The Definitive Book on Lethal Injection Is Here

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Given lethal injection’s prevalence among execution methods today, the lack of a definitive exploration of whether and how it works has always been surprising. While Amherst professor Austin Sarat, perhaps the most prolific and thorough researcher of botched executions, produced 2022’s worthwhile Lethal Injection and the False Promise of Humane Executions, that work wanted for both length (at just under 200 pages) and focus. Students of the carceral state, or anyone curious about what the state does with their money behind closed doors, were left piecing together what information might slip through eyewitness reports and legal filings.

No longer. Corinna Barrett Lain’s Secrets of the Killing State: The Untold Story of Lethal Injection combines the thoroughness of a graduate seminar with the righteous indignation of civil-liberties forbears to produce a comprehensive and scathing indictment of America’s least-known horror show.

Secrets of the Killing State Combines an Admirable Understanding of Medicine with an Expert Legal History

In the introduction, Lain admits her own faulty (but popular) presupposition: that lethal injection mirrors the humane euthanasia of people and pets from which it borrowed its drugs, with only occasional mishaps separating it from the “quiet death“ Justice Scalia rhapsodized about in Callins v. Collins. In Lain’s telling, a comprehensive study reveals the opposite: an “exceedingly delicate, error-prone procedure.” “Botched executions are not random glitches,” she says, “but rather the spillover effects of a system that is deeply broken. Lethal injection not working well is how lethal injection works.“

The story of lethal injection, progressing as it does in fits and starts along multiple locations, is a tough one to tell comprehensively. Lain gives readers a sense of the subject via an innovative narrative structure: she begins with the quintessential lethal injection disaster (the 2014 botched execution of Clayton Lockett), then branches out to the issues that derailed Lockett’s execution and others, with a chilling reminder—that the Supreme Court has blessed this “hot mess”—peppered throughout.

Medical practitioners thoroughly object to the idea that lethal injection is medicine, but problems with drugs are at its heart, and understanding one of medical science’s trickiest puzzles (sedation) is necessary to understanding where executioners have gone wrong. Lain—a law professor by trade—displays an adept grasp of what each sedative is known to do, suspected to do, and where lethal injection compromises its intended uses not only morally but chemically; her explanation of the difference between “unconscious“ and “insensate“ deserves special praise. An equal part of lethal injection’s “delicateness“ is the web of private rules designed to keep legitimate drugs and providers out of the death chamber; Lain devotes multiple subsequent chapters to both explaining the medical community’s position and to scathing biographies of individuals persuaded to cross the line.

All of this plays out against a background of torturous deaths, and Lain spares no detail of the many men who’ve met fates like Lockett’s, yet she equally understands that the true atrocities of lethal injection are committed in dress shoes and half-Windsors. The killing state must have aesthetic executions, she surmises, and permits itself any seeming excess to do so. Prison officials outwardly committed to fighting illicit drug trafficking buy drugs in parking lots; attorneys general divert medication orders from legitimate state clinics; “top cops“ apply makeup to a dead body to conceal screwups from medical examiners; the federal government hamstrings its own enforcement arms via twisted logic (that, to be fair, they seem to no longer believe). Lain’s stylistic incredulity inspires shock at these developments even to the well-informed reader. Special ire, however, is reserved for the Supreme Court, which has routinely looked at shocking admissions from prison officials and “abject indifference“ from state solicitors, only to conclude that “The Eighth Amendment simply has nothing to say about how prisoners are executed.“ She saves her final, and perhaps her finest, chapter to discuss what she calls “The Secrecy Solution,“ identifying the wave of state laws and policy designed to shield every actor in an execution as not just protecting themselves from litigation, but from any of the public scrutiny and comment necessary in a functioning democracy.

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Secrets does contain a few small, and not especially meaningful, errors. Lain somewhat understates the use cases for etomidate and midazolam, and her insistence on the necessity of physicians to set central lines will come as a surprise to the book’s audience of clinicians. Lain also does little to address the (admittedly small, and admittedly ineffectual) changes states have made to address competency questions.

Lain’s authorial choice to situate her book in the present also requires telling only the parts of its history that provide necessary context, leaving much of that history still to be told. Lethal injection’s legislative inventor, Bill Wiseman (who appears only in passing in Secrets), has a biography that might be better suited to Greek tragedy than Lain’s Zola-esque tack. Lain, for her part, is content to let the purpose of the method be what it’s done, and it’s hard to argue with her. Whatever lethal injection may have been meant to be, Secrets of the Killing State is an essential guide to what it’s become.

1  Sarat’s Lethal Injection is an excellent read because, not despite, its frequent forays into the author’s well-trod background in broader capital punishment scholarship and advocacy, and is best read as an extension of the latter.

2  Publishers, if you’re listening.