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In this medical thriller, practicing surgeon and accomplishednovelist Harry Kraus uses complex characters, fascinating medicaldetails, and depictions of spiritual warfare to keep readersriveted. Buy from our partners. What Readers Are Saying What do you think? Write your own comment on this book! The number of shooting executions slowly decreased; and, in February , the Supreme People's Court ordered the discontinuation of firing squads by the following year under the conclusion that injections were more humane to the prisoner.

It has been suggested that the switch is also in response to executions being horrifying to the public. Lethal injections are less expensive than firing squads, with a single dose costing yuan compared to yuan for a shooting execution. Just like China, executions in Vietnam were also mainly by means of shooting. The use of lethal injection method was approved by the government in June , adopted in and only executed in The drugs used consist of sodium thiopental anesthetic , pancuronium bromide paralyzing substance and potassium chloride stops cardiac activity.

This led to drug shortages, use of domestic poisons and shooting execution to be considered to be adopted back. The first prisoner in Vietnam to be executed by lethal injection, on August 6, , was the year-old man Nguyen Anh Tuan, arrested for murder and robbery. Typically, three drugs are used in lethal injection. Sodium thiopental is used to induce unconsciousness, pancuronium bromide Pavulon to cause muscle paralysis and respiratory arrest, and potassium chloride to stop the heart. Fentanyl is in a class of medications called narcotic opiate analgesics.

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It works by changing the way the brain and nervous system respond to pain. Fentanyl comes as a lozenge on a handle Actiq , a sublingual underneath the tongue tablet Abstral , a film Onsolis , and a buccal between the gum and cheek tablet Fentora to dissolve in the mouth. Sodium thiopental US trade name: Sodium Pentothal is an ultra-short acting barbiturate, often used for anesthesia induction and for medically induced coma. The typical anesthesia induction dose is 0.

A full medical dose of thiopental reaches the brain in about 30 seconds. This induces an unconscious state. The half-life of this drug is about When a 'mega-dose' is administered, as in state-sanctioned lethal injection, the concentration in the brain during the tail phase of the distribution remains higher than the peak concentration found in the induction dose for anesthesia, because repeated doses—or a single very high dose as in lethal injection—accumulate in high concentrations in body fat, from which the thiopental is gradually released.

Historically, thiopental has been one of the most commonly used and studied drugs for the induction of coma.

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It is likely that this data was used to develop the initial protocols for state-sanctioned lethal injection, according to which one gram of thiopental was used to induce the coma. Pentobarbital was introduced at the end of due to a shortage of sodium thiopental, [38] and has since become the primary sedative in lethal injections in the United States.

Barbiturates are the same class of drug used in medically assisted suicide. In euthanasia protocols, the typical dose of thiopental is 1. Pancuronium bromide Trade name: The related drug curare , like pancuronium, is a non-depolarizing muscle relaxant a paralytic agent that blocks the action of acetylcholine at the motor end-plate of the neuromuscular junction. Binding of acetylcholine to receptors on the end-plate causes depolarization and contraction of the muscle fiber; non-depolarizing neuromuscular blocking agents like pancuronium stop this binding from taking place.

The typical dose for pancuronium bromide in capital punishment by lethal injection is 0. Paralysis of respiratory muscles will lead to death in a considerably shorter time. Other drugs in use are tubocurarine chloride and succinylcholine chloride. Pancuronium bromide is a derivative of the alkaloid malouetine from the plant Malouetia bequaertiana. Doctors prescribe potassium for patients when potassium levels are insufficient, called hypokalemia , in the blood.

The potassium can be given orally, which is the safest route; or it can be given intravenously, in which case strict rules and hospital protocols govern the rate at which it is given. The usual intravenous dose is 10—20 mEq per hour and it is given slowly since it takes time for the electrolyte to equilibrate into the cells. When used in state-sanctioned lethal injection, bolus potassium injection affects the electrical conduction of heart muscle.

Elevated potassium, or hyperkalemia , causes the resting electrical potential of the heart muscle cells to be lower than normal less negative and more depolarised than normal at rest. The sodium voltage-gated channels required for the rapid phase 0 depolarisation spike in the ventricular and atrial action potential can fire once, but will inactivate rapidly and becoming inexcitable due to closure of a specific inactivation gate.

This blockage would normally be removed from the pore when the membrane repolarises to more than mV however as there is a raised resting membrane potential this negative membrane potential cannot be reached and the inactivation of the sodium voltage-gated channels cannot be relieved. Thus there can be no subsequent action potentials generated within the affected sarcomere.

Depolarizing the muscle cell inhibits its ability to fire by reducing the available number of sodium channels they are placed in an inactivated state. Cases of patients dying from hyperkalemia usually secondary to renal failure are well known in the medical community, where patients have been known to die very rapidly, having previously seemed to be normal. The Ohio protocol, developed after the incomplete execution of Romell Broom , ensures the rapid and painless onset of anesthesia by only using sodium thiopental and eliminating the use of Pavulon and potassium as the second and third drugs, respectively.

It also provides for a secondary fail-safe measure using intramuscular injection of midazolam and hydromorphone in the event intravenous administration of the sodium thiopental proves problematic. In the brief for the U. On December 8, , Kenneth Biros became the first person executed using Ohio's new single-drug execution protocol.

He was pronounced dead at On September 10, , Washington became the second state to use the single-drug Ohio protocol with the execution of Cal Coburn Brown , who was proclaimed dead within two minutes after receiving the single-drug injection of sodium thiopental. Five additional states Arkansas , Kentucky , Louisiana , North Carolina , and Tennessee have announced that they are switching to a single-drug protocol but, as of April , have not executed anyone since switching protocols. After sodium thiopental began being used in executions, Hospira , the only American company that made the drug, stopped manufacturing it due to its use in executions.

Pentobarbital, often used for animal euthanasia , [46] was used as part of a three-drug cocktail for the first time on December 16, , when John David Duty was executed in Oklahoma. Lethal injection has also been used in cases of euthanasia to facilitate voluntary death in patients with terminal or chronically painful conditions. In individuals who are incapable of swallowing lethal doses of medication, an intravenous route is preferred. The following is a Dutch protocol for parenteral intravenous administration to obtain euthanasia, with the old protocol listed first and the new protocol listed second:.

A euthanasia machine may allow an individual to perform the process alone. In , the Supreme Court ruled in Hill v.

Lethal Mercy by Harry Kraus

McDonough that death-row inmates in the United States could challenge the constitutionality of states' lethal injection procedures through a federal civil rights lawsuit. Since then, numerous death-row inmates have brought such challenges in the lower courts, claiming that lethal injection as currently practiced violates the ban on "cruel and unusual punishment" found in the Eighth Amendment to the United States Constitution. For example, courts have found that lethal injection as practiced in California, [50] Florida, [51] and Tennessee [52] is unconstitutional.

Other courts have found that lethal injection as practiced in Missouri, [53] Arizona, [54] and Oklahoma [55] is constitutionally acceptable. As of , California has nearly prisoners condemned to death by lethal injection despite the moratorium imposed when in a federal court found California's lethal injection procedures to be unconstitutional. On April 16, , the Supreme Court rejected Baze v.

Rees , thereby upholding Kentucky's method of lethal injection in a majority 7—2 decision. Supreme Court also upheld lethal injection in the case Glossip v. The American Medical Association AMA believes that a physician's opinion on capital punishment is a personal decision. Since the AMA is founded on preserving life, they argue that a doctor "should not be a participant" in executions in any professional capacity with the exception of "certifying death, provided that the condemned has been declared dead by another person" and "relieving the acute suffering of a condemned person while awaiting execution.

Typically, most states do not require that physicians administer the drugs for lethal injection, but most states do require doctors, nurses or paramedics to prepare the substances before their application and to attest the inmate's death after it. Some states specifically detail that participation in a lethal injection is not to be considered practicing medicine.

Opponents of lethal injection have voiced concerns that abuse, misuse and even criminal conduct is possible when there is not a proper chain of command and authority for the acquisition of death-inducing drugs. Opponents of lethal injection believe that it is not actually painless as practiced in the United States. Opponents argue that the thiopental is an ultrashort-acting barbiturate that may wear off anesthesia awareness and lead to consciousness and an uncomfortable death wherein the inmates are unable to express discomfort because they have been rendered paralyzed by the paralytic agent.

Opponents point to the fact that sodium thiopental is typically used as an induction agent and not used in the maintenance phase of surgery because of its short-acting nature. Following the administration of thiopental, pancuronium bromide is given. Opponents argue that pancuronium bromide not only dilutes the thiopental, but since the inmate is paralyzed also prevents the inmate from expressing pain.

Additional concerns have been raised over whether inmates are administered an appropriate level of thiopental owing to the rapid redistribution of the drug out of the brain to other parts of the body. Additionally, opponents argue that the method of administration is also flawed. They state that since the personnel administering the lethal injection lack expertise in anesthesia, the risk of failing to induce unconsciousness is greatly increased. In reference to this problem, Jay Chapman , the creator of the American method, said, "It never occurred to me when we set this up that we'd have complete idiots administering the drugs.

Finally, the remote administration results in an increased risk that insufficient amounts of the lethal injection drugs enter the bloodstream. In total, opponents argue that the effect of dilution or improper administration of thiopental is that the inmate dies an agonizing death through suffocation due to the paralytic effects of pancuronium bromide and the intense burning sensation caused by potassium chloride.

Opponents of lethal injection, as currently practiced, argue that the procedure employed is designed to create the appearance of serenity and a painless death, rather than actually providing it. More specifically, opponents object to the use of pancuronium bromide, arguing that its use in lethal injection serves no useful purpose since the inmate is physically restrained.

Therefore, the default function of pancuronium bromide would be to suppress the autonomic nervous system, specifically to stop breathing. In , University of Miami researchers, in cooperation with the attorney representing death-row inmates from Virginia , published a research letter in the medical journal The Lancet. The article presented protocol information from Texas, Virginia, and North and South Carolina, which showed that executioners had no anesthesia training, drugs were administered remotely with no monitoring for anesthesia, data were not recorded, and no peer review was done.

The authors attributed the risk of consciousness among inmates to the lack of training and monitoring in the process, but carefully make no recommendations on how to alter the protocol or how to improve the process. Indeed, the authors conclude, "because participation of doctors in protocol design or execution is ethically prohibited, adequate anesthesia cannot be certain. Therefore, to prevent unnecessary cruelty and suffering, cessation and public review of lethal injections is warranted.

Paid expert consultants on both sides of the lethal-injection debate have found opportunity to criticize the Lancet article. Subsequent to the initial publication in the Lancet , three letters to the editor and a response from the authors extended the analysis. The issue of contention is whether thiopental, like many lipid-soluble drugs, may be redistributed from blood into tissues after death, effectively lowering thiopental concentrations over time, or whether thiopental may distribute from tissues into the blood, effectively increasing post mortem blood concentrations over time.

Given the near absence of scientific, peer-reviewed data on the topic of thiopental post mortem pharmacokinetics , the controversy continues in the lethal injection community and in consequence, many legal challenges to lethal injection have not used the Lancet article. In , the same group that authored the Lancet study extended its study of the lethal-injection process through a critical examination of the pharmacology of the barbiturate thiopental. This study — published in the online journal PloS Medicine [70] — confirmed and extended the conclusions made in the article and goes further to disprove the assertion that the lethal-injection process is painless.


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To date, these two studies by the University of Miami team serve as the only critical peer-reviewed examination of the pharmacology of the lethal injection process. According to the new lethal injection protocols section above, single-drug lethal injection is already in use, or intended, in 11 states. The execution can be painlessly accomplished, without risk of consciousness, by the injection of a single large dose of a barbiturate.

Another possibility would be I. V administration of a powerful and fast-acting opioid , such as sufentanyl , which would ensure comfort while killing via respiratory depression.

When sodium pentobarbital, a barbiturate used often in single drug animal euthanasia, is administered in an overdose, it causes rapid unconsciousness followed by paralysis of the diaphragm. This drug may also kill via cardiac arrhythmia. On occasion, difficulties inserting the intravenous needles have also occurred, sometimes taking over half an hour to find a suitable vein.

In addition, opponents point to instances where the intravenous line has failed, or when adverse reactions to drugs or unnecessary delays happen during the process of execution.


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On December 13, , Angel Nieves Diaz was not executed successfully in Florida using a standard lethal-injection dose. Diaz was 55 years old, and had been sentenced to death for murder. Diaz did not succumb to the lethal dose even after 35 minutes, necessitating a second dose of drugs to complete the execution. At first, a prison spokesman denied Diaz had suffered pain, and claimed the second dose was needed because Diaz had some sort of liver disease.

William Hamilton, stated that Diaz's liver appeared normal, but that the needle had been pierced through Diaz's vein into his flesh. The deadly chemicals had subsequently been injected into soft tissue, rather than into the vein. A study published in in the peer-reviewed journal PLoS Medicine suggested that "the conventional view of lethal injection leading to an invariably peaceful and painless death is questionable".

The execution of Romell Broom was abandoned in Ohio on September 15, , after prison officials failed to find a vein after 2 hours of trying on his arms, legs, hands, and ankle. This has stirred up intense debate in the United States about lethal injection. According to reporters, the execution of McGuire took more than 20 minutes and McGuire was gasping for air for 10 to 13 minutes.

Jake isn't a fan of such a practice, and he would be willing to prove his innocence Did Jake really kill his wife, or is someone trying to frame him? If so, who--or what--could be behind such a thing? Kraus' books are usually absorbing medical thrillers, but this one is definitely the worst of his that I've read. Not only is the novel overly long, but the out-of-order chronology goes from tolerable to annoying as the book progresses.

If you are new to the works of Dr. Harry Kraus, I would suggest starting with The Stain, which blew me away in many ways. It's still passable; I've read much worse, but this isn't what I've come to expect from Christian fiction's resident M. Jan 26, Donna rated it really liked it Shelves: Enjoyed reading this one Jun 11, Jocelyn Montalvo Cullum marked it as to-read Shelves: I registered a book at BookCrossing. Jun 14, Kaitlyn lovell rated it really liked it. Suzanne rated it really liked it Sep 09, Suzanne rated it liked it Mar 29, Monica Willyard rated it really liked it May 10, Sarah rated it liked it May 15, Mary rated it really liked it Mar 22, Sherilyn rated it liked it Apr 27, Ruth Neufeld rated it liked it Sep 02, Donna Vaniddekinge rated it it was amazing Aug 31, Chelsea rated it it was ok Dec 21, Margie rated it liked it Mar 13, Jodie Huston rated it it was amazing Oct 27, Sharon Seeberger rated it liked it Oct 16, Kristen rated it really liked it Jul 17, Kendra rated it really liked it Feb 19, Virginia Smith rated it it was amazing Feb 20, Tamra rated it liked it Feb 10, Jennifer rated it really liked it Aug 19, Ray rated it really liked it Oct 18,