The PLoS Medicine editors have received a lot of email about lethal injection since we published a research article finding that drugs used in executions may cause more suffering than expected.

It's no surprise that the death penalty is a matter of great interest, but we didn’t know the research article by Koniaris and our accompanying editorial would receive quite so much attention. The day after publication, Google News showed some three hundred links to stories about the article. It seemed that every major US daily, and many international ones, had either picked up a wire-service story or had written their own piece. It’s hard to say how many of those who wrote had actually read the article and considered the arguments of the editorial, and how many were writing in response to the broader news coverage.

Many messages were more scornful and disparaging than is usual for medical journal correspondence, but then the topic was an unusual one for a research article. We didn’t think it would be appropriate to include all of these messages as correspondence in PLoS Medicine, but thought our blog might be a good place to provide a sense of them.

In our editorial we expressed the view that “lethal injection is simply the latest in a long line of execution methods that have been found to be inhumane.” Some wrote to assert that painless execution should indeed be technically possible. As one physician put it:

“My suggestion would be to return to the Guillotine. The spinal nerves are severed immediately. There are many decades of empiric evidence with minimum malfunction and no complaints of botched executions.”

Another physician (whose response we did post) noted that he opposed the death penalty, but felt that arguments based on the method of execution were inadequate, because “Any qualified anesthesiologist could propose more reliable techniques. It is unreasonable to assert that a condemned person cannot be put to sleep painlessly, when tens of thousands of people are anesthetized every single day for surgery with modern fast-acting anesthetic drugs (propofol, in particular) that are far more suitable than the outmoded execution drug thiopental. Induction of surgical anesthesia does occasionally cause slight injection pain, so how then can it be “cruel and unusual” to use the same drug and method for the initial step in executions?”

Along similar lines, I noticed a letter from a veterinarian to a local paper noting that he had humanely put down hundreds of beloved cats, dogs, and horses over the years, and that it must be possible to do the same with humans.

 We did indeed note in the editorial that “it is not our intention to encourage further research to ‘improve’ lethal injection” because “there is no humane way of forcibly killing someone.” Just to clarify, we didn’t mean painless. We meant humane, by the dictionary definition:

1. "having what are considered the best qualities of mankind; kind, tender, merciful, synmpathetic, etc. 2. Civilizing, humanizing. (Webster's New World Dicionary of the American Language, 2nd College Edition, 1980. )

The current online Oxford Compact Dictionary confirms that the definition of “humane” hasn’t changed much in 25 years: "Having or showing compassion or benevolence.”
 
Painless execution may be possible (although, as we noted, research to test that hypothesis would be unethical). But how can execution be humanizing or benevolent? As we also noted in the editorial, “an implicit goal … of imposing the death penalty is not rational but emotional: the desire for revenge.” The responses provide abundant evidence that, regrettably, we were right on the money. Here are four unedited examples:

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“I cannot believe that people actually care about an inmate suffering a little. Think of the suffering his victims and survivors are going through. If they wouldn't commit these crimes that are punishable by death we wouldn't have this discussion. They took the rights of others without any consideration, so why should they have any rights? Please get your head on straight, or maybe we should go to the old wild west form of justice: public lynchings which are quick or, even better, a firing squad.”

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“thats the trouble with todays bleeding heart agenda - the criminals have more rights than the victims of these heinous crimes. Its a sad world we live in where there is more compassion and sympathy for the criminal than for their victims - im sure this paper was written in such a biased light & each of the writers would be singing a different tune - had their family members been raped and killed - by some lowlife that gets to 'go to sleep' rather than face the wrath he really deserves for his actions.”

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IF someone killed your kid after raping them repeatedly, would you care if the SOB who did it died slowly and painfully? The answer- NO! If you are worried that someone who deserves to die is in pain, volunteer to trade places with him in the room. I'm sure that he (or she) would love that! If lethal injection is so bad, go back to public hanging, like we have here in Montana. It sure makes people think twice before committing a gruesome crime.

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“Why should these monsters get any kind of mercy. mass murderers, rapists, & child molestors should die in the most horrible ways emaginable, the same pain and phsychological damage that they caused should be inflicted upon them as they die. These animals should be thankful that they are getting this leathel injection because it does not even compare to what they have done to get the death penalty in the first place. There are far better things to study than if it is ethical and humane to use this 3 drug combo to kill these scums of the erath. So dont waste whatever money it is you people are wasting on this. And it better not be tax money because I do not want my tax money to fund such meaningless pesuits of knowledge. So study other things, these animals do not need your mercy.”

And so on. In disagreeing with our call to end the death penalty, these writers present the desire for revenge as the major justification for the death penalty. Indeed, most who wrote seemed to assume that taking a life in exchange for a life is so obviously reasonable that any further consideration of the matter is simply misguided.

I agree with some of these writers that killing by the state is nothing other than actual violence that human beings inflict on other human beings, and might as well be recognized as such. But I do not agree that repaying criminal violence with state-approved violence is the right solution.

Giving execution a veneer of medical anesthesia makes it convenient to overlook the fact that when we as a society inflict death --by whatever method-- we tend to compound, rather than recognize, the anger and vengefulness that create the conditions for violent crime in the first place. Because rage and denial combine to perpetuate violence, it is the responsibility of physicians and medical journal editors, among others, to bring to light both the unwillingness of some to acknowledge violence and the furious demands of others to inflict it. This is not simply an exercise in compassion for those guilty of horrible crimes. When it comes to suffering and death that governments inflict in the name of decent people, execution doesn’t amount to even the tip of the iceberg.