(Slip Opinion) OCTOBER TERM, 2007 1
Syllabus
NOTE: Where it is feasible, a syllabus (headnote) will be released, as is
being done in connection with this case, at the time the opinion is issued.
The syllabus constitutes no part of the opinion of the Court but has been
prepared by the Reporter of Decisions for the convenience of the reader.
See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337.
SUPREME COURT OF THE UNITED STATES
Syllabus
BAZE ET AL. v. REES, COMMISSIONER, KENTUCKY
DEPARTMENT OF CORRECTIONS, ET AL.
CERTIORARI TO THE SUPREME COURT OF KENTUCKY
No. 07–5439. Argued January 7, 2008—Decided April 16, 2008
Lethal injection is used for capital punishment by the Federal Govern-
ment and 36 States, at least 30 of which (including Kentucky) use the
same combination of three drugs: The first, sodium thiopental, in-
duces unconsciousness when given in the specified amounts and
thereby ensures that the prisoner does not experience any pain asso-
ciated with the paralysis and cardiac arrest caused by the second and
third drugs, pancuronium bromide and potassium chloride. Among
other things, Kentucky’s lethal injection protocol reserves to qualified
personnel having at least one year’s professional experience the re-
sponsibility for inserting the intravenous (IV) catheters into the pris-
oner, leaving it to others to mix the drugs and load them into sy-
ringes; specifies that the warden and deputy warden will remain in
the execution chamber to observe the prisoner and watch for any IV
problems while the execution team administers the drugs from an-
other room; and mandates that if, as determined by the warden and
deputy, the prisoner is not unconscious within 60 seconds after the
sodium thiopental’s delivery, a new dose will be given at a secondary
injection site before the second and third drugs are administered.
Petitioners, convicted murderers sentenced to death in Kentucky
state court, filed suit asserting that the Commonwealth’s lethal injec-
tion protocol violates the Eighth Amendment’s ban on “cruel and un-
usual punishments.” The state trial court held extensive hearings
and entered detailed factfindings and conclusions of law, ruling that
there was minimal risk of various of petitioners’ claims of improper
administration of the protocol, and upholding it as constitutional.
The Kentucky Supreme Court affirmed, holding that the protocol
does not violate the Eighth Amendment because it does not create a
substantial risk of wanton and unnecessary infliction of pain, torture,
2 BAZE v. REES
Syllabus
or lingering death.
Held: The judgment is affirmed.
217 S. W. 3d 207, affirmed.
CHIEF JUSTICE ROBERTS, joined by JUSTICE KENNEDY and JUSTICE
ALITO, concluded that Kentucky’s lethal injection protocol satisfies
the Eighth Amendment. Pp. 8–24.
1. To constitute cruel and unusual punishment, an execution
method must present a “substantial” or “objectively intolerable” risk
of serious harm. A State’s refusal to adopt proffered alternative pro-
cedures may violate the Eighth Amendment only where the alterna-
tive procedure is feasible, readily implemented, and in fact signifi-
cantly reduces a substantial risk of severe pain. Pp. 8–14.
(a) This Court has upheld capital punishment as constitutional.
See Gregg v. Georgia, 428 U. S. 153, 177. Because some risk of pain
is inherent in even the most humane execution method, if only from
the prospect of error in following the required procedure, the Consti-
tution does not demand the avoidance of all risk of pain. Petitioners
contend that the Eighth Amendment prohibits procedures that create
an “unnecessary risk” of pain, while Kentucky urges the Court to ap-
prove the “ ‘substantial risk’ ” test used below. Pp. 8–9.
(b) This Court has held that the Eighth Amendment forbids
“punishments of torture, . . . and all others in the same line of unnec-
essary cruelty,” Wilkerson v. Utah, 99 U. S. 130, 136, such as disem-
boweling, beheading, quartering, dissecting, and burning alive, all of
which share the deliberate infliction of pain for the sake of pain, id.,
at 135. Observing also that “[p]unishments are cruel when they in-
volve torture or a lingering death[,] . . . something inhuman and bar-
barous [and] . . . more than the mere extinguishment of life,” the
Court has emphasized that an electrocution statute it was upholding
“was passed in the effort to devise a more humane method of reach-
ing the result.” In re Kemmler, 136 U. S. 436, 447. Pp. 9–10.
(c) Although conceding that an execution under Kentucky’s pro-
cedures would be humane and constitutional if performed properly,
petitioners claim that there is a significant risk that the procedures
will not be properly followed—particularly, that the sodium thiopen-
tal will not be properly administered to achieve its intended effect—
resulting in severe pain when the other chemicals are administered.
Subjecting individuals to a substantial risk of future harm can be
cruel and unusual punishment if the conditions presenting the risk
are “sure or very likely to cause serious illness and needless suffer-
ing” and give rise to “sufficiently imminent dangers.” Helling v.
McKinney, 509 U. S. 25, 33, 34–35. To prevail, such a claim must
present a “substantial risk of serious harm,” an “objectively intoler-
able risk of harm.” Farmer v. Brennan, 511 U. S. 825, 842, 846, and
Cite as: 553 U. S. ____ (2008) 3
Syllabus
n. 9. For example, the Court has held that an isolated mishap alone
does not violate the Eighth Amendment, Louisiana ex rel. Francis v.
Resweber, 329 U. S. 459, 463–464, because such an event, while re-
grettable, does not suggest cruelty or a “substantial risk of serious
harm.” Pp. 10–12.
(d) Petitioners’ primary contention is that the risks they have
identified can be eliminated by adopting certain alternative proce-
dures. Because allowing a condemned prisoner to challenge a State’s
execution method merely by showing a slightly or marginally safer
alternative finds no support in this Court’s cases, would embroil the
courts in ongoing scientific controversies beyond their expertise, and
would substantially intrude on the role of state legislatures in im-
plementing execution procedures, petitioners’ proposed “unnecessary
risk” standard is rejected in favor of Farmer’s “substantial risk of se-
rious harm” test. To effectively address such a substantial risk, a
proffered alternative procedure must be feasible, readily imple-
mented, and in fact significantly reduce a substantial risk of severe
pain. A State’s refusal to adopt such an alternative in the face of
these documented advantages, without a legitimate penological justi-
fication for its current execution method, can be viewed as “cruel and
unusual.” Pp. 12–14.
2. Petitioners have not carried their burden of showing that the
risk of pain from maladministration of a concededly humane lethal
injection protocol, and the failure to adopt untried and untested al-
ternatives, constitute cruel and unusual punishment. Pp. 14–23.
(a) It is uncontested that failing a proper dose of sodium thiopen-
tal to render the prisoner unconscious, there is a substantial, consti-
tutionally unacceptable risk of suffocation from the administration of
pancuronium bromide and of pain from potassium chloride. It is,
however, difficult to regard a practice as “objectively intolerable”
when it is in fact widely tolerated. Probative but not conclusive in
this regard is the consensus among the Federal Government and the
States that have adopted lethal injection and the specific three-drug
combination Kentucky uses. Pp. 14–15.
(b) In light of the safeguards Kentucky’s protocol puts in place,
the risks of administering an inadequate sodium thiopental dose
identified by petitioners are not so substantial or imminent as to
amount to an Eighth Amendment violation. The charge that Ken-
tucky employs untrained personnel unqualified to calculate and mix
an adequate dose was answered by the state trial court’s finding,
substantiated by expert testimony, that there would be minimal risk
of improper mixing if the manufacturers’ thiopental package insert
instructions were followed. Likewise, the IV line problems alleged by
petitioners do not establish a sufficiently substantial risk because IV
4 BAZE v. REES
Syllabus
team members must have at least one year of relevant professional
experience, and the presence of the warden and deputy warden in the
execution chamber allows them to watch for IV problems. If an insuf-
ficient dose is initially administered through the primary IV site, an
additional dose can be given through the secondary site before the
last two drugs are injected. Pp. 15–17.
(c) Nor does Kentucky’s failure to adopt petitioners’ proposed al-
ternatives demonstrate that the state execution procedure is cruel
and unusual. Kentucky’s continued use of the three-drug protocol
cannot be viewed as posing an “objectively intolerable risk” when no
other State has adopted the one-drug method and petitioners have
proffered no study showing that it is an equally effective manner of
imposing a death sentence. Petitioners contend that Kentucky
should omit pancuronium bromide because it serves no therapeutic
purpose while suppressing muscle movements that could reveal an
inadequate administration of sodium thiopental. The state trial
court specifically found that pancuronium bromide serves two
purposes: (1) preventing involuntary convulsions or seizures during
unconsciousness, thereby preserving the procedure’s dignity, and
(2) hastening death. Petitioners assert that their barbiturate-only
protocol is used routinely by veterinarians for putting animals to
sleep and that 23 States bar veterinarians from using a neuromus-
cular paralytic agent like pancuronium bromide. These arguments
overlook the States’ legitimate interest in providing for a quick, cer-
tain death, and in any event, veterinary practice for animals is not an
appropriate guide for humane practices for humans. Petitioners
charge that Kentucky’s protocol lacks a systematic mechanism, such
as a Bispectral Index monitor, blood pressure cuff, or electrocardio-
gram, for monitoring the prisoner’s “anesthetic depth.” But expert
testimony shows both that a proper thiopental dose obviates the con-
cern that a prisoner will not be sufficiently sedated, and that each of
the proposed alternatives presents its own concerns. Pp. 17–23.
JUSTICE STEVENS concluded that instead of ending the controversy,
this case will generate debate not only about the constitutionality of
the three-drug protocol, and specifically about the justification for the
use of pancuronium bromide, but also about the justification for the
death penalty itself. States wishing to decrease the risk that future
litigation will delay executions or invalidate their protocol would do
well to reconsider their continued use of pancuronium bromide.
Moreover, although experience demonstrates that imposing that pen-
alty constitutes the pointless and needless extinction of life with only
negligible social or public returns, this conclusion does not justify a
refusal to respect this Court’s precedents upholding the death pen-
alty and establishing a framework for evaluating the constitutional-
Cite as: 553 U. S. ____ (2008) 5
Syllabus
ity of particular execution methods, under which petitioners’ evidence
fails to prove that Kentucky’s protocol violates the Eighth Amend-
ment. Pp. 1–18.
JUSTICE THOMAS, joined by JUSTICE SCALIA, concluded that the plu-
rality’s formulation of the governing standard finds no support in the
original understanding of the Cruel and Unusual Punishments
Clause or in this Court’s previous method-of-execution cases; casts
constitutional doubt on long-accepted methods of execution; and in-
jects the Court into matters it has no institutional capacity to resolve.
The historical practices leading to the Clause’s inclusion in the Bill of
Rights, the views of early commentators on the Constitution, and this
Court’s cases, see, e.g., Wilkerson v. Utah, 99 U. S. 130, 135–136, all
demonstrate that an execution method violates the Eighth Amend-
ment only if it is deliberately designed to inflict pain. Judged under
that standard, this is an easy case: Because it is undisputed that
Kentucky adopted its lethal injection protocol in an effort to make
capital punishment more humane, not to add elements of terror,
pain, or disgrace to the death penalty, petitioners’ challenge must
fail. Pp. 1–15.
JUSTICE BREYER concluded that there cannot be found, either in the
record or in the readily available literature, sufficient grounds to be-
lieve that Kentucky’s lethal injection method creates a significant
risk of unnecessary suffering. Although the death penalty has seri-
ous risks—e.g., that the wrong person may be executed, that unwar-
ranted animus about the victims’ race, for example, may play a role,
and that those convicted will find themselves on death row for many
years—the penalty’s lawfulness is not before the Court. And peti-
tioners’ proof and evidence, while giving rise to legitimate concern, do
not show that Kentucky’s execution method amounts to “cruel and
unusual punishmen[t].” Pp. 1–7.
ROBERTS, C. J., announced the judgment of the Court and delivered
an opinion, in which KENNEDY and ALITO, JJ., joined. ALITO, J., filed a
concurring opinion. STEVENS, J., filed an opinion concurring in the
judgment. SCALIA, J., filed an opinion concurring in the judgment, in
which THOMAS, J., joined. THOMAS, J., filed an opinion concurring in the
judgment, in which SCALIA, J., joined. BREYER, J., filed an opinion con-
curring in the judgment. GINSBURG, J., filed a dissenting opinion, in
which SOUTER, J., joined.
Cite as: 553 U. S. ____ (2008) 1
Opinion of ROBERTS, C. J.
NOTICE: This opinion is subject to formal revision before publication in the
preliminary print of the United States Reports. Readers are requested to
notify the Reporter of Decisions, Supreme Court of the United States, Wash-
ington, D. C. 20543, of any typographical or other formal errors, in order
that corrections may be made before the preliminary print goes to press.
SUPREME COURT OF THE UNITED STATES
_________________
No. 07–5439
_________________
RALPH BAZE AND THOMAS C. BOWLING, PETI-
TIONERS v. JOHN D. REES, COMMISSIONER,
KENTUCKY DEPARTMENT OF
CORRECTIONS, ET AL.
ON WRIT OF CERTIORARI TO THE SUPREME COURT
OF KENTUCKY
[April 16, 2008]
CHIEF JUSTICE ROBERTS announced the judgment of the
Court and delivered an opinion, in which JUSTICE
KENNEDY and JUSTICE ALITO join.
Like 35 other States and the Federal Government,
Kentucky has chosen to impose capital punishment for
certain crimes. As is true with respect to each of these
States and the Federal Government, Kentucky has altered
its method of execution over time to more humane means
of carrying out the sentence. That progress has led to the
use of lethal injection by every jurisdiction that imposes
the death penalty.
Petitioners in this case—each convicted of double homi-
cide—acknowledge that the lethal injection procedure, if
applied as intended, will result in a humane death. They
nevertheless contend that the lethal injection protocol is
unconstitutional under the Eighth Amendment’s ban on
“cruel and unusual punishments,” because of the risk that
the protocol’s terms might not be properly followed, result-
ing in significant pain. They propose an alternative proto-
2 BAZE v. REES
Opinion of ROBERTS, C. J.
col, one that they concede has not been adopted by any
State and has never been tried.
The trial court held extensive hearings and entered
detailed Findings of Fact and Conclusions of Law. It
recognized that “[t]here are no methods of legal execution
that are satisfactory to those who oppose the death pen-
alty on moral, religious, or societal grounds,” but con-
cluded that Kentucky’s procedure “complies with the
constitutional requirements against cruel and unusual
punishment.” App. 769. The State Supreme Court af-
firmed. We too agree that petitioners have not carried
their burden of showing that the risk of pain from malad-
ministration of a concededly humane lethal injection
protocol, and the failure to adopt untried and untested
alternatives, constitute cruel and unusual punishment.
The judgment below is affirmed.
I
A
By the middle of the 19th century, “hanging was the
‘nearly universal form of execution’ in the United States.”
Campbell v. Wood, 511 U. S. 1119 (1994) (Blackmun, J.,
dissenting from denial of certiorari) (quoting State v.
Frampton, 95 Wash. 2d 469, 492, 627 P. 2d 922, 934
(1981)); Denno, Getting to Death: Are Executions Consti-
tutional? 82 Iowa L. Rev. 319, 364 (1997) (counting 48
States and Territories that employed hanging as a method
of execution). In 1888, following the recommendation of a
commission empaneled by the Governor to find “ ‘the most
humane and practical method known to modern science of
carrying into effect the sentence of death,’ ” New York
became the first State to authorize electrocution as a form
of capital punishment. Glass v. Louisiana, 471 U. S. 1080,
1082, and n. 4 (1985) (Brennan, J., dissenting from denial
of certiorari); Denno, supra, at 373. By 1915, 11 other
States had followed suit, motivated by the “well-grounded
Cite as: 553 U. S. ____ (2008) 3
Opinion of ROBERTS, C. J.
belief that electrocution is less painful and more humane
than hanging.” Malloy v. South Carolina, 237 U. S. 180,
185 (1915).
Electrocution remained the predominant mode of execu-
tion for nearly a century, although several methods, in-
cluding hanging, firing squad, and lethal gas were in use
at one time. Brief for Fordham University School of Law
et al. as Amici Curiae 5–9 (hereinafter Fordham Brief).
Following the 9-year hiatus in executions that ended with
our decision in Gregg v. Georgia, 428 U. S. 153 (1976),
however, state legislatures began responding to public
calls to reexamine electrocution as a means of assuring a
humane death. See S. Banner, The Death Penalty: An
American History 192–193, 296–297 (2002). In 1977,
legislators in Oklahoma, after consulting with the head of
the anesthesiology department at the University of Okla-
homa College of Medicine, introduced the first bill propos-
ing lethal injection as the State’s method of execution. See
Brief for Petitioners 4; Fordham Brief 21–22. A total of 36
States have now adopted lethal injection as the exclusive
or primary means of implementing the death penalty,
making it by far the most prevalent method of execution in
the United States.1 It is also the method used by the
——————
1 Twenty-seven of the 36 States that currently provide for capital
punishment require execution by lethal injection as the sole method.
See Ariz. Rev. Stat. Ann. §13–704 (West 2001); Ark. Code Ann. §5–4–
617 (2006); Colo. Rev. Stat. Ann. §18–1.3–1202 (2007); Conn. Gen. Stat.
§54–100 (2007); Del. Code Ann., Tit. 11, §4209 (2006 Supp.); Ga. Code
Ann. §17–10–38 (2004); Ill. Comp. Stat., ch. 725, §5/119–5 (West 2006);
Ind. Code §35–38–6–1 (West 2004); Kan. Stat. Ann. §22–4001 (2006
Cum. Supp.); Ky. Rev. Stat. Ann. §431.220 (West 2006); La. Stat. Ann.
§15:569 (West 2005); Md. Crim. Law Code Ann. §2–303 (Lexis Supp.
2007); Miss. Code Ann. §99–19–51 (2007); Mont. Code Ann. §46–19–103
(2007); Nev. Rev. Stat. §176.355 (2007); N. J. Stat. Ann. §2C:49–2 (West
2007) (repealed Dec. 17, 2007); N. M. Stat. Ann. §31–14–11 (2000);
N. C. Gen. Stat. Ann. §15–187 (Lexis 2007); N. Y. Correc. Law Ann.
§658 (West 2003) (held unconstitutional in People v. LaValle, 3 N. Y. 3d
4 BAZE v. REES
Opinion of ROBERTS, C. J.
Federal Government. See 18 U. S. C. §3591 et seq. (2000
ed. and Supp. V); App. to Brief for United States as
Amicus Curiae 1a–6a (lethal injection protocol used by the
Federal Bureau of Prisons).
Of these 36 States, at least 30 (including Kentucky) use
the same combination of three drugs in their lethal injec-
tion protocols. See Workman v. Bredesen, 486 F. 3d 896,
902 (CA6 2007). The first drug, sodium thiopental (also
known as Pentathol), is a fast-acting barbiturate sedative
that induces a deep, comalike unconsciousness when given
in the amounts used for lethal injection. App. 762–763,
631–632. The second drug, pancuronium bromide (also
——————
88, 130–131, 817 N. E. 2d 341, 367 (2004)); Ohio Rev. Code Ann.
§2949.22 (Lexis 2006); Okla. Stat., Tit. 22, §1014 (West 2001); Ore. Rev.
Stat. §137.473 (2003); Pa. Stat. Ann., Tit. 61, §3004 (Purdon 1999);
S. D. Codified Laws §23A–27A–32 (Supp. 2007); Tenn. Code Ann. §40–
23–114 (2006); Tex. Code Crim. Proc. Ann., Art. 43.14 (Vernon 2006
Supp. Pamphlet); Utah Code Ann. §77–18–5.5 (Lexis Supp. 2007); Wyo.
Stat. Ann. §7–13–904 (2007). Nine States allow for lethal injection in
addition to an alternative method, such as electrocution, see Ala. Code
§§15–18–82 to 82.1 (Supp. 2007); Fla. Stat. §922.105 (2006); S. C. Code
Ann. §24–3–530 (2007); Va. Code Ann. §53.1–234 (Lexis Supp. 2007),
hanging, see N. H. Rev. Stat. Ann. §630:5 (2007); Wash. Rev. Code
§10.95.180 (2006), lethal gas, see Cal. Penal Code Ann. §3604 (West
2000); Mo. Rev. Stat. §546.720 (2007 Cum. Supp.), or firing squad, see
Idaho Code §19–2716 (Lexis 2004). Nebraska is the only State whose
statutes specify electrocution as the sole method of execution, see Neb.
Rev. Stat. §29–2532 (1995), but the Nebraska Supreme Court recently
struck down that method under the Nebraska Constitution, see State v.
Mata, No. S–05–1268, 2008 WL 351695, *40 (2008).
Although it is undisputed that the States using lethal injection
adopted the protocol first developed by Oklahoma without significant
independent review of the procedure, it is equally undisputed that, in
moving to lethal injection, the States were motivated by a desire to find
a more humane alternative to then-existing methods. See Fordham
Brief 2–3. In this regard, Kentucky was no different. See id., at 29–30
(quoting statement by the State Representative who sponsored the bill
to replace electrocution with lethal injection in Kentucky: “if we are
going to do capital punishment, it needs to be done in the most humane
manner” (internal quotation marks omitted)).
Cite as: 553 U. S. ____ (2008) 5
Opinion of ROBERTS, C. J.
known as Pavulon), is a paralytic agent that inhibits all
muscular-skeletal movements and, by paralyzing the
diaphragm, stops respiration. Id., at 763. Potassium
chloride, the third drug, interferes with the electrical
signals that stimulate the contractions of the heart, induc-
ing cardiac arrest. Ibid. The proper administration of the
first drug ensures that the prisoner does not experience
any pain associated with the paralysis and cardiac arrest
caused by the second and third drugs. Id., at 493–494,
541, 558–559.
B
Kentucky replaced electrocution with lethal injection in
1998. 1998 Ky. Acts ch. 220, p. 777. The Kentucky stat-
ute does not specify the drugs or categories of drugs to be
used during an execution, instead mandating that “every
death sentence shall be executed by continuous intrave-
nous injection of a substance or combination of substances
sufficient to cause death.” Ky. Rev. Stat. Ann.
§431.220(1)(a) (West 2006). Prisoners sentenced before
1998 have the option of electing either electrocution or
lethal injection, but lethal injection is the default if—as is
the case with petitioners—the prisoner refuses to make a
choice at least 20 days before the scheduled execution.
§431.220(1)(b). If a court invalidates Kentucky’s lethal
injection method, Kentucky law provides that the method
of execution will revert to electrocution. §431.223.
Shortly after the adoption of lethal injection, officials
working for the Kentucky Department of Corrections set
about developing a written protocol to comply with the
requirements of §431.220(1)(a). Kentucky’s protocol called
for the injection of 2 grams of sodium thiopental, 50 milli-
grams of pancuronium bromide, and 240 milliequivalents
of potassium chloride. In 2004, as a result of this litiga-
tion, the department chose to increase the amount of
sodium thiopental from 2 grams to 3 grams. App. 762–
6 BAZE v. REES
Opinion of ROBERTS, C. J.
763, 768. Between injections, members of the execution
team flush the intravenous (IV) lines with 25 milligrams
of saline to prevent clogging of the lines by precipitates
that may form when residual sodium thiopental comes
into contact with pancuronium bromide. Id., at 761, 763–
764. The protocol reserves responsibility for inserting the
IV catheters to qualified personnel having at least one
year of professional experience. Id., at 984. Currently,
Kentucky uses a certified phlebotomist and an emergency
medical technician (EMT) to perform the venipunctures
necessary for the catheters. Id., at 761–762. They have
up to one hour to establish both primary and secondary
peripheral intravenous sites in the arm, hand, leg, or foot
of the inmate. Id., at 975–976. Other personnel are re-
sponsible for mixing the solutions containing the three
drugs and loading them into syringes. Id., at 761.
Kentucky’s execution facilities consist of the execution
chamber, a control room separated by a one-way window,
and a witness room. Id., at 203. The warden and deputy
warden remain in the execution chamber with the pris-
oner, who is strapped to a gurney. The execution team
administers the drugs remotely from the control room
through five feet of IV tubing. Id., at 286. If, as deter-
mined by the warden and deputy warden through visual
inspection, the prisoner is not unconscious within 60
seconds following the delivery of the sodium thiopental to
the primary IV site, a new 3-gram dose of thiopental is
administered to the secondary site before injecting the
pancuronium and potassium chloride. Id., at 978–979. In
addition to assuring that the first dose of thiopental is
successfully administered, the warden and deputy warden
also watch for any problems with the IV catheters and
tubing.
A physician is present to assist in any effort to revive
the prisoner in the event of a last-minute stay of execu-
tion. Id., at 764. By statute, however, the physician is
Cite as: 553 U. S. ____ (2008) 7
Opinion of ROBERTS, C. J.
prohibited from participating in the “conduct of an execu-
tion,” except to certify the cause of death. Ky. Rev. Stat.
Ann. §431.220(3). An electrocardiogram (EKG) verifies
the death of the prisoner. App. 764. Only one Kentucky
prisoner, Eddie Lee Harper, has been executed since the
Commonwealth adopted lethal injection. There were no
reported problems at Harper’s execution.
C
Petitioners Ralph Baze and Thomas C. Bowling were
each convicted of two counts of capital murder and sen-
tenced to death. The Kentucky Supreme Court upheld
their convictions and sentences on direct appeal. See Baze
v. Commonwealth, 965 S. W. 2d 817, 819–820, 826 (1997),
cert. denied, 523 U. S. 1083 (1998); Bowling v. Common-
wealth, 873 S. W. 2d 175, 176–177, 182 (1993), cert. de-
nied, 513 U. S. 862 (1994).
After exhausting their state and federal collateral reme-
dies, Baze and Bowling sued three state officials in the
Franklin Circuit Court for the Commonwealth of Ken-
tucky, seeking to have Kentucky’s lethal injection protocol
declared unconstitutional. After a 7-day bench trial dur-
ing which the trial court received the testimony of ap-
proximately 20 witnesses, including numerous experts,
the court upheld the protocol, finding there to be minimal
risk of various claims of improper administration of the
protocol. App. 765–769. On appeal, the Kentucky Su-
preme Court stated that a method of execution violates the
Eighth Amendment when it “creates a substantial risk of
wanton and unnecessary infliction of pain, torture or
lingering death.” 217 S. W. 3d 207, 209 (2006). Applying
that standard, the court affirmed. Id., at 212.
We granted certiorari to determine whether Kentucky’s
lethal injection protocol satisfies the Eighth Amendment.
551 U. S. ___ (2007). We hold that it does.
8 BAZE v. REES
Opinion of ROBERTS, C. J.
II
The Eighth Amendment to the Constitution, applicable
to the States through the Due Process Clause of the Four-
teenth Amendment, see Robinson v. California, 370 U. S.
660, 666 (1962), provides that “[e]xcessive bail shall not be
required, nor excessive fines imposed, nor cruel and un-
usual punishments inflicted.” We begin with the princi-
ple, settled by Gregg, that capital punishment is constitu-
tional. See 428 U. S., at 177 (joint opinion of Stewart,
Powell, and STEVENS, JJ.). It necessarily follows that
there must be a means of carrying it out. Some risk of
pain is inherent in any method of execution—no matter
how humane—if only from the prospect of error in follow-
ing the required procedure. It is clear, then, that the
Constitution does not demand the avoidance of all risk of
pain in carrying out executions.
Petitioners do not claim that it does. Rather, they con-
tend that the Eighth Amendment prohibits procedures
that create an “unnecessary risk” of pain. Brief for Peti-
tioners 38. Specifically, they argue that courts must
evaluate “(a) the severity of pain risked, (b) the likelihood
of that pain occurring, and (c) the extent to which alterna-
tive means are feasible, either by modifying existing exe-
cution procedures or adopting alternative procedures.”
Ibid. Petitioners envision that the quantum of risk neces-
sary to make out an Eighth Amendment claim will vary
according to the severity of the pain and the availability of
alternatives, Reply Brief for Petitioners 23–24, n. 9, but
that the risk must be “significant” to trigger Eighth
Amendment scrutiny, see Brief for Petitioners 39–40;
Reply Brief for Petitioners 25–26.
Kentucky responds that this “unnecessary risk” stan-
dard is tantamount to a requirement that States adopt the
“ ‘least risk’ ” alternative in carrying out an execution, a
standard the Commonwealth contends will cast recurring
constitutional doubt on any procedure adopted by the
Cite as: 553 U. S. ____ (2008) 9
Opinion of ROBERTS, C. J.
States. Brief for Respondents 29, 35. Instead, Kentucky
urges the Court to approve the “ ‘substantial risk’ ” test
used by the courts below. Id., at 34–35.
A
This Court has never invalidated a State’s chosen pro-
cedure for carrying out a sentence of death as the infliction
of cruel and unusual punishment. In Wilkerson v. Utah,
99 U. S. 130 (1879), we upheld a sentence to death by
firing squad imposed by a territorial court, rejecting the
argument that such a sentence constituted cruel and
unusual punishment. Id., at 134–135. We noted there the
difficulty of “defin[ing] with exactness the extent of the
constitutional provision which provides that cruel and
unusual punishments shall not be inflicted.” Id., at 135–
136. Rather than undertake such an effort, the Wilkerson
Court simply noted that “it is safe to affirm that punish-
ments of torture, . . . and all others in the same line of
unnecessary cruelty, are forbidden” by the Eighth
Amendment. Id., at 136. By way of example, the Court
cited cases from England in which “terror, pain, or dis-
grace were sometimes superadded” to the sentence, such
as where the condemned was “embowelled alive, be-
headed, and quartered,” or instances of “public dissection
in murder, and burning alive.” Id., at 135. In contrast, we
observed that the firing squad was routinely used as a
method of execution for military officers. Id., at 137.
What each of the forbidden punishments had in common
was the deliberate infliction of pain for the sake of pain—
“superadd[ing]” pain to the death sentence through torture
and the like.
We carried these principles further in In re Kemmler,
136 U. S. 436 (1890). There we rejected an opportunity to
incorporate the Eighth Amendment against the States in a
challenge to the first execution by electrocution, to be
carried out by the State of New York. Id., at 449. In
10 BAZE v. REES
Opinion of ROBERTS, C. J.
passing over that question, however, we observed that
“[p]unishments are cruel when they involve torture or a
lingering death; but the punishment of death is not cruel
within the meaning of that word as used in the Constitu-
tion. It implies there something inhuman and barbarous,
something more than the mere extinguishment of life.”
Id., at 447. We noted that the New York statute adopting
electrocution as a method of execution “was passed in the
effort to devise a more humane method of reaching the
result.” Ibid.
B
Petitioners do not claim that lethal injection or the
proper administration of the particular protocol adopted
by Kentucky by themselves constitute the cruel or wanton
infliction of pain. Quite the contrary, they concede that “if
performed properly,” an execution carried out under Ken-
tucky’s procedures would be “humane and constitutional.”
Brief for Petitioners 31. That is because, as counsel for
petitioners admitted at oral argument, proper administra-
tion of the first drug, sodium thiopental, eliminates any
meaningful risk that a prisoner would experience pain
from the subsequent injections of pancuronium and potas-
sium chloride. See Tr. of Oral Arg. 5; App. 493–494 (tes-
timony of petitioners’ expert that, if sodium thiopental is
“properly administered” under the protocol, “[i]n virtually
every case, then that would be a humane death”).
Instead, petitioners claim that there is a significant risk
that the procedures will not be properly followed—in
particular, that the sodium thiopental will not be properly
administered to achieve its intended effect—resulting in
severe pain when the other chemicals are administered.
Our cases recognize that subjecting individuals to a risk of
future harm—not simply actually inflicting pain—can
qualify as cruel and unusual punishment. To establish
that such exposure violates the Eighth Amendment, how-
Cite as: 553 U. S. ____ (2008) 11
Opinion of ROBERTS, C. J.
ever, the conditions presenting the risk must be “sure or
very likely to cause serious illness and needless suffering,”
and give rise to “sufficiently imminent dangers.” Helling
v. McKinney, 509 U. S. 25, 33, 34–35 (1993) (emphasis
added). We have explained that to prevail on such a claim
there must be a “substantial risk of serious harm,” an
“objectively intolerable risk of harm” that prevents prison
officials from pleading that they were “subjectively blame-
less for purposes of the Eighth Amendment.” Farmer v.
Brennan, 511 U. S. 825, 842, 846, and n. 9 (1994).
Simply because an execution method may result in pain,
either by accident or as an inescapable consequence of
death, does not establish the sort of “objectively intoler-
able risk of harm” that qualifies as cruel and unusual. In
Louisiana ex rel. Francis v. Resweber, 329 U. S. 459
(1947), a plurality of the Court upheld a second attempt at
executing a prisoner by electrocution after a mechanical
malfunction had interfered with the first attempt. The
principal opinion noted that “[a]ccidents happen for which
no man is to blame,” id., at 462, and concluded that such
“an accident, with no suggestion of malevolence,” id., at
463, did not give rise to an Eighth Amendment violation,
id., at 463–464.
As Justice Frankfurter noted in a separate opinion
based on the Due Process Clause, however, “a hypothetical
situation” involving “a series of abortive attempts at elec-
trocution” would present a different case. Id., at 471
(concurring opinion). In terms of our present Eighth
Amendment analysis, such a situation—unlike an “inno-
cent misadventure,” id., at 470—would demonstrate an
“objectively intolerable risk of harm” that officials may not
ignore. See Farmer, 511 U. S., at 846, and n. 9. In other
words, an isolated mishap alone does not give rise to an
Eighth Amendment violation, precisely because such an
event, while regrettable, does not suggest cruelty, or that
the procedure at issue gives rise to a “substantial risk of
12 BAZE v. REES
Opinion of ROBERTS, C. J.
serious harm.” Id., at 842.
C
Much of petitioners’ case rests on the contention that
they have identified a significant risk of harm that can be
eliminated by adopting alternative procedures, such as a
one-drug protocol that dispenses with the use of pan-
curonium and potassium chloride, and additional monitor-
ing by trained personnel to ensure that the first dose of
sodium thiopental has been adequately delivered. Given
what our cases have said about the nature of the risk of
harm that is actionable under the Eighth Amendment, a
condemned prisoner cannot successfully challenge a
State’s method of execution merely by showing a slightly
or marginally safer alternative.
Permitting an Eighth Amendment violation to be estab-
lished on such a showing would threaten to transform
courts into boards of inquiry charged with determining
“best practices” for executions, with each ruling sup-
planted by another round of litigation touting a new and
improved methodology. Such an approach finds no sup-
port in our cases, would embroil the courts in ongoing
scientific controversies beyond their expertise, and would
substantially intrude on the role of state legislatures in
implementing their execution procedures—a role that by
all accounts the States have fulfilled with an earnest
desire to provide for a progressively more humane manner
of death. See Bell v. Wolfish, 441 U. S. 520, 562 (1979)
(“The wide range of ‘judgment calls’ that meet constitu-
tional and statutory requirements are confided to officials
outside of the Judicial Branch of Government”). Accord-
ingly, we reject petitioners’ proposed “unnecessary risk”
standard, as well as the dissent’s “untoward” risk varia-
tion. See post, at 2, 11 (opinion of GINSBURG, J.).2
——————
2 The difficulties inherent in such approaches are exemplified by the
controversy surrounding the study of lethal injection published in the
Cite as: 553 U. S. ____ (2008) 13
Opinion of ROBERTS, C. J.
Instead, the proffered alternatives must effectively
address a “substantial risk of serious harm.” Farmer,
supra, at 842. To qualify, the alternative procedure must
be feasible, readily implemented, and in fact significantly
reduce a substantial risk of severe pain. If a State refuses
to adopt such an alternative in the face of these docu-
mented advantages, without a legitimate penological
justification for adhering to its current method of execu-
tion, then a State’s refusal to change its method can be
viewed as “cruel and unusual” under the Eighth Amend-
ment.3
——————
April 2005 edition of the British medical journal the Lancet. After
examining thiopental concentrations in toxicology reports based on
blood samples drawn from 49 executed inmates, the study concluded
that “most of the executed inmates had concentrations that would not
be expected to produce a surgical plane of anaesthesia, and 21 (43%)
had concentrations consistent with consciousness.” Koniaris, Zimmers,
Lubarsky, & Sheldon, Inadequate Anaesthesia in Lethal Injection for
Execution, 365 Lancet 1412, 1412–1413. The study was widely cited
around the country in motions to stay executions and briefs on the
merits. See, e.g., Denno, The Lethal Injection Quandary: How Medicine
Has Dismantled the Death Penalty, 76 Ford. L. Rev. 49, 105, n. 366
(2007) (collecting cases in which claimants cited the Lancet study). But
shortly after the Lancet study appeared, peer responses by seven
medical researchers criticized the methodology supporting the original
conclusions. See Groner, Inadequate Anaesthesia in Lethal Injection
for Execution, 366 Lancet 1073–1074 (Sept. 2005). These researchers
noted that because the blood samples were taken “several hours to days
after” the inmates’ deaths, the postmortem concentrations of thiopen-
tal—a fat-soluble compound that passively diffuses from blood into
tissue—could not be relied on as accurate indicators for concentrations
during life. Id., at 1073. The authors of the original study responded to
defend their methodology. Id., at 1074–1076. See also post, at 2–4
(BREYER, J., concurring in judgment).
We do not purport to take sides in this dispute. We cite it only to
confirm that a “best practices” approach, calling for the weighing of
relative risks without some measure of deference to a State’s choice of
execution procedures, would involve the courts in debatable matters far
exceeding their expertise.
3 JUSTICE THOMAS agrees that courts have neither the authority nor
14 BAZE v. REES
Opinion of ROBERTS, C. J.
III
In applying these standards to the facts of this case, we
note at the outset that it is difficult to regard a practice as
“objectively intolerable” when it is in fact widely tolerated.
Thirty-six States that sanction capital punishment have
adopted lethal injection as the preferred method of execu-
tion. The Federal Government uses lethal injection as
well. See supra, at 3–4, and n. 1. This broad consensus
goes not just to the method of execution, but also to the
specific three-drug combination used by Kentucky. Thirty
States, as well as the Federal Government, use a series of
sodium thiopental, pancuronium bromide, and potassium
chloride, in varying amounts. See supra, at 4. No State
uses or has ever used the alternative one-drug protocol
belatedly urged by petitioners. This consensus is proba-
tive but not conclusive with respect to that aspect of the
alternatives proposed by petitioners.
In order to meet their “heavy burden” of showing that
Kentucky’s procedure is “cruelly inhumane,” Gregg, 428
U. S., at 175 (joint opinion of Stewart, Powell, and STE-
VENS, JJ.), petitioners point to numerous aspects of the
protocol that they contend create opportunities for error.
Their claim hinges on the improper administration of the
first drug, sodium thiopental. It is uncontested that,
failing a proper dose of sodium thiopental that would
render the prisoner unconscious, there is a substantial,
constitutionally unacceptable risk of suffocation from the
administration of pancuronium bromide and pain from the
——————
the expertise to function as boards of inquiry determining best practices
for executions, see post, at 9 (opinion concurring in judgment) (quoting
this opinion); post, at 13, but contends that the standard we adopt
inevitably poses such concerns. In our view, those concerns are effec-
tively addressed by the threshold requirement reflected in our cases of
a “ ‘substantial risk of serious harm’ ” or an “ ‘objectively intolerable risk
of harm,’ ” see supra, at 11, and by the substantive requirements in the
articulated standard.
Cite as: 553 U. S. ____ (2008) 15
Opinion of ROBERTS, C. J.
injection of potassium chloride. See Tr. of Oral Arg. 27.
We agree with the state trial court and State Supreme
Court, however, that petitioners have not shown that the
risk of an inadequate dose of the first drug is substantial.
And we reject the argument that the Eighth Amendment
requires Kentucky to adopt the untested alternative pro-
cedures petitioners have identified.
A
Petitioners contend that there is a risk of improper
administration of thiopental because the doses are difficult
to mix into solution form and load into syringes; because
the protocol fails to establish a rate of injection, which
could lead to a failure of the IV; because it is possible that
the IV catheters will infiltrate into surrounding tissue,
causing an inadequate dose to be delivered to the vein;
because of inadequate facilities and training; and because
Kentucky has no reliable means of monitoring the anes-
thetic depth of the prisoner after the sodium thiopental
has been administered. Brief for Petitioners 12–20.
As for the risk that the sodium thiopental would be
improperly prepared, petitioners contend that Kentucky
employs untrained personnel who are unqualified to calcu-
late and mix an adequate dose, especially in light of the
omission of volume and concentration amounts from the
written protocol. Id., at 45–46. The state trial court,
however, specifically found that “[i]f the manufacturers’
instructions for reconstitution of Sodium Thiopental are
followed, . . . there would be minimal risk of improper
mixing, despite converse testimony that a layperson would
have difficulty performing this task.” App. 761. We can-
not say that this finding is clearly erroneous, see Hernan-
dez v. New York, 500 U. S. 352, 366 (1991) (plurality opin-
ion), particularly when that finding is substantiated by
expert testimony describing the task of reconstituting
powder sodium thiopental into solution form as “[n]ot
16 BAZE v. REES
Opinion of ROBERTS, C. J.
difficult at all. . . . You take a liquid, you inject it into a
vial with the powder, then you shake it up until the pow-
der dissolves and, you’re done. The instructions are on the
package insert.” 5 Tr. 695 (Apr. 19, 2005).
Likewise, the asserted problems related to the IV lines
do not establish a sufficiently substantial risk of harm to
meet the requirements of the Eighth Amendment. Ken-
tucky has put in place several important safeguards to
ensure that an adequate dose of sodium thiopental is
delivered to the condemned prisoner. The most significant
of these is the written protocol’s requirement that mem-
bers of the IV team must have at least one year of profes-
sional experience as a certified medical assistant, phle-
botomist, EMT, paramedic, or military corpsman. App.
984. Kentucky currently uses a phlebotomist and an
EMT, personnel who have daily experience establishing IV
catheters for inmates in Kentucky’s prison population.
Id., at 273–274; Tr. of Oral Arg. 27–28. Moreover, these
IV team members, along with the rest of the execution
team, participate in at least 10 practice sessions per year.
App. 984. These sessions, required by the written proto-
col, encompass a complete walk-through of the execution
procedures, including the siting of IV catheters into volun-
teers. Ibid. In addition, the protocol calls for the IV team
to establish both primary and backup lines and to prepare
two sets of the lethal injection drugs before the execution
commences. Id., at 975. These redundant measures
ensure that if an insufficient dose of sodium thiopental is
initially administered through the primary line, an addi-
tional dose can be given through the backup line before
the last two drugs are injected. Id., at 279–280, 337–338,
978–979.
The IV team has one hour to establish both the primary
and backup IVs, a length of time the trial court found to be
“not excessive but rather necessary,” id., at 762, contrary
to petitioners’ claim that using an IV inserted after any
Cite as: 553 U. S. ____ (2008) 17
Opinion of ROBERTS, C. J.
“more than ten or fifteen minutes of unsuccessful attempts
is dangerous because the IV is almost certain to be unreli-
able,” Brief for Petitioners 47. And, in any event, merely
because the protocol gives the IV team one hour to estab-
lish intravenous access does not mean that team members
are required to spend the entire hour in a futile attempt to
do so. The qualifications of the IV team also substantially
reduce the risk of IV infiltration.
In addition, the presence of the warden and deputy
warden in the execution chamber with the prisoner allows
them to watch for signs of IV problems, including infiltra-
tion. Three of the Commonwealth’s medical experts testi-
fied that identifying signs of infiltration would be “very
obvious,” even to the average person, because of the swell-
ing that would result. App. 385–386. See id., at 353, 600–
601. Kentucky’s protocol specifically requires the warden
to redirect the flow of chemicals to the backup IV site if
the prisoner does not lose consciousness within 60 sec-
onds. Id., at 978–979. In light of these safeguards, we
cannot say that the risks identified by petitioners are so
substantial or imminent as to amount to an Eighth
Amendment violation.
B
Nor does Kentucky’s failure to adopt petitioners’ pro-
posed alternatives demonstrate that the Commonwealth’s
execution procedure is cruel and unusual.
First, petitioners contend that Kentucky could switch
from a three-drug protocol to a one-drug protocol by using
a single dose of sodium thiopental or other barbiturate.
Brief for Petitioners 51–57. That alternative was not
proposed to the state courts below.4 As a result, we are
——————
4 Petitioners did allude to an “alternative chemical or combination of
chemicals” that could replace Kentucky’s three-drug protocol in their
post-trial brief, see App. 684, but based on the arguments presented
there, it is clear they intended to refer only to other, allegedly less
18 BAZE v. REES
Opinion of ROBERTS, C. J.
left without any findings on the effectiveness of petition-
ers’ barbiturate-only protocol, despite scattered references
in the trial testimony to the sole use of sodium thiopental
or pentobarbital as a preferred method of execution. See
Reply Brief for Petitioners 18, n. 6.
In any event, the Commonwealth’s continued use of the
three-drug protocol cannot be viewed as posing an “objec-
tively intolerable risk” when no other State has adopted
the one-drug method and petitioners proffered no study
showing that it is an equally effective manner of imposing
a death sentence. See App. 760–761, n. 8 (“Plaintiffs have
not presented any scientific study indicating a better
method of execution by lethal injection”). Indeed, the
State of Tennessee, after reviewing its execution proce-
dures, rejected a proposal to adopt a one-drug protocol
using sodium thiopental. The State concluded that the
one-drug alternative would take longer than the three-
drug method and that the “required dosage of sodium
thiopental would be less predictable and more variable
when it is used as the sole mechanism for producing death
. . . .” Workman, 486 F. 3d, at 919 (Appendix A). We need
not endorse the accuracy of those conclusions to note
simply that the comparative efficacy of a one-drug method
of execution is not so well established that Kentucky’s
failure to adopt it constitutes a violation of the Eighth
Amendment.
Petitioners also contend that Kentucky should omit the
second drug, pancuronium bromide, because it serves no
therapeutic purpose while suppressing muscle movements
——————
painful drugs that could substitute for potassium chloride as a heart-
stopping agent, see id., at 701. Likewise, the only alternatives to the
three-drug protocol presented to the Kentucky Supreme Court were
those that replaced potassium chloride with other drugs for inducing
cardiac arrest, or that omitted pancuronium bromide, or that added an
analgesic to relieve pain. See Brief for Appellants in No. 2005–SC–
00543, pp. 38, 39, 40.
Cite as: 553 U. S. ____ (2008) 19
Opinion of ROBERTS, C. J.
that could reveal an inadequate administration of the first
drug. The state trial court, however, specifically found
that pancuronium serves two purposes. First, it prevents
involuntary physical movements during unconsciousness
that may accompany the injection of potassium chloride.
App. 763. The Commonwealth has an interest in preserv-
ing the dignity of the procedure, especially where convul-
sions or seizures could be misperceived as signs of con-
sciousness or distress. Second, pancuronium stops
respiration, hastening death. Ibid. Kentucky’s decision to
include the drug does not offend the Eighth Amendment.5
Petitioners’ barbiturate-only protocol, they contend, is
not untested; it is used routinely by veterinarians in put-
ting animals to sleep. Moreover, 23 States, including
Kentucky, bar veterinarians from using a neuromuscular
paralytic agent like pancuronium bromide, either ex-
pressly or, like Kentucky, by specifically directing the use
of a drug like sodium pentobarbital. See Brief for Dr.
Kevin Concannon et al. as Amici Curiae 18, n. 5. If pan-
curonium is too cruel for animals, the argument goes, then
it must be too cruel for the condemned inmate. Whatever
rhetorical force the argument carries, see Workman, su-
pra, at 909 (describing the comparison to animal euthana-
sia as “more of a debater’s point”), it overlooks the States’
legitimate interest in providing for a quick, certain death.
In the Netherlands, for example, where physician-assisted
euthanasia is permitted, the Royal Dutch Society for the
Advancement of Pharmacy recommends the use of a mus-
cle relaxant (such as pancuronium dibromide) in addition
to thiopental in order to prevent a prolonged, undignified
death. See Kimsma, Euthanasia and Euthanizing Drugs
——————
5 JUSTICE STEVENS’s conclusion that the risk addressed by pan-
curonium bromide is “vastly outweighed” by the risk of pain at issue
here, see post, at 3 (opinion concurring in judgment), depends, of
course, on the magnitude of the risk of such pain. As explained, that
risk is insignificant in light of the safeguards Kentucky has adopted.
20 BAZE v. REES
Opinion of ROBERTS, C. J.
in The Netherlands, reprinted in Drug Use in Assisted
Suicide and Euthanasia 193, 200, 204 (M. Battin & A.
Lipman eds. 1996). That concern may be less compelling
in the veterinary context, and in any event other methods
approved by veterinarians—such as stunning the animal
or severing its spinal cord, see 6 Tr. 758–759 (Apr. 20,
2005)—make clear that veterinary practice for animals is
not an appropriate guide to humane practices for humans.
Petitioners also fault the Kentucky protocol for lacking a
systematic mechanism for monitoring the “anesthetic
depth” of the prisoner. Under petitioners’ scheme, quali-
fied personnel would employ monitoring equipment, such
as a Bispectral Index (BIS) monitor, blood pressure cuff, or
EKG to verify that a prisoner has achieved sufficient
unconsciousness before injecting the final two drugs. The
visual inspection performed by the warden and deputy
warden, they maintain, is an inadequate substitute for the
more sophisticated procedures they envision. Brief for
Petitioners 19, 58.
At the outset, it is important to reemphasize that a
proper dose of thiopental obviates the concern that a
prisoner will not be sufficiently sedated. All the experts
who testified at trial agreed on this point. The risks of
failing to adopt additional monitoring procedures are thus
even more “remote” and attenuated than the risks posed
by the alleged inadequacies of Kentucky’s procedures
designed to ensure the delivery of thiopental. See Hamil-
ton v. Jones, 472 F. 3d 814, 817 (CA10 2007) (per curiam);
Taylor v. Crawford, 487 F. 3d 1072, 1084 (CA8 2007).
But more than this, Kentucky’s expert testified that a
blood pressure cuff would have no utility in assessing the
level of the prisoner’s unconsciousness following the intro-
duction of sodium thiopental, which depresses circulation.
App. 578. Furthermore, the medical community has yet to
endorse the use of a BIS monitor, which measures brain
function, as an indication of anesthetic awareness. Ameri-
Cite as: 553 U. S. ____ (2008) 21
Opinion of ROBERTS, C. J.
can Society of Anesthesiologists, Practice Advisory for
Intraoperative Awareness and Brain Function Monitoring,
104 Anesthesiology 847, 855 (Apr. 2006); see Brown v.
Beck, 445 F. 3d 752, 754–755 (CA4 2006) (Michael, J.,
dissenting). The asserted need for a professional anesthe-
siologist to interpret the BIS monitor readings is nothing
more than an argument against the entire procedure,
given that both Kentucky law, see Ky. Rev. Stat. Ann.
§431.220(3), and the American Society of Anesthesiolo-
gists’ own ethical guidelines, see Brief for American Soci-
ety of Anesthesiologists as Amicus Curiae 2–3, prohibit
anesthesiologists from participating in capital punish-
ment. Nor is it pertinent that the use of a blood pressure
cuff and EKG is “the standard of care in surgery requiring
anesthesia,” as the dissent points out. Post, at 6. Peti-
tioners have not shown that these supplementary proce-
dures, drawn from a different context, are necessary to
avoid a substantial risk of suffering.
The dissent believes that rough-and-ready tests for
checking consciousness—calling the inmate’s name, brush-
ing his eyelashes, or presenting him with strong, noxious
odors—could materially decrease the risk of administering
the second and third drugs before the sodium thiopental
has taken effect. See ibid. Again, the risk at issue is
already attenuated, given the steps Kentucky has taken to
ensure the proper administration of the first drug. More-
over, the scenario the dissent posits involves a level of
unconsciousness allegedly sufficient to avoid detection of
improper administration of the anesthesia under Ken-
tucky’s procedure, but not sufficient to prevent pain. See
post, at 9–10. There is no indication that the basic tests
the dissent advocates can make such fine distinctions. If
these tests are effective only in determining whether the
sodium thiopental has entered the inmate’s bloodstream,
see post, at 6, the record confirms that the visual inspec-
tion of the IV site under Kentucky’s procedure achieves
22 BAZE v. REES
Opinion of ROBERTS, C. J.
that objective. See supra, at 17.6
The dissent would continue the stay of these executions
(and presumably the many others held in abeyance pend-
ing decision in this case) and send the case back to the
lower courts to determine whether such added measures
redress an “untoward” risk of pain. Post, at 11. But an
inmate cannot succeed on an Eighth Amendment claim
simply by showing one more step the State could take as a
failsafe for other, independently adequate measures. This
approach would serve no meaningful purpose and would
frustrate the State’s legitimate interest in carrying out a
sentence of death in a timely manner. See Baze v. Parker,
371 F. 3d 310, 317 (CA6 2004) (petitioner Baze sentenced
to death in 1994); Bowling v. Parker, 138 F. Supp. 2d 821,
840 (ED Ky. 2001) (petitioner Bowling sentenced to death
in 1991).
JUSTICE STEVENS suggests that our opinion leaves the
disposition of other cases uncertain, see post, at 1, but the
standard we set forth here resolves more challenges than
he acknowledges. A stay of execution may not be granted
on grounds such as those asserted here unless the con-
demned prisoner establishes that the State’s lethal injec-
tion protocol creates a demonstrated risk of severe pain.
He must show that the risk is substantial when compared
to the known and available alternatives. A State with a
lethal injection protocol substantially similar to the proto-
col we uphold today would not create a risk that meets
this standard.
——————
6 Resisting this point, the dissent rejects the expert testimony that
problems with the intravenous administration of sodium thiopental
would be obvious, see post, at 10, testimony based not only on the pain
that would result from injecting the first drug into tissue rather than
the vein, see App. 600–601, but also on the swelling that would occur,
see id., at 353. See also id., at 385–386. Neither of these expert con-
clusions was disputed below.
Cite as: 553 U. S. ____ (2008) 23
Opinion of ROBERTS, C. J.
* * *
Reasonable people of good faith disagree on the morality
and efficacy of capital punishment, and for many who
oppose it, no method of execution would ever be accept-
able. But as Justice Frankfurter stressed in Resweber,
“[o]ne must be on guard against finding in personal disap-
proval a reflection of more or less prevailing condemna-
tion.” 329 U. S., at 471 (concurring opinion). This Court
has ruled that capital punishment is not prohibited under
our Constitution, and that the States may enact laws
specifying that sanction. “[T]he power of a State to pass
laws means little if the State cannot enforce them.”
McCleskey v. Zant, 499 U. S. 467, 491 (1991). State efforts
to implement capital punishment must certainly comply
with the Eighth Amendment, but what that Amendment
prohibits is wanton exposure to “objectively intolerable
risk,” Farmer, 511 U. S., at 846, and n. 9, not simply the
possibility of pain.
Kentucky has adopted a method of execution believed to
be the most humane available, one it shares with 35 other
States. Petitioners agree that, if administered as in-
tended, that procedure will result in a painless death. The
risks of maladministration they have suggested—such as
improper mixing of chemicals and improper setting of IVs
by trained and experienced personnel—cannot remotely be
characterized as “objectively intolerable.” Kentucky’s
decision to adhere to its protocol despite these asserted
risks, while adopting safeguards to protect against them,
cannot be viewed as probative of the wanton infliction of
pain under the Eighth Amendment. Finally, the alterna-
tive that petitioners belatedly propose has problems of its
own, and has never been tried by a single State.
Throughout our history, whenever a method of execu-
tion has been challenged in this Court as cruel and un-
usual, the Court has rejected the challenge. Our society
has nonetheless steadily moved to more humane methods
24 BAZE v. REES
Opinion of ROBERTS, C. J.
of carrying out capital punishment. The firing squad,
hanging, the electric chair, and the gas chamber have each
in turn given way to more humane methods, culminating
in today’s consensus on lethal injection. Gomez v. United
States Dist. Court for Northern Dist. of Cal., 503 U. S. 653,
657 (1992) (STEVENS, J., dissenting); App. 755. The broad
framework of the Eighth Amendment has accommodated
this progress toward more humane methods of execution,
and our approval of a particular method in the past has
not precluded legislatures from taking the steps they deem
appropriate, in light of new developments, to ensure hu-
mane capital punishment. There is no reason to suppose
that today’s decision will be any different.7
The judgment below concluding that Kentucky’s proce-
dure is consistent with the Eighth Amendment is, accord-
ingly, affirmed.
It is so ordered.
——————
7 We do not agree with JUSTICE STEVENS that anything in our opinion
undermines or remotely addresses the validity of capital punishment.
See post, at 11. The fact that society has moved to progressively more
humane methods of execution does not suggest that capital punishment
itself no longer serves valid purposes; we would not have supposed that
the case for capital punishment was stronger when it was imposed
predominantly by hanging or electrocution.
Cite as: 553 U. S. ____ (2008) 1
ALITO, J., concurring
SUPREME COURT OF THE UNITED STATES
_________________
No. 07–5439
_________________
RALPH BAZE AND THOMAS C. BOWLING, PETI-
TIONERS v. JOHN D. REES, COMMISSIONER,
KENTUCKY DEPARTMENT OF
CORRECTIONS, ET AL.
ON WRIT OF CERTIORARI TO THE SUPREME COURT
OF KENTUCKY
[April 16, 2008]
JUSTICE ALITO, concurring.
I join the plurality opinion but write separately to ex-
plain my view of how the holding should be implemented.
The opinion concludes that “a State’s refusal to change its
method [of execution] can be viewed as ‘cruel and unusual’
under the Eighth Amendment” if the State, “without a
legitimate penological justification,” rejects an alternative
method that is “feasible” and “readily” available and that
would “significantly reduce a substantial risk of severe
pain.” Ante, at 13. Properly understood, this standard
will not, as JUSTICE THOMAS predicts, lead to litigation
that enables “those seeking to abolish the death penalty
. . . to embroil the States in never-ending litigation con-
cerning the adequacy of their execution procedures.” Post,
at 12 (opinion concurring in judgment).
I
As the plurality opinion notes, the constitutionality of
capital punishment is not before us in this case, and there-
fore we proceed on the assumption that the death penalty
is constitutional. Ante, at 8. From that assumption, it
follows that there must be a constitutional means of carry-
ing out a death sentence.
2 BAZE v. REES
ALITO, J., concurring
We also proceed in this case on the assumption that
lethal injection is a constitutional means of execution. See
Gregg v. Georgia, 428 U. S. 153, 175 (1976) (joint opinion
of Stewart, Powell, and STEVENS, JJ.) (“[I]n assessing a
punishment selected by a democratically elected legisla-
ture against the constitutional measure, we presume its
validity”). Lethal injection was adopted by the Federal
Government and 36 States because it was thought to be
the most humane method of execution, and petitioners
here do not contend that lethal injection should be aban-
doned in favor of any of the methods that it replaced—
execution by electric chair, the gas chamber, hanging, or a
firing squad. Since we assume for present purposes that
lethal injection is constitutional, the use of that method by
the Federal Government and the States must not be
blocked by procedural requirements that cannot practica-
bly be satisfied.
Prominent among the practical constraints that must be
taken into account in considering the feasibility and avail-
ability of any suggested modification of a lethal injection
protocol are the ethical restrictions applicable to medical
professionals. The first step in the lethal injection proto-
cols currently in use is the anesthetization of the prisoner.
If this step is carried out properly, it is agreed, the pris-
oner will not experience pain during the remainder of the
procedure. Every day, general anesthetics are adminis-
tered to surgical patients in this country, and if the medi-
cal professionals who participate in these surgeries also
participated in the anesthetization of prisoners facing
execution by lethal injection, the risk of pain would be
minimized. But the ethics rules of medical professionals—
for reasons that I certainly do not question here—prohibit
their participation in executions.
Guidelines issued by the American Medical Association
(AMA) state that “[a]n individual’s opinion on capital
punishment is the personal moral decision of the individ-
Cite as: 553 U. S. ____ (2008) 3
ALITO, J., concurring
ual,” but that “[a] physician, as a member of a profession
dedicated to preserving life when there is hope of doing so,
should not be a participant in a legally authorized execu-
tion.” AMA, Code of Medical Ethics, Policy E–2.06 Capital
Punishment (2000), online at http://www.ama-assn.org/
ama1/pub/upload/mm/369/e206capitalpunish.pdf (all Inter-
net materials as visited Apr. 14, 2008, and available in
Clerk of Court’s case file). The guidelines explain:
“Physician participation in an execution includes, but
is not limited to, the following actions: prescribing or
administering tranquilizers and other psychotropic
agents and medications that are part of the execution
procedure; monitoring vital signs on site or remotely
(including monitoring electrocardiograms); attending
or observing an execution as a physician; and render-
ing of technical advice regarding execution.” Ibid.
The head of ethics at the AMA has reportedly opined
that “[e]ven helping to design a more humane protocol
would disregard the AMA code.” Harris, Will Medics’
Qualms Kill the Death Penalty? 441 Nature 8–9 (May 4,
2006).
The American Nurses Association (ANA) takes the
position that participation in an execution “is a breach of
the ethical traditions of nursing, and the Code for Nurses.”
ANA, Position Statement: Nurses’ Participation in Capital
Punishment (1994), online at http://nursingworld.org/Main
MenuCategories /HealthcareandPolicyIssues /ANAPosition
StatementsEthicsandHumanRights.aspx. This means, the
ANA explains, that a nurse must not “take part in as-
sessment, supervision or monitoring of the procedure or
the prisoner; procuring, prescribing or preparing medica-
tions or solutions; inserting the intravenous catheter;
injecting the lethal solution; and attending or witnessing
the execution as a nurse.” Ibid.
The National Association of Emergency Medical Techni-
4 BAZE v. REES
ALITO, J., concurring
cians (NAEMT) holds that “[p]articipation in capital pun-
ishment is inconsistent with the ethical precepts and goals
of the [Emergency Medical Services] profession.” NAEMT,
Position Statement on EMT and Paramedic Participa-
tion in Capital Punishment (June 9, 2006), online at
http://www.naemt.org/aboutNAEMT/capitalpunishment.htm
The NAEMT’s Position Statement advises that emergency
medical technicians and paramedics should refrain from
the same activities outlined in the ANA statement. Ibid.
Recent litigation in California has demonstrated the
effect of such ethics rules. Michael Morales, who was
convicted and sentenced to death for a 1981 murder, filed
a federal civil rights action challenging California’s lethal
injection protocol, which, like Kentucky’s, calls for the
sequential administration of three drugs: sodium pento-
thal, pancuronium bromide, and potassium chloride. The
District Court enjoined the State from proceeding with the
execution unless it either (1) used only sodium pentothal
or another barbiturate or (2) ensured that an anesthesi-
ologist was present to ensure that Morales remained
unconscious throughout the process. Morales v. Hickman,
415 F. Supp. 2d 1037, 1047 (ND Cal. 2006). The Ninth
Circuit affirmed the District Court’s order, Morales v.
Hickman, 438 F. 3d 926, 931 (2006), and the State ar-
ranged for two anesthesiologists to be present for the
execution. However, they subsequently concluded that
“they could not proceed for reasons of medical ethics,”
Morales v. Tilton, 465 F. Supp. 2d 972, 976 (ND Cal.
2006), and neither Morales nor any other prisoner in
California has since been executed, see Denno, The Lethal
Injection Quandary: How Medicine Has Dismantled the
Death Penalty, 76 Ford. L. Rev. 49 (2007).
Objections to features of a lethal injection protocol must
be considered against the backdrop of the ethics rules of
medical professionals and related practical constraints.
Assuming, as previously discussed, that lethal injection is
Cite as: 553 U. S. ____ (2008) 5
ALITO, J., concurring
not unconstitutional per se, it follows that a suggested
modification of a lethal injection protocol cannot be re-
garded as “feasible” or “readily” available if the modifica-
tion would require participation—either in carrying out
the execution or in training those who carry out the execu-
tion—by persons whose professional ethics rules or tradi-
tions impede their participation.
II
In order to show that a modification of a lethal injection
protocol is required by the Eighth Amendment, a prisoner
must demonstrate that the modification would “signifi-
cantly reduce a substantial risk of severe pain.” Ante, at
13 (emphasis added). Showing merely that a modification
would result in some reduction in risk is insufficient.
Moreover, an inmate should be required to do more than
simply offer the testimony of a few experts or a few stud-
ies. Instead, an inmate challenging a method of execution
should point to a well-established scientific consensus.
Only if a State refused to change its method in the face of
such evidence would the State’s conduct be comparable to
circumstances that the Court has previously held to be in
violation of the Eighth Amendment. See Farmer v. Bren-
nan, 511 U. S. 825, 836 (1994).
The present case well illustrates the need for this type
of evidence. Although there has been a proliferation of
litigation challenging current lethal injection protocols,
evidence regarding alleged defects in these protocols and
the supposed advantages of alternatives is strikingly
haphazard and unreliable. As THE CHIEF JUSTICE and
JUSTICE BREYER both note, the much-discussed Lancet
article, Koniaris, Zimmers, Lubarsky, & Sheldon, Inade-
quate Anaesthesia in Lethal Injection for Execution, 365
Lancet 1412 (Apr. 2005), that prompted criticism of the
three-drug protocol has now been questioned, see Groner,
Inadequate Anaesthesia in Lethal Injection for Execution,
6 BAZE v. REES
ALITO, J., concurring
366 Lancet 1073 (Sept. 2005). And the lack of clear guid-
ance in the currently available scientific literature is
dramatically illustrated by the conclusions reached by
petitioners and by JUSTICE STEVENS regarding what they
view as superior alternatives to the three-drug protocol.
Petitioners’ chief argument is that Kentucky’s procedure
violates the Eighth Amendment because it does not em-
ploy a one-drug protocol involving a lethal dose of an
anesthetic. By “relying . . . on a lethal dose of an anes-
thetic,” petitioners contend, Kentucky “would virtually
eliminate the risk of pain.” Brief for Petitioners 51. Peti-
tioners point to expert testimony in the trial court that “a
three-gram dose of thiopental would cause death within
three minutes to fifteen minutes.” Id., at 54, n. 16.
The accuracy of that testimony is not universally ac-
cepted. Indeed, the medical authorities in the Nether-
lands, where assisted suicide is legal, have recommended
against the use of a lethal dose of a barbiturate. An
amicus supporting petitioners, Dr. Robert D. Truog, Pro-
fessor of Medical Ethics and Anesthesiology at Harvard
Medical School, has made the following comments about
the use of a lethal dose of a barbiturate:
“A number of experts have said that 2 or 3 or 5
g[rams] of pentothal is absolutely going to be lethal.
The fact is that, at least in this country, none of us
have any experience with this. . . .
“If we go to Holland, where euthanasia is legal, and
we look at a study from 2000 of 535 cases of euthana-
sia, in 69% of those cases, they used a paralytic agent.
Now, what do they know that we haven’t figured out
yet? I think what they know is that it’s actually very
difficult to kill someone with just a big dose of a barbi-
turate. And, in fact, they report that in 6% of those
cases, there were problems with completion. And in I
think five of those, the person actually woke up, came
Cite as: 553 U. S. ____ (2008) 7
ALITO, J., concurring
back out of coma.” Perspective Roundtable: Physi-
cians and Execution—Highlights from a Discussion of
Lethal Injection, 358 New England J. Med. 448
(2008).
JUSTICE STEVENS does not advocate a one-drug protocol
but argues that “States wishing to decrease the risk that
future litigation will delay executions or invalidate their
protocols would do well to reconsider their continued use
of pancuronium bromide” in the second step of the three-
drug protocol.* Post, at 8 (opinion concurring in judg-
ment). But this very drug, pancuronium bromide, is rec-
ommended by the Royal Dutch Society for the Advance-
ment of Pharmacy as the second of the two drugs to be
used in cases of euthanasia. See Kimsma, Euthanasia and
Euthanizing Drugs in The Netherlands, reprinted in Drug
Use in Assisted Suicide and Euthanasia 193, 200, 204 (M.
Battin & A. Lipman eds. 1996).
My point in citing the Dutch study is not that a multi-
drug protocol is in fact better than a one-drug protocol or
that it is advisable to use pancuronium bromide. Rather,
my point is that public policy on the death penalty, an
issue that stirs deep emotions, cannot be dictated by the
testimony of an expert or two or by judicial findings of fact
based on such testimony.
III
The seemingly endless proceedings that have character-
——————
* In making this recommendation, he states that “[t]here is a general
understanding among veterinarians that the risk of pain is sufficiently
serious that the use of [this] drug should be proscribed when an
animal’s life is being terminated.” Post, at 1-2. But the American
Veterinary Medical Association (AVMA) guidelines take pains to point
out that the Association’s guidelines should not be interpreted as
commenting on the execution of humans by lethal injection. AVMA,
Guidelines on Euthanasia (June 2007), online at http://avma.org/issues/
animal_welfare/euthanasia.pdf.
8 BAZE v. REES
ALITO, J., concurring
ized capital litigation during the years following Gregg are
well documented. In 1989, the Report of the Judicial
Conference’s Ad Hoc Committee on Federal Habeas Cor-
pus in Capital Cases, chaired by Justice Powell, noted the
lengthy delays produced by collateral litigation in death
penalty cases. See Committee Report and Proposal 2–4.
The Antiterrorism and Effective Death Penalty Act of
1996 (AEDPA) was designed to address this problem. See,
e.g., Woodford v. Garceau, 538 U. S. 202, 206 (2003)
(“Congress enacted AEDPA to reduce delays in the execu-
tion of state and federal criminal sentences, particularly in
capital cases . . .” (citing Williams v. Taylor, 529 U. S.
362, 386 (2000) (opinion of STEVENS, J.))); H. R. Rep. No.
104–23, p. 8 (1995) (stating that AEDPA was “designed to
curb the abuse of the habeas corpus process, and particu-
larly to address the problem of delay and repetitive litiga-
tion in capital cases”).
Misinterpretation of the standard set out in the plural-
ity opinion or adoption of the standard favored by the
dissent and JUSTICE BREYER would create a grave danger
of extended delay. The dissenters and JUSTICE BREYER
would hold that the protocol used in carrying out an exe-
cution by lethal injection violates the Eighth Amendment
if it creates an “untoward, readily avoidable risk of inflict-
ing severe and unnecessary pain.” See post, at 11
(GINSBURG, J., dissenting) (emphasis added); post, at 1
(BREYER, J., concurring in judgment). Determining
whether a risk is “untoward,” we are told, requires a
weighing of three factors—the severity of the pain that
may occur, the likelihood of this pain, and the availability
of alternative methods. Post, at 4 (GINSBURG, J., dissent-
ing). We are further informed that “[t]he three factors are
interrelated; a strong showing on one reduces the impor-
tance of others.” Ibid.
An “untoward” risk is presumably a risk that is “unfor-
tunate” or “marked by or causing trouble or unhappiness.”
Cite as: 553 U. S. ____ (2008) 9
ALITO, J., concurring
Webster’s Third New International Dictionary 2513
(1971); Random House Dictionary of the English Lan-
guage 1567 (1967). This vague and malleable standard
would open the gates for a flood of litigation that would go
a long way toward bringing about the end of the death
penalty as a practical matter. While I certainly do not
suggest that this is the intent of the Justices who favor
this test, the likely consequences are predictable.
The issue presented in this case—the constitutionality
of a method of execution—should be kept separate from
the controversial issue of the death penalty itself. If the
Court wishes to reexamine the latter issue, it should do so
directly, as JUSTICE STEVENS now suggests. Post, at 12.
The Court should not produce a de facto ban on capital
punishment by adopting method-of-execution rules that
lead to litigation gridlock.
Cite as: 553 U. S. ____ (2008) 1
STEVENS, J., concurring in judgment
SUPREME COURT OF THE UNITED STATES
_________________
No. 07–5439
_________________
RALPH BAZE AND THOMAS C. BOWLING, PETI-
TIONERS v. JOHN D. REES, COMMISSIONER,
KENTUCKY DEPARTMENT OF
CORRECTIONS, ET AL.
ON WRIT OF CERTIORARI TO THE SUPREME COURT
OF KENTUCKY
[April 16, 2008]
JUSTICE STEVENS, concurring in the judgment.
When we granted certiorari in this case, I assumed that
our decision would bring the debate about lethal injection
as a method of execution to a close. It now seems clear
that it will not. The question whether a similar three-
drug protocol may be used in other States remains open,
and may well be answered differently in a future case on
the basis of a more complete record. Instead of ending the
controversy, I am now convinced that this case will gener-
ate debate not only about the constitutionality of the
three-drug protocol, and specifically about the justification
for the use of the paralytic agent, pancuronium bromide,
but also about the justification for the death penalty itself.
I
Because it masks any outward sign of distress, pan-
curonium bromide creates a risk that the inmate will
suffer excruciating pain before death occurs. There is a
general understanding among veterinarians that the risk
of pain is sufficiently serious that the use of the drug
should be proscribed when an animal’s life is being termi-
2 BAZE v. REES
STEVENS, J., concurring in judgment
nated.1 As a result of this understanding among knowl-
edgeable professionals, several States—including Ken-
tucky—have enacted legislation prohibiting use of the
drug in animal euthanasia. See 2 Ky. Admin. Regs., tit.
201, ch. 16:090, §5(1) (2004).2 It is unseemly—to say the
——————
1 The 2000 Report of the American Veterinary Medical Association
(AVMA) Panel on Euthanasia stated that a “combination of pentobarbi-
tal with a neuromuscular blocking agent is not an acceptable euthana-
sia agent.” 218 J. Am. Veterinary Med. Assn. 669, 680 (2001). In a
2006 supplemental statement, however, the AVMA clarified that this
statement was intended as a recommendation against mixing a barbi-
turate and neuromuscular blocking agent in the same syringe, since
such practice creates the possibility that the paralytic will take effect
before the barbiturate, rendering the animal paralyzed while still
conscious. The 2007 AVMA Guidelines on Euthanasia plainly state
that the application of a barbiturate, paralyzing agent, and potassium
chloride delivered in separate syringes or stages is not discussed in the
report. Several veterinarians, however, have filed an amici brief in this
case arguing that the three-drug cocktail fails to measure up to veteri-
nary standards and that the use of pancuronium bromide should be
prohibited. See Brief for Dr. Kevin Concannon et al. as amici curiae
16–18. The Humane Society has also declared “inhumane” the use of
“any combination of sodium pentobarbital with a neuromuscular
blocking agent.” R. Rhoades, The Humane Society of the United States,
Euthanasia Training Manual 133 (2002); see also Alper, Anesthetizing
the Public Conscience: Lethal Injection and Animal Euthanasia, 35
Fordham Urb. L. J. ___, ___ (forthcoming 2008), online at
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1109258 (all Inter-
net materials as visited Apr. 10, 2008, and available in Clerk of Court’s
case file) (concluding, based on a comprehensive study of animal
euthanasia laws and regulations that “the field of animal euthanasia
has reached a unanimous consensus . . . that neuromuscular blocking
agents like pancuronium have no legitimate place in the execution
process”).
2 See also, e.g., Fla. Stat. §828.058(3) (2006) (“[A]ny substance which
acts as a neuromuscular blocking agent . . . may not be used on a dog or
cat for any purpose”); N. J. Stat. Ann. §4:22–19.3 (West 1998) (“When-
ever any dog, cat, or any other domestic animal is to be destroyed, the
use of succinylcholine chloride, curare, curariform drugs, or any other
substance which acts as a neuromuscular blocking agent is prohib-
ited”); N. Y. Agric. & Mkts. Law Ann. §374(2–b) (West 2004) (“No
Cite as: 553 U. S. ____ (2008) 3
STEVENS, J., concurring in judgment
least—that Kentucky may well kill petitioners using a
drug that it would not permit to be used on their pets.
Use of pancuronium bromide is particularly disturbing
because—as the trial court specifically found in this case—
it serves “no therapeutic purpose.” App. 763. The drug’s
primary use is to prevent involuntary muscle movements,
and its secondary use is to stop respiration. In my view,
neither of these purposes is sufficient to justify the risk
inherent in the use of the drug.
The plurality believes that preventing involuntary
movement is a legitimate justification for using pan-
curonium bromide because “[t]he Commonwealth has an
interest in preserving the dignity of the procedure, espe-
cially where convulsions or seizures could be misperceived
as signs of consciousness or distress.” Ante, at 19. This is
a woefully inadequate justification. Whatever minimal
interest there may be in ensuring that a condemned in-
mate dies a dignified death, and that witnesses to the
execution are not made uncomfortable by an incorrect
belief (which could easily be corrected) that the inmate is
in pain, is vastly outweighed by the risk that the inmate is
actually experiencing excruciating pain that no one can
detect.3 Nor is there any necessity for pancuronium bro-
——————
person shall euthanize any dog or cat with T–61, curare, any curari-
form drug, any neuro-muscular blocking agent or any other paralyzing
drug”); Tenn. Code Ann. §44–17–303(c) (2007) (“Succinylcholine chlo-
ride, curare, curariform mixtures . . . or any substance that acts as a
neuromuscular blocking agent . . . may not be used on any non-livestock
animal for the purpose of euthanasia”). According to a recent study,
not a single State sanctions the use of a paralytic agent in the admini-
stration of animal euthanasia, 9 States explicitly ban the use of such
drugs, 13 others ban it by implication—i.e., by mandating the use of
nonparalytic drugs, 12 arguably ban it by reference to the AVMA
guidelines, and 8 others express a strong preference for use of nonpara-
lytic drugs. Anesthetizing the Public Conscience, supra, at ____, and
App.1.
3 Indeed, the decision by prison administrators to use the drug on
4 BAZE v. REES
STEVENS, J., concurring in judgment
mide to be included in the cocktail to inhibit respiration
when it is immediately followed by potassium chloride,
which causes death quickly by stopping the inmate’s
heart.
Moreover, there is no nationwide endorsement of the
use of pancuronium bromide that merits any special pre-
sumption of respect. While state legislatures have ap-
proved lethal injection as a humane method of execution,
the majority have not enacted legislation specifically
approving the use of pancuronium bromide, or any given
combination of drugs.4 And when the Colorado Legisla-
——————
humans for aesthetic reasons is not supported by any consensus of
medical professionals. To the contrary, the medical community has
considered—and rejected—this aesthetic rationale for administering
neuromuscular blocking agents in end-of-life care for terminally ill
patients whose families may be disturbed by involuntary movements
that are misperceived as signs of pain or discomfort. As explained in an
amici curiae brief submitted by critical care providers and clinical
ethicists, the medical and medical ethics communities have rejected
this rationale because there is a danger that such drugs will mask signs
that the patient is actually in pain. See Brief for Critical Care Provid-
ers et al. as amici curiae.
4 Of the 35 state statutes providing for execution by lethal injection,
only approximately one-third specifically approve the use of a chemical
paralytic agent. See Ark. Code Ann. §5–4–617 (2006); Idaho Code §19–
2716 (Lexis 2004); Ill. Comp. Stat., ch. 725, §5/119–5 (West 2006); Md.
Crim. Law Code Ann. §2–303 (Lexis Supp. 2007); Miss. Code Ann. §99–
19–51 (2007); Mont. Code Ann. §46–19–103 (2007); N. H. Rev. Stat.
Ann. §630:5 (2007); N. M. Stat. Ann. §31–14–11 (2000); N. C. Gen. Stat.
Ann. §15–187 (Lexis 2007); Okla. Stat., Tit. 22, §1014 (West 2001); Ore.
Rev. Stat. §137.473 (2003); Pa. Stat. Ann., Tit. 61, §3004 (Purdon 1999);
Wyo. Stat. Ann. §7–13–904 (2007). Twenty of the remaining States do
not specify any particular drugs. See Ariz. Rev. Stat. Ann. §13–704
(West 2001); Cal. Penal Code Ann. §3604 (West 2000); Conn. Gen. Stat.
§54–100 (2007); Del. Code Ann., Tit. 11, §4209 (2006 Supp.); Fla. Stat.
§922.105 (2006); Ga. Code Ann. §17–10–38 (2004); Ind. Code §35–38–6–
1 (West 2004); Kan. Stat. Ann. §22–4001 (2006 Cum. Supp.); Ky. Rev.
Stat. Ann. §431.220 (West 2006); La. Stat. Ann. §15:569 (West 2005);
Mo. Rev. Stat. §546.720 (2007 Cum. Supp.); Nev. Rev. Stat. §176.355
(2007); Ohio Rev. Code Ann. §2949.22 (Lexis 2006); S. C. Code Ann.
Cite as: 553 U. S. ____ (2008) 5
STEVENS, J., concurring in judgment
ture focused on the issue, it specified a one-drug protocol
consisting solely of sodium thiopental. See Colo. Rev. Stat.
Ann. §18–1.3–1202 (2007).5 In the majority of States that
use the three-drug protocol, the drugs were selected by
unelected Department of Correction officials with no spe-
cialized medical knowledge and without the benefit of
expert assistance or guidance. As such, their drug selec-
tions are not entitled to the kind of deference afforded
legislative decisions.
Nor should the failure of other state legislatures, or of
Congress, to outlaw the use of the drug on condemned
prisoners be viewed as a nationwide endorsement of an
unnecessarily dangerous practice. Even in those States
where the legislature specifically approved the use of a
paralytic agent, review of the decisions that led to the
adoption of the three-drug protocol has persuaded me that
they are the product of “ ‘administrative convenience’ ” and
a “stereotyped reaction” to an issue, rather than a careful
analysis of relevant considerations favoring or disfavoring
a conclusion. See Mathews v. Lucas, 427 U. S. 495, 519,
520–521 (1976) (STEVENS, J., dissenting). Indeed, the trial
court found that “the various States simply fell in line”
behind Oklahoma, adopting the protocol without any
critical analysis of whether it was the best available alter-
——————
§24–3–530 (2007); S. D. Codified Laws §23A–27A–32 (Supp. 2007);
Tenn. Code Ann. §40–23–114 (2006); Tex. Code Crim. Proc. Ann., Art.
43.14 (Vernon 2006 Supp. Pamphlet); Utah Code Ann. §77–18–5.5
(Lexis Supp. 2007); Va. Code Ann. §53.1–234 (Lexis Supp. 2007); Wash.
Rev. Code §10.95.180 (2006).
5 Colorado’s statute provides for “a continuous intravenous injection
of a lethal quantity of sodium thiopental or other equally or more
effective substance sufficient to cause death.” §18–1.3–1202. Despite
the fact that the statute specifies only sodium thiopental, it appears
that Colorado uses the same three drugs as other States. See Denno,
The Lethal Injection Quandary: How Medicine Has Dismantled the
Death Penalty, 76 Ford. L. Rev. 49, 97, and n. 322 (2007).
6 BAZE v. REES
STEVENS, J., concurring in judgment
native.6 App. 756; see also post, at 5 (GINSBURG, J.,
dissenting).
New Jersey’s experience with the creation of a lethal
injection protocol is illustrative. When New Jersey re-
stored the death penalty in 1983, its legislature “fell in
line” and enacted a statute that called for inmates to be
executed by “continuous, intravenous administration until
the person is dead of a lethal quantity of an ultrashort-
acting barbiturate in combination with a chemical para-
lytic agent in a quantity sufficient to cause death.” N. J.
Stat. Ann. §2C:49–2 (West 2005). New Jersey Department
of Corrections (DOC) officials, including doctors and ad-
ministrators, immediately expressed concern. The Capital
Sentencing Unit’s chief doctor, for example, warned the
Assistant Commissioner that he had “ ‘concerns . . . in
regard to the chemical substance classes from which the
lethal substances may be selected.’ ” Edwards, New Jer-
sey’s Long Waltz With Death, 170 N. J. L. J. 657, 673
(2002).7 Based on these concerns, the former DOC Com-
missioner lobbied the legislature to amend the lethal
injection statute to provide DOC with discretion to select
more humane drugs: “ ‘[We wanted] a generic statement,
like “drugs to be determined and identified by the commis-
——————
6 Notably, the Oklahoma medical examiner who devised the protocol
has disavowed the use of pancuronium bromide. When asked in a
recent interview why he included it in his formula, he responded: “ ‘It’s
a good question. If I were doing it now, I would probably eliminate it.’ ”
E. Cohen, Lethal injection creator: Maybe it’s time to change
the formula, http://www.cnn.com/2007/HEALTH/04/30/lethal.injection/
index.html.
7 Officials of the DOC had before them an advisory paper submitted
by a group of New York doctors recommending sodium thiopental
“ ‘without the addition of other drugs,’ ” and the supervisor of the
Health Services Unit was informed in a memo from a colleague that
pancuronium bromide “ ‘will cause paralysis of the vocal chords and
stop breathing, and hence could cause death by asphyxiation.’ ” Ed-
wards, 170 N. J. L. J., at 673.
Cite as: 553 U. S. ____ (2008) 7
STEVENS, J., concurring in judgment
sioner, or the attorney general, or the Department of
Health” ’. . . . ‘Who knew what the future was going to
bring?’ ” Ibid. And these concerns likely motivated the
DOC’s decision to adopt a protocol that omitted pan-
curonium bromide—despite the legislature’s failure to act
on the proposed amendment. See Denno, When Legisla-
tures Delegate Death: The Troubling Paradox Behind
State Uses of Electrocution and Lethal Injection and What
It Says About Us, 63 Ohio St. L. J. 63, 117–118, 233 (2002)
(explaining that the New Jersey protocol in effect in 2002
called for use of a two-drug cocktail consisting of sodium
thiopental and potassium chloride).
Indeed, DOC officials seemed to harbor the same con-
cerns when they undertook to revise New Jersey’s lethal
injection protocol in 2005. At a public hearing on the
proposed amendment, the DOC Supervisor of Legal and
Legislative Affairs told attendees that the drugs to be used
in the lethal injection protocol were undetermined:
“Those substances have not been determined at this
point because when and if an execution is scheduled
the [DOC] will be doing research and determining the
state-of-the-art drugs at that point in time . . . . We
have not made a decision on which specific drugs be-
cause we will have several months once we know that
somebody is going to be executed and it will give us
the opportunity at that point to decide which would be
the most humane.
“And things change. We understand that the state-
of-the-art is changing daily so to say we are going to
use something today when something may be more
humane becomes known later wouldn’t make sense for
us.” Tr. of Public Hearing on Proposed Amendments
to the New Jersey Lethal Injection Protocol 36 (Feb. 4,
2005).
It is striking that when this state agency—with some
8 BAZE v. REES
STEVENS, J., concurring in judgment
specialized medical knowledge and with the benefit of
some expert assistance and guidance—focused on the
issue, it disagreed with the legislature’s “stereotyped
reaction,” Mathews, 427 U. S., at 520, 521 (STEVENS, J.,
dissenting), and specified a two-drug protocol that omitted
pancuronium bromide.8
In my view, therefore, States wishing to decrease the
risk that future litigation will delay executions or invali-
date their protocols would do well to reconsider their
continued use of pancuronium bromide.9
II
The thoughtful opinions written by THE CHIEF JUSTICE
and by JUSTICE GINSBURG have persuaded me that cur-
rent decisions by state legislatures, by the Congress of the
United States, and by this Court to retain the death pen-
alty as a part of our law are the product of habit and
inattention rather than an acceptable deliberative process
that weighs the costs and risks of administering that
penalty against its identifiable benefits, and rest in part
on a faulty assumption about the retributive force of the
death penalty.
——————
8 Further, concerns about this issue may have played a role in New
Jersey’s subsequent decisions to create a New Jersey Death Penalty
Study Commission in 2006, and ultimately to abolish the death penalty
in 2007.
9 For similar reasons, States may also be well advised to reconsider
the sufficiency of their procedures for checking the inmate’s conscious-
ness. See, post, at 5–10 (GINSBURG, J., dissenting).
JUSTICE ALITO correctly points out that the Royal Dutch Society for
the Advancement of Pharmacy recommends pancuronium bromide “as
the second of the two drugs to be used in cases of euthanasia.” Ante, at
7 (concurring opinion). In the Netherlands, however, physicians with
training in anesthesiology are involved in assisted suicide. For reasons
JUSTICE ALITO details, see ante, at 2–4, physicians have no similar role
in American executions. When trained medical personnel administer
anesthesia and monitor the individual’s anesthetic depth, the serious
risks that concern me are not presented.
Cite as: 553 U. S. ____ (2008) 9
STEVENS, J., concurring in judgment
In Gregg v. Georgia, 428 U. S. 153 (1976), we explained
that unless a criminal sanction serves a legitimate pe-
nological function, it constitutes “gratuitous infliction of
suffering” in violation of the Eighth Amendment. We then
identified three societal purposes for death as a sanction:
incapacitation, deterrence, and retribution. See id., at
183, and n. 28 (joint opinion of Stewart, Powell, and
STEVENS, JJ.). In the past three decades, however, each of
these rationales has been called into question.
While incapacitation may have been a legitimate ra-
tionale in 1976, the recent rise in statutes providing for
life imprisonment without the possibility of parole demon-
strates that incapacitation is neither a necessary nor a
sufficient justification for the death penalty.10 Moreover, a
recent poll indicates that support for the death penalty
drops significantly when life without the possibility of
parole is presented as an alternative option.11 And the
available sociological evidence suggests that juries are less
likely to impose the death penalty when life without pa-
role is available as a sentence.12
——————
10 Forty-eight States now have some form of life imprisonment with-
out parole, with the majority of statutes enacted within the last two
decades. See Note, A Matter of Life and Death: The Effect of Life-
Without-Parole Statutes on Capital Punishment, 119 Harv. L. Rev.
1838, 1839, 1841–1844 (2006).
11 See R. Dieter, Sentencing For Life: Americans Embrace Alterna-
tives to the Death Penalty (Apr. 1993), http://www.deathpenaltyinfo.
org/article.php?scid=45&did=481.
12 In one study, potential capital jurors in Virginia stated that know-
ing about the existence of statutes providing for life without the possi-
bility of parole would significantly influence their sentencing decision.
In another study, a significant majority of potential capital jurors in
Georgia said they would be more likely to select a life sentence over a
death sentence if they knew that the defendant would be ineligible for
parole for at least 25 years. See Note, 119 Harv. L. Rev., at 1845.
Indeed, this insight drove our decision in Simmons v. South Carolina,
512 U. S. 154 (1994), that capital defendants have a due process right
to require that their sentencing juries be informed of their ineligibility
10 BAZE v. REES
STEVENS, J., concurring in judgment
The legitimacy of deterrence as an acceptable justifica-
tion for the death penalty is also questionable, at best.
Despite 30 years of empirical research in the area, there
remains no reliable statistical evidence that capital pun-
ishment in fact deters potential offenders.13 In the ab-
sence of such evidence, deterrence cannot serve as a suffi-
cient penological justification for this uniquely severe and
irrevocable punishment.
We are left, then, with retribution as the primary ra-
tionale for imposing the death penalty. And indeed, it is
the retribution rationale that animates much of the re-
maining enthusiasm for the death penalty.14 As Lord
Justice Denning argued in 1950, “ ‘some crimes are so
outrageous that society insists on adequate punishment,
because the wrong-doer deserves it, irrespective of
whether it is a deterrent or not.’ ” See Gregg, 428 U. S., at
184, n. 30. Our Eighth Amendment jurisprudence has
narrowed the class of offenders eligible for the death pen-
——————
for parole.
13 Admittedly, there has been a recent surge in scholarship asserting
the deterrent effect of the death penalty, see, e.g., Mocan & Gittings,
Getting Off Death Row: Commuted Sentences and the Deterrent Effect
of Capital Punishment, 46 J. Law & Econ. 453 (2003); Adler & Sum-
mers, Capital Punishment Works, Wall Street Journal, Nov. 2, 2007,
p. A13, but there has been an equal, if not greater, amount of scholar-
ship criticizing the methodologies of those studies and questioning the
results, see, e.g., Fagan, Death and Deterrence Redux: Science, Law
and Causal Reasoning on Capital Punishment, 4 Ohio St. J. Crim. L.
255 (2006); Donohue & Wolfers, Uses and Abuses of Empirical Evidence
in the Death Penalty Debate, 58 Stan. L. Rev. 791 (2005).
14 Retribution is the most common basis of support for the death pen-
alty. A recent study found that 37% of death penalty supporters cited
“an eye for an eye/they took a life/fits the crime” as their reason for
supporting capital punishment. Another 13% cited “They deserve it.”
The next most common reasons—“sav[ing] taxpayers money/cost
associated with prison” and deterrence—were each cited by 11% of
supporters. See Dept. of Justice, Bureau of Justice Statistics, Source-
book of Criminal Justice Statistics 147 (2003) (Table 2.55), online at
http://www.albany.edu/sourcebook/pdf/t255.pdf.
Cite as: 553 U. S. ____ (2008) 11
STEVENS, J., concurring in judgment
alty to include only those who have committed outrageous
crimes defined by specific aggravating factors. It is the
cruel treatment of victims that provides the most persua-
sive arguments for prosecutors seeking the death penalty.
A natural response to such heinous crimes is a thirst for
vengeance.15
At the same time, however, as the thoughtful opinions
by THE CHIEF JUSTICE and JUSTICE GINSBURG make
pellucidly clear, our society has moved away from public
and painful retribution towards ever more humane forms
of punishment. State-sanctioned killing is therefore be-
coming more and more anachronistic. In an attempt to
bring executions in line with our evolving standards of
decency, we have adopted increasingly less painful meth-
ods of execution, and then declared previous methods
barbaric and archaic. But by requiring that an execution
be relatively painless, we necessarily protect the inmate
from enduring any punishment that is comparable to the
suffering inflicted on his victim.16 This trend, while ap-
propriate and required by the Eighth Amendment’s prohi-
bition on cruel and unusual punishment, actually under-
——————
15 For example, family members of victims of the Oklahoma City
bombing called for the Government to “ ‘put [Timothy McVeigh] inside a
bomb and blow it up.’ ” Walsh, One Arraigned, Two Undergo Question-
ing, Washington Post, Apr. 22, 1995, pp. A1, A13. Commentators at the
time noted that an overwhelming percentage of Americans felt that
executing McVeigh was not enough. Linder, A Political Verdict:
McVeigh: When Death Is Not Enough, L. A. Times, June 8, 1997, p. M1.
16 For example, one survivor of the Oklahoma City bombing expressed
a belief that “ ‘death by [lethal] injection [was] “too good” for McVeigh.’ ”
A. Sarat, When the State kills: Capital Punishment and the American
Condition 64 (2001). Similarly, one mother, when told that her child’s
killer would die by lethal injection, asked: “Do they feel anything? Do
they hurt? Is there any pain? Very humane compared to what they’ve
done to our children. The torture they’ve put our kids through. I think
sometimes it’s too easy. They ought to feel something. If it’s fire
burning all the way through their body or whatever. There ought to be
some little sense of pain to it.” Id., at 60 (emphasis deleted).
12 BAZE v. REES
STEVENS, J., concurring in judgment
mines the very premise on which public approval of the
retribution rationale is based. See, e.g., Kaufman-Osborn,
Regulating Death: Capital Punishment and the Late
Liberal State, 111 Yale L. J. 681, 704 (2001) (explaining
that there is “a tension between our desire to realize the
claims of retribution by killing those who kill, and . . . a
method [of execution] that, because it seems to do no harm
other than killing, cannot satisfy the intuitive sense of
equivalence that informs this conception of justice”); A.
Sarat, When the State Kills: Capital Punishment and the
American Condition 60–84 (2001).
Full recognition of the diminishing force of the principal
rationales for retaining the death penalty should lead this
Court and legislatures to reexamine the question recently
posed by Professor Salinas, a former Texas prosecutor and
judge: “Is it time to Kill the Death Penalty?” See Salinas,
34 Am. J. Crim. L. 39 (2006). The time for a dispassion-
ate, impartial comparison of the enormous costs that
death penalty litigation imposes on society with the bene-
fits that it produces has surely arrived.17
——————
17 For a discussion of the financial costs as well as some of the less
tangible costs of the death penalty, see Kozinski & Gallagher, Death:
The Ultimate Run-On Sentence, 46 Case W. Res. L. Rev. 1 (1995)
(discussing, inter alia, the burden on the courts and the lack of finality
for victim’s families). Although a lack of finality in death cases may
seem counterintuitive, Kozinski and Gallagher explain:
“Death cases raise many more issues, and far more complex issues,
than other criminal cases, and they are attacked with more gusto and
reviewed with more vigor in the courts. This means there is a strong
possibility that the conviction or sentence will be reconsidered—
seriously reconsidered—five, ten, twenty years after the trial. . . . One
has to wonder and worry about the effect this has on the families of the
victims, who have to live with the possibility—and often the reality—of
retrials, evidentiary hearings, and last-minute stays of execution for
decades after the crime.” Id., at 17–18 (footnotes omitted).
Thus, they conclude that “we are left in limbo, with machinery that is
immensely expensive, that chokes our legal institutions so they are
impeded from doing all the other things a society expects from its
Cite as: 553 U. S. ____ (2008) 13
STEVENS, J., concurring in judgment
III
“[A] penalty may be cruel and unusual because it is
excessive and serves no valid legislative purpose.”
Furman v. Georgia, 408 U. S. 238, 331 (1972) (Marshall,
J., concurring); see also id., at 332 (“The entire thrust of
the Eighth Amendment is, in short, against ‘that which is
excessive’ ”). Our cases holding that certain sanctions are
“excessive,” and therefore prohibited by the Eighth
Amendment, have relied heavily on “objective criteria,”
such as legislative enactments. See, e.g., Solem v. Helm,
463 U. S. 277, 292 (1983); Harmelin v. Michigan, 501 U. S.
957 (1991); United States v. Bajakajian, 524 U. S. 321
(1998). In our recent decision in Atkins v. Virginia, 536
U. S. 304 (2002), holding that death is an excessive sanc-
tion for a mentally retarded defendant, we also relied
heavily on opinions written by Justice White holding that
the death penalty is an excessive punishment for the
crime of raping a 16-year-old woman, Coker v. Georgia,
——————
courts, [and] that visits repeated trauma on victims’ families . . . .” Id.,
at 27–28; see also Block, A Slow Death, N. Y. Times, Mar. 15, 2007,
p. A27 (discussing the “enormous costs and burdens to the judicial
system” resulting from the death penalty).
Some argue that these costs are the consequence of judicial insistence
on unnecessarily elaborate and lengthy appellate procedures. To the
contrary, they result “in large part from the States’ failure to apply
constitutionally sufficient procedures at the time of initial [conviction
or] sentencing.” Knight v. Florida, 528 U. S. 990, 998 (1999) (BREYER,
J., dissenting from denial of certiorari). They may also result from a
general reluctance by States to put large numbers of defendants to
death, even after a sentence of death is imposed. Cf. Tempest, Death
Row Often Means a Long Life; California condemns many murderers,
but few are ever executed, L. A. Times, Mar. 6, 2006, p. B1 (noting that
California death row inmates account for about 20% of the Nation’s
total death row population, but that the State accounts for only 1% of
the Nation’s executions). In any event, they are most certainly not the
fault of judges who do nothing more than ensure compliance with
constitutional guarantees prior to imposing the irrevocable punishment
of death.
14 BAZE v. REES
STEVENS, J., concurring in judgment
433 U. S. 584 (1977), and for a murderer who did not
intend to kill, Enmund v. Florida, 458 U. S. 782 (1982). In
those opinions we acknowledged that “objective evidence,
though of great importance, did not ‘wholly determine’ the
controversy, ‘for the Constitution contemplates that in the
end our own judgment will be brought to bear on the
question of the acceptability of the death penalty under
the Eighth Amendment.’ ” Atkins, 536 U. S., at 312 (quot-
ing Coker, 433 U. S., at 597 (plurality opinion)).
Justice White was exercising his own judgment in 1972
when he provided the decisive vote in Furman, the case
that led to a nationwide reexamination of the death pen-
alty. His conclusion that death amounted to “cruel and
unusual punishment in the constitutional sense” as well
as the “dictionary sense,” rested on both an uncontrover-
sial legal premise and on a factual premise that he admit-
tedly could not “prove” on the basis of objective criteria.
408 U. S., at 312, 313 (concurring opinion). As a matter of
law, he correctly stated that the “needless extinction of life
with only marginal contributions to any discernible social
or public purposes . . . would be patently excessive” and
violative of the Eighth Amendment. Id., at 312. As a
matter of fact, he stated, “like my Brethren, I must arrive
at judgment; and I can do no more than state a conclusion
based on 10 years of almost daily exposure to the facts and
circumstances of hundreds and hundreds of federal and
state criminal cases involving crimes for which death is
the authorized penalty.” Id., at 313. I agree with Justice
White that there are occasions when a Member of this
Court has a duty to make judgments on the basis of data
that falls short of absolute proof.
Our decisions in 1976 upholding the constitutionality of
the death penalty relied heavily on our belief that ade-
quate procedures were in place that would avoid the dan-
ger of discriminatory application identified by Justice
Douglas’ opinion in Furman, id., at 240–257 (concurring
Cite as: 553 U. S. ____ (2008) 15
STEVENS, J., concurring in judgment
opinion), of arbitrary application identified by Justice
Stewart, id., at 306 (same), and of excessiveness identified
by Justices Brennan and Marshall. In subsequent years a
number of our decisions relied on the premise that “death
is different” from every other form of punishment to justify
rules minimizing the risk of error in capital cases. See,
e.g., Gardner v. Florida, 430 U. S. 349, 357–358 (1977)
(plurality opinion). Ironically, however, more recent cases
have endorsed procedures that provide less protections to
capital defendants than to ordinary offenders.
Of special concern to me are rules that deprive the
defendant of a trial by jurors representing a fair cross
section of the community. Litigation involving both chal-
lenges for cause and peremptory challenges has persuaded
me that the process of obtaining a “death qualified jury” is
really a procedure that has the purpose and effect of ob-
taining a jury that is biased in favor of conviction. The
prosecutorial concern that death verdicts would rarely be
returned by 12 randomly selected jurors should be viewed
as objective evidence supporting the conclusion that the
penalty is excessive.18
Another serious concern is that the risk of error in
capital cases may be greater than in other cases because
the facts are often so disturbing that the interest in mak-
ing sure the crime does not go unpunished may overcome
residual doubt concerning the identity of the offender.
Our former emphasis on the importance of ensuring that
decisions in death cases be adequately supported by rea-
son rather than emotion, Gardner, 430 U. S. 349, has been
undercut by more recent decisions placing a thumb on the
——————
18 See Uttecht v. Brown, 551 U. S. 1, ___ (2007) (slip op., at 1)
(STEVENS, J., dissenting) (explaining that “[m]illions of Americans
oppose the death penalty,” and that “[a] cross section of virtually every
community in the country includes citizens who firmly believe the
death penalty is unjust but who nevertheless are qualified to serve as
jurors in capital cases”).
16 BAZE v. REES
STEVENS, J., concurring in judgment
prosecutor’s side of the scales. Thus, in Kansas v. Marsh,
548 U. S. 163 (2006), the Court upheld a state statute that
requires imposition of the death penalty when the jury
finds that the aggravating and mitigating factors are in
equipoise. And in Payne v. Tennessee, 501 U. S. 808
(1991), the Court overruled earlier cases and held that
“victim impact” evidence relating to the personal charac-
teristics of the victim and the emotional impact of the
crime on the victim’s family is admissible despite the fact
that it sheds no light on the question of guilt or innocence
or on the moral culpability of the defendant, and thus
serves no purpose other than to encourage jurors to make
life or death decisions on the basis of emotion rather than
reason.
A third significant concern is the risk of discriminatory
application of the death penalty. While that risk has been
dramatically reduced, the Court has allowed it to continue
to play an unacceptable role in capital cases. Thus, in
McCleskey v. Kemp, 481 U. S. 279 (1987), the Court upheld
a death sentence despite the “strong probability that [the
defendant’s] sentencing jury . . . was influenced by the fact
that [he was] black and his victim was white.” Id., at 366
(STEVENS, J., dissenting); see also Evans v. State, 396 Md.
256, 323, 914 A. 2d 25, 64 (2006), cert. denied, 552 U. S.
___ (2007) (affirming a death sentence despite the exis-
tence of a study showing that “the death penalty is statis-
tically more likely to be pursued against a black person
who murders a white victim than against a defendant in
any other racial combination”).
Finally, given the real risk of error in this class of cases,
the irrevocable nature of the consequences is of decisive
importance to me. Whether or not any innocent defen-
dants have actually been executed, abundant evidence
accumulated in recent years has resulted in the exonera-
tion of an unacceptable number of defendants found guilty
of capital offenses. See Garrett, Judging Innocence, 108
Cite as: 553 U. S. ____ (2008) 17
STEVENS, J., concurring in judgment
Colum. L. Rev. 55 (2008); Risinger, Innocents Convicted:
An Empirically Justified Factual Wrongful Conviction
Rate, 97 J. Crim. L. & C. 761 (2007). The risk of executing
innocent defendants can be entirely eliminated by treating
any penalty more severe than life imprisonment without
the possibility of parole as constitutionally excessive.
In sum, just as Justice White ultimately based his con-
clusion in Furman on his extensive exposure to countless
cases for which death is the authorized penalty, I have
relied on my own experience in reaching the conclusion
that the imposition of the death penalty represents “the
pointless and needless extinction of life with only marginal
contributions to any discernible social or public purposes.
A penalty with such negligible returns to the State [is]
patently excessive and cruel and unusual punishment
violative of the Eighth Amendment.” Furman, 408 U. S.,
at 312 (White, J., concurring). 19
IV
The conclusion that I have reached with regard to the
constitutionality of the death penalty itself makes my
——————
19 Not a single Justice in Furman concluded that the mention of dep-
rivation of “life” in the Fifth and Fourteenth Amendments insulated the
death penalty from constitutional challenge. The five Justices who
concurred in the judgment necessarily rejected this argument, and even
the four dissenters, who explicitly acknowledged that the death penalty
was not considered impermissibly cruel at the time of the framing,
proceeded to evaluate whether anything had changed in the interven-
ing 181 years that nevertheless rendered capital punishment unconsti-
tutional. Furman, 408 U. S., at 380–384 (Burger, C.J., joined by
Blackmun, Powell, and Rehnquist, JJ., dissenting); see also id., at 420
(“Nor are ‘cruel and unusual punishments’ and ‘due process of law’
static concepts whose meaning and scope were sealed at the time of
their writing”) (Powell, J., joined by Burger, C.J., and Blackmun and
Rehnquist, JJ., dissenting). And indeed, the guarantees of procedural
fairness contained in the Fifth and Fourteenth Amendments do not
resolve the substantive questions relating to the separate limitations
imposed by the Eighth Amendment.
18 BAZE v. REES
STEVENS, J., concurring in judgment
decision in this case particularly difficult. It does not,
however, justify a refusal to respect precedents that re-
main a part of our law. This Court has held that the
death penalty is constitutional, and has established a
framework for evaluating the constitutionality of particu-
lar methods of execution. Under those precedents,
whether as interpreted by THE CHIEF JUSTICE or JUSTICE
GINSBURG, I am persuaded that the evidence adduced by
petitioners fails to prove that Kentucky’s lethal injection
protocol violates the Eighth Amendment. Accordingly, I
join the Court’s judgment.
Cite as: 553 U. S. ____ (2008) 1
SCALIA, J., concurring in judgment
SUPREME COURT OF THE UNITED STATES
_________________
No. 07–5439
_________________
RALPH BAZE AND THOMAS C. BOWLING, PETI-
TIONERS v. JOHN D. REES, COMMISSIONER,
KENTUCKY DEPARTMENT OF
CORRECTIONS, ET AL.
ON WRIT OF CERTIORARI TO THE SUPREME COURT
OF KENTUCKY
[April 16, 2008]
JUSTICE SCALIA, with whom JUSTICE THOMAS joins, con-
curring in the judgment.
I join the opinion of JUSTICE THOMAS concurring in the
judgment. I write separately to provide what I think is
needed response to JUSTICE STEVENS’ separate opinion.
I
JUSTICE STEVENS concludes as follows: “[T]he imposi-
tion of the death penalty represents the pointless and
needless extinction of life with only marginal contributions
to any discernible social or public purposes. A penalty
with such negligible returns to the State [is] patently
excessive and cruel and unusual punishment violative of
the Eighth Amendment.” Ante, at 17 (opinion concurring
in judgment) (internal quotation marks omitted; second
bracket in original).
This conclusion is insupportable as an interpretation of
the Constitution, which generally leaves it to democrati-
cally elected legislatures rather than courts to decide what
makes significant contribution to social or public purposes.
Besides that more general proposition, the very text of the
document recognizes that the death penalty is a permissi-
ble legislative choice. The Fifth Amendment expressly
2 BAZE v. REES
SCALIA, J., concurring in judgment
requires a presentment or indictment of a grand jury to
hold a person to answer for “a capital, or otherwise infa-
mous crime,” and prohibits deprivation of “life” without
due process of law. U. S. Const., Amdt. 5. The same
Congress that proposed the Eighth Amendment also en-
acted the Act of April 30, 1790, which made several of-
fenses punishable by death. 1 Stat. 112 (1st Cong., 2d
Sess. 1790); see also Gregg v. Georgia, 428 U. S. 153, 176–
178 (1976) (joint opinion of Stewart, Powell, and STEVENS,
JJ.). Writing in 1976, Professor Hugo Bedau—no friend of
the death penalty himself—observed that “[u]ntil fifteen
years ago, save for a few mavericks, no one gave any
credence to the possibility of ending the death penalty by
judicial interpretation of constitutional law.” The Courts,
the Constitution, and Capital Punishment 118 (1977).
There is simply no legal authority for the proposition that
the imposition of death as a criminal penalty is unconsti-
tutional other than the opinions in Furman v. Georgia,
408 U. S. 238 (1972), which established a nationwide
moratorium on capital punishment that JUSTICE STEVENS
had a hand in ending four years later in Gregg.
II
What prompts JUSTICE STEVENS to repudiate his prior
view and to adopt the astounding position that a criminal
sanction expressly mentioned in the Constitution violates
the Constitution? His analysis begins with what he be-
lieves to be the “uncontroversial legal premise” that the
“ ‘extinction of life with only marginal contributions to any
discernible social or public purposes . . . would be patently
excessive’ and violative of the Eighth Amendment.” Ante,
at 14 (quoting in part Furman, supra, at 312 (White, J.,
concurring)); see also ante, at 9 (citing Gregg, supra, at
183, and n. 28). Even if that were uncontroversial in the
abstract (and it is certainly not what occurs to me as the
meaning of “cruel and unusual punishments”), it is assur-
Cite as: 553 U. S. ____ (2008) 3
SCALIA, J., concurring in judgment
edly controversial (indeed, flat-out wrong) as applied to a
mode of punishment that is explicitly sanctioned by the
Constitution. As to that, the people have determined
whether there is adequate contribution to social or public
purposes, and it is no business of unelected judges to set
that judgment aside. But even if we grant JUSTICE
STEVENS his “uncontroversial premise,” his application of
that premise to the current practice of capital punishment
does not meet the “heavy burden [that] rests on those who
would attack the judgment of the representatives of the
people.” Gregg, supra, at 175 (joint opinion of Stewart,
Powell, and STEVENS, JJ.). That is to say, JUSTICE
STEVENS’ policy analysis of the constitutionality of capital
punishment fails on its own terms.
According to JUSTICE STEVENS, the death penalty pro-
motes none of the purposes of criminal punishment be-
cause it neither prevents more crimes than alternative
measures nor serves a retributive purpose. Ante, at 9. He
argues that “the recent rise in statutes providing for life
imprisonment without the possibility of parole” means
that States have a ready alternative to the death penalty.
Ibid. Moreover, “[d]espite 30 years of empirical research
in the area, there remains no reliable statistical evidence
that capital punishment in fact deters potential offenders.”
Ante, at 10. Taking the points together, JUSTICE STEVENS
concludes that the availability of alternatives, and what
he describes as the unavailability of “reliable statistical
evidence,” renders capital punishment unconstitutional.
In his view, the benefits of capital punishment—as com-
pared to other forms of punishment such as life imprison-
ment—are outweighed by the costs.
These conclusions are not supported by the available
data. JUSTICE STEVENS’ analysis barely acknowledges the
“significant body of recent evidence that capital punish-
ment may well have a deterrent effect, possibly a quite
powerful one.” Sunstein & Vermeule, Is Capital Punish-
4 BAZE v. REES
SCALIA, J., concurring in judgment
ment Morally Required? Acts, Omissions, and Life-Life
Tradeoffs, 58 Stan. L. Rev. 703, 706 (2006); see also id., at
706, n. 9 (listing the approximately half a dozen studies
supporting this conclusion). According to a “leading na-
tional study,” “each execution prevents some eighteen
murders, on average.” Id., at 706. “If the current evidence
is even roughly correct . . . then a refusal to impose capital
punishment will effectively condemn numerous innocent
people to death.” Ibid.
Of course, it may well be that the empirical studies
establishing that the death penalty has a powerful deter-
rent effect are incorrect, and some scholars have disputed
its deterrent value. See ante, at 10, n. 13. But that is not
the point. It is simply not our place to choose one set of
responsible empirical studies over another in interpreting
the Constitution. Nor is it our place to demand that state
legislatures support their criminal sanctions with foolproof
empirical studies, rather than commonsense predictions
about human behavior. “The value of capital punishment
as a deterrent of crime is a complex factual issue the
resolution of which properly rests with the legislatures,
which can evaluate the results of statistical studies in
terms of their own local conditions and with a flexibility of
approach that is not available to the courts.” Gregg, su-
pra, at 186 (joint opinion of Stewart, Powell, and STEVENS,
JJ.). Were JUSTICE STEVENS’ current view the constitu-
tional test, even his own preferred criminal sanction—life
imprisonment without the possibility of parole—may fail
constitutional scrutiny, because it is entirely unclear that
enough empirical evidence supports that sanction as
compared to alternatives such as life with the possibility of
parole.
But even if JUSTICE STEVENS’ assertion about the deter-
rent value of the death penalty were correct, the death
penalty would yet be constitutional (as he concedes) if it
served the appropriate purpose of retribution. I would
Cite as: 553 U. S. ____ (2008) 5
SCALIA, J., concurring in judgment
think it difficult indeed to prove that a criminal sanction
fails to serve a retributive purpose—a judgment that
strikes me as inherently subjective and insusceptible of
judicial review. JUSTICE STEVENS, however, concludes
that, because the Eighth Amendment “protect[s] the in-
mate from enduring any punishment that is comparable to
the suffering inflicted on his victim,” capital punishment
serves no retributive purpose at all. Ante, at 11. The
infliction of any pain, according to JUSTICE STEVENS,
violates the Eighth Amendment’s prohibition against cruel
and unusual punishments, but so too does the imposition
of capital punishment without pain because a criminal
penalty lacks a retributive purpose unless it inflicts pain
commensurate with the pain that the criminal has caused.
In other words, if a punishment is not retributive enough,
it is not retributive at all. To state this proposition is to
refute it, as JUSTICE STEVENS once understood. “[T]he
decision that capital punishment may be the appropriate
sanction in extreme cases is an expression of the commu-
nity’s belief that certain crimes are themselves so grievous
an affront to humanity that the only adequate response
may be the penalty of death.” Gregg, 428 U. S., at 184
(joint opinion of Stewart, Powell, and STEVENS, JJ.).
JUSTICE STEVENS’ final refuge in his cost-benefit analy-
sis is a familiar one: There is a risk that an innocent per-
son might be convicted and sentenced to death—though
not a risk that JUSTICE STEVENS can quantify, because he
lacks a single example of a person executed for a crime he
did not commit in the current American system. See ante,
at 15–17. His analysis of this risk is thus a series of
sweeping condemnations that, if taken seriously, would
prevent any punishment under any criminal justice sys-
tem. According to him, “[t]he prosecutorial concern that
death verdicts would rarely be returned by 12 randomly
selected jurors should be viewed as objective evidence
supporting the conclusion that the penalty is excessive.”
6 BAZE v. REES
SCALIA, J., concurring in judgment
Ante, at 15. But prosecutors undoubtedly have a similar
concern that any unanimous conviction would rarely be
returned by 12 randomly selected jurors. That is why
they, like defense counsel, are permitted to use the chal-
lenges for cause and peremptory challenges that JUSTICE
STEVENS finds so troubling, in order to arrive at a jury
that both sides believe will be more likely to do justice in a
particular case. JUSTICE STEVENS’ concern that prosecu-
tors will be inclined to challenge jurors who will not find a
person guilty supports not his conclusion, but the separate
(and equally erroneous) conclusion that peremptory chal-
lenges and challenges for cause are unconstitutional.
According to JUSTICE STEVENS, “the risk of error in capital
cases may be greater than in other cases because the facts
are often so disturbing that the interest in making sure
the crime does not go unpunished may overcome residual
doubt concerning the identity of the offender.” Ibid. That
rationale, however, supports not JUSTICE STEVENS’ con-
clusion that the death penalty is unconstitutional, but the
more sweeping proposition that any conviction in a case in
which facts are disturbing is suspect—including, of course,
convictions resulting in life without parole in those States
that do not have capital punishment. The same is true of
JUSTICE STEVENS’ claim that there is a risk of “discrimina-
tory application of the death penalty.” Ante, at 16. The
same could be said of any criminal penalty, including life
without parole; there is no proof that in this regard the
death penalty is distinctive.
But of all JUSTICE STEVENS’ criticisms of the death
penalty, the hardest to take is his bemoaning of “the
enormous costs that death penalty litigation imposes on
society,” including the “burden on the courts and the lack
of finality for victim’s families.” Ante, at 12, and n. 17.
Those costs, those burdens, and that lack of finality are in
large measure the creation of JUSTICE STEVENS and other
Justices opposed to the death penalty, who have “encum-
Cite as: 553 U. S. ____ (2008) 7
SCALIA, J., concurring in judgment
ber[ed] [it] . . . with unwarranted restrictions neither
contained in the text of the Constitution nor reflected in
two centuries of practice under it”—the product of their
policy views “not shared by the vast majority of the Ameri-
can people.” Kansas v. Marsh, 548 U. S. 163, 186 (2006)
(SCALIA, J., concurring).
III
But actually none of this really matters. As JUSTICE
STEVENS explains, “ ‘objective evidence, though of great
importance, [does] not wholly determine the controversy,
for the Constitution contemplates that in the end our own
judgment will be brought to bear on the question of the
acceptability of the death penalty under the Eighth
Amendment.’ ” Ante, at 14 (quoting Atkins v. Virginia, 536
U. S. 304, 312 (2002); emphasis added; some internal
quotation marks omitted). “I have relied on my own ex-
perience in reaching the conclusion that the imposition of
the death penalty” is unconstitutional. Ante, at 17 (em-
phasis added).
Purer expression cannot be found of the principle of rule
by judicial fiat. In the face of JUSTICE STEVENS’ experi-
ence, the experience of all others is, it appears, of little
consequence. The experience of the state legislatures and
the Congress—who retain the death penalty as a form of
punishment—is dismissed as “the product of habit and
inattention rather than an acceptable deliberative proc-
ess.” Ante, at 8. The experience of social scientists whose
studies indicate that the death penalty deters crime is
relegated to a footnote. Ante, at 10, n. 13. The experience
of fellow citizens who support the death penalty is de-
scribed, with only the most thinly veiled condemnation, as
stemming from a “thirst for vengeance.” Ante, at 11. It is
JUSTICE STEVENS’ experience that reigns over all.
* * *
8 BAZE v. REES
SCALIA, J., concurring in judgment
I take no position on the desirability of the death pen-
alty, except to say that its value is eminently debatable
and the subject of deeply, indeed passionately, held
views—which means, to me, that it is preeminently not a
matter to be resolved here. And especially not when it is
explicitly permitted by the Constitution.
Cite as: 553 U. S. ____ (2008) 1
THOMAS, J., concurring in judgment
SUPREME COURT OF THE UNITED STATES
_________________
No. 07–5439
_________________
RALPH BAZE AND THOMAS C. BOWLING, PETI-
TIONERS v. JOHN D. REES, COMMISSIONER,
KENTUCKY DEPARTMENT OF
CORRECTIONS, ET AL.
ON WRIT OF CERTIORARI TO THE SUPREME COURT
OF KENTUCKY
[April 16, 2008]
JUSTICE THOMAS, with whom JUSTICE SCALIA joins,
concurring in the judgment.
Although I agree that petitioners have failed to estab-
lish that Kentucky’s lethal injection protocol violates the
Eighth Amendment, I write separately because I cannot
subscribe to the plurality opinion’s formulation of the
governing standard. As I understand it, that opinion
would hold that a method of execution violates the Eighth
Amendment if it poses a substantial risk of severe pain
that could be significantly reduced by adopting readily
available alternative procedures. Ante, at 13. This stan-
dard—along with petitioners’ proposed “unnecessary risk”
standard and the dissent’s “untoward risk” standard, post,
at 2—finds no support in the original understanding of the
Cruel and Unusual Punishments Clause or in our previous
method-of-execution cases; casts constitutional doubt on
long-accepted methods of execution; and injects the Court
into matters it has no institutional capacity to resolve.
Because, in my view, a method of execution violates the
Eighth Amendment only if it is deliberately designed to
inflict pain, I concur only in the judgment.
2 BAZE v. REES
THOMAS, J., concurring in judgment
I
The Eighth Amendment’s prohibition on the “in-
flict[ion]” of “cruel and unusual punishments” must be
understood in light of the historical practices that led the
Framers to include it in the Bill of Rights. JUSTICE
STEVENS’ ruminations notwithstanding, see ante, at 8–18
(opinion concurring in judgment), it is clear that the
Eighth Amendment does not prohibit the death penalty.
That is evident both from the ubiquity of the death pen-
alty in the founding era, see S. Banner, The Death Pen-
alty: An American History 23 (2002) (hereinafter Banner)
(noting that, in the late 18th century, the death penalty
was “the standard penalty for all serious crimes”), and
from the Constitution’s express provision for capital pun-
ishment, see, e.g., Amdt. 5 (requiring an indictment or
presentment of a grand jury to hold a person for “a capital,
or otherwise infamous crime,” and prohibiting deprivation
of “life” without due process of law).
That the Constitution permits capital punishment in
principle does not, of course, mean that all methods of
execution are constitutional. In English and early colonial
practice, the death penalty was not a uniform punishment,
but rather a range of punishments, some of which the
Framers likely regarded as cruel and unusual. Death by
hanging was the most common mode of execution both
before and after 1791, and there is no doubt that it re-
mained a permissible punishment after enactment of the
Eighth Amendment. “An ordinary death by hanging was
not, however, the harshest penalty at the disposal of the
seventeenth- and eighteenth-century state.” Banner 70.
In addition to hanging, which was intended to, and often
did, result in a quick and painless death, “[o]fficials also
wielded a set of tools capable of intensifying a death sen-
tence,” that is, “ways of producing a punishment worse
than death.” Id., at 54.
One such “tool” was burning at the stake. Because
Cite as: 553 U. S. ____ (2008) 3
THOMAS, J., concurring in judgment
burning, unlike hanging, was always painful and de-
stroyed the body, it was considered “a form of super-
capital punishment, worse than death itself.” Id., at 71.
Reserved for offenders whose crimes were thought to pose
an especially grave threat to the social order—such as
slaves who killed their masters and women who killed
their husbands—burning a person alive was so dreadful a
punishment that sheriffs sometimes hanged the offender
first “as an act of charity.” Id., at 72.
Other methods of intensifying a death sentence included
“gibbeting,” or hanging the condemned in an iron cage so
that his body would decompose in public view, see id., at
72–74, and “public dissection,” a punishment Blackstone
associated with murder, 4 W. Blackstone, Commentaries
376 (1769) (hereinafter Blackstone). But none of these
was the worst fate a criminal could meet. That was re-
served for the most dangerous and reprobate offenders—
traitors. “The punishment of high treason,” Blackstone
wrote, was “very solemn and terrible,” id., at 92, and
involved “embowelling alive, beheading, and quartering,”
id., at 376. Thus, the following death sentence could be
pronounced on seven men convicted of high treason in
England:
“ ‘That you and each of you, be taken to the place from
whence you came, and from thence be drawn on a
hurdle to the place of execution, where you shall be
hanged by the necks, not till you are dead; that you be
severally taken down, while yet alive, and your bowels
be taken out and burnt before your faces—that your
heads be then cut off, and your bodies cut in four
quarters, to be at the King’s disposal. And God Al-
mighty have mercy on your souls.’ ” G. Scott, History
of Capital Punishment 179 (1950).*
——————
* As gruesome as these methods of execution were, they were not the
4 BAZE v. REES
THOMAS, J., concurring in judgment
The principal object of these aggravated forms of capital
punishment was to terrorize the criminal, and thereby
more effectively deter the crime. Their defining character-
istic was that they were purposely designed to inflict pain
and suffering beyond that necessary to cause death. As
Blackstone put it, “in very atrocious crimes, other circum-
stances of terror, pain, or disgrace [were] superadded.” 4
Blackstone 376. These “superadded” circumstances “were
carefully handed out to apply terror where it was thought
to be most needed,” and were designed “to ensure that
death would be slow and painful, and thus all the more
frightening to contemplate.” Banner 70.
Although the Eighth Amendment was not the subject of
extensive discussion during the debates on the Bill of
Rights, there is good reason to believe that the Framers
viewed such enhancements to the death penalty as falling
within the prohibition of the Cruel and Unusual Punish-
ments Clause. By the late 18th century, the more violent
modes of execution had “dwindled away,” id., at 76, and
would for that reason have been “unusual” in the sense
that they were no longer “regularly or customarily em-
ployed,” Harmelin v. Michigan, 501 U. S. 957, 976 (1991)
(opinion of SCALIA, J.); see also Weems v. United States,
217 U. S. 349, 395 (1910) (White, J., dissenting) (noting
that, “prior to the formation of the Constitution, the neces-
sity for the protection afforded by the cruel and unusual
——————
worst punishments the Framers would have been acquainted with.
After surveying the various “superadd[itions]” to the death penalty in
English law, as well as lesser punishments such as “mutilation or
dismembering, by cutting off the hand or ears” and stigmatizing the
offender “by slitting the nostrils, or branding in the hand or cheek,”
Blackstone was able to congratulate his countrymen on their refine-
ment, in contrast to the barbarism on the Continent: “Disgusting as
this catalogue may seem, it will afford pleasure to an English reader,
and do honor to the English law, to compare it with that shocking
apparatus of death and torment to be met with in the criminal codes of
almost every other nation in Europe.” 4 Blackstone 377.
Cite as: 553 U. S. ____ (2008) 5
THOMAS, J., concurring in judgment
punishment guarantee of the English bill of rights had
ceased to be a matter of concern, because as a rule the
cruel bodily punishments of former times were no longer
imposed”). Embellishments upon the death penalty de-
signed to inflict pain for pain’s sake also would have fallen
comfortably within the ordinary meaning of the word
“cruel.” See 1 S. Johnson, A Dictionary of the English
Language 459 (1773) (defining “cruel” to mean “[p]leased
with hurting others; inhuman; hard-hearted; void of pity;
wanting compassion; savage; barbarous; unrelenting”); 1
N. Webster, An American Dictionary of the English Lan-
guage 52 (1828) (defining “cruel” as “[d]isposed to give
pain to others, in body or mind; willing or pleased to tor-
ment, vex or afflict; inhuman; destitute of pity, compassion
or kindness”).
Moreover, the evidence we do have from the debates on
the Constitution confirms that the Eighth Amendment
was intended to disable Congress from imposing torturous
punishments. It was the absence of such a restriction on
Congress’ power in the Constitution as drafted in Phila-
delphia in 1787 that led one delegate at the Massachusetts
ratifying convention to complain that Congress was “no-
where restrained from inventing the most cruel and un-
heard-of punishments, and annexing them to crimes; and
there is no constitutional check on them, but that racks
and gibbets may be amongst the most mild instruments of
their discipline.” 2 J. Elliot, The Debates in the Several
State Conventions on the Adoption of the Federal Consti-
tution 111 (2d ed. 1891). Similarly, during the ratification
debate in Virginia, Patrick Henry objected to the lack of a
Bill of Rights, in part because there was nothing to pre-
vent Congress from inflicting “tortures, or cruel and bar-
barous punishment[s].” 3 id., at 447–448.
Early commentators on the Constitution likewise inter-
preted the Cruel and Unusual Punishments Clause as
referring to torturous punishments. One commentator
6 BAZE v. REES
THOMAS, J., concurring in judgment
viewed the Eighth Amendment as prohibiting “horrid
modes of torture”:
“The prohibition of cruel and unusual punishments,
marks the improved spirit of the age, which would not
tolerate the use of the rack or the stake, or any of
those horrid modes of torture, devised by human in-
genuity for the gratification of fiendish passion.” J.
Bayard, A Brief Exposition of the Constitution of the
United States 154 (2d ed. 1840).
Similarly, another commentator found “sufficient reasons”
for the Eighth Amendment in the “barbarous and cruel
punishments” inflicted in less enlightened countries:
“Under the [Eighth] amendment the infliction of cruel
and unusual punishments, is also prohibited. The
various barbarous and cruel punishments inflicted
under the laws of some other countries, and which
profess not to be behind the most enlightened nations
on earth in civilization and refinement, furnish suffi-
cient reasons for this express prohibition. Breaking
on the wheel, flaying alive, rending asunder with
horses, various species of horrible tortures inflicted in
the inquisition, maiming, mutilating and scourging to
death, are wholly alien to the spirit of our humane
general constitution.” B. Oliver, The Rights of An
American Citizen 186 (1832) (reprint 1970).
So barbaric were the punishments prohibited by the
Eighth Amendment that Joseph Story thought the provi-
sion “wholly unnecessary in a free government, since it is
scarcely possible, that any department of such a govern-
ment should authorize, or justify such atrocious conduct.”
3 J. Story, Commentaries on the Constitution of the
United States 750 (1833).
II
Consistent with the original understanding of the Cruel
Cite as: 553 U. S. ____ (2008) 7
THOMAS, J., concurring in judgment
and Unusual Punishments Clause, this Court’s cases have
repeatedly taken the view that the Framers intended to
prohibit torturous modes of punishment akin to those that
formed the historical backdrop of the Eighth Amendment.
See, e.g., Estelle v. Gamble, 429 U. S. 97, 102 (1976)
(“[T]he primary concern of the drafters was to proscribe
‘torture[s]’ and other ‘barbar[ous]’ methods of punish-
ment”); Weems, 217 U. S., at 390 (White, J., dissenting)
(“[I]t may not be doubted, and indeed is not questioned by
any one, that the cruel punishments against which the bill
of rights provided were the atrocious, sanguinary and
inhuman punishments which had been inflicted in the
past upon the persons of criminals”). That view has per-
meated our method-of-execution cases. Thrice the Court
has considered a challenge to a modern method of execu-
tion, and thrice it has rejected the challenge, each time
emphasizing that the Eighth Amendment is aimed at
methods of execution purposely designed to inflict pain.
In the first case, Wilkerson v. Utah, 99 U. S. 130 (1879),
the Court rejected the contention that death by firing
squad was cruel and unusual. In so doing, it reviewed the
various modes of execution catalogued by Blackstone,
repeating his observation that “in very atrocious crimes
other circumstances of terror, pain, or disgrace were some-
times superadded.” Id., at 135. The Court found it “safe
to affirm that punishments of torture, such as those men-
tioned by [Blackstone], and all others in the same line of
unnecessary cruelty, are forbidden by [the Eighth
Amendment].” Id., at 136. The unanimous Court had no
difficulty concluding that death by firing squad did not
“fal[l] within that category.” Ibid.
Similarly, when the Court in In re Kemmler, 136 U. S.
436, 446 (1890), unanimously rejected a challenge to
electrocution, it interpreted the Eighth Amendment to
prohibit punishments that “were manifestly cruel and
unusual, as burning at the stake, crucifixion, breaking on
8 BAZE v. REES
THOMAS, J., concurring in judgment
the wheel, or the like”:
“Punishments are cruel when they involve torture or a
lingering death; but the punishment of death is not
cruel, within the meaning of that word as used in the
Constitution. It implies there something inhuman
and barbarous, something more than the mere extin-
guishment of life.” Id., at 447.
Finally, in Louisiana ex rel. Francis v. Resweber, 329
U. S. 459 (1947), the Court rejected the petitioner’s con-
tention that the Eighth Amendment prohibited Louisiana
from subjecting him to a second attempt at electrocution,
the first attempt having failed when “[t]he executioner
threw the switch but, presumably because of some me-
chanical difficulty, death did not result.” Id., at 460 (plu-
rality opinion). Characterizing the abortive attempt as
“an accident, with no suggestion of malevolence,” id., at
463, the plurality opinion concluded that “the fact that
petitioner ha[d] already been subjected to a current of
electricity [did] not make his subsequent execution any
more cruel in the constitutional sense than any other
execution”:
“The cruelty against which the Constitution protects a
convicted man is cruelty inherent in the method of
punishment, not the necessary suffering involved in
any method employed to extinguish life humanely.
The fact that an unforeseeable accident prevented the
prompt consummation of the sentence cannot, it
seems to us, add an element of cruelty to a subsequent
execution. There is no purpose to inflict unnecessary
pain nor any unnecessary pain involved in the pro-
posed execution.” Id., at 464.
III
In light of this consistent understanding of the Cruel
and Unusual Punishments Clause as forbidding purposely
Cite as: 553 U. S. ____ (2008) 9
THOMAS, J., concurring in judgment
torturous punishments, it is not surprising that even an
ardent abolitionist was constrained to acknowledge in
1977 that “[a]n unbroken line of interpreters has held that
it was the original understanding and intent of the fram-
ers of the Eighth Amendment . . . to proscribe as ‘cruel and
unusual’ only such modes of execution as compound the
simple infliction of death with added cruelties or indigni-
ties.” H. Bedau, The Courts, the Constitution, and Capital
Punishment 35. What is surprising is the plurality’s
willingness to discard this unbroken line of authority in
favor of a standard that finds no support in the original
understanding of the Eighth Amendment or in our
method-of-execution cases and that, disclaimers notwith-
standing, “threaten[s] to transform courts into boards of
inquiry charged with determining ‘best practices’ for exe-
cutions, with each ruling supplanted by another round of
litigation touting a new and improved methodology.”
Ante, at 12.
We have never suggested that a method of execution is
“cruel and unusual” within the meaning of the Eighth
Amendment simply because it involves a risk of pain—
whether “substantial,” “unnecessary,” or “untoward”—that
could be reduced by adopting alternative procedures. And
for good reason. It strains credulity to suggest that the
defining characteristic of burning at the stake, disembow-
eling, drawing and quartering, beheading, and the like
was that they involved risks of pain that could be elimi-
nated by using alternative methods of execution. Quite
plainly, what defined these punishments was that they
were designed to inflict torture as a way of enhancing a
death sentence; they were intended to produce a penalty
worse than death, to accomplish something “more than the
mere extinguishment of life.” Kemmler, supra, at 447.
The evil the Eighth Amendment targets is intentional
infliction of gratuitous pain, and that is the standard our
method-of-execution cases have explicitly or implicitly
10 BAZE v. REES
THOMAS, J., concurring in judgment
invoked.
Thus, the Court did not find it necessary in Wilkerson to
conduct a comparative analysis of death by firing squad as
opposed to hanging or some other method of execution.
Nor did the Court inquire into the precise procedures used
to execute an individual by firing squad in order to deter-
mine whether they involved risks of pain that could be
alleviated by adopting different procedures. It was enough
that death by firing squad was well established in military
practice, 99 U. S., at 134–135, and plainly did not fall
within the “same line of unnecessary cruelty” as the pun-
ishments described by Blackstone, id., at 136.
The same was true in Kemmler. One searches the opin-
ion in vain for a comparative analysis of electrocution
versus other methods of execution. The Court observed
that the New York Legislature had adopted electrocution
in order to replace hanging with “ ‘the most humane and
practical method known to modern science of carrying into
effect the sentence of death in capital cases.’ ” 136 U. S., at
444. But there is no suggestion that the Court thought it
necessary to sift through the “voluminous mass of evi-
dence . . . taken [in the courts below] as to the effect of
electricity as an agent of death,” id., at 442, in order to
confirm that electrocution in fact involved less substantial
risks of pain or lingering death than hanging. The court
below had rejected the challenge because the “act was
passed in the effort to devise a more humane method of
reaching the result,” and “courts were bound to presume
that the legislature was possessed of the facts upon which
it took action.” Id., at 447. Treating the lower court’s
decision “as involving an adjudication that the statute was
not repugnant to the Federal Constitution,” ibid., the
Court found that conclusion “so plainly right,” ibid., that it
had “no hesitation” in denying the writ of error, id., at 449.
Likewise in Resweber, the Court was confronted in
dramatic fashion with the reality that the electric chair
Cite as: 553 U. S. ____ (2008) 11
THOMAS, J., concurring in judgment
involved risks of error or malfunction that could result in
excruciating pain. See 329 U. S., at 480, n. 2 (Burton, J.,
dissenting) (quoting affidavits from the petitioner’s brief
recounting that during the unsuccessful first attempt at
electrocution, the petitioner’s “ ‘lips puffed out and his
body squirmed and tensed and he jumped so that the chair
rocked on the floor’ ”). But absent “malevolence” or a
“purpose to inflict unnecessary pain,” the Court concluded
that the Constitution did not prohibit Louisiana from
subjecting the petitioner to those very risks a second time
in order to carry out his death sentence. Id., at 463, 464
(plurality opinion); id., at 471 (Frankfurter, J., concur-
ring); see also Furman v. Georgia, 408 U. S. 238, 326–327
(1972) (Marshall, J., concurring) (describing Resweber as
holding “that the legislature adopted electrocution for a
humane purpose, and that its will should not be thwarted
because, in its desire to reduce pain and suffering in most
cases, it may have inadvertently increased suffering in one
particular case”). No one suggested that Louisiana was
required to implement additional safeguards or alterna-
tive procedures in order to reduce the risk of a second
malfunction. And it was the dissenters in Resweber who
insisted that the absence of an intent to inflict pain was
irrelevant. 329 U. S., at 477 (Burton, J., dissenting) (“The
intent of the executioner cannot lessen the torture or
excuse the result”).
IV
Aside from lacking support in history or precedent, the
various risk-based standards proposed in this case suffer
from other flaws, not the least of which is that they cast
substantial doubt on every method of execution other than
lethal injection. It may well be that other methods of
execution such as hanging, the firing squad, electrocution,
and lethal gas involve risks of pain that could be elimi-
nated by switching to lethal injection. Indeed, they have
12 BAZE v. REES
THOMAS, J., concurring in judgment
been attacked as unconstitutional for that very reason.
See, e.g., Gomez v. United States Dist. Court for Northern
Dist. of Cal., 503 U. S. 653, 654, 656–657 (1992) (STEVENS,
J., dissenting) (arguing that lethal gas violates the Eighth
Amendment because of “the availability of more humane
and less violent methods of execution,” namely, lethal
injection); Glass v. Louisiana, 471 U. S. 1080, 1093 (1985)
(Brennan, J., dissenting from denial of certiorari) (arguing
that electrocution violates the Eighth Amendment because
it poses risks of pain that could be alleviated by “other
currently available means of execution,” such as lethal
injection); Campbell v. Wood, 18 F. 3d 662, 715 (CA9 1994)
(Reinhardt, J., concurring and dissenting) (arguing that
hanging violates the Eighth Amendment because it in-
volves risks of pain and mutilation not presented by lethal
injection). But the notion that the Eighth Amendment
permits only one mode of execution, or that it requires an
anesthetized death, cannot be squared with the history of
the Constitution.
It is not a little ironic—and telling—that lethal injec-
tion, hailed just a few years ago as the humane alternative
in light of which every other method of execution was
deemed an unconstitutional relic of the past, is the subject
of today’s challenge. It appears the Constitution is “evolv-
ing” even faster than I suspected. And it is obvious that,
for some who oppose capital punishment on policy
grounds, the only acceptable end point of the evolution is
for this Court, in an exercise of raw judicial power unsup-
ported by the text or history of the Constitution, or even
by a contemporary moral consensus, to strike down the
death penalty as cruel and unusual in all circumstances.
In the meantime, though, the next best option for those
seeking to abolish the death penalty is to embroil the
States in never-ending litigation concerning the adequacy
of their execution procedures. But far from putting an end
to abusive litigation in this area, and thereby vindicating
Cite as: 553 U. S. ____ (2008) 13
THOMAS, J., concurring in judgment
in some small measure the States’ “significant interest in
meting out a sentence of death in a timely fashion,” Nelson
v. Campbell, 541 U. S. 637, 644 (2004), today’s decision is
sure to engender more litigation. At what point does a
risk become “substantial”? Which alternative procedures
are “feasible” and “readily implemented”? When is a
reduction in risk “significant”? What penological justifica-
tions are “legitimate”? Such are the questions the lower
courts will have to grapple with in the wake of today’s
decision. Needless to say, we have left the States with
nothing resembling a bright-line rule.
Which brings me to yet a further problem with compara-
tive-risk standards: They require courts to resolve medical
and scientific controversies that are largely beyond judi-
cial ken. Little need be said here, other than to refer to
the various opinions filed by my colleagues today. Under
the competing risk standards advanced by the plurality
opinion and the dissent, for example, the difference be-
tween a lethal injection procedure that satisfies the
Eighth Amendment and one that does not may well come
down to one’s judgment with respect to something as
hairsplitting as whether an eyelash stroke is necessary to
ensure that the inmate is unconscious, or whether instead
other measures have already provided sufficient assurance
of unconsciousness. Compare post, at 6 (GINSBURG, J.,
dissenting) (criticizing Kentucky’s protocol because “[n]o
one calls the inmate’s name, shakes him, brushes his
eyelashes to test for a reflex, or applies a noxious stimulus
to gauge his response”), with ante, at 22 (rejecting the
dissent’s criticisms because “an inmate cannot succeed on
an Eighth Amendment claim simply by showing one more
step the State could take as a failsafe for other, independ-
ently adequate measures”). We have neither the authority
nor the expertise to micromanage the States’ administra-
tion of the death penalty in this manner. There is simply
no reason to believe that “unelected” judges without scien-
14 BAZE v. REES
THOMAS, J., concurring in judgment
tific, medical, or penological training are any better suited
to resolve the delicate issues surrounding the administra-
tion of the death penalty than are state administrative
personnel specifically charged with the task. Cf. ante, at 5
(STEVENS, J., concurring in judgment) (criticizing the
States’ use of the three-drug protocol because “[i]n the
majority of States that use the three-drug protocol, the
drugs were selected by unelected Department of Correc-
tion officials with no specialized medical knowledge and
without the benefit of expert assistance or guidance”).
In short, I reject as both unprecedented and unworkable
any standard that would require the courts to weigh the
relative advantages and disadvantages of different meth-
ods of execution or of different procedures for implement-
ing a given method of execution. To the extent that there
is any comparative element to the inquiry, it should be
limited to whether the challenged method inherently
inflicts significantly more pain than traditional modes of
execution such as hanging and the firing squad. See, e.g.,
Gray v. Lucas, 463 U. S. 1237, 1239–1240 (1983) (Burger,
C. J., concurring in denial of certiorari) (rejecting an
Eighth Amendment challenge to lethal gas because the
petitioner had not shown that “ ‘the pain and terror result-
ing from death by cyanide gas is so different in degree or
nature from that resulting from other traditional modes of
execution as to implicate the eighth amendment right’ ”
(quoting Gray v. Lucas, 710 F. 2d 1048, 1061 (CA5 1983)));
Hernandez v. State, 43 Ariz. 424, 441, 32 P. 2d 18, 25
(1934) (“The fact that [lethal gas] is less painful and more
humane than hanging is all that is required to refute
completely the charge that it constitutes cruel and un-
usual punishment within the meaning of this expression
as used in [the Eighth Amendment]”).
V
Judged under the proper standard, this is an easy case.
Cite as: 553 U. S. ____ (2008) 15
THOMAS, J., concurring in judgment
It is undisputed that Kentucky adopted its lethal injection
protocol in an effort to make capital punishment more
humane, not to add elements of terror, pain, or disgrace to
the death penalty. And it is undisputed that, if adminis-
tered properly, Kentucky’s lethal injection protocol will
result in a swift and painless death. As the Sixth Circuit
observed in rejecting a similar challenge to Tennessee’s
lethal injection protocol, we “do not have a situation where
the State has any intent (or anything approaching intent)
to inflict unnecessary pain; the complaint is that the
State’s pain-avoidance procedure may fail because the
executioners may make a mistake in implementing it.”
Workman v. Bredesen, 486 F. 3d 896, 907 (2007). But
“[t]he risk of negligence in implementing a death-penalty
procedure . . . does not establish a cognizable Eighth
Amendment claim.” Id., at 907–908. Because Kentucky’s
lethal injection protocol is designed to eliminate pain
rather than to inflict it, petitioners’ challenge must fail. I
accordingly concur in the Court’s judgment affirming the
decision below.
Cite as: 553 U. S. ____ (2008) 1
BREYER, J., concurring in judgment
SUPREME COURT OF THE UNITED STATES
_________________
No. 07–5439
_________________
RALPH BAZE AND THOMAS C. BOWLING, PETI-
TIONERS v. JOHN D. REES, COMMISSIONER,
KENTUCKY DEPARTMENT OF
CORRECTIONS, ET AL.
ON WRIT OF CERTIORARI TO THE SUPREME COURT
OF KENTUCKY
[April 16, 2008]
JUSTICE BREYER, concurring in the judgment.
Assuming the lawfulness of the death penalty itself,
petitioners argue that Kentucky’s method of execution,
lethal injection, nonetheless constitutes a constitutionally
forbidden, “cruel and usual punishmen[t].” U. S. Const.,
Amdt. 8. In respect to how a court should review such a
claim, I agree with JUSTICE GINSBURG. She highlights the
relevant question, whether the method creates an unto-
ward, readily avoidable risk of inflicting severe and un-
necessary suffering. Post, at 11 (dissenting opinion). I
agree that the relevant factors—the “degree of risk,” the
“magnitude of pain,” and the “availability of alterna-
tives”—are interrelated and each must be considered.
Post, at 4. At the same time, I believe that the legal mer-
its of the kind of claim presented must inevitably turn not
so much upon the wording of an intermediate standard of
review as upon facts and evidence. And I cannot find,
either in the record in this case or in the literature on the
subject, sufficient evidence that Kentucky’s execution
method poses the “significant and unnecessary risk of
inflicting severe pain” that petitioners assert. Brief for
Petitioners 28.
In respect to the literature, I have examined the periodi-
2 BAZE v. REES
BREYER, J., concurring in judgment
cal article that seems first to have brought widespread
legal attention to the claim that lethal injection might
bring about unnecessary suffering. See ante, at 13, n. 2
(plurality opinion); Denno, The Lethal Injection Quandary:
How Medicine Has Dismantled the Death Penalty, 76
Ford. L. Rev. 49, 105, n. 366 (2007) (collecting cases in
which condemned inmates cited the Lancet study). The
article, by Dr. Leonidas G. Koniaris, Teresa A. Zimmers
(of the University of Miami School of Medicine), and oth-
ers, appeared in the April 16, 2005, issue of the Lancet, an
eminent, peer-reviewed medical journal. See Koniaris,
Zimmers, Lubarsky, & Sheldon, Inadequate Anaesthesia
in Lethal Injection for Execution, 365 Lancet 1412 (here-
inafter Lancet Study). The authors examined “autopsy
toxicology results from 49 executions in Arizona, Georgia,
North Carolina, and South Carolina.” Id., at 1412–1413.
The study noted that lethal injection usually consists of
sequential administration of a barbiturate (sodium thio-
pental), followed by injection of a paralyzing agent (pan-
curonium bromide) and a heart-attack-inducing drug
(potassium chloride). The study focused on the effective-
ness of the first drug in anaesthetizing the inmate. See
id., at 1412. It noted that the four States used 2 grams of
thiopental. Id., at 1413. (Kentucky follows a similar
system but currently uses 3 grams of sodium thiopental.
See ante, at 5–6 (plurality opinion)). Although the sodium
thiopental dose (of, say, 2 grams) was several times the
dose used in ordinary surgical operations, the authors
found that the level of barbiturate present in the blood-
stream several hours (or more) after death was lower than
the level one might expect to find during an operation.
Lancet Study 1413–1414. With certain qualifications,
they state that “21 (43%)” of the examined instances “had
[thiopental] concentrations consistent with consciousness,”
id., at 1413,—a fact that should create considerable con-
cern given the related likelihood of unexpressed suffering.
Cite as: 553 U. S. ____ (2008) 3
BREYER, J., concurring in judgment
The authors suggest that, among other things, inadequate
training may help explain the results. Id., at 1414.
The Lancet Study, however, may be seriously flawed. In
its September 24, 2005, issue, the Lancet published three
responses. The first, by one of the initial referees, Jona-
than I. Groner of Children’s Hospital, Columbus, Ohio,
claimed that a low level of thiopental in the bloodstream
does not necessarily mean that an inadequate dose was
given, for, under circumstances likely common to lethal
injections, thiopental can simply diffuse from the blood-
stream into surrounding tissues. See Inadequate Anaes-
thesia in Lethal Injection for Execution, 366 Lancet 1073.
And a long pause between death and measurement means
that this kind of diffusion likely occurred. See ibid. For
this reason and others, Groner, who said he had initially
“expressed strong support for the article,” had become
“concerned” that its key finding “may be erroneous be-
cause of lack of equipoise in the study.” Ibid.
The second correspondents, Mark J. S. Heath (petition-
ers’ expert in their trial below), Donald R. Stanski, and
Derrick J. Pounder, respectively of the Department of
Anesthesiology, Columbia University, of Stanford Univer-
sity School of Medicine, and the University of Dundee,
United Kingdom, concluded that “Koniaris and colleagues
do not present scientifically convincing data to justify their
conclusion that so large a proportion of inmates have
experienced awareness during lethal injection.” Ibid.
These researchers noted that because the blood samples
were taken “several hours to days after” the inmates’
deaths, the postmortem concentrations of thiopental—a
lipophilic drug that diffuses from blood into tissue—could
not be relied on as accurate indicators for concentrations
in the blood stream during life. Ibid. See also ante, at 12–
13, n. 2 (plurality opinion).
The third correspondents, Robyn S. Weisman, Jeffrey N.
Bernstein, and Richard S. Weisman, of the University of
4 BAZE v. REES
BREYER, J., concurring in judgment
Miami, School of Medicine, and Florida Poison Informa-
tion Center, said that “[p]ost-mortem drug concentrations
are extremely difficult to interpret and there is substantial
variability in results depending on timing, anatomical
origin of the specimen, and physical and chemical proper-
ties of the drug.” 366 Lancet, at 1074. They believed that
the original finding “requires further assessment.” Ibid.
The authors of the original study replied, defending the
accuracy of their findings. See id., at 1074–1076. Yet,
neither the petition for certiorari nor any of the briefs filed
in this Court (including seven amici curiae briefs support-
ing the petitioners) make any mention of the Lancet
Study, which was published during petitioners’ trial. In
light of that fact, and the responses to the original study, a
judge, nonexpert in these matters, cannot give the Lancet
Study significant weight.
The literature also contains a detailed article on the
subject, which appeared in 2002 in the Ohio State Law
Journal. The author, Professor Deborah W. Denno, exam-
ined executions by lethal injection in the 36 States where
thiopental is used. See When Legislatures Delegate
Death: The Troubling Paradox Behind State Uses of Elec-
trocution and Lethal Injection and What It Says About Us,
63 Ohio St. L. J. 63. In Table 9, the author lists 31
“Botched Lethal Injection Executions” in the time from our
decision in Gregg v. Georgia, 429 U. S. 1301 (1976),
through 2001. See Denno, 63 Ohio St. L. J., at 139–141.
Of these, 19 involved a problem of locating a suitable vein
to administer the chemicals. Ibid. Eleven of the remain-
ing 12 apparently involved strong, readily apparent physi-
cal reactions. Ibid. One, taking place in Illinois in 1990,
is described as involving “some indication that, while
appearing calm on the outside due to the paralyzing
drugs, [the inmate] suffered excruciating pain.” Id., at
139. The author adds that “[t]here were reports of faulty
equipment and inexperienced personnel.” Ibid. This
Cite as: 553 U. S. ____ (2008) 5
BREYER, J., concurring in judgment
article, about which Professor Denno testified at petition-
ers’ trial and on which petitioners rely in this Court, may
well provide cause for concern about the administration of
the lethal injection. But it cannot materially aid the
petitioners here. That is because, as far as the record here
reveals, and as the Kentucky courts found, Kentucky’s use
of trained phlebotomists and the presence of observers
should prevent the kind of “botched” executions that
Denno’s Table 9 documents.
The literature also casts a shadow of uncertainty upon
the ready availability of some of the alternatives to lethal
execution methods. Petitioners argued to the trial court,
for example, that Kentucky should eliminate the use of a
paralytic agent, such as pancuronium bromide, which
could, by preventing any outcry, mask suffering an inmate
might be experiencing because of inadequate administra-
tion of the anesthetic. See Brief for Petitioners 51–57;
Reply Brief for Petitioners 18, and n. 6. And they point
out that use of pancuronium bromide to euthanize animals
is contrary to veterinary standards. See id., at 20 (citing
Brief for Dr. Kevin Concannon et al. as Amici Curiae 17–
18). See also the Concannon Brief 4, 18, n. 5 (noting that
Kentucky, like 22 other States, prohibits the use of neu-
romuscular blocking agents in euthanizing animals). In
the Netherlands, however, the use of pancuronium bro-
mide is recommended for purposes of lawful assisted
suicide. See ante, at 19–20 (plurality opinion) (discussing
the Royal Dutch Society for the Advancement of Pharmacy
recommendation of the use of a muscle relaxant such as
pancuronium in addition to thiopental). See also Kimsma,
Euthanasia and Euthanizing Drugs in The Netherlands,
reprinted in Drug Use in Assisted Suicide and Euthanasia
193, 199–202 (M. Battin & A. Lipman eds. 1996) (discuss-
ing use of neuromuscular relaxants). Why, one might ask,
if the use of pancuronium bromide is undesirable, would
those in the Netherlands, interested in practices designed
6 BAZE v. REES
BREYER, J., concurring in judgment
to bring about a humane death, recommend the use of
that, or similar, drugs? Petitioners pointed out that in the
Netherlands, physicians trained in anesthesiology are
involved in assisted suicide, while that is not the case in
Kentucky. See Tr. of Oral Arg. 55. While important, that
difference does not resolve the apparently conflicting
views about the inherent propriety or impropriety of use of
this drug to extinguish human life humanely.
Similarly, petitioners argue for better trained personnel.
But it is clear that both the American Medical Association
(AMA) and the American Nursing Association (ANA) have
rules of ethics that strongly oppose their members’ par-
ticipation in executions. See Brief for American Society
of Anesthesiologists as Amicus Curiae 2–3 (citing
AMA, Code of Medical Ethics, Policy E–2.06 Capital
Punishment (2000), online at http://www.ama-assn.org/
ama1/pub/upload/mm/369/e206capitalpunish.pdf (all In-
ternet materials as visited Apr. 10, 2008, and available
in Clerk of Court’s case file)); ANA, Position State-
ment: Nurses’ Participation in Capital Punishment
(1994), http://nursingworld.org/MainMenuCategories/
HealthcareandPolicyIssues/ANAPositionStatements/
EthicsandHumanRights.aspx (noting that nurses’ par-
ticipation in executions “is viewed as contrary to the fun-
damental goals and ethical traditions of the profession”).
Cf. Ky. Rev. Stat. Ann. §431.220(3) (West 2006) (Kentucky
prohibiting a physician from participating in the “conduct
of an execution,” except to certify the cause of death). And
these facts suggest that finding better trained personnel
may be more difficult than might, at first blush, appear.
Nor can I find in the record in this case any stronger
evidence in petitioners’ favor than the literature itself
provides of an untoward, readily avoidable risk of severe
pain. Indeed, JUSTICE GINSBURG has accepted what I
believe is petitioners’ strongest claim, namely, Kentucky
Cite as: 553 U. S. ____ (2008) 7
BREYER, J., concurring in judgment
should require more thorough testing as to unconscious-
ness. See post, at 5–11. In respect to this matter, how-
ever, I must agree with the plurality and JUSTICE
STEVENS. The record provides too little reason to believe
that such measures, if adopted in Kentucky, would make a
significant difference.
The upshot is that I cannot find, either in the record or
in the readily available literature that I have seen, suffi-
cient grounds to believe that Kentucky’s method of lethal
injection creates a significant risk of unnecessary suffer-
ing. The death penalty itself, of course, brings with it
serious risks, for example, risks of executing the wrong
person, see, e.g., ante, at 16–17 (STEVENS, J., concurring in
judgment), risks that unwarranted animus (in respect,
e.g., to the race of victims), may play a role, see, e.g., ante,
at 16, risks that those convicted will find themselves on
death row for many years, perhaps decades, to come, see
Smith v. Arizona, 552 U. S. ___ (2007) (BREYER, J., dis-
senting from denial of certiorari). These risks in part
explain why that penalty is so controversial. But the
lawfulness of the death penalty is not before us. And
petitioners’ proof and evidence, while giving rise to legiti-
mate concern, do not show that Kentucky’s method of
applying the death penalty amounts to “cruel and unusual
punishmen[t].”
For these reasons, I concur in the judgment.
Cite as: 553 U. S. ____ (2008) 1
GINSBURG, J., dissenting
SUPREME COURT OF THE UNITED STATES
_________________
No. 07–5439
_________________
RALPH BAZE AND THOMAS C. BOWLING, PETI-
TIONERS v. JOHN D. REES, COMMISSIONER,
KENTUCKY DEPARTMENT OF
CORRECTIONS, ET AL.
ON WRIT OF CERTIORARI TO THE SUPREME COURT
OF KENTUCKY
[April 16, 2008]
JUSTICE GINSBURG, with whom JUSTICE SOUTER joins,
dissenting.
It is undisputed that the second and third drugs used in
Kentucky’s three-drug lethal injection protocol, pan-
curonium bromide and potassium chloride, would cause a
conscious inmate to suffer excruciating pain. Pan-
curonium bromide paralyzes the lung muscles and results
in slow asphyxiation. App. 435, 437, 625. Potassium
chloride causes burning and intense pain as it circulates
throughout the body. Id., at 348, 427, 444, 600, 626. Use
of pancuronium bromide and potassium chloride on a
conscious inmate, the plurality recognizes, would be “con-
stitutionally unacceptable.” Ante, at 14.
The constitutionality of Kentucky’s protocol therefore
turns on whether inmates are adequately anesthetized by
the first drug in the protocol, sodium thiopental. Ken-
tucky’s system is constitutional, the plurality states, be-
cause “petitioners have not shown that the risk of an
inadequate dose of the first drug is substantial.” Ante, at
15. I would not dispose of the case so swiftly given the
character of the risk at stake. Kentucky’s protocol lacks
basic safeguards used by other States to confirm that an
inmate is unconscious before injection of the second and
2 BAZE v. REES
GINSBURG, J., dissenting
third drugs. I would vacate and remand with instructions
to consider whether Kentucky’s omission of those safe-
guards poses an untoward, readily avoidable risk of inflict-
ing severe and unnecessary pain.
I
The Court has considered the constitutionality of a
specific method of execution on only three prior occasions.
Those cases, and other decisions cited by the parties and
amici, provide little guidance on the standard that should
govern petitioners’ challenge to Kentucky’s lethal injection
protocol.
In Wilkerson v. Utah, 99 U. S. 130 (1879), the Court held
that death by firing squad did not rank among the “cruel
and unusual punishments” banned by the Eighth
Amendment. In so ruling, the Court did not endeavor “to
define with exactness the extent of the constitutional
provision which provides that cruel and unusual punish-
ments shall not be inflicted.” Id., at 135–136. But it was
“safe to affirm,” the Court stated, that “punishments of
torture . . . , and all others in the same line of unnecessary
cruelty, are forbidden.” Id., at 136.
Next, in In re Kemmler, 136 U. S. 436 (1890), death by
electrocution was the assailed method of execution.1 The
Court reiterated that the Eighth Amendment prohibits
“torture” and “lingering death.” Id., at 447. The word
“cruel,” the Court further observed, “implies . . . something
inhuman . . . something more than the mere extinguish-
ment of life.” Ibid. Those statements, however, were
made en passant. Kemmler’s actual holding was that the
Eighth Amendment does not apply to the States, id., at
——————
1 Hanging was the State’s prior mode of execution. Electrocution,
considered “less barbarous,” indeed “the most humane” way to adminis-
ter the death penalty, was believed at the time to “result in instantane-
ous, and consequently in painless, death.” In re Kemmler, 136 U. S.
436, 443–444 (1890) (internal quotation marks omitted).
Cite as: 553 U. S. ____ (2008) 3
GINSBURG, J., dissenting
448–449,2 a proposition we have since repudiated, see, e.g.,
Robinson v. California, 370 U. S. 660 (1962).
Finally, in Louisiana ex rel. Francis v. Resweber, 329
U. S. 459 (1947), the Court rejected Eighth and Four-
teenth Amendment challenges to a reelectrocution follow-
ing an earlier attempt that failed to cause death. The
plurality opinion in that case first stated: “The traditional
humanity of modern Anglo-American law forbids the
infliction of unnecessary pain in the execution of the death
sentence.” Id., at 463. But the very next sentence varied
the formulation; it referred to the “[p]rohibition against
the wanton infliction of pain.” Ibid.
No clear standard for determining the constitutionality
of a method of execution emerges from these decisions.
Moreover, the age of the opinions limits their utility as an
aid to resolution of the present controversy. The Eighth
Amendment, we have held, “ ‘must draw its meaning from
the evolving standards of decency that mark the progress
of a maturing society.’ ” Atkins v. Virginia, 536 U. S. 304,
311–312 (2002) (quoting Trop v. Dulles, 356 U. S. 86, 101
(1958) (plurality opinion)). Wilkerson was decided 129
years ago, Kemmler 118 years ago, and Resweber 61 years
ago. Whatever little light our prior method-of-execution
cases might shed is thus dimmed by the passage of time.
Further phrases and tests can be drawn from more
recent decisions, for example, Gregg v. Georgia, 428 U. S.
153 (1976). Speaking of capital punishment in the ab-
stract, the lead opinion said that the Eighth Amendment
prohibits “the unnecessary and wanton infliction of pain,”
id., at 173 (joint opinion of Stewart, Powell, and STEVENS,
JJ.); the same opinion also cautioned that a death sen-
——————
2 The Court also ruled in Kemmler that the State’s election to carry
out the death penalty by electrocution in lieu of hanging encountered
no Fourteenth Amendment shoal: No privilege or immunity of United
States citizenship was entailed, nor did the Court discern any depriva-
tion of due process. Id., at 448–449.
4 BAZE v. REES
GINSBURG, J., dissenting
tence cannot “be imposed under sentencing procedures
that creat[e] a substantial risk that it would be inflicted in
an arbitrary and capricious manner,” id., at 188.
Relying on Gregg and our earlier decisions, the Ken-
tucky Supreme Court stated that an execution procedure
violates the Eighth Amendment if it “creates a substantial
risk of wanton and unnecessary infliction of pain, torture
or lingering death.” 217 S. W. 3d 207, 209, 210 (2006).
Petitioners respond that courts should consider “(a) the
severity of pain risked, (b) the likelihood of that pain
occurring, and (c) the extent to which alternative means
are feasible.” Brief for Petitioners 38 (emphasis added).
The plurality settles somewhere in between, requiring a
“substantial risk of serious harm” and considering
whether a “feasible, readily implemented” alternative can
“significantly reduce” that risk. Ante, at 13 (internal
quotation marks omitted).
I agree with petitioners and the plurality that the de-
gree of risk, magnitude of pain, and availability of alterna-
tives must be considered. I part ways with the plurality,
however, to the extent its “substantial risk” test sets a
fixed threshold for the first factor. The three factors are
interrelated; a strong showing on one reduces the impor-
tance of the others.
Lethal injection as a mode of execution can be expected,
in most instances, to result in painless death. Rare
though errors may be, the consequences of a mistake
about the condemned inmate’s consciousness are horren-
dous and effectively undetectable after injection of the
second drug. Given the opposing tugs of the degree of risk
and magnitude of pain, the critical question here, as I see
it, is whether a feasible alternative exists. Proof of “a
slightly or marginally safer alternative” is, as the plurality
notes, insufficient. Ante, at 12. But if readily available
measures can materially increase the likelihood that the
protocol will cause no pain, a State fails to adhere to con-
Cite as: 553 U. S. ____ (2008) 5
GINSBURG, J., dissenting
temporary standards of decency if it declines to employ
those measures.
II
Kentucky’s Legislature adopted lethal injection as a
method of execution in 1998. See 1998 Ky. Acts ch. 220, p.
777, Ky. Rev. Stat. Ann. §431.220(1)(a) (West 2006).
Lawmakers left the development of the lethal injection
protocol to officials in the Department of Corrections.
Those officials, the trial court found, were “given the task
without the benefit of scientific aid or policy oversight.”
App. 768. “Kentucky’s protocol,” that court observed, “was
copied from other states and accepted without challenge.”
Ibid. Kentucky “did not conduct any independent scien-
tific or medical studies or consult any medical profession-
als concerning the drugs and dosage amounts to be in-
jected into the condemned.” Id., at 760. Instead, the trial
court noted, Kentucky followed the path taken in other
States that “simply fell in line” behind the three-drug
protocol first developed by Oklahoma in 1977. Id., at 756.
See also ante, at 4, n. 1 (plurality opinion).
Kentucky’s protocol begins with a careful measure: Only
medical professionals may perform the venipunctures and
establish intravenous (IV) access. Members of the IV
team must have at least one year’s experience as a certi-
fied medical assistant, phlebotomist, emergency medical
technician (EMT), paramedic, or military corpsman. App.
984; ante, at 16 (plurality opinion). Kentucky’s IV team
currently has two members: a phlebotomist with 8 years’
experience and an EMT with 20 years’ experience. App.
273–274. Both members practice siting catheters at ten
lethal injection training sessions held annually. Id., at
984.
Other than using qualified and trained personnel to
establish IV access, however, Kentucky does little to en-
sure that the inmate receives an effective dose of sodium
6 BAZE v. REES
GINSBURG, J., dissenting
thiopental. After siting the catheters, the IV team leaves
the execution chamber. Id., at 977. From that point
forward, only the warden and deputy warden remain with
the inmate. Id., at 276. Neither the warden nor the dep-
uty warden has any medical training.
The warden relies on visual observation to determine
whether the inmate “appears” unconscious. Id., at 978. In
Kentucky’s only previous execution by lethal injection, the
warden’s position allowed him to see the inmate best from
the waist down, with only a peripheral view of the in-
mate’s face. See id., at 213–214. No other check for con-
sciousness occurs before injection of pancuronium bro-
mide. Kentucky’s protocol does not include an automatic
pause in the “rapid flow” of the drugs, id., at 978, or any of
the most basic tests to determine whether the sodium
thiopental has worked. No one calls the inmate’s name,
shakes him, brushes his eyelashes to test for a reflex, or
applies a noxious stimulus to gauge his response.
Nor does Kentucky monitor the effectiveness of the
sodium thiopental using readily available equipment, even
though the inmate is already connected to an electrocar-
diogram (EKG), id., at 976. A drop in blood pressure or
heart rate after injection of sodium thiopental would not
prove that the inmate is unconscious, see id., at 579–580;
ante, at 20–21 (plurality opinion), but would signal that
the drug has entered the inmate’s bloodstream, see App.
424, 498, 578, 580; 8 Tr. 1099 (May 2, 2005). Kentucky’s
own expert testified that the sodium thiopental should
“cause the inmate’s blood pressure to become very, very
low,” App. 578, and that a precipitous drop in blood pres-
sure would “confir[m]” that the drug was having its ex-
pected effect, id., at 580. Use of a blood pressure cuff and
EKG, the record shows, is the standard of care in surgery
requiring anesthesia. Id., at 539.3
——————
3 The plurality deems medical standards irrelevant in part because
Cite as: 553 U. S. ____ (2008) 7
GINSBURG, J., dissenting
A consciousness check supplementing the warden’s
visual observation before injection of the second drug is
easily implemented and can reduce a risk of dreadful pain.
Pancuronium bromide is a powerful paralytic that pre-
vents all voluntary muscle movement. Once it is injected,
further monitoring of the inmate’s consciousness becomes
impractical without sophisticated equipment and training.
Even if the inmate were conscious and in excruciating
pain, there would be no visible indication.4
Recognizing the importance of a window between the
first and second drugs, other States have adopted safe-
guards not contained in Kentucky’s protocol. See Brief for
Criminal Justice Legal Foundation as Amicus Curiae 19–
23.5 Florida pauses between injection of the first and
second drugs so the warden can “determine, after consul-
tation, that the inmate is indeed unconscious.” Light-
bourne v. McCollum, 969 So. 2d 326, 346 (Fla. 2007) (per
curiam) (internal quotation marks omitted). The warden
——————
“drawn from a different context.” Ante, at 21. Medical professionals
monitor blood pressure and heart rate, however, not just to save lives,
but also to reduce the risk of consciousness during otherwise painful
procedures. Considering that the constitutionality of Kentucky’s
protocol depends on guarding against the same risk, see supra, at 1;
ante, at 14–15 (plurality opinion), the plurality’s reluctance to consider
medical practice is puzzling. No one is advocating the wholesale
incorporation of medical standards into the Eighth Amendment. But
Kentucky could easily monitor the inmate’s blood pressure and heart
rate without physician involvement. That medical professionals
consider such monitoring important enough to make it the standard of
care in medical practice, I remain persuaded, is highly instructive.
4 Petitioners’ expert testified that a layperson could not tell from vis-
ual observation if a paralyzed inmate was conscious and that doing so
would be difficult even for a professional. App. 418. Kentucky’s war-
den candidly admitted: “I honestly don’t know what you’d look for.” Id.,
at 283.
5 Because most death-penalty States keep their protocols secret, a
comprehensive survey of other States’ practices is not available. See
Brief for American Civil Liberties Union et al. as Amici Curiae 6–12.
8 BAZE v. REES
GINSBURG, J., dissenting
does so by touching the inmate’s eyelashes, calling his
name, and shaking him. Id., at 347.6 If the inmate’s
consciousness remains in doubt in Florida, “the medical
team members will come out from the chemical room and
consult in the assessment of the inmate.” Ibid. During
the entire execution, the person who inserted the IV line
monitors the IV access point and the inmate’s face on
closed circuit television. Ibid.
In Missouri, “medical personnel must examine the
prisoner physically to confirm that he is unconscious using
standard clinical techniques and must inspect the catheter
site again.” Taylor v. Crawford, 487 F. 3d 1072, 1083
(CA8 2007). “The second and third chemicals are injected
only after confirmation that the prisoner is unconscious
and after a period of at least three minutes has elapsed
from the first injection of thiopental.” Ibid.
In California, a member of the IV team brushes
the inmate’s eyelashes, speaks to him, and shakes him
at the halfway point and, again, at the completion of
the sodium thiopental injection. See State of Califor-
nia, San Quentin Operational Procedure No. 0–770, Exe-
cution by Lethal Injection, §V(S)(4)(e) (2007), online at
http://www.cdcr.ca.gov/News/docs/RevisedProtocol.pdf.
In Alabama, a member of the execution team “begin[s]
by saying the condemned inmate’s name. If there is no
——————
6 Florida’s expert in Lightbourne v. McCollum, 969 So. 2d 326 (Fla.
2007) (per curiam), who also served as Kentucky’s expert in this case,
testified that the eyelash test is “probably the most common
first assessment that we use in the operating room to determine . . .
when a patient might have crossed the line from being conscious
to unconscious.” 4 Tr. in Florida v. Lightbourne, No. 81–170–CF
(Fla. Cir. Ct., Marion Cty.), p. 511, online at http://www.cjlf.org/files/
LightbourneRecord.pdf (all Internet materials as visited Apr. 14, 2008,
and in Clerk of Court’s case file). “A conscious person, if you touch their
eyelashes very lightly, will blink; an unconscious person typically will
not.” Ibid. The shaking and name-calling tests, he further testified,
are similar to those taught in basic life support courses. See id., at 512.
Cite as: 553 U. S. ____ (2008) 9
GINSBURG, J., dissenting
response, the team member will gently stroke the con-
demned inmate’s eyelashes. If there is no response, the
team member will then pinch the condemned inmate’s
arm.” Respondents’ Opposition to Callahan’s Application
for a Stay of Execution in Callahan v. Allen, O. T. 2007,
No. 07A630, p. 3 (internal quotation marks omitted).
In Indiana, officials inspect the injection site after ad-
ministration of sodium thiopental, say the inmate’s name,
touch him, and use ammonia tablets to test his response to
a noxious nasal stimulus. See Tr. of Preliminary Injunc-
tion Hearing in 1:06–cv–1859 (SD Ind.), pp. 199–200,
online at http://www.law.berkeley.edu/clinics/dpclinic/
LethalInjection/Public/MoralesTaylorAmicus/20.pdf (here-
inafter Timberlake Hearing).7
These checks provide a degree of assurance—missing
from Kentucky’s protocol—that the first drug has been
properly administered. They are simple and essentially
costless to employ, yet work to lower the risk that the
inmate will be subjected to the agony of conscious suffoca-
tion caused by pancuronium bromide and the searing pain
caused by potassium chloride. The record contains no
explanation why Kentucky does not take any of these
elementary measures.
The risk that an error administering sodium thiopental
would go undetected is minimal, Kentucky urges, because
if the drug was mistakenly injected into the inmate’s
tissue, not a vein, he “would be awake and screaming.”
Tr. of Oral Arg. 30–31. See also Brief for Respondents 42;
Brief for State of Texas et al. as Amici Curiae 26–27. That
argument ignores aspects of Kentucky’s protocol that
render passive reliance on obvious signs of consciousness,
such as screaming, inadequate to determine whether the
inmate is experiencing pain.
——————
7 In Indiana, a physician also examines the inmate after injection of
the first drug. Timberlake Hearing 199.
10 BAZE v. REES
GINSBURG, J., dissenting
First, Kentucky’s use of pancuronium bromide to para-
lyze the inmate means he will not be able to scream after
the second drug is injected, no matter how much pain he is
experiencing. Kentucky’s argument, therefore, appears to
rest on the assertion that sodium thiopental is itself pain-
ful when injected into tissue rather than a vein. See App.
601. The trial court made no finding on that point, and
Kentucky cites no supporting evidence from executions in
which it is known that sodium thiopental was injected into
the inmate’s soft tissue. See, e.g., Lightbourne, 969 So. 2d,
at 344 (describing execution of Angel Diaz).
Second, the inmate may receive enough sodium thiopen-
tal to mask the most obvious signs of consciousness with-
out receiving a dose sufficient to achieve a surgical plane
of anesthesia. See 7 Tr. 976 (Apr. 21, 2005). If the drug is
injected too quickly, the increase in blood pressure can
cause the inmate’s veins to burst after a small amount of
sodium thiopental has been administered. Cf. App. 217
(describing risk of “blowout”). Kentucky’s protocol does
not specify the rate at which sodium thiopental should be
injected. The executioner, who does not have any medical
training, pushes the drug “by feel” through five feet of
tubing. Id., at 284, 286–287.8 In practice sessions, unlike
in an actual execution, there is no resistance on the cathe-
ter, see id., at 285; thus the executioner’s training may
lead him to push the drugs too fast.
“The easiest and most obvious way to ensure that an
inmate is unconscious during an execution,” petitioners
argued to the Kentucky Supreme Court, “is to check for
consciousness prior to injecting pancuronium [bromide].”
Brief for Appellants in No. 2005–SC–00543, p. 41. See
——————
8 The length of the tubing contributes to the risk that the inmate will
receive an inadequate dose of sodium thiopental. The warden and
deputy warden watch for obvious leaks in the execution chamber, see
ante, at 6 (plurality opinion), but the line also snakes into the neighbor-
ing control room through a small hole in the wall, App. 280.
Cite as: 553 U. S. ____ (2008) 11
GINSBURG, J., dissenting
also App. 30 (Complaint) (alleging Kentucky’s protocol
does not “require the execution team to determine that the
condemned inmate is unconscious prior to administering
the second and third chemicals”). The court did not ad-
dress petitioners’ argument. I would therefore remand
with instructions to consider whether the failure to in-
clude readily available safeguards to confirm that the
inmate is unconscious after injection of sodium thiopental,
in combination with the other elements of Kentucky’s
protocol, creates an untoward, readily avoidable risk of
inflicting severe and unnecessary pain.