It's impossible to ask a death row inmate whether they're suffering as they are being put to death by lethal injection. The typical three-drug cocktail first anesthetizes them (rendering them unconscious) and then paralyzes them before stopping their heart. But it turns out their bodies can tell us. NPR reports on research that's been done since 2016 that "is now at the forefront of constitutional challenges to the death penalty in the United States"—evidence NPR has itself expanded upon. Anesthesiologist Dr. Joel Zivot and anatomical pathologist Mark Edgar of Atlanta's Emory University Hospital have reviewed the autopsies of more than 35 executed inmates and found roughly 75% of them had lungs that were too heavy: They had experienced pulmonary edema, a condition in which the lungs fill with blood, plasma, and fluid and can feel like suffocation or drowning.
NPR used public records requests to access 216 autopsies and found signs of pulmonary edema in 84% of them. NPR reports the legal battles the findings have spurred have two questions at their center: "First, why are lethal injection drugs causing pulmonary edema? And second, how much pain can inmates feel as their lungs fill with fluid?" In terms of the former, doctors say what's happening is akin to a fatal heroin overdose: Such a high dose of a drug is administered so quickly that the lungs are damaged. How high? Often 500 milligrams of midazolam, versus the 1 or 2 milligrams a hospital patient might get. As far the second point, experts say the commonly used midazolam doesn't put a person in an anesthetic state, meaning they would feel the suffocating sensation—along with the "searing pain" caused by the final drug, potassium chloride. (Read the full story for much more.)