Killing with kindness

Three times they prepared to hang John Lee, but three times the trapdoor refused to open. At Exeter Prison on February 23, 1885, the condemned man stood on the gallows with a hood over his head and a rope around his neck, waiting for the floor to vanish beneath him. Between attempts, the apparatus was checked and found to work perfectly, but each time Lee assumed the position with a noose around his neck, the trapdoor jammed again.

Eventually, the authorities abandoned the execution, and his death sentence was commuted to life imprisonment. He became famous as “The Man They Could Not Hang.” About 20 years later, he was released and moved to the USA where he wrote a best-selling 94-page memoir, and gave lecture tours.

More than 140 years later, the recent events in Tennessee offer a reminder that replacing the rope with a syringe and putting people down like unwanted pets has not abolished the possibility of an attempted judicial execution going terribly wrong, which has always been the case, but there is something peculiarly modern about trying to kill somebody, failing, and then calling an ambulance to send them to the hospital for resuscitation.

That was exactly the position Tennessee found itself in after its September 30 attempt to execute a 50-year-old woman called Christa Pike. According to news reports, she survived the administration of two vials of pentobarbital. This was supposed to be a ‘lethal injection’, but obviously was not lethal enough as she continued to “snore” and was then rushed to the hospital.

(The existing journalistic accounts are confusing, because in the absence of medical personnel, it would be difficult to tell the difference between snoring and agonal breathing which resembles snoring and is part of the process of dying. In agonal breathing, the heart has stopped, but the brain stem fires off infrequent impulses to breathe causing something similar to snoring. This process usually lasts for a few minutes. A recording of a blood oxygen level would give a better idea of what was going on, but it is not clear whether Pike was hooked up to the kind of digital vital signs machine that enabled me to review my own oxygen levels and rate of respiration when I had surgery at the IESS hospital.)

Governor Bill Lee (no relation to lucky John Lee AFAIK) then ordered an ‘independent review’ and suspended the rest of Tennessee’s planned program of executions for the rest of the year.

Pike was convicted of the brutal murder of Colleen Slemmer more than 30 years ago. It was a horrifying and heinous killing, but a state’s obligation to carry out its own laws properly does not necessarily depend on whether the person concerned is sympathetic.

Earlier in 2026 Tennessee also abandoned its attempt to execute a man called Tony Carruthers after not being able to gain access to a vein to give the injection. These are different failures, and the investigation must establish what happened in Pike’s case. At the time of writing, it would be premature to declare that the drug, the veins, or the executioners were responsible for the fiasco.

The broader problem, however, has been around for some time. Execution technology has followed medical technology into the intravenous age. Over my lifetime, the drip and the intravenous catheter have become almost universal familiar features of hospital treatment. Selected patients can now even self-administer prescribed intravenous medicines at home through an established line, after training and with professional support.

Yet equipment that looks like medical equipment does not automatically create a medical service and a procedure for putting someone to death is not a medical procedure, even if it is written in the same format.

The visible act of administering a medicine is only one part of the process. Other factors to take into account include a person’s medical condition, the quality of the drug, the reliability of the equipment, and the ability to recognise that something has gone wrong.

About 50 years ago I had a go at starting a few intravenous lines myself. I would not claim expertise at venepuncture, and my successes may have owed a lot to good veins rather than skill on my part. And I was not always successful.

My sister, who trained as a doctor in the early 1970s, remembers being expected to start intravenous lines without being taught at all. Perhaps her account became more emphatic in the telling, but medical apprenticeship was not always generous with instruction and in those days you could not even watch a YouTube instructional video. You could be theoretically and legally qualified to do a procedure without having any idea of how to do it.

The same distinction matters today. A registered nurse who regularly works with difficult intravenous access may have far more relevant experience than another nurse or a doctor who seldom or never does it. Watching a video or practicing on a model is obviously useful training for budding executioners, but it does not beat routinely performing a procedure three times before lunch on every working day.

There is also an ethical obstacle. because American medical and nursing organisations oppose participation in executions, although that does not mean that clinicians never participate–just that they keep quiet about it.

I personally knew a registered nurse in Florida who was in charge of Florida’s execution room at the Florida State Prison at Raiford. I know that he was in charge of setting up all the equipment in the room and assigning staff, and I suspect that he also took part in executions, but this was always the kind of subject that people kept mum about, and I certainly never asked him, even when I was once invited to a sacrificial turkey dinner at his in-laws’ place and the wine was flowing. Such things are kept secret on a need to know basis.

This is an awkward contradiction, because the state wants the benefits of medical expertise for a task that the professions themselves regard as contrary to their purpose.

Tennessee’s current single-drug procedure is sometimes described as though state legislators had written a pharmaceutical recipe into law, but that isn’t how it works. The statute establishes ‘lethal injection’ as the default method; the Department of Correction specifies the procedure. It adopted its present pentobarbital protocol in December 2024, after a review prompted by earlier failures in drug testing and compliance.

What legislators may not understand when they think of a ‘lethal injection’ is that while giving a simple injection into tissue, for example giving granny insulin or giving your dog a monthly shot of ivermectin in the scruff of the neck to prevent heartworm is quite different from the much more complex and difficult technique of giving a drug into a vein so that it reaches the heart, lungs, and brain within seconds.

As someone who spent many years writing operating procedures, I can see a potential problem right here, because prison administrators may not have the necessary medical expertise to write such policies, and people who do have the medical expertise have no experience of how to kill people and make it look nice for the public.

And anyway, adding more drugs to the execution cocktail does not necessarily improve matters. The traditional three-drug execution sequence includes a paralysing agent. If anaesthesia is inadequate, paralysis can conceal suffering. Veterinary practice, incidentally, accepts both pentobarbital alone and certain combination products like Euthasol. Counting the ingredients doesn’t tell us much about the competence of the service delivering them.

Someone will inevitably ask why the state does not simply use fentanyl, given its reputation for killing people without even trying. But a substance capable of causing fatal overdoses is not thereby guaranteed to produce a rapid, painless death. Fentanyl’s effects vary, and it can cause dangerous respiratory muscle rigidity. Deadliness and predictable action are different qualities.

However, although it is tricky finding the perfect drug for the job, killing someone quickly and painlessly is quite easy. For example you can put someone to sleep with laughing gas, and then have an executioner finish them off with a bullet or two to the brain from point blank range. In many parts of America use of a gun to kill ailing pets or dispose of dangerous rattlesnakes and vermin is entirely routine and normal. However, the problem with this is that unlike in the movies, the ‘optics’ will not always be pretty, especially if the executioner’s apron is spattered with blood.

Canada and Switzerland are sometimes offered as evidence that assisted death works without these problems and has fewer problems. Canada predominantly uses clinician-administered medical assistance in dying; Switzerland requires the person to press the button to perform the final act themselves. Neither system is immune to complications. Ontario reported complications in 1.8 percent of assisted deaths in 2023, mainly involving intravenous access. Those figures do not mean every complication caused suffering, and cannot sensibly be compared directly with rates of “botched” executions.

Before injections came the gallows, the electric chair and the gas chamber, each accompanied by assurances of technical improvements that would possibly improve the experience for the person dying, but perhaps designed more to improve the experience of the executioner and witnesses.

Hanging is generally effective, but association with the lynching of Black Americans helped discredit it, and concerns about strangulation and accidental decapitation also mattered. The last judicial hanging in the United States was in 1996 in Delaware. Interestingly the inmate had been given a choice and refused lethal injection, saying that being given a choice was worse than being hanged.

From Cuenca, this succession of improved methods can seem a distant argument. Ecuador’s position is unusually easy to find. Article 66 of the constitution says: “No habrá pena de muerte.” There shall be no death penalty.

That does not mean Ecuador has solved violence, prison security or the administration of justice. It means the state has ruled out execution as a punishment.

According to Amnesty International’s latest annual report, executions were recorded in 17 countries in 2025. That is the number known to have carried them out that year, not the larger number retaining the penalty in law. Amnesty recorded at least 2,707 executions, excluding the thousands it believes took place in China, where the figures remain secret. (Iran is notorious for carrying out death sentences in which recipients are hanged from construction cranes in public squares, and ISIS executed some prisoners in Iraq and Syria by throwing them from buildings. While these methods seem to be effective, they are very unlikely to catch on in the USA.)

Charlie is somewhat agnostic about the death penalty, mainly because he does not know for sure whether being locked up in prison until you die there of natural causes is a fate worse than death. For some people it might be. If the citizens of an American state want to retain it, that is a decision for them to make through their democratic institutions, within constitutional limits. But even then, deciding that somebody should die and deciding how much the public should see are separate questions.

Executions already have witnesses. In Tennessee these include selected journalists and, if they wish to attend, members of the immediate family of the victim of the crime for which the inmate was sentenced to death. The latter are entitled to watch from a separate area. Witnesses view the execution chamber through windows, but blinds that do up and down can and do interrupt their view at certain moments. During Pike’s attempted execution, journalists reported periods when they could hear what was happening inside the room, but could not see it.

There is something curious about allowing a small audience of reporters and relatives to watch a public act while still reserving the right to draw the curtain on the proceedings without explanation.

Victims’ relatives may attend hoping for justice, relief or what is commonly called ‘closure’ which may in some cases be a sense of vengeance satisfied, or something else. But does seeing the murderer die liberate someone from the memory of the murder that may have occurred thirty years ago? And is it worth it if the surviving family members have to be subjected to thirty years of mental torture and lives ruined before they get relief?

There is no single answer. Some relatives describe satisfaction or a sense that a decades-long legal ordeal has ended. Others find that the execution does not provide the release they expected. A 2014 study of witnesses’ statements found that, among those who mentioned closure, opinions were evenly divided about whether the execution had provided it. Another study found that some relatives described closure, healing or a step towards either.

These studies examined statements reported in the press, rather than following every family’s psychological health over many years. They cannot tell us precisely what witnessing does to an individual, though they do warn against promising that an execution will bring grief to an end. Finishing a criminal case and finishing mourning are quite different things.

Families should be able to make their own decisions about attending, with honest preparation and support. They should not be expected to watch, forgive, feel satisfied or emerge healed on somebody else’s timetable.

Personally, I would require executions to be on live TV, so that any adult citizen who wished to watch and obtain ‘closure’ could do so in the comfort of their home. Needless to say, nobody would be obliged to tune in and the program would not carry commercial advertising. The cameras could show justice in action without turning grieving relatives into part of the broadcast.

There are a few obvious objections. A death could become entertainment, and distressing footage could circulate indefinitely on social media. Yet long before television existed executions were popular public spectacles and drew crowds of thousands. Their former popularity complicates the comforting assumption that watching necessarily turns people against them.

Public hangings combined punishment, spectacle and an intended warning. A modern broadcast might reinforce support for capital punishment, weaken it or leave viewers divided. Charlie would not presume to predict the result.

Supporters might also argue that visibility would strengthen deterrence. If witnessing the punishment is supposed to discourage crime, hiding it behind prison walls limits that particular argument. A warning intended for the public ought to be visible to the public.

That is an argument for openness, not proof of effectiveness. A major National Research Council review concluded that existing research could not reliably establish whether capital punishment decreased, increased or had no effect on homicide. It did not establish what broadcasting executions would do. A punishment can be frightening to watch without necessarily changing the behaviour of someone contemplating murder.

The strongest case for TV, in Charlie’s view, is accountability. If citizens believe execution is necessary, they may also believe its distressing consequences are a price worth paying. But that judgment should be made with those consequences visible, rather than tucked away in an official press release saying that a named inmate passed away peacefully after breakfast with the help of a firing squad.

There is something to be said for having the courage of one’s convictions. If a state chooses to execute people, it should also have the courage to let its citizens watch.

Killing with kindness is quite a claim. Those in whose name it is done should be allowed to judge the kindness for themselves.