Lethal Injection Isn't Medicine, But It's Inherited Medical Racism

A report on botched lethal injections holds a warning for legitimate medicine.

Photo by Raghavendra V. Konkathi on Unsplash

The groundbreaking anti-capital-punishment nonprofit Reprieve, previously known for leading the charge against pharmaceutical compliance in executions, has released a definitive report on botched lethal injections¹. Lethal injection in the modern era: cruel, unusual and racist demonstrates that “racism does not just exist in the US’s police stations and courts…It extends to the execution chamber too,” including the stunning finding that lethal injections of Black subjects are 220% as likely to be botched as their white counterparts.

As the report itself states, the undeniable role of race in American capital punishment has been well-known for decades. Prosecutors seek the death penalty more often against Black defendants, more often exclude minority jurors, and secure death sentences for white-victim/Black-perpetrator crimes at double the rate of other racial compositions. What Reprieve found is that the outcomes of executions follows—and even exceeds—those disparities:

– In the state of Arkansas, 75% of botched lethal injection executions were of Black people, despite executions of Black people accounting for just 33% of all executions.
– In the state of Georgia, 86% of botched lethal injection executions were of Black people, despite executions of Black people accounting for just 30% of all executions.
– In the state of Oklahoma, 83% of botched lethal injection executions were of Black people, despite executions of Black people accounting for just 30% of all executions.²

It’s rare that legitimate medicine has much to learn from the caricature of it performed to kill prisoners. However, the report does present an opportunity for the medical community to reflect on the outcomes of racial inequalities presented in the execution chamber.

What Is Medical Racism?

A 2022 paper in BMC Public Health gave perhaps the most useful definition of “medical racism:” the ways in which “groups of people who are racialized as inferior…are devalued, disempowered, and subjected to differential treatment in various institutions, including healthcare, resulting in negative material consequences affecting people’s living conditions, everyday lives, including access to healthcare and health outcomes.“ Much of this persists in beliefs about Black people’s anatomy and physiology, which has directly led to disastrous results in American executions.

The quintessential example of a botched lethal injection also provides one of the most illuminating examples: Reprieve notes that the paramedic who failed to secure a line on Clayton Lockett credited her failure to “Black people hav[ing] smaller veins,“ a problem that, to the extent it’s true at all (and it’s “far from conclusive“), isn’t significant enough to affect the temporary IV access used in EMS and, unfortunately, in executions. Per Oklahoma’s investigation into the Lockett execution, this unsubstantiated belief was espoused by a paramedic with 35 years of experience, holding both Oklahoma licensure and NREMT certification, and an instructor at the Intermediate level (now known as Advanced EMT, and whose scope includes IV access), meaning that a generation of providers is working with this flawed knowledge base. It’s not just a problem for allied health, either: as late as 2016, up to 40% of medical students believed myths like Black people having “thicker skin“ or “weaker nerve endings.“

How Racism May Be Making Lives and Deaths Worse

While the anecdote from Lockett’s execution may be attention-grabbing, the final result of Reprieve’s analysis may hold even worse news for medicine: there was no obvious causative factor leading to racial disparities in lethal injection. IV access issues weren’t significantly worse for Black subjects; as I’ve noted before, there are several relatively race-neutral factors contributing to death row prisoners having difficult veins. Nor did any specific indicator of a botched execution occur more frequently in the Black than the white population. Rather, it may be, as Reprieve posits, that “racial disparities extend into the execution chamber.”

This mirrors a significant problem for the healthcare community. Tenacious medical myths and implicit bias play a significant role in unequal healthcare outcomes, but they don’t explain everything. As the Kaiser Family Foundation points out, differences in the social determinants of health persist from decades-old segregationist policy; without absolving the healthcare system of its own sins, we should at least acknowledge the problems it’s downstream of.

There’s not much that lethal injection can teach to legitimate medicine (for reasons not primarily but including a sunlight allergy that prevents it from doing so). The goals are diametrically opposed, the methods only superficially similar, and the incentives aligned completely differently. I’ve compared lethal injection to World War II-era crimes against humanity before, and the same taint of such an atrocity lingers over any knowledge gained. Still, if any lesson can be wrangled from our ongoing atrocity, we might as well learn it.

1. Special thanks to AICES Canada for publicizing the study.

2. It should be noted that Reprieve partially relies on Austin Sarat’s data for the prevalence of botched lethal injections, which means his disclaimer applies: the use of a three-drug cocktail including a paralytic, as Arkansas and Oklahoma do and Georgia has within Reprieve’s sample, means that botched executions may be significantly undercounted.