SUPREME COURT OF THE UNITED STATES
_________________
No. 14–7955
_________________
RICHARD E. GLOSSIP, et al., PETITIONERS
v. KEVIN J. GROSS, et al.
on writ of certiorari to the united states
court of appeals for the tenth circuit
[June 29, 2015]
Justice Sotomayor, with whom Justice Ginsburg,
Justice Breyer, and Justice Kagan join, dissenting.
Petitioners, three inmates on Oklahoma’s death
row, challenge the constitutionality of the State’s lethal
injection protocol. The State plans to execute petitioners using
three drugs: midazolam, rocuronium bromide, and potassium chloride.
The latter two drugs are intended to paralyze the inmate and stop
his heart. But they do so in a torturous manner, causing burning,
searing pain. It is thus critical that the first drug, midazolam,
do what it is supposed to do, which is to render and keep the
inmate unconscious. Petitioners claim that midazolam cannot be
expected to perform that function, and they have presented ample
evidence showing that the State’s planned use of this drug poses
substantial, constitutionally intolerable risks.
Nevertheless, the Court today turns aside
petitioners’ plea that they at least be allowed a stay of execution
while they seek to prove midazolam’s inadequacy. The Court achieves
this result in two ways: first, by deferring to the District
Court’s decision to credit the scientifically unsupported and
implausible testimony of a single expert witness; and second, by
faulting petitioners for failing to satisfy the wholly novel
requirement of proving the availability of an alternative means for
their own executions. On both counts the Court errs. As a result,
it leaves petitioners exposed to what may well be the chemical
equivalent of being burned at the stake.
I
A
The Eighth Amendment succinctly prohibits the
infliction of “cruel and unusual punishments.” Seven years ago, in
Baze v.
Rees, 553 U. S. 35 (2008) , the Court
addressed the application of this mandate to Kentucky’s lethal
injection protocol. At that time, Kentucky, like at least 29 of the
35 other States with the death penalty, utilized a series of three
drugs to perform executions: (1) sodium thiopental, a “fast-acting
barbiturate sedative that induces a deep, comalike unconsciousness
when given in the amounts used for lethal injection”; (2)
pancuronium bromide, “a paralytic agent that inhibits all
muscular-skeletal movements and . . . stops respiration”;
and (3) potassium chloride, which “interferes with the electrical
signals that stimulate the contractions of the heart, inducing
cardiac arrest.”
Id., at 44 (plurality opinion of Roberts,
C. J.).
In
Baze, it was undisputed that absent a
“proper dose of sodium thiopental,” there would be a “substantial,
constitutionally unacceptable risk of suffocation from the
administration of pancuronium bromide and pain from the injection
of potassium chloride.”
Id., at 53. That is because, if
given to a conscious inmate, pancuronium bromide would leave him or
her asphyxiated and unable to demonstrate “any outward sign of
distress,” while potassium chloride would cause “excruciating
pain.”
Id., at 71 (Stevens, J., concurring in judgment). But
the
Baze petitioners conceded that if administered as
intended, Kentucky’s method of execution would nevertheless “result
in a humane death,”
id., at 41 (plurality opinion), as the
“proper administration” of sodium thiopental “eliminates any
meaningful risk that a prisoner would experience pain from the
subsequent injections of pancuronium and potassium chloride,”
id., at 49. Based on that premise, the Court ultimately
rejected the challenge to Kentucky’s protocol, with the plurality
opinion concluding that the State’s procedures for administering
these three drugs ensured there was no “objectively intolerable
risk” of severe pain.
Id., at 61–62 (internal quotation
marks omitted).
B
For many years, Oklahoma performed executions
using the same three drugs at issue in
Baze. After
Baze was decided, however, the primary producer of sodium
thiopental refused to continue permitting the drug to be used in
executions.
Ante, at 4–5. Like a number of other States,
Oklahoma opted to substitute pentobarbital, another barbiturate, in
its place. But in March 2014, shortly before two scheduled
executions, Oklahoma found itself unable to secure this drug. App.
144.
The State rescheduled the executions for the
following month to give it time to locate an alternative
anesthetic. In less than a week, a group of officials from the
Okla-homa Department of Corrections and the Attorney General’s
office selected midazolam to serve as a replacement for
pentobarbital.
Id., at 145, 148–149.
Soon thereafter, Oklahoma used midazolam for the
first time in its execution of Clayton Lockett. That execution did
not go smoothly. Ten minutes after an intravenous (IV) line was set
in Lockett’s groin area and 100 milligrams of midazolam were
administered, an attending physician declared Lockett unconscious.
Id., at 392–393. When the paralytic and potassium chloride
were administered, however, Lockett awoke.
Ibid. Various
witnesses reported that Lockett began to writhe against his
restraints, saying, “[t]his s*** is f***ing with my mind,”
“something is wrong,” and “[t]he drugs aren’t working.”
Id.,
at 53 (internal quotation marks omitted). State officials ordered
the blinds lowered, then halted the execution.
Id., at 393,
395. But 10 minutes later—approximately 40 minutes after the
execution began—Lockett was pronounced dead.
Id., at
395.
The State stayed all future executions while it
sought to determine what had gone wrong in Lockett’s. Five months
later, the State released an investigative report identifying a
flaw in the IV line as the principal difficulty: The IV had failed
to fully deliver the lethal drugs into Lockett’s veins.
Id.,
at 398. An autopsy determined, however, that the concentration of
midazolam in Lockett’s blood was more than sufficient to render an
average person unconscious.
Id., at 397, 405.
In response to this report, the State modified
its lethal injection protocol. The new protocol contains a number
of procedures designed to guarantee that members of the execution
team are able to insert the IV properly, and charges them with
ensuring that the inmate is unconscious.
Id., at 57–66,
361–369. But the protocol continues to authorize the use of the
same three-drug formula used to kill Lockett—though it does
increase the intended dose of midazolam from 100 milligrams to 500
milligrams.
Id., at 61. The State has indicated that it
plans to use this drug combination in all upcoming executions,
subject to only an immaterial substitution of paralytic agents.
Ante, at 7–8.
C
In June 2014, inmates on Oklahoma’s death row
filed a 42 U. S. C. §1983 suit against respondent prison
officials challenging the constitutionality of Oklahoma’s method of
execution. After the State released its revised execution protocol,
the four inmates whose executions were most imminent—Charles
Warner, along with petitioners Richard Glossip, John Grant, and
Benjamin Cole—moved for a preliminary injunction. They contended,
among other things, that the State’s intended use of midazolam
would violate the Eighth Amendment because, unlike sodium
thiopental or pentobarbital, the drug “is incapable of producing a
state of unawareness that will be reliably maintained after either
of the other two pain-producing drugs . . . is injected.”
Amended Complaint ¶101.
The District Court held a 3-day evidentiary
hearing, at which petitioners relied principally on the testimony
of two experts: Dr. David Lubarsky, an anesthesiologist, and Dr.
Larry Sasich, a doctor of pharmacy. The State, in turn, based its
case on the testimony of Dr. Roswell Evans, also a doctor of
pharmacy.
To a great extent, the experts’ testimony
overlapped. All three experts agreed that midazolam is from a class
of sedative drugs known as benzodiazepines (a class that includes
Valium and Xanax), and that it has no analgesic—or
pain-relieving—effects. App. 205 (Lubarsky), 260–261
(Sasich)
, 311 (Evans). They further agreed that while
midazolam can be used to render someone unconscious, it is not
approved by the Federal Drug Administration (FDA) for use as, and
is not in fact used as, a “sole drug to produce and maintain
anesthesia in surgical proceedings.”
Id., at 307, 327
(Evans); see
id., at 171 (Lubarsky);
id., at 262
(Sasich). Finally, all three experts recognized that midazolam is
subject to a ceiling effect, which means that there is a point at
which increasing the dose of the drug does not result in any
greater effect.
Id., at 172 (Lubarsky), 243 (Sasich), 331
(Evans).
The experts’ opinions diverged, however, on the
crucial questions of how this ceiling effect operates, and whether
it will prevent midazolam from keeping a condemned inmate
unconscious when the second and third lethal injection drugs are
administered. Dr. Lubarsky testified that while benzodiazepines
such as midazolam may, like barbiturate drugs such as sodium
thiopental and pentobarbital, induce unconsciousness by inhibiting
neuron function, they do so in a materially different way.
Id., at 207. More specifically, Dr. Lubarsky explained that
both barbiturates and benzodiazepines initially cause sedation by
facilitating the binding of a naturally occurring chemical called
gamma-aminobutyric acid (GABA) with GABA receptors, which then
impedes the flow of electrical impulses through the neurons in the
central nervous system.
Id., at 206. But at higher doses,
barbiturates also act as a GABA substitute and mimic its
neuron-suppressing effects.
Ibid. By contrast,
benzodiazepines lack this mimicking function, which means their
effect is capped at a lower level of sedation.
Ibid.
Critically, according to Dr. Lubarsky, this ceiling on midazolam’s
sedative effect is reached before full anesthesia can be achieved.
Ibid. Thus, in his view, while “midazolam unconsciousness is
. . . sufficient” for “minor procedure[s],” Tr. of
Preliminary Injunction Hearing 132–133 (Tr.), it is incapable of
keeping someone “insensate and immobile in the face of [more]
noxious stimuli,” including the extreme pain and discomfort
associated with administration of the second and third drugs in
Oklahoma’s lethal injection protocol, App. 218. Dr. Sasich endorsed
Dr. Lubarsky’s description of the ceiling effect, and offered
similar reasons for reaching the same conclusion. See
id.,
at 243, 248, 262.
In support of these assertions, both experts
cited a variety of evidence. Dr. Lubarsky emphasized, in
particular, Arizona’s 2014 execution of Joseph Wood, which had been
conducted using midazolam and the drug hydromorphone rather than
the three-drug cocktail Oklahoma intends to employ.[
1]
Id., at 176. Despite being
administered 750 milligrams of midazolam, Wood had continued
breathing and moving for nearly two hours—which, according to Dr.
Lubarsky, would not have occurred “during extremely deep levels of
anesthesia.”
Id., at 177. Both experts also cited various
scientific articles and textbooks to support their conclusions. For
instance, Dr. Lubarsky relied on a study measuring the brain
activity of rats that were administered midazolam, which showed
that the drug’s impact significantly tailed off at higher doses.
See Hovinga et al., Pharmacokinetic-EEG Effect Relationship of
Midazolam in Aging BN/BiRij Rats, 107 British J. Pharmacology 171,
173, Fig. 2 (1992). He also pointed to a pharmacology textbook that
confirmed his description of how benzodiazepines and barbiturates
produce their effects, see Stoelting & Hillier 127–128,
140–144, and a survey article concluding that “[m]idazolam cannot
be used alone . . . to maintain adequate anesthesia,”
Reves, Fragen, Vinik, & Greenblatt, Midazolam: Pharmacology and
Uses, 62 Anesthesiology 310, 318 (1985) (Reves). For his part, Dr.
Sasich referred to a separate survey article, which similarly
recognized and described the ceiling effect to which
benzodiazepines are subject. See Saari, Uusi- Oukari, Ahonen, &
Olkkola, Enhancement of GABAergic Activity: Neuropharmacological
Effects of Benzodiazepines and Therapeutic Use in Anesthesiology,
63 Pharamacological Rev. 243, 244, 250 (2011) (Saari).
By contrast, Dr. Evans, the State’s expert,
asserted that a 500-milligram dose of midazolam would “render the
person unconscious and ‘insensate’ during the remainder of the
[execution] procedure.” App. 294. He rested this conclusion on two
interrelated propositions.
First, observing that a therapeutic dose of
midazolam to treat anxiety is less than 5 milligrams for a
70-kilogram adult, Dr. Evans emphasized that Oklahoma’s planned
administration of 500 milligrams of the drug was “at least 100
times the normal therapeutic dose.”
Ibid. While he
acknowledged that “[t]here are no studies that have been done
. . . administering that much . . . midazolam
. . . to anybody,” he noted that deaths had occurred in
doses as low as 0.04 to 0.07 milligrams per kilogram (2.8 to 4.9
milligrams for a 70-kilogram adult), and contended that a
500-milligram dose would itself cause death within less than an
hour—a conclusion he characterized as “essentially an extrapolation
from a toxic effect.”
Id., at 327; see
id.,at
308.
Second, in explaining how he reconciled his
opinion with the evidence of midazolam’s ceiling effect, Dr. Evans
testified that while “GABA receptors are found across the entire
body,” midazolam’s ceiling effect is limited to the “spinal cord”
and there is “no ceiling effect” at the “higher level of [the]
brain.”
Id., at 311–312. Consequently, in his view, “as you
increase the dose of midazolam, it’s a linear effect, so you’re
going to continue to get an impact from higher doses of the drug,”
id., at 332, until eventually “you’re paralyzing the brain,”
id., at 314. Dr. Evans also understood the chemical source
of midazolam’s ceiling effect somewhat differently from
petitioners’ experts. Although he agreed that midazolam produces
its effect by “binding to [GABA] receptors,”
id., at 293, he
appeared to believe that midazolam produced sedation by “inhibiting
GABA” from attaching to GABA receptors, not by promoting GABA’s
sedative effects,
id., at 312. Thus, when asked about Dr.
Lubarsky’s description of the ceiling effect, Dr. Evans
characterized the phenomenon as stemming from “the competitive
nature of substances trying to attach to GABA receptors.”
Id., at 313.
Dr. Evans cited no scholarly research in support
of his opinions. Instead, he appeared to rely primarily on two
sources: the Web site www.drugs.com, and a “Material Safety Data
Sheet” produced by a midazolam manufacturer. See
id., at
303. Both simply contained general information that covered the
experts’ areas of agreement.
D
The District Court denied petitioners’ motion
for a preliminary injunction. It began by making a series of
factual findings regarding the characteristics of midazolam and its
use in Oklahoma’s execution protocol. Most relevant here, the
District Court found that “[t]he proper administration of 500
milligrams of midazolam . . . would make it a virtual
certainty that an individual will be at a sufficient level of
unconsciousness to resist the noxious stimuli which could occur
from the application of the second and third drugs.”
Id., at
77. Respecting petitioners’ contention that there is a “ceiling
effect which prevents an increase in dosage from having a
corresponding incremental effect on anesthetic depth,” the District
Court concluded:
“Dr. Evans testified persuasively
. . . that whatever the ceiling effect of midazolam may
be with respect to anesthesia, which takes effect at the spinal
cord level, there is no ceiling effect with respect to the ability
of a 500 milligram dose of midazolam to effectively paralyze the
brain, a phenomenon which is not anesthesia but does have the
effect of shutting down respiration and eliminating the
individual’s awareness of pain.”
Id., at 78.
Having made these findings, the District Court
held that petitioners had shown no likelihood of success on the
merits of their Eighth Amendment claim for two independent reasons.
First, it determined that petitioners had “failed to establish that
proceeding with [their] execution[s] . . . on the basis
of the revised protocol presents . . . ‘an objectively
intolerable risk of harm.’ ”
Id., at 96. Second, the
District Court held that petitioners were unlikely to prevail
because they had not identified any “ ‘known and available
alternative’ ” means by which they could be executed—a
requirement it understood
Baze to impose.
Id., at 97.
The District Court concluded that the State “ha[d] affirmatively
shown that sodium thiopental and pentobarbital, the only
alternatives to which the [petitioners] have even alluded, are not
available to the [State].”
Id., at 98.
The Court of Appeals for the Tenth Circuit
affirmed.
Warner v.
Gross, 776 F. 3d 721 (2015).
It, like the District Court, held that petitioners were unlikely to
prevail on the merits because they had failed to prove the
existence of “ ‘known and available alternatives.’ ”
Id., at 732. “In any event,” the court continued, it was
unable to conclude that the District Court’s factual findings had
been clearly erroneous, and thus petitioners had also “failed to
establish that the use of midazolam in their executions
. . . creates a demonstrated risk of severe pain.”
Ibid.
Petitioners and Charles Warner filed a petition
for certiorari and an application to stay their executions. The
Court denied the stay application, and Charles Warner was executed
on January 15, 2015. See
Warner v.
Gross, 574
U. S. ___ (2015) (Sotomayor, J., dissenting from denial of
certiorari). The Court subsequently granted certiorari and, at the
request of the State, stayed petitioners’ pending executions.
II
I begin with the second of the Court’s two
holdings: that the District Court properly found that petitioners
did not demonstrate a likelihood of showing that Oklahoma’s
execution protocol poses an unconstitutional risk of pain. In
reaching this conclusion, the Court sweeps aside substantial
evidence showing that, while midazolam may be able to
induce
unconsciousness, it cannot be utilized to
maintain
unconsciousness in the face of agonizing stimuli. Instead, like the
District Court, the Court finds comfort in Dr. Evans’ wholly
unsupported claims that 500 milligrams of midazolam will
“paralyz[e] the brain.” In so holding, the Court disregards an
objectively intolerable risk of severe pain.
A
Like the Court, I would review for clear error
the District Court’s finding that 500 milligrams of midazolam will
render someone sufficiently unconscious “ ‘to resist the
noxious stimuli which could occur from the application of the
second and third drugs.’ ”
Ante, at 18–19 (quoting App.
77). Unlike the Court, however, I would do so without abdicating
our duty to examine critically the factual predicates for the
District Court’s finding—namely, Dr. Evans’ testimony that
midazolam has a “ceiling effect” only “at the spinal cord level,”
and that a “500 milligram dose of midazolam” can therefore
“effectively paralyze the brain.”
Id., at 78. To be sure, as
the Court observes, such scientific testimony may at times lie at
the boundaries of fed-eral courts’ expertise. See
ante, at
17–18. But just because a purported expert says something does not
make it so. Especially when important constitutional rights are at
stake, federal district courts must carefully evaluate the premises
and evidence on which scientific conclusions are based, and
appellate courts must ensure that the courts below have in fact
carefully considered all the evidence presented. Clear error exists
“when although there is evidence to support” a finding, “the
reviewing court on the entire evidence is left with the definite
and firm conviction that a mistake has been committed.”
United
States v.
United States Gypsum Co., 333 U. S. 364,
395 (1948) . Here, given the numerous flaws in Dr. Evans’
testimony, there can be little doubt that the District Court
clearly erred in relying on it.
To begin, Dr. Evans identified no scientific
literature to support his opinion regarding midazolam’s properties
at higher-than-normal doses. Apart from a Material Safety Data
Sheet that was relevant only insofar as it suggests that a low dose
of midazolam may occasionally be toxic, see
ante, at 27—an
issue I discuss further below—Dr. Evans’ testimony seems to have
been based on the Web site www.drugs.com. The Court may be right
that “petitioners do not identify any incorrect statements from
drugs.com on which Dr. Evans relied.”
Ante, at 27. But that
is because there were
no statements from drugs.com that
supported the critically disputed aspects of Dr. Evans’ opinion. If
anything, the Web site supported petitioners’ contentions, as it
expressly cautioned that midazolam “[s]hould not be used alone for
maintenance of anesthesia,” App. H to Pet. for Cert. 6159, and
contained no warning that an excessive dose of midazolam could
“paralyze the brain,” see
id., at 6528–6529.
Most importantly, nothing from drugs.com—or, for
that matter, any other source in the record—corroborated Dr. Evans’
key testimony that midazolam’s ceiling effect is limited to the
spinal cord and does not pertain to the brain. Indeed, the State
appears to have disavowed Dr. Evans’ spinal-cord theory, refraining
from even mentioning it in its brief despite the fact that the
District Court expressly relied on this testimony as the basis for
finding that larger doses of midazolam will have greater anesthetic
effects. App. 78. The Court likewise assiduously avoids defending
this theory.
That is likely because this aspect of Dr. Evans’
testi-mony was not just unsupported, but was directly refuted by
the studies and articles cited by Drs. Lubarsky and Sasich. Both of
these experts relied on academic texts describing benzodiazepines’
ceiling effect and explaining why it prevents these drugs from
rendering a person completely insensate. See Stoelting &
Hillier 141, 144 (describing midazolam’s ceiling effect and
contrasting the drug with barbiturates); Saari 244 (observing that
“abolishment of perception of environmental stimuli cannot usually
be generated”). One study further made clear that the ceiling
effect is apparent in the brain. See
id., at 250.
These scientific sources also appear to
demonstrate that Dr. Evans’ spinal-cord theory—
i.e., that
midazolam’s ceiling effect is limited to the spinal cord—was
premised on a basic misunderstanding of midazolam’s mechanism of
action. I say “appear” not because the sources themselves are
unclear about how midazolam operates: They plainly state that
midazolam functions by promoting GABA’s inhibitory effects on the
central nervous system. See,
e.g., Stoelting & Hillier
140. Instead, I use “appear” because discerning the rationale
underlying Dr. Evans’ testimony is difficult. His spinal-cord
theory might, however, be explained at least in part by his
apparent belief that rather than promoting GABA’s inhibitory
effects, midazolam produces sedation by “compet[ing]” with GABA and
thus “inhibit[ing]” GABA’s effect. App. 312–313.[
2] Regardless, I need not delve too deeply
into Dr. Evans’ alternative scientific reality. It suffices to say
that to the extent that Dr. Evans’ testimony was based on his
understanding of the source of midazolam’s pharmacological
properties, that understanding was wrong.
These inconsistencies and inaccuracies go to the
very heart of Dr. Evans’ expert opinion, as they were the key
components of his professed belief that one can extrapolate from
what is known about midazolam’s effect at low doses to conclude
that the drug would “paralyz[e] the brain” at Oklahoma’s planned
dose.
Id., at 314. All three experts recognized that there
had been no scientific testing on the use of this amount of
midazolam in conjunction with these particular lethal injection
drugs. See
ante, at 19; App. 176 (Lubarsky), 243–244
(Sasich), 327 (Evans). For this reason, as the Court correctly
observes, “extrapolation was reasonable.”
Ante, at 20. But
simply because extrapolation may be reasonable or even required
does not mean that every conceivable method of extrapolation can be
credited, or that all estimates stemming from purported
extrapolation are worthy of belief. Dr. Evans’ view was that
because 40 milligrams of midazolam could be used to induce
unconsciousness, App. 294, and because more drug will generally
produce more effect, a significantly larger dose of 500 milligrams
would not just induce unconsciousness but allow for its maintenance
in the face of extremely painful stimuli, and ultimately even cause
death itself. In his words: “[A]s you increase the dose of
midazolam, it’s a linear effect, so you’re going to continue to get
an impact from higher doses of the drug.”
Id., at 332. If,
however, there is a ceiling with respect to midazolam’s effect on
the brain—as petitioners’ experts established there is—then such
simplistic logic is not viable. In this context, more is not
necessarily better, and Dr. Evans was plainly wrong to presume it
would be.
If Dr. Evans had any other basis for the
“extrapolation” that led him to conclude 500 milligrams of
midazolam would “paralyz[e] the brain,”
id., at 314, it was
even further divorced from scientific evidence and logic. Having
emphasized that midazolam had been known to cause approximately 80
deaths, Dr. Evans asserted that his opinion regarding the efficacy
of Oklahoma’s planned use of the drug represented “essentially an
extrapolation from a
toxic effect.”
Id., at 327
(emphasis added); see
id., at 308. Thus, Dr. Evans appeared
to believe—and again, I say “appeared” because his rationale is not
clear—that because midazolam caused
some deaths, it would
necessarily cause complete unconsciousness and then death at
especially high doses. But Dr. Evans also thought, and Dr. Lubarsky
confirmed, that these midazolam fatalities had occurred at very low
doses—well below what any expert said would produce
unconsciousness. See
id., at 207, 308. These deaths thus
seem to represent the rare, unfortunate side effects that one would
expect to see with any drug at normal therapeutic doses; they
provide no indication of the effect one would expect midazolam to
have on the brain at substantially higher doses. Deaths occur with
almost any product. One might as well say that because some people
occasionally die from eating one peanut, one hundred peanuts would
necessarily induce a coma and death in anyone.[
3]
In sum, then, Dr. Evans’ conclusions were
entirely unsupported by any study or third-party source,
contradicted by the extrinsic evidence proffered by petitioners,
inconsistent with the scientific understanding of midazolam’s
properties, and apparently premised on basic logical errors. Given
these glaring flaws, the District Court’s acceptance of Dr. Evans’
claim that 500 milligrams of midazolam would “paralyz[e] the brain”
cannot be credited. This is not a case “[w]here there are two
permissibleviews of the evidence,” and the District Court chose
one; rather, it is one where the trial judge credited “one of two
or more witnesses” even though that witness failed to tell “a
coherent and facially plausible story that is not contradicted by
extrinsic evidence.”
Anderson v.
Bessemer City, 470
U. S. 564 –575 (1985). In other words, this is a case in which
the District Court clearly erred. See
ibid.
B
Setting aside the District Court’s erroneous
factual finding that 500 milligrams of midazolam will necessarily
“paralyze the brain,” the question is whether the Court is
nevertheless correct to hold that petitioners failed to demonstrate
that the use of midazolam poses an “objectively intolerable risk”
of severe pain. See
Baze, 553 U. S., at 50 (plurality
opinion) (internal quotation marks omitted). I would hold that they
made this showing. That is because, in stark contrast to Dr. Evans,
petitioners’ experts were able to point to objective evidence
indicating that midazolam cannot serve as an effective anesthetic
that “render[s] a person insensate to pain caused by the second and
third [lethal injection] drugs.”
Ante, at 23.
As observed above, these experts cited multiple
sources supporting the existence of midazolam’s ceiling effect.
That evidence alone provides ample reason to doubt midazolam’s
efficacy. Again, to prevail on their claim, petitioners need only
establish an intolerable
risk of pain, not a certainty. See
Baze, 553 U. S., at 50. Here, the State is attempting
to use midazolam to produce an effect the drug has never previously
been demonstrated to produce, and despite studies indicating that
at some point increasing the dose will not actually increase the
drug’s effect. The State is thus proceeding in the face of a very
real risk that the drug will not work in the manner it claims.
Moreover, and perhaps more importantly, the
record provides good reason to think this risk is substantial. The
Court insists that petitioners failed to provide “probative
evidence” as to whether “midazolam’s ceiling effect occurs below
the level of a 500-milligram dose and at a point at which the drug
does not have the effect of rendering a person insensate to pain.”
Ante, at 23. It emphasizes that Dr. Lubarsky was unable to
say “at what dose the ceiling effect occurs,” and could only
estimate that it was “ ‘[p]robably after about . . .
40 to 50 milligrams.’ ”
Ante, at 23 (quoting App.
225).
But the precise
dose at which midazolam
reaches its ceiling effect is irrelevant if there is no dose at
which the drug can, in the Court’s words, render a person
“insensate to pain.”
Ante, at 23. On this critical point,
Dr. Lubarsky was quite clear.[
4] He explained that the drug “does not work to produce” a
“lack of consciousness as noxious stimuli are applied,” and is “not
sufficient to produce a surgical plane of anesthesia in human
beings.” App. 204. He also noted that “[t]he drug would never be
used and has never been used as a sole anesthetic to give
anesthesia during a surgery,”
id., at 223, and asserted that
“the drug was not approved by the FDA as a sole anesthetic because
after the use of fairly large doses that were sufficient to reach
the ceiling effect and produce induction of unconsciousness, the
patients responded to the surgery,”
id., at 219. Thus, Dr.
Lubarsky may not have been able to identify whether this effect
would be reached at 40, 50, or 60 milligrams or some higher
threshold, but he could specifythat at no level would midazolam
reliably keep an in-mate unconscious once the second and third
drugs were delivered.[
5]
These assertions were amply supported by the
evidence of the manner in which midazolam is and can be used. All
three experts agreed that midazolam is utilized as the sole
sedative only in minor procedures. Dr. Evans, for example,
acknowledged that while midazolam may be used as the sole drug in
some procedures that are not “terribly invasive,” even then “you
would [generally] see it used in combination with a narcotic.”
Id., at 307. And though, as the Court observes, Dr. Sasich
believed midazolam could be “used for medical procedures like
colonoscopies and gastroscopies,”
ante, at 21, he insisted
that these procedures were not necessarily painful, and that it
would be a “big jump” to conclude that midazolam would be effective
to maintain unconsciousness throughout an execution. Tr. 369–370.
Indeed, the record provides no reason to think that these
procedures cause excruciating pain remotely comparable to that
produced by the second and third lethal injection drugs Oklahoma
intends to use.
As for more painful procedures, the consensus
was also clear: Midazolam is not FDA-approved for, and is not used
as, a sole drug to maintain unconsciousness. See App. 171
(Lubarsky), 262 (Sasich), 327 (Evans). One might infer from the
fact that midazolam
is not used as the sole anesthetic for
more serious procedures that it
cannot be used for them. But
drawing such an inference is unnecessary, as petitioners’ experts
invoked sources expressly stating as much. In particular, Dr.
Lubarsky pointed to a survey article that cited four separate
authorities and declared that “[m]idazolam cannot be used alone
. . . to maintain adequate anesthesia.” Reves 318; see
also Stoelting & Hillier 145 (explaining that midzolam is used
for “induction of anesthesia,” and that, “
[i]n combination with
other drugs, [it] may be used for maintenance of anesthesia”
(emphasis added)).
This evidence was alone sufficient, but if one
wanted further support for these conclusions it was provided by the
Lockett and Wood executions. The procedural flaws that marred the
Lockett execution created the conditions for an unintended (and
grotesque) experiment on midazolam’s efficacy. Due to problems with
the IV line, Lockett was not fully paralyzed after the second and
third drugs were administered. He had, however, been administered
more than enough midazolam to “render an average person
unconscious,” as the District Court found. App. 57. When Lockett
awoke and began to writhe and speak, he demonstrated the critical
difference between midazolam’s ability to render an inmate
unconscious and its ability to maintain the inmate in that state.
The Court insists that Lockett’s execution involved “only 100
milligrams of midazolam,”
ante, at 28, but as explained
previously, more is not necessarily better given midazolam’s
ceiling effect.
The Wood execution is perhaps even more
probative. Despite being given over 750 milligrams of midazolam,
Wood gasped and snorted for nearly two hours. These reactions were,
according to Dr. Lubarsky, inconsistent with Wood being fully
anesthetized, App. 177–178, and belie the claim that a lesser dose
of 500 milligrams would somehow suffice. The Court attempts to
distinguish the Wood execution on the ground that the timing of
Arizona’s administration of midazolam was different.
Ante,
at 28. But as Dr. Lubarsky testified, it did not “matter” whether
in Wood’s execution the “midazolam was introduced all at once or
over . . . multiple doses,” because “[t]he drug has a
sufficient half life that the effect is cumulative.” App. 220; see
also Saari 253 (midazolam’s “elimination half-life ranges from 1.7
to 3.5 h[ours]”).[
6] Nor does
the fact that Wood’s dose of midazolam was paired with
hydromorphone rather than a paralytic and potassium chromide, see
ante, at 29, appear to have any relevance—other than that
the use of this analgesic drug may have meant that Wood did not
experience the same degree of searing pain that an inmate executed
under Oklahoma’s protocol may face.
By contrast, Florida’s use of this same
three-drug protocol in 11 executions, see
ante, at 28
(citing Brief for State of Florida as
Amicus Curiae 1),
tells us virtually nothing. Although these executions have featured
no obvious mishaps, the key word is “obvious.” Because the protocol
involves the administration of a powerful paralytic, it is, as Drs.
Sasich and Lubarsky explained, impossible to tell whether the
condemned inmate in fact remained unconscious. App. 218, 273; see
also
Baze, 553 U. S., at 71 (Stevens, J., concurring in
judgment). Even in these executions, moreover, there have been
indications of the inmates’ possible awareness. See Brief for State
of Alabama et al. as
Amici Curiae 9–13 (describing the 11
Flor-ida executions, and noting that some allegedly involved
blinking and other movement after administration of the three
drugs).[
7]
Finally, none of the State’s “safeguards” for
administering these drugs would seem to mitigate the substantial
risk that midazolam will not work, as the Court contends. See
ante, at 21–22. Protections ensuring that officials have
properly secured a viable IV site will not enable midazolam to have
an effect that it is chemically incapable of having. Nor is there
any indication that the State’s monitoring of the inmate’s
consciousness will be able to anticipate whether the inmate will
remain unconscious while the second and third drugs are
administered. No one questions whether midazolam can induce
unconsciousness. The problem, as Lockett’s execution vividly
illustrates, is that an unconscious inmate may be awakened by the
pain and respiratory distress caused by administration of the
second and third drugs. At that point, even if it were possible to
determine whether the inmate is conscious—dubious, given the use of
a paralytic—it is already too late. Presumably for these reasons,
the Tenth Circuit characterized the District Court’s reliance on
these procedural mechanisms as “not relevant to its rejection of
[petitioners’] claims regarding the inherent characteristics of
midazolam.”
Warner, 776 F. 3d, at 733.
C
The Court not only disregards this record
evidence of midazolam’s inadequacy, but also fails to fully
appreciate the procedural posture in which this case arises.
Petitioners have not been accorded a full hearing on the merits of
their claim. They were granted only an abbreviated evidentiary
proceeding that began less than three months after the State issued
its amended execution protocol; they did not even have the
opportunity to present rebuttal evidence after Dr. Evans testified.
They sought a preliminary injunction, and thus were not required to
prove their claim, but only to show that they were likely to
succeed on the merits. See
Winter v.
Natural Resources
Defense Council, Inc., 555 U. S. 7, 20 (2008) ;
Hill v.
McDonough, 547 U. S. 573, 584 (2006)
.
Perhaps the State could prevail after a full
hearing, though this would require more than Dr. Evans’ unsupported
testimony. At the preliminary injunction stage, however,
petitioners presented compelling evidence suggesting that midazolam
will not work as the State intends. The State, by contrast, offered
absolutely no contrary evidence worth crediting. Petitioners are
thus at the very least
likely to prove that, due to
midazolam’s inherent deficiencies, there is a constitutionally
intolerable risk that they will be awake, yet unable to move, while
chemicals known to cause “excruciating pain” course through their
veins.
Baze, 553 U. S., at 71 (Stevens, J., concurring
in judgment).
III
The Court’s determination that the use of
midazolam poses no objectively intolerable risk of severe pain is
factually wrong. The Court’s conclusion that petitioners’ challenge
also fails because they identified no available alternative means
by which the State may kill them is legally indefensible.
A
This Court has long recognized that certain
methods of execution are categorically off-limits. The Court first
confronted an Eighth Amendment challenge to a method of execution
in
Wilkerson v.
Utah, 99 U. S. 130 (1879) .
Although
Wilkerson approved the particular method at
issue—the firing squad—it made clear that “public dissection,”
“burning alive,” and other “punishments of torture . . .
in the same line of unnecessary cruelty, are forbidden by [the
Eighth A]mendment to the Constitution.”
Id., at 135–136.
Eleven years later, in rejecting a challenge to the first proposed
use of the electric chair, the Court again reiterated that “if the
punishment prescribed for an offense against the laws of the State
were manifestly cruel and unusual, as burning at the stake,
crucifixion, breaking on the wheel, or the like, it would be the
duty of the courts to adjudge such penalties to be within the
constitutional prohibition.”
In re Kemmler, 136 U. S.
436, 446 (1890) .
In the more than a century since, the Members of
this Court have often had cause to debate the full scope of the
Eighth Amendment’s prohibition of cruel and unusual punishment.
See,
e.g., Furman v.
Georgia, 408 U. S. 238
(1972) . But there has been little dispute that it at the very
least precludes the imposition of “barbarous physical punishments.”
Rhodes v.
Chapman, 452 U. S. 337, 345 (1981) ;
see,
e.g.,
Solem v.
Helm, 463 U. S. 277,
284 (1983) ;
id., at 312–313 (Burger, C. J.,
dissenting);
Baze, 553 U. S., at 97–99 (Thomas, J.,
concurring in judgment);
Harmelin v.
Michigan, 501
U. S. 957, 976 (1991) (opinion of Scalia, J.). Nor has there
been any question that the Amendment prohibits such “inherently
barbaric punishments
under all circumstances.”
Graham
v.
Florida, 560 U. S. 48 (2010) (emphasis added).
Simply stated, the “ Eighth Amendment
categorically
prohibits the infliction of cruel and unusual punishments.”
Penry v.
Lynaugh, 492 U. S. 302, 330 (1989)
(emphasis added).
B
The Court today, however, would convert this
categorical prohibition into a conditional one. A method of
execution that is intolerably painful—even to the point of being
the chemical equivalent of burning alive—will, the Court holds, be
unconstitutional
if, and only if, there is a “known and
available alternative” method of execution.
Ante, at 15. It
deems
Baze to foreclose any argument to the contrary.
Ante, at 14.
Baze held no such thing. In the first
place, the Court cites only the plurality opinion in
Baze as
support for its known-and-available-alternative requirement. See
ibid. Even assuming that the
Baze plurality set forth
such a requirement—which it did not—none of the Members of the
Court whose concurrences were necessary to sustain the
Baze
Court’s judgment articulated a similar view. See 553 U. S., at
71–77, 87 (Stevens, J., concurring in judgment);
id., at 94,
99–107 (Thomas, J., concurring in judgment);
id., at
107–108, 113 (Breyer, J., concurring in judgment). In general, “the
holding of the Court may be viewed as that position taken by those
Members who concurred in the judgments on the narrowest grounds.”
Marks v.
United States, 430 U. S. 188, 193
(1977) (internal quotation marks omitted). And as the Court
observes,
ante, at 14, n. 2, the opinion of Justice
Thomas, joined by Justice Scalia, took the broadest position with
respect to the degree of intent that state officials must have
inorder to have violated the Eighth Amendment, concluding that only
a method of execution deliberately designedto inflict pain, and not
one simply designed with deliberate indifference to the risk of
severe pain, would be un-constitutional. 553 U. S., at 94
(Thomas, J., concurringin judgment). But this understanding of the
Eighth Amendment’s intent requirement is unrelated to, and thus not
any broader or narrower than, the requirement the Court now divines
from
Baze. Because the position that a plaintiff challenging
a method of execution under the Eighth Amendment must prove the
availability of an alternative means of execution did not
“represent the views of a majority of the Court,” it was not the
holding of the
Baze Court.
CTS Corp. v.
Dynamics
Corp. of America, 481 U. S. 69, 81 (1987) .
In any event, even the
Baze plurality
opinion provides no support for the Court’s proposition. To be
sure, that opinion contains the following sentence: “[The
condemned] must show that the risk is substantial when compared to
the known and available alternatives.” 553 U. S., at 61. But
the meaning of that key sentence and the limits of the requirement
it imposed are made clear by the sentence directly preceding it: “A
stay of execution may not be granted
on grounds such as those
asserted here unless the condemned prisoner establishes that
the State’s lethal injection protocol creates a demonstrated risk
of severe pain.”
Ibid. (emphasis added). In
Baze, the
very premise of the petitioners’ Eighth Amendment claim was that
they had “identified a significant risk of harm [in Kentucky’s
protocol] that [could] be eliminated by adopting alternative
procedures.”
Id., at 51. Their basic theory was that even if
the risk of pain was only, say, 25%, that risk would be objectively
intolerable if there was an obvious alternative that would reduce
the risk to 5%. See Brief for Petitioners in
Baze v.
Rees, O. T. 2007, No. 07–5439, p. 29 (“In view of
the severity of the pain risked and the ease with which it could be
avoided, Petitioners should not have been required to show a high
likelihood that they would suffer such pain
. . . ”). Thus, the “grounds . . .
asserted” for relief in
Baze were that the State’s protocol
was intolerably risky given the alternative procedures the State
could have employed.
Addressing this claim, the
Baze plurality
clarified that “a condemned prisoner cannot successfully challenge
a State’s method of execution merely by showing a slightly or
marginally safer alternative,” 553 U. S., at 51; instead, to
succeed in a challenge of this type, the comparative risk must be
“substantial,”
id., at 61. Nowhere did the plurality suggest
that
all challenges to a State’s method of execution would
require this sort of comparative-risk analysis. Recognizing the
relevance of available alternatives is not at all the same as
concluding that their absence precludes a claimant from showing
that a chosen method carries objectively intolerable risks. If, for
example, prison officials chose a method of execution that has a
99% chance of causing lingering and excruciating pain, certainly
that risk would be objectively intolerable whether or not the
officials ignored other methods in making this choice. Irrespective
of the existence of alternatives, there are some risks “so grave
that it violates contemporary standards of decency to expose
anyone unwillingly to” them.
Helling v.
McKinney, 509 U. S. 25, 36 (1993) (emphasis in
original).
That the
Baze plurality’s statement
regarding a condemned inmate’s ability to point to an available
alternative means of execution pertained only to challenges
premised on the existence of such alternatives is further evidenced
by the opinion’s failure to distinguish or even mention the Court’s
unanimous decision in
Hill v.
McDonough, 547
U. S. 573 .
Hill held that a §1983 plaintiff
challenging a State’s method of execution need not “identif[y] an
alternative, authorized method of execution.”
Id., at 582.
True, as the Court notes,
ante, at 14–15,
Hill did so
in the context of addressing §1983’s pleading standard, rejecting
the proposed alternative-means requirement because the Court saw no
basis for the “[i]mposition of heightened pleading requirements.”
547 U. S., at 582. But that only confirms that the Court in
Hill did not view the availability of an alternative means
of execution as an element of an Eighth Amendment claim: If it had,
then requiring the plaintiff to plead this element would not have
meant imposing a heightened standard at all, but rather would have
been entirely consistent with “traditional pleading requirements.”
Ibid.; see
Ashcroft v.
Iqbal, 556 U. S.
662, 678 (2009) . The
Baze plurality opinion should not be
understood to have so carelessly tossed aside
Hill’s
underlying premise less than two years later.
C
In reengineering
Baze to support its
newfound rule, the Court appears to rely on a flawed syllogism. If
the death penalty is constitutional, the Court reasons, then there
must be a means of accomplishing it, and thus some available method
of execution must be constitutional. See
ante, at 4, 15–16.
But even accepting that the death penalty is, in the abstract,
consistent with evolving standards of decency, but see
ante,
p.
___ (Breyer, J., dissenting), the Court’s conclusion does
not follow. The constitutionality of the death penalty may inform
our conception of the degree of pain that would render a particular
method of imposing it unconstitutional. See
Baze, 553
U. S., at 47 (plurality opinion) (because “[s]ome risk of pain
is inherent in any method of execution,” “[i]t is clear
. . . the Constitution does not demand the avoidance of
all risk of pain”). But a method of execution that is “barbarous,”
Rhodes, 452 U. S., at 345, or “involve[s] torture or a
lingering death,”
Kemmler, 136 U. S., at 447, does not
become less so just because it is the only method currently
available to a State. If all available means of conducting an
execution constitute cruel and unusual punishment, then conducting
the execution will constitute cruel and usual punishment. Nothing
compels a State to perform an execution. It does not get a
constitutional free pass simply because it desires to deliver the
ultimate penalty; its ends do not justify any and all means. If a
State wishes to carry out an execution, it must do so subject to
the constraints that our Constitution imposes on it, including the
obligation to ensure that its chosen method is not cruel and
unusual. Certainly the condemned has no duty to devise or pick a
constitutional instrument of his or her own death.
For these reasons, the Court’s
available-alternative requirement leads to patently absurd
consequences. Petitioners contend that Oklahoma’s current protocol
is a barbarous method of punishment—the chemical equivalent of
being burned alive. But under the Court’s new rule, it would not
matter whether the State intended to use midazolam, or instead to
have petitioners drawn and quartered, slowly tortured to death, or
actually burned at the stake: because petitioners failed to prove
the availability of sodium thiopental or pentobarbital, the State
could execute them using whatever means it designated. But see
Baze, 553 U. S., at 101–102 (Thomas, J., concurring in
judgment) (“It strains credulity to suggest that the defining
characteristic of burning at the stake, disemboweling, drawing and
quartering, beheading, and the like was that they involved risks of
pain that could be eliminated by using alternative methods of
execution”).[
8] The Eighth
Amendment cannot possibly countenance such a result.
D
In concocting this additional requirement, the
Court is motivated by a desire to preserve States’ ability to
conduct executions in the face of changing circumstances. See
ante, at 4–6, 27–28. It is true, as the Court details, that
States have faced “practical obstacle[s]” to obtaining lethal
injection drugs since
Baze was decided.
Ante, at 4.
One study concluded that recent years have seen States change their
protocols “with a frequency that is unprecedented among execution
methods in this country’s history.” Denno, Lethal Injection Chaos
Post-
Baze, 102 Geo. L. J. 1331, 1335 (2014).
But why such developments compel the Court’s
imposition of further burdens on those facing execution is a
mystery. Petitioners here had no part in creating the shortage of
execution drugs; it is odd to punish them for the actions of
pharmaceutical companies and others who seek to disassociate
themselves from the death penalty—actions which are, of course,
wholly lawful. Nor, certainly, should these rapidly changing
circumstances give us any greater confidence that the execution
methods ultimately selected will be sufficiently humane to satisfy
the Eighth Amendment. Quite the contrary. The execution protocols
States hurriedly devise as they scramble to locate new and untested
drugs, see
supra, at 3, are all the more likely to be cruel
and unusual—presumably, these drugs would have been the States’
first choice were they in fact more effective. But see Denno, The
Lethal Injection Quandry: How Medicine Has Dismantled the Death
Penalty, 76 Ford. L. Rev. 49, 65–79 (2007) (describing the
hurried and unreasoned process by which States first adopted the
original three-drug protocol). Courts’ review of execution methods
should be more, not less, searching when States are engaged in what
is in effect human experimentation.
It is also worth noting that some condemned
inmates may read the Court’s surreal requirement that they
iden-tify the means of their death as an invitation to propose
methods of executions less consistent with modern sensibilities.
Petitioners here failed to meet the Court’s new test because of
their assumption that the alternative drugs to which they pointed,
pentobarbital and sodium thiopental, were available to the State.
See
ante, at 13–14. This was perhaps a reasonable
assumption, especially given that neighboring Texas and Missouri
still to this day continue to use pentobarbital in executions. See
The Death Penalty Institute, Execution List 2015, online at
www.deathpenaltyinfo.org/execution-list-2015 (as visited June 26,
2015, and available in the Clerk of the Court’s case file).
In the future, however, condemned inmates might
well decline to accept States’ current reliance on lethal
injection. In particular, some inmates may suggest the firing squad
as an alternative. Since the 1920’s, only Utah has utilized this
method of execution. See S. Banner, The Death Penalty 203 (2002);
Johnson, Double Murderer Executed by Firing Squad in Utah,
N. Y. Times, June 19, 2010, p. A12. But there is evidence to
suggest that the firing squad is significantly more reliable than
other methods, including lethal injection using the various
combinations of drugs thus far developed. See A. Sarat, Gruesome
Spectacles: Botched Executions and America’s Death Penalty, App. A,
p. 177 (2014) (calculating that while 7.12% of the 1,054
executions by lethal injection between 1900 and 2010 were
“botched,” none of the 34 executions by firing squad had been).
Just as important, there is some reason to think that it is
relatively quick and painless. See Banner,
supra, at
203.
Certainly, use of the firing squad could be seen
as a devolution to a more primitive era. See
Wood v.
Ryan, 759 F. 3d 1076, 1103 (CA9 2014) (Kozinski,
C. J., dissenting from denial of rehearing en banc). That is
not to say, of course, that it would therefore be unconstitutional.
But lethal injection represents just the latest iteration of the
States’ centuries-long search for “neat and non-disfiguring
homicidal methods.” C. Brandon, The Electric Chair: An Unnatural
American History 39 (1999) (quoting Editorial, New York Herald,
Aug. 10, 1884); see generally Banner,
supra, at 169–207. A
return to the firing squad—and the blood and physical violence that
comes with it—is a step in the opposite direction. And some might
argue that the visible brutality of such a death could conceivably
give rise to its own Eighth Amendment concerns. See
Campbell
v.
Wood, 511 U. S. 1119 –1123 (1994) (Blackmun, J.,
dissenting from denial of stay of execution and certiorari);
Glass v.
Louisiana, 471 U. S. 1080, 1085 (1985)
(Brennan, J., dissenting from denial of certiorari). At least from
a condemned inmate’s perspective, however, such visible yet
relatively painless violence may be vastly preferable to an
excruciatingly painful death hidden behind a veneer of medication.
The States may well be reluctant to pull back the curtain for fear
of how the rest of us might react to what we see. But we deserve to
know the price of our collective comfort before we blindly allow a
State to make condemned inmates pay it in our names.
* * *
“By protecting even those convicted of heinous
crimes, the Eighth Amendment reaffirms the duty of the government
to respect the dignity of all persons.”
Roper v.
Simmons, 543 U. S. 551, 560 (2005) . Today, however,
the Court absolves the State of Oklahoma of this duty. It does so
by misconstruing and ignoring the record evidence regarding the
constitutional insufficiency of midazolam as a sedative in a
three-drug lethal injection cocktail, and by imposing a wholly
unprecedented obligation on the condemned inmate to identify an
available means for his or her own execution. The contortions
necessary to save this particular lethal injection protocol are not
worth the price. I dissent.