How can it be more beneficial to use drugs then harmful?

Why is there a debate in the USA about which drugs to use when executing people, when medical anesthesiologic drugs can be used to deal with pain?

• The question, though controversial, is NOT about the appropriateness of capital punishment or the ethics of medical staff. Rather, I see an inconsistency between The US recently (June-14) executed people with painfull procedure (see http://www.theatlantic.com/national/archive/2014/04/Oklahoma/361414/), partially due to not having the "right" drugs at hand Medical anesthesiologists (and veterinaries, btw) know how to quickly knock someone off and remove all sensation of pain. They do so everyday, with readily-available drugs I see a blatant inefficiency at best, and an active willingness to make people suffer at worst. Two other Quora questions relate to this, but have unsatisfactory answers:

• Answer:

  Thanks for the A2A. So far as I can tell, the problem is that when lethal injections began in the 80's, they wanted a triply redundant system, and they asked some physicians what could be used. Physicians are not very skilled at killing people. They came up with three agents that kill in three different ways (in theory). These agents were pentobarbital, trade name Nembutal, (which stops breathing in overdose by stopping consciousness), succinylcholine (a paralytic agent) which prevents breathing (but doesn't stop consciousness) and potassium chloride (which stops the heart by causing arrhythmias). These agents worked reasonably well if given in correct order (nembutal first, or otherwise it's very bad to be paralyzed and want to breathe but not be able to). Naturally there was complaining. Then, since anesthesia as a profession no longer depends on nembutal (using short acting agents like propofol and etomidate) the European makers of Nembutal stopped selling it, or jacked up the price of the human drug, out of protest against the US death penalty. This caused the US authorities to look around for an agent that caused unconsciouness, but nobody considered getting rid of the paralytic or the potassium (which causes a lot of pain if not injected exactly into a vein). Eventually it occurred to prison executioners in Ohio that they could use a simple cocktail of the narcotic Dilaudid (similar to morphine or heroin but more powerful) and Versed (similar to Xanax, but available IV). They used this successfully, but it takes longer to kill than the 3-drug cocktail, and again there was complaining. It causes death by unconsciousness and respiratory arrest. The subject gasps automatically while unconscious and it's harder on the observers than it is on the prisoner. In Oklahoma they apparently included potassium, which caused pain when a prisoner who had gotten the calming Versed but not Nembutal, woke up when the potassium was pushed in rapidly and probably exploded a vein and leaked into tissues, where it causes nerve pain. One difficulty with executions is that they tend to try to make things mechanical, with a machine pump pushing in potassium solution, and this doesn't work well in medicine sometimes when the machine exceeds the vein capacity to take fluid. Nembutal is available as a veterinary euthanasia drug, but the authorities never talked to vets, and so don't know about it, apparently. Vets doing euthanasia use a blue-colored solution of Nembutal (again, barbiturate, pentobarbital, that stops breathing) called Fatal Plus. It's a liquid colored blue so it won't get mixed up  with other IV drugs. It's a knockoff of an even older vet drug, still also used, called Euthasol, which is a fluid colored red for the same reason, and consists of  Nembutal plus phenytoin (Dilantin) which also stops the heart. But the  latter drug combo is more viscous, and although it works faster, it is in a very alkaline solution and can be very painful if a vein is missed. Nembutal, like all other respiratory drugs, takes 10 minutes or so to stop the heart (from lack of oxygen). Otherwise, Fatal Plus would work fine. By law, only vets can prescribe it, so some federal law would have to be broken, however. Contrary to popular belief it's not that easy to reliably and quickly kill somebody with modern anesthesia agents. An agent like etomidate can knock somebody unconscious, but wouldn't necessarily and reliably stop breathing well enough to kill. There is no agent that stops the heart that does not hurt to inject if you miss the site. Vets have the option of doing direct cardiac puncture if they can't find a vein, and there's nobody willing to do that on humans. Without nembutal access, overall, the Ohio cocktail of Dilaudid is about the best one can do, perhaps preceded by Versed and then etomidate. The suggestion of using another execution method once the person is unconscious, like suspension hanging or perhaps gunshot, could be done. Laws would again have to be rewritten. A persistent suggestion is asphyxiation with a non-oxygen containing inert gas like nitrogen or helium, which could be administered into a transparent hood to go over the head, and which would not be a danger to bystanders (thus not needing a chamber). This could probably be done even without anesthesia, as asphyxia from pure lack of oxygen produces almost no symptoms. But certainly, it could be combined with a starting-off using a short-acting anesthetic like etomidate, and before that, an anxiety-blocker like Versed. And it would probably be faster (due to better oxygen clean out) than pure respiratory arrest. Inert gas had one more advantage as a backup (with some intramuscular sedation) for condemned prisoners who you can't get a good IV into. These need a live "cut down" now, which can't be fun. Yet again, however, laws would have to be rewritten to allow the combined procedure. And there would still be complaining no matter what, as complaints cause delays. I'm against the death penalty, but think it should be humane at least. Personally I think prisoners should be able to choose between the IV cocktail du jour with or without inert gas asphyxiation; and (for the complainers) the old hanging or electrocution. But as for the specifics of cocktail design, just tell them and their attorneys that this is not Burger King. Steve Harris, MD Gunna add the disclaimer, for grins.This answer is not a substitute for professional medical advic...