Overview of Lethal Injection Following Christa Pike's Execution Attempt

<p>Lethal injections are under scrutiny after Christa Pike survived two rounds of drugs during Tennessee's failed attempt to execute her.</p><p><strong>Why it matters: </strong>Lethal injection has been the dominant U.S. execution method for decades, accounting for roughly 89% of the 1,683 executions carried out since 1976, according to the Death Penalty Information Center.</p><hr /><p><strong>Driving the news: </strong>Pike, convicted of killing a classmate three decades ago, survived two rounds of lethal injection drugs Wednesday in what would have been the state's first execution of a woman in 200 years.</p><ul><li>In response, Governor Bill Lee halted executions and ordered a "comprehensive, third-party review" of the failed attempt.</li><li>Pike's execution attempt followed hours of legal uncertainty in which courts first stayed the execution before reversing course.</li><li>Pike is still alive as of Thursday afternoon, her attorney stated at a news conference, noting she is receiving "lifesaving care" after the failed attempt that her attorney described as "torture."</li></ul><p><strong>The big picture: </strong>Execution protocols vary by state, but lethal injections generally follow the same basic process.</p><p><em>Here's what to know.</em></p><h2>Why states adopted lethal injection</h2><p><strong>Flashback: </strong>Lethal injections emerged after the Supreme Court allowed capital punishment to return in the 1970s.</p><ul><li>Oklahoma became the first state to authorize the practice in 1977. Texas carried out its first execution five years later.</li><li>Before lethal injections, states commonly used methods like electrocution, gas, hanging, and firing squads. Lawmakers considered injections to be less violent and cheaper.</li></ul><p><strong>Lethal injections are </strong>now used in all death penalty states.</p><ul><li>The Supreme Court requires states to reserve the death penalty only for the most heinous murders.</li></ul><p><strong>Several states </strong>— Idaho, Mississippi, Oklahoma, South Carolina, and Utah — allow firing squads.</p><ul><li>Idaho made firing squad its primary execution method in July.</li></ul><h2>How lethal injections are administered</h2><p><strong>There isn't one </strong>standard procedure. States use different protocols, but the basic process is similar.</p><ul><li>A fatal dose of drugs is delivered through an IV while the prisoner is restrained, often to a gurney.</li><li>Arizona, for example, requires two IV catheters, one as a backup in case the first line fails.</li></ul><p><strong>Physicians often </strong>don't administer lethal injections because the American Medical Association's Code of Medical Ethics states that doctors should not participate in executions.</p><ul><li>States instead sometimes rely on execution teams that can include prison guards, corrections employees, and other personnel trained to administer the drugs.</li></ul><h2>What drugs are used in lethal injections</h2><p><strong>How it works</strong>: There are two main ways these drugs are administered.</p><ul><li><strong>One drug path</strong> — The state administers a sedative or barbiturate, commonly pentobarbital, to cause death.</li><li><strong>Three drug path </strong>— Another method includes giving a sedative or anesthetic, then a paralytic before a final drug stops the heart.</li></ul><p><strong>Yes, but: </strong>Pentobarbital itself is controversial, with critics questioning whether it really causes a painless death.</p><ul><li>A Justice Department review under the Biden administration cited concerns that the drug possibly caused pain and suffering.</li><li>President Trump's Department of Justice reauthorized the federal use of pentobarbital.</li></ul><h2>Lethal injections don't always work as planned</h2><p><strong>Pike's case is not the first </strong>lethal injection gone wrong. The Death Penalty Information Center states that 75 of 1,054 lethal injections (about 7%) were botched from 1890 to 2010 — the most of any method.</p><p><strong>What they're saying:</strong> Witnesses to some executions have described prisoners gasping for air and struggling to breathe.</p><ul><li>Some prisoners survive the initial attempt but later die from complications or other medical causes, sometimes linked to the execution attempt. Others are executed at a later date.</li><li>Autopsies have found evidence of prisoner suffering from pulmonary edema, which is a buildup of fluid in the lungs that can create the same sensation as drowning, according to NPR.</li></ul><p><strong>Case in point:</strong> In 2022, Alabama called off Kenneth Smith's execution after officials couldn't insert an IV before his death warrant expired.</p><ul><li>Smith survived but was later executed in 2024 through nitrogen hypoxia, a first in American history.</li><li>In 2014, the execution of Clayton Lockett in Oklahoma went badly after officials failed to properly establish an IV. He died nearly an hour later.</li></ul><p><strong>Go deeper: </strong>America is seeing an uptick in executions.</p>