In the United States, the death penalty is applied using lethal injection, the electric chair, firing squad, hanging, and gas chamber, but in the 32 states in which the death penalty is legal, the most common method is lethal injection: of all the executions conducted since 1976, only 3 people were hanged, 3 were put to death by firing squad, 11 were killed using gas, 158 were electrocuted and 1,177 were given a lethal injection.

Death via lethal injection involves an injection of thiopental which sedates the person, another consisting of pancuroniom bromide which acts as a muscle relaxant, and then an injection of potassium chloride to stop the heart. Paradoxically, it is this pharmaceutical “final solution” which is now holding up and delaying the application of the death sentence for the 3,100 inmates on death row, and not the opposition to the death penalty on the part of American citizens.

According to the recent issue of Nature (Nature 502; 417-418, 2013) the lethal injection set for 23 October to be applied to Allen Nicklasson in Missouri, was postponed not due to a review of his case, but because the use one of the drugs – the anaesthetic propofol – is being questioned. Produced by the German firm Fresenius, propofol is at the centre of an international controversy arising from a European law which prohibits the export of drugs and devices used in acts of torture or executions. If this law is applied, propofol, which is used up to 50 million times per year in anaesthetic-surgical procedures in the United States, may no longer be made available to the country’s hospitals.

It is not the first time that Europe’s opposition to capital punishment has affected the supply of drugs used for anaesthetic purposes in the United States. American hospitals have been using the common sedative sodium thiopental since 2011. But its manufacturer, the American pharmaceutical firm Hospira, has abandoned plans to produce the drug in its Italian plant after Italian authorities reminded the firm that thiopental could not be used in executions. The United States has seen numerous shortages of this drug, which is difficult to produce and costly.

Another sedative, pentobarbital, was chosen as an alternative in 2009. But in 2011, the Danish company Lundbeck, the only supplier of pentobarbital in the United States, also banned the use of its product in executions, in keeping with the European directives. On 15 October, the State of Florida executed William Happ using midazolam as a sedative after running out of pentobarbital. But midazolam, which is similar to diazepam (Valium), had never been used in an execution before, and according to reports, Happ was still blinking and moving his head minutes after he was given the injection. “We’ve turned this into a circus of experimenting on prisoners,” said David Lubarsky in Nature (Nature 502; 417-418, 2013), Chairman of the Department of Anaesthesiology of the University of Miami (José Ramón Zarate. Diario Médico 4/10-11-2013).