The New Straits Times, June 24, 2001
By Professor Dzulkifli Abdul Razak
On April 19, 1945, the US experienced its worst terrorist attack when a truck bomb exploded outside the Alfred P. Murrah Federal Building in Oklahoma City. While US Government officials were quick to stereotype it as yet another Islamic terrorism, it turned out to be an all-American affair.
Timothy James McVeigh, a decorated Gulf War veteran, brought "the bloody taste of terrorism to America's heartland", killing 168 people . He was found guilty and sentenced to death.
Unlike Guy Fawkes who was severely tortured and hanged for trying to blow up the House of Lords in England some 400 years ago, McVeigh received a supposedly humane punishment, that is, execution by lethal injection.
He became the first person to be executed by the US Government, at a Terre Haute prison facility in Indiana, since 1963. Oklahoma reportedly was the first state to adopt lethal injection 1977.
The injection generally consists of three drugs, namely sodium thiopentone (or thiopenthal, in US), pancuronium bromide and potassium chloride.
Curiously enough, each is a "medicine" in its won right. In contrast, previously, poisons like prussic acid were used, and then cyanide gas; but were ruled out subsequently due, in part, to medical ethnics.
Sodium thiopentone belongs to a class of drugs called barbiturates, noted for their marked sedative effect due to their action on the brain. In helps one to lose consciousness rapidly. It can reach the brain in effective concentrations in less than one minute when injected.
Pancuronium bromide on the other hand, is an example of a class of drugs better known as muscle-relaxing agents or muscle relaxants. Injected, the drug can cause muscle to relax by preventing the appropriate chemical (namely acetylcholine) in the muscle from reacting with its sites of action (receptors)
Acetylcholine is the naturally-occurring chemical released from the nerve cells at the muscles to cause them to contract. Thus, by blocking the action sites of acetylcholine, no muscular contraction can take place, and instead the muscle becomes more relaxed or paralysed.
Potassium chloride is made up of two important electrolytes: potassium and chloride. In the right proportion, both are necessary for a normal bodily functions, especially in relation to activities involving the nerves and muscle.
In other words, they are clinically useful as long as the dose used remains within the recommended levels. When exceeded, the drug turns toxic, even lethal.
In the case of sodium thiopentone, for example, the patient can quickly pass through the hypnotic (sleep) stage into comatose (loss of consciousness) stage and then death, if the dose is high enough. All these are due to the brain functions being heavily suppressed by the drug.
Pancuronium bromide can cause muscular paralysis instead. Muscular activities in many part of the body can be totally impaired. When major muscles such as those that regulate breathing (the diaphragm, and related lung muscles) are affected, breathing ceases (apnoea) and death ensues swiftly.
By injecting toxic doses, potassium chloride induces the heart to stop beating suddenly (cardiac arrest) due to the inhibition of essential cardiac functions, caused by potassium in particular.
Ad the drugs used in lethal injection are concocted to kill rather than heal, the dose of each of the drugs is often high enough to assert a quick "lethal" action (less than 10 minutes ) in a synergistic manner. This is made even more efficient by injecting the drugs directly into the body.
While each drug acts almost independently on the different "vital" organs of the body, viz, the brain, respiratory (breathing) and cardiac (heart) muscles respectively, their cumulative action is fatal.
When all is said and done, McVeigh's friendish act can serve as a useful lesson in drug safety, namely, that all medicines can prove lethal be it as an individual item, or more so if used in combination.
Paraphrasing it: medicines must be properly used, otherwise outcomes could be fatal.
It is vital to know and understand the relevant aspects of medicines before using them. Get the correct information from the prescriber and/or dispenser of the medicines and be in control over whatever medicines you are using.
To conclude, on matter of drug safety and health, it may be worthwhile quoting the poem "Invictus", as Mc Veigh did in his final moments (though for different reasons): "I am the master of my fate; I am the captain of my soul."
Recommended website: http://howstuffworks.com/lethal-injection.html
