One man died screaming, “They butchered me!”

Tuesday night, one more botched execution by lethal injection occurred. Clayton Lockett, according to the Associated Press, “began breathing heavily, writhing, clenching his teeth and straining to lift his head off the pillow,” approximately 10 minutes after an executioner pumped into him a clandestinely-procured lethal injection. The state initially blamed the problem on the 38-year-old’s veins, claiming there had been a rupture. In the end, he died of a heart attack.

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Lockett’s attorney, David Autry, expressed skepticism at the state’s assessment. “I’m not a medical professional, but Mr. Lockett was not someone who had compromised veins,” he said. “He was in very good shape. He had large arms and very prominent veins.”

Either way, there’s no disagreement the execution didn’t go as planned — an occurrence that’s far from a rarity. In a procedure fraught with complexity and controversy, critics say lethal injections have been problematic dozens of times and caused unintended and prolonged agony.

The reasons behind the bungled executions vary. Sometimes, a condemned is a drug addict with wrecked veins and left in the position of helping an executioner find a proper vein. Other times, there’s a mechanical malfunction. Or there’s a human error. Or there are times when something went terribly wrong — but it’s not immediately entirely clear what.

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In all, the act of killing — but killing legally — has become one of the most complex endeavors in modern government. Though less than before, the death penalty retains clear public approval. Roughly 55 percent of Americans support it, recent Pew research shows. But the logistical foundation that enables executions is, in some ways, deteriorating.

The idea of a lethal injection was first introduced in the late 1800s, when a New York doctor named J. Mount Bleyer proposed a means of execution that he touted as a more humane alternative to hanging. Ultimately, most states went with the electric chair. But that also occasionally went wrong, and some men actually caught on fire.

Since the early 1980s, lethal injections have been in active use, with more than 1,000 people killed by it during that time span.

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So why, if lethal injections have such a long history and the procedure of administering a needle is relatively simple, do very public mistakes still happen? It’s undeniably easy to kill someone, but the process of capital justice has been complicated by moral, legal, medical issues — not to mention the Constitutional, which prohibits “cruel or unusual” punishment.

Human executions would be easier to accomplish if doctors wanted any part of it. But they don’t. The Hippocratic Oath bars doctors from performing executions, so the task often falls to prison employees who may not have the proper experience or training. This can lead to incorrect dosages or improperly inserted needles. Complicating the matter is that some of the sentenced once used intravenous drug, making it even more difficult to find a proper vein.

What’s more, American pharmaceutical companies have stopped manufacturing and supplying effective drugs. The last one, Hospira, stopped making it in 2011. Manufacturers that continue production, mostly based in death penalty-free Europe, often don’t want to participate — and now legally cannot. The European Union has banned exporting the drugs.

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“Because the European Union opposes the death penalty, it prohibits the export of goods for execution,” said Rebecca Dresser, a biomedical ethics expert at Washington University in St. Louis. “….Capital cases are expensive, and state budgets are tight. [There’s] high costs and concern about erroneous convictions.”

As a result, the drug sodium thiopental, which has historically been the key ingredient to the lethal injection cocktail, has become scarce, leaving many states with scores on death row, but without one of the most widely-used tools to kill them.

One Utah man once even asked for “the firing squad, please.” And today, some states — like Florida, Oklahoma, and Texas — experiment with controversial new drug cocktails. “We don’t know how these drugs are going to react because they’ve never been used to kill someone,” Deborah Denno, an expert on lethal injections at Fordham University, told Mother Jones.

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By Tuesday morning it was unclear what, exactly, had gone wrong in the execution of Clayton Lockett, who was convicted of shooting a 19-year-old woman, who was buried alive. The state director of corrections, Robert Patton, said “the line had blown,” and the drugs had stopped flowing into Lockett.

But public defender Madeline Cohen said in a statement, “Unless we have a full and independent investigation, we’ll never know. … No execution should take place in Oklahoma until there has been a full investigation into Clayton Lockett’s death, including an independent autopsy and full transparency surrounding the drugs and the process of administering them.”