Why botched lethal injections are becoming more common

The failed execution of Christa Pike Wednesday night in Tennessee wasn’t the first time a lethal injection didn’t go as planned.

It wasn’t even the first time this year in the state of Tennessee.

“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 who’s written several books about capital punishment.

Over the past decade and a half, pharmaceutical companies have restricted their products from being used in executions, and for even longer, major medical groups, including the American Medical Association and American Nurses Association , have opposed or prohibited their members from participating.

The result is a “Frankenstein version of the medical model,” said Corinna Barrett Lain , a 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.”

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

Executions using lethal injection were botched about 7% of the time between 1890 and 2010, according to Sarat, whose data was published by the Death Penalty Information Center. A botched execution means it didn’t proceed as designed, resulting in delays, unnecessary pain and sometimes gruesome outcomes . That compares with a rate of 3.2% for all execution methods combined.

Since 2010, the botch rate for lethal injections has been ticking higher, Sarat said, closer to 8%, including “a spate of people who,” like Pike, “survived lethal injections.”

Sarat attributes that uptick to “difficulties with drug suppliers.”

Lethal injection was developed in 1977 in Oklahoma as officials sought less brutal-seeming alternatives to hanging, firing squads, gas chambers and the electric chair. It was first used five years later in Texas. The protocol involved an administration of an anesthetic, sodium thiopental, followed by pancuronium bromide, a paralytic agent, and finally by potassium chloride to stop the heart, all in much higher doses than they’re typically used.

Pharmaceutical companies, which sell these drugs for medical purposes, came under pressure in 2010 from a human rights group in the UK, called Reprieve , which led a campaign to stop European companies from exporting drugs to the US for use in capital punishment.

Dipti Vaidya/Imagn/Reuters

What’s next for Christa Pike after surviving lethal injection

Though some initially balked , saying they couldn’t control distribution of their products once sold to US suppliers, and that the drugs had important medical uses, they ultimately put restrictions in place. The UK and Europe also implemented export controls and American drug companies ultimately followed suit .

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

That led to shortages of the products used for lethal injection, leading states to seek supply elsewhere, including compounding pharmacies, Lain said. Compounders typically make drugs that need to be customized for patients, such as when they might have an allergy to an ingredient in the version made by the manufacturer. They aren’t regulated by the US Food and Drug Administration in the same way as traditional pharmaceutical companies.

In 2015, as states were increasingly looking to compounding pharmacies, the Alliance for Pharmacy Compounding said it discouraged compounding of lethal injection drugs – though the group said it recognized “an individual practitioner’s right to determine whether to dispense a medication based upon his or her personal, ethical and religious beliefs.”

The group didn’t say it based its position on a moral stance, but instead on the belief that there should be a “national discussion … on whether a pharmaceutical manufacturer can restrict the use of FDA-approved products only to purposes that adhere to their corporate values.”

Lain said some compounding pharmacies that agreed to supply executioners have been found to have “horrible, just horrible histories,” and noted that as a result, drugs supplied for lethal injection may have the wrong potency, or could have been stored improperly, affecting their performance as well.

Even before the first lethal injection was carried out, the American Medical Association said physicians shouldn’t participate, and that ban stands in the group’s Code of Medical Ethics .

“An individual’s opinion on capital punishment is the personal moral decision of the individual,” the code reads. “However, as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.”

The American Nurses Association said it has also held since the early 1980s that “nurses should not assume any role in the capital punishment of an incarcerated individual,” and in 2016 extended its position to oppose capital punishment broadly. The National Association of Emergency Medical Technicians said in 2010 it had “strong opposition to participation by EMTs, paramedics or other emergency medical practitioners.”

Christa Pike survived her execution. What happened?

Who actually administers lethal injection drugs is often shrouded in secrecy, like many aspects of the process, Lain said. There may be what she called a “quote medical team” tasked with inserting IVs, but “then you have the other team, the team that pushes the syringes.”

In many places, that may be non-medical prison guards, Lain said, who push down syringes to administer the drugs from “an ante chamber through seven feet of tubing.”

Among the most common reasons cited for botched lethal injections, according to data provided by the Death Penalty Information Center, is an inability to insert the IV.

That’s what happened in May in Tennessee’s previous failed execution. Tony Carruthers’ execution was halted after officials struggled for more than an hour to find a vein. The governor granted Carruthers a one-year stay.

The original 1977 lethal injection protocol has changed amid issues with drug supply and botched executions. Pike, 50, who was sentenced to death for a 1995 murder, was administered two doses of just one drug, pentobarbital, a sedative. She was in critical condition and receiving life-saving medical care, her legal team said Thursday afternoon.

It’s not yet clear why the execution failed. Lain said it could have been an error administering the drug, so that it went to tissue instead of the vein; lack of potency; or just that “people react to drugs differently,” and this was just one drug rather than three.

Amid issues with lethal injection, states have been turning to alternative methods, and the US Department of Justice in April said it would expand manners of execution to include death by firing squad. Alabama started using nitrogen hypoxia , a method of asphyxiation, in 2024.

“The United States has been on a quest since the end of the nineteenth century to find a method of execution that would be safe, reliable and humane,” said Sarat. “There is no such method.”

“When we say we’re not going to punish people cruelly, that is not just about them and their suffering,” Sarat added; “that’s about us and who we want to be.”

周三晚在田纳西州，克里斯塔·派克的死刑执行失败，但这并非第一次注射死刑未能按计划进行。

这甚至不是今年田纳西州第一次发生这种情况。

“随着各州在注射死刑方面遇到更多困难，死刑执行后幸存下来的案例肯定有所增加，”阿默斯特学院法理学和政治学教授奥斯汀·萨拉特说道，他曾撰写过多本关于死刑的书籍。

在过去的十五年里，制药公司限制了其产品用于执行死刑，而包括美国医学会和美国护士协会在内的主要医疗团体，更长时间以来，一直反对或禁止其成员参与死刑。

里士满大学法学院教授、2025 年出版的《杀戮国家的秘密：注射死刑不为人知的故事》一书的作者科琳娜·巴雷特·莱恩表示，其结果是“医学模式的弗兰肯斯坦版本”。

莱恩告诉CNN：“这是一个非常精细、容易出错的手术，由未经培训的人员进行，使用的药物也是从黑市上私下购买的。从一开始就注定会失败。”

根据萨拉特（Sarat）的数据（该数据由死刑信息中心发布），1890年至2010年间，注射死刑的执行失败率约为7%。执行失败指的是死刑执行过程未按计划进行，导致延误、不必要的痛苦，有时甚至造成惨烈的后果。相比之下，所有死刑执行方式的总体失败率仅为3.2%。

萨拉特说，自 2010 年以来，注射死刑的失败率一直在上升，接近 8%，其中包括像派克这样的“一批从注射死刑中幸存下来的人”。

萨拉特将这一增长归因于“与药品供应商的合作困难”。

1977年，俄克拉荷马州官员为了寻找比绞刑、枪决、毒气室和电椅更温和的死刑替代方案，发明了注射死刑。五年后，德克萨斯州首次使用注射死刑。该方案包括先注射麻醉剂硫喷妥钠，再注射肌肉松弛剂泮库溴铵，最后注射氯化钾使心脏停止跳动，所有药物的剂量都远高于通常使用的剂量。

2010 年，英国人权组织 Reprieve 向出售这些药物用于医疗用途的制药公司施压，该组织发起了一场运动，阻止欧洲公司向美国出口用于死刑的药物。

迪普蒂·瓦伊迪亚/伊玛格恩/路透社

克丽斯塔·派克在注射死刑后幸存下来，接下来会怎样？

尽管一些公司最初有所抵触，声称一旦产品售予美国供应商，他们就无法控制产品的分销，而且这些药物具有重要的医疗用途，但最终他们还是采取了限制措施。英国和欧洲也实施了出口管制，美国制药公司最终也纷纷效仿。

萨拉特说：“制药公司开始说，‘我们不希望有这种负面宣传。’”

莱恩表示，这导致用于注射死刑的产品短缺，迫使各州从其他渠道寻求供应，包括配制药房。配制药房通常为患者定制药物，例如当患者对原制药公司生产的药物中的某种成分过敏时。它们不受美国食品药品监督管理局（FDA）的监管，不像传统制药公司那样受到监管。

2015 年，随着各州越来越多地寻求配药药房，配药联盟表示不鼓励配制注射死刑药物——尽管该组织表示承认“个体执业者有权根据其个人、伦理和宗教信仰来决定是否配药”。

该组织并未表示其立场是基于道德立场，而是基于这样一种信念，即应该就“制药商是否可以将获得 FDA 批准的产品的使用限制在符合其企业价值观的用途上”展开“全国性讨论”。

莱恩表示，一些同意向行刑者提供药物的配药药房被发现有着“极其糟糕的历史记录”，并指出，因此，用于注射死刑的药物可能效力不对，或者储存不当，从而影响其效果。

甚至在第一次注射死刑执行之前，美国医学协会就表示医生不应该参与，这一禁令也写入了该组织的《医学伦理守则》。

“个人对死刑的看法是其个人的道德选择，”该准则写道。“然而，作为一名致力于在有希望的情况下挽救生命的专业人士，医生绝不能参与合法执行的死刑。”

美国护士协会表示，自20世纪80年代初以来，该协会一直坚持“护士不应参与对被监禁者的死刑执行”，并在2016年扩大了其立场，全面反对死刑。全国紧急医疗技术员协会在2010年表示，“强烈反对急救医疗技术员、护理人员或其他紧急医疗从业人员参与死刑执行”。

克丽斯塔·派克在死刑执行中幸存了下来。究竟发生了什么？

莱恩说，就像死刑执行过程中的许多环节一样，实际负责注射药物的人往往秘而不宣。她提到，可能有一支所谓的“医疗团队”负责插入静脉输液管，但“还有另一支团队，负责注射药物的团队”。

莱恩说，在很多地方，执行这项任务的可能是非医务人员，他们用注射器从“前室通过七英尺长的管道”给病人注射药物。

根据死刑信息中心提供的数据，导致注射死刑失败的最常见原因之一是无法插入静脉注射针。

今年五月，田纳西州上一次死刑执行失败，情况也是如此。托尼·卡拉瑟斯的死刑在执行人员努力寻找静脉一个多小时后被中止。州长给予卡拉瑟斯一年缓刑。

由于药物供应问题和执行失败事件频发，1977年制定的注射死刑方案已做出修改。现年50岁的派克因1995年的一起谋杀案被判处死刑，她被注射了两剂戊巴比妥钠（一种镇静剂）。她的律师团队周四下午表示，她当时情况危急，正在接受救命的医疗护理。

目前尚不清楚行刑失败的原因。莱恩表示，可能是注射药物时出现失误，导致药物渗入组织而非静脉；也可能是药物效力不足；或者仅仅是因为“每个人对药物的反应都不一样”，而且这次只使用了一种药物，而不是三种。

由于注射死刑存在诸多问题，各州纷纷转向其他替代方法。美国司法部于今年4月表示，将扩大死刑执行方式，包括枪决。阿拉巴马州于2024年开始使用氮气窒息法执行死刑。

萨拉特说：“自19世纪末以来，美国一直在寻求一种安全、可靠且人道的死刑执行方法。但这样的方法并不存在。”

萨拉特补充说：“当我们说我们不会残酷地惩罚人们时，这不仅仅关乎他们和他们的痛苦；这关乎我们自己以及我们想成为什么样的人。”