The Death Penalty in the OSCE Area–Background Paper 2021 Methods of execution: the effects of the lethal injection Since 2016, ODIHR has been highlighting the ways in which methods of execution, and especially lethal injection protocols, can constitute cruel, inhuman and degrading treatment or punishment.233 In September 2020, a report by the American media organization NPR (National Public Radio) analysed more than 300 autopsies from individuals who were executed between 1990 and 2019 in nine American states.234 The inquiry found that when lethal injections were administered (using pentobarbital, as well as other drugs, such as midazolam), the inmates were still alive and trying to breathe while their lungs filled with fluid. In fact, in 84 per cent of the cases examined, individuals showed signs of pulmonary edema. This raises concerns about inmates not being properly anesthetized, and the resulting feelings of suffocation and drowning they experience. These findings were presented to several federal courts and the Supreme Court to determine whether lethal injection protocols constitute cruel and unusual punishment according to the Eighth Amendment.235 To date, no court has yet ruled on the relevance of pain associated with pulmonary edema in the context of the Eighth Amendment. Expert medical evidence presented in Roane v. Barr, demonstrated that it is a, “virtual medical certainty that most, if not all, prisoners will experience excruciating suffering, including sensations of drowning and suffocation (flash pulmonary edema),” as a result of an injection of 5 grams of pentobarbital.236 The ongoing debate on lethal injection protocols prompted Ohio Governor Mike DeWine to put all the state’s executions on hold on 8 December 2020. Overall, lethal injection protocols, as well as difficulties procuring drugs for lethal injections, led to de-facto moratoria on executions in several other states.237 In March 2021, South Carolina advanced a bill to allow the state to carry out executions by electric chair if lethal-injection drugs were not available. At the time of writing, the law in South Carolina allows prisoners to choose between lethal injection and electric chair as the method of execution. However, lethal injection constitutes the default method, 233 See ODIHR Background Papers, 2015–2020, op. cit., note 5. 234 NPR, Gasping For Air: Autopsies Reveal Troubling Effects Of Lethal Injection, 21 September 2020. 235 Equal Justice Initiative, Lethal Injections Cause Suffocation and Severe Pain, Autopsies Show, 22 September 2020 and NPR, Gasping For Air: Autopsies Reveal Troubling Effects Of Lethal Injection, 21 September 2020. 236 Roane v. Barr (In re Fed. Bureau of Prisons’ Execution Protocol Cases), 980 F.3d 123 (D.C. Cir. 2020), 18 November 2020. 237 Amnesty International Global Report: Death sentences and executions 2020”, op. cit., note 152, p. 18. 55