Tennessee’s Execution Protocol Requires Medical Skills. Doctors Say Their Ethics May Forbid Them.
By The Redemption Project Newsroom
Government Desk
Tennessee’s failed attempt to execute Tony Carruthers has reopened a question larger than one condemned man, one execution chamber or one delayed sentence.
Can the state carry out its current lethal-injection protocol without asking medical professionals to do work their own profession says they should not perform?
That is now one of the conflicts facing Gov. Bill Lee after Tennessee halted Carruthers’ execution May 21 because the execution team could not establish the required intravenous access. According to state officials and witnesses, one IV line was placed, but Tennessee’s protocol required a backup line before lethal drugs could be administered. After more than an hour of additional attempts, the second line still could not be established.
Lee halted the execution and granted Carruthers a one-year reprieve. The failed attempt has since drawn calls for review from death-penalty opponents, medical professionals and even Republican lawmakers who continue to support capital punishment.
On July 28, more than 40 Tennessee physicians, nurses and other medical professionals publicly asked Lee to pause executions until the state shows it has corrected the failures exposed during the Carruthers execution attempt. The medical professionals said doctors and other health workers should not be placed in roles that conflict with their ethical obligations.
That moment exposed a practical problem inside Tennessee’s death-penalty system.
Lethal injection depends on medical skill.
Medical ethics may prohibit the people with those skills from participating.
The procedure behind the punishment
Many people understand lethal injection as a simple shot. It is not.
Execution by lethal injection requires reliable venous access, correct placement of IV lines, confirmation that drugs will enter the bloodstream and monitoring during the procedure. If the line fails, infiltrates tissue or cannot be maintained, the execution can become prolonged, painful or impossible to complete.
Establishing IV access is routine in medicine, but it is not always easy. Patients with chronic illness, dehydration, obesity, scar tissue, prior IV drug use or other medical complications can present difficult access problems. In ordinary clinical settings, that can require advanced vascular-access skill.
That is where the conflict begins. The state needs qualified people to perform procedures that look and function like medicine. But major medical organizations have long said physicians should not participate in executions, except for limited acts such as certifying death after the execution is complete.
The American Medical Association’s ethics guidance defines physician participation in executions broadly, including actions that directly cause death, assist another person in causing death or automatically cause an execution to be carried out. Its examples include starting IV lines, selecting injection sites, monitoring vital signs and supervising lethal injection.
The reasoning is simple.
Medicine exists to heal.
Execution exists to kill as punishment.
The protocol problem
Lee has indicated he does not believe Tennessee’s execution protocol needs to be changed. He has said the protocol was followed and suggested the Carruthers incident does not justify rewriting the state’s method.
That position raises a hard question.
If the protocol worked as written, why could the execution not be completed?
The backup IV requirement appears to be a safeguard. Losing access during an execution could create serious complications. Requiring a second line is meant to reduce that risk.
But in Carruthers’ case, the safeguard became the barrier. The state could not proceed without the backup line. The team could not place the backup line, and the governor stopped the execution.
That sequence does not automatically prove the protocol is unconstitutional or that anyone acted improperly. Those claims belong in court, licensing complaints and official reviews. But it does show that Tennessee’s execution system depends on a medical task that may be difficult, specialized and ethically contested.
Accountability beyond the death-penalty debate
This story should not be reduced to another argument over whether the death penalty should exist.
Even some supporters of capital punishment are asking whether Tennessee’s system is competent enough to carry it out. Republican state senators urged Lee to order an independent review of the failed execution while making clear they continue to support the death penalty.
That distinction is important. Their concern was not whether the state has legal authority to execute. Their concern was whether the state can administer the process properly.
That is a government accountability question.
Who performs the medical procedures? What credentials are required? How often does the execution team train? Are outside contractors used? Who verifies competency? What happens when the team cannot complete the required steps?
Because Tennessee shields much of its execution team from public identification, many of those answers remain unclear. There are reasons for confidentiality in capital cases, but secrecy also limits public oversight when an execution fails in front of witnesses and the state says the protocol remains sound.
The licensing question
A later complaint filed with the Tennessee Department of Health alleged that the physician involved in the Carruthers execution attempted to place a central venous line despite acknowledging he had not performed that procedure in more than a decade. Those allegations remain unresolved and should not be treated as proven facts.
But they illustrate why the licensing issue matters. Physicians, nurses, paramedics and contractors may all have professional rules, training requirements and competency standards.
If the state relies on licensed medical professionals, the state also runs into the ethical limits of those professions. If it avoids doctors and relies on less traditional personnel, it may create new questions about skill, safety and liability.
Either path requires public explanation.
The question Tennessee must answer
Tennessee has chosen lethal injection as its execution method.
That choice requires more than a legal protocol on paper. It requires people capable of carrying out the procedure safely, consistently and constitutionally.
The failed Carruthers execution showed that the most important question may not be whether Tennessee can write an execution protocol.
It is whether Tennessee can staff one.
Doctors are asking the governor to pause executions because they believe the state’s system places medical professionals in an impossible position. Supporters of the death penalty are asking for review because the system failed to function.
Those concerns come from different places.
They point to the same problem.
Before Tennessee carries out another execution, the state owes the public a clear answer: who is medically qualified to perform the procedure, and why should their profession allow them to do it?
I am a retired detective and criminal justice / government educator based in Tennessee. I am a commentary write for Tennessee Lookout and a weekly columnist with Knox TN Today. My work examines public policy, public safety systems and civic responsibility. My reporting and commentary have also appeared in Governing, The Arizona Capitol Times, South Florida Sun Sentinel, Police1, among other state and regional outlets.
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