends have increasingly distanced themselves from executions.

As drug supplies become more difficult to obtain and trained clinicians remain unwilling to participate, states face a procedure that may look medical in theory but can be far less predictable in practice.