When states adopted the three-drug protocol for lethal injection, capital punishment took on the appearance of a medical procedure. Examples from the past five years, however, have thoroughly disproved the pretense. Photograph by Daniel Biskup / laif / Redux

Last week, the global drug company Pfizer announced sweeping new restrictions on the distribution of seven of its products, preventing them from being used to carry out the death penalty. Pfizer came into possession of those products, which include sedatives, paralytics, a pain medication, and a drug used to prevent or treat low levels of potassium in the blood, when it acquired the pharmaceutical company Hospira, in September. Its decision is an enormously significant one for the death penalty in the United States, and ends a long and chaotic chapter in which governments, drug companies, and activists worldwide have gradually closed the open market for the federally approved drugs that have been used for lethal injections.

“Manufacturers never wanted their medicines to be used to end the lives of prisoners,” Maya Foa, the director of the death-penalty team at Reprieve, an international human-rights organization, told me. Foa advised Hospira and other pharmaceutical manufacturers on ways they could protect their products from being misused in the death penalty. “Their business is in making medicines to save and improve the lives of patients. The last thing they want is for the medicines they promote as lifesaving to be used in lethal-injection executions.”

When Oklahoma adopted a three-drug protocol for lethal injection, in 1977, leading the way for other states, capital punishment took on the appearance of a medical procedure. The first drug induces unconsciousness, the second drug causes paralysis and halts breathing, and the third stops the heart. Lethal injection was said to be humane, at least compared with the other methods used during this period: electrocution, which entails smoke and burning flesh, and has sometimes caused the person being electrocuted to catch fire; the gas chamber, which is ghastly in the slowness of the asphyxiation it causes; hanging, which can snap a person’s head off or leave him alive but strangling to death; and the firing squad, efficient yet primitive.

Examples from the past five years, however, have thoroughly disproved the pretense that lethal injection is a more professional procedure. Thanks to good scholarship and good lawyering, we now know that, while the drugs that are injected have been tested and approved for medical use, none of them have been validated through medical testing for use in executions. We also know that careful training in the administration of lethal injections is the exception rather than the rule. States have published manuals with conflicting instructions, have followed sloppy procedures for executions, and have been reprimanded for holding them in inadequate spaces. In 2014, the legal scholar Austin Sarat wrote that, of all executions by lethal injection carried out between 1980 and 2010, about seven per cent were botched, often causing apparently agonizing pain for the person being executed.

Looking back, the problems that have drawn public scrutiny should not come as much of a surprise. By the time the Supreme Court agreed to review Kentucky’s lethal-injection protocol, in 2007, death-row prisoners had brought so many lawsuits challenging lethal injection that the Court effectively put a moratorium on executions in all thirty-six states with capital punishment on the books. In Baze v. Rees, the Court upheld Kentucky’s lethal-injection protocol by 7–2, on the ground that the inmates challenging it had failed to prove that the protocol created “a demonstrated risk of severe pain.” Justice John Paul Stevens voted to uphold the death penalty in the state, out of respect for precedent, but in his concurrence he expressed his opposition to capital punishment for the first time. He also predicted that the ruling, rather than ending the controversy about lethal injection, would generate even more debate, ultimately leading to questions “about the justification for the death penalty itself.”

The legal scholar Deborah Denno has documented more than three hundred lawsuits filed in the six years following the Baze decision that have cited the case in challenging lethal injection as a method of execution. Most of them were unsuccessful, but they reveal that twenty states, rather than maintaining protocols substantially similar to Kentucky’s, made “unfettered substitutions” in “desperate attempts to adhere to their execution schedules” as a result of drug shortages. Those substitutions meant that inmates were guinea pigs for new forms of lethal injection. Drug companies, for their part, didn’t want their drugs used in executions, and tried maneuvers, many without success, to prevent that use.

In 2009, Hospira suspended production of sodium thiopental, a short-acting anesthetic that was the first drug administered in lethal injections. In 2010, after Hospira stopped making sodium thiopental, Oklahoma switched to using pentobarbital as an anesthetic. In 2011, the Copenhagen-based Lundbeck imposed controls on the use of pentobarbital. In 2012, Missouri replaced its three-drug protocol for lethal injections with a one-drug protocol, using propofol. Within a year, the drug-makers Fresenius Kabi, Teva, and Hospira had put distribution controls on propofol and other drugs that were part of state protocols for lethal injections. In 2013, Arkansas replaced its three-drug protocol with a one-drug protocol, using phenobarbital; the next month, the British company Hikma put controls on phenobarbital. In the past five years, about two dozen companies, making thirteen different drugs, have blocked their use in lethal injections, according to Reprieve.

States have generally been secretive about how they carry out lethal injections, but in the past five years they have become especially so. They are mainly concerned about losing their providers of lethal-injection drugs should the companies’ names become public: companies that do not want their products associated with executions will know that their drugs are being used. In 2013, Georgia passed the Lethal Injection Secrecy Act, which treats the names of companies that provide and supply drugs, and the names of the people who carry out executions, as state secrets. Federal courts have denied legal efforts by inmates to know which drugs will be used to execute them and what evidence exists of the drugs’ efficacy, but with the disappearance of F.D.A.-approved drugs there is a more compelling argument, based on the standard of fairness in due process, that inmates have a right to such information.

States have also been increasingly misleading in their efforts to obtain drugs for executions. In one lawsuit, a chain of e-mails from July, 2011, surfaced, from the Ohio Department of Mental Health, which was trying to purchase pentobarbital for use in lethal injections. In the e-mail chain, a wholesaler explains that Lundbeck would no longer sell it to the wholesaler, and gives the department the phone number for the company so the state can try to buy it directly. The final e-mail, apparently from one department official to another, says, “When you call them to see if they will sell to us make sure you say we are the Department of Mental Health do not mention anything about corrections in the phone call or what we use the drug for.”

In another lawsuit, according to a 2014 account in the Lens, a nonprofit public-interest newsroom in New Orleans, the Louisiana Department of Corrections would not disclose the supplier of a drug that it had purchased for an upcoming execution. Ulysses Gene Thibodeaux, the chief judge of the state’s Third Circuit Court of Appeals, revealed to the Lens that it came from Lake Charles Memorial Hospital, where he is a member of its operator’s board of directors. He said, “We assumed the drug was for one of their patients, so we sent it. We did not realize what the focus was. Had we known of the real use, we never would have done it.”

When Hospira stopped producing sodium thiopental, one state after another ran out of the anesthetic. In scrambling to find another supplier, several states showed themselves to be more interested in scoring product than in administering the death penalty in a fair, reliable manner. An opportunistic distributor called Dream Pharma, which operated out of the back of the Elgone Driving Academy, in London, supplied untested sodium thiopental to Arizona, Arkansas, California, Georgia, South Carolina, and perhaps other states, before the British government tightened its export restrictions and later banned the sale of sodium thiopental from the United Kingdom. A federal appeals court later prohibited the F.D.A. from letting sodium thiopental from foreign suppliers into the country.