Q&A: The Human Cost of Carrying Out the Death Penalty W&L Law Professor Alexandra Klein discusses Tennessee's failed execution and the impact the practice has on those tasked with carrying out the process.

By Law Communications
October 2, 2026

Tennessee’s failed execution of Christa Gail Pike on Sept. 30 has renewed questions about the reliability, cruelty, and human consequences of lethal injection. According to news reports, Pike remained alive after the state administered the two doses of pentobarbital called for under its execution protocol, and she was later transported to a hospital. The incident came just months after Tennessee abandoned the execution of Tony Carruthers when members of the execution team were unable to establish the intravenous access necessary to administer the lethal drugs. Following the Pike execution attempt, Gov. Bill Lee suspended executions for the remainder of the year and ordered an independent review of the state’s procedures.

Washington and Lee law professor Alexandra Klein studies the death penalty, the Eighth Amendment, and the law surrounding methods of execution. Her scholarship has examined how courts evaluate pain in lethal-injection cases and whether existing Eighth Amendment doctrine adequately protects condemned prisoners from suffering during an execution. More recently, Klein has examined an often-overlooked group in the capital punishment system: the people responsible for carrying out executions. Her article, “The Dirty Work of Executioners,” forthcoming in the UC Irvine Law Review, explores the psychological and moral consequences that execution work can have on participants, including moral injury, trauma, anxiety, stigma, and other harms.

In this Q&A, Klein discusses what Tennessee’s failed executions reveal about lethal injection, how courts think about pain and failure under the Eighth Amendment, and what the experiences of execution-team members can tell us about the broader human costs of capital punishment.

Tennessee has now experienced two very different failed execution attempts within a matter of months. What do these incidents tell us about the assumption that lethal injection can be made into a predictable and reliable procedure?

They just confirm what the attorneys who practice in this area and scholars who study capital punishment already know: lethal injection is a method of execution that creates a substantial risk of pain and suffering and raises serious constitutional questions. Professor Corinna Lain, who visited W&L Law this past spring to discuss her outstanding book on lethal injection, “Secrets of the Killing State,” has said that lethal injection is not what its proponents claim it is. I agree. There are too many problems with lethal injection for me to list them all here, but it’s definitely not what people assume it is—a person simply drifting off to sleep. Instead, it is a procedure that is prone to error, involves using drugs that do not, and cannot, do what the state claims they do, and execution participants often do not have the kind of training and expertise needed.

The botched execution of Christa Pike is especially concerning because Ms. Pike has survived receiving two doses of the lethal injection drugs. That’s a first. There have been botched executions that involved drug problems, such as what happened to Joseph Wood in Arizona in 2014 or Dennis McGuire, in Ohio in 2014. Both of those men died, although it took much longer than it should have. The people who have survived a botched lethal injection typically do so because the execution team was unable to establish IV access, which is what happened to Mr. Carruthers. Right now, not all of the facts are available and it’s not clear what happened, so we need more information. At the time of this Q&A, Ms. Pike remains in critical condition in the hospital, and her prognosis is unknown. What is clear is that something went terribly wrong during Tennessee’s attempt to execute Ms. Pike.

I think an honest accounting of capital punishment requires understanding the harm to everyone involved: victims, the condemned, and people who experience the collateral harm of the death penalty. That includes the family of the condemned, lawyers, judges, jurors, and yes, execution participants. Regardless of one’s opinion of the death penalty, we should acknowledge and understand the costs of imposition.

Your scholarship has examined the role of pain in Eighth Amendment challenges to execution methods. How well does current Supreme Court doctrine account for the possibility of pain or suffering when lethal injection goes wrong?

Not well. To prove that a state’s method of execution violates the Eighth Amendment, a prisoner must show that the method presents a substantial risk of severe pain, that there is a readily available alternative that would significantly reduce that risk, and that the state has refused to adopt that alternative without a legitimate penological reason. To date, only one person has ever prevailed. Jeffrey Lee managed to prove that Alabama’s nitrogen gas executions would violate his Eighth Amendment rights against cruel and unusual punishment.

There are a lot of problems with this test. First, courts compare historical execution practices to contemporary ones, which isn’t a great comparison—people used to be executed in really brutal ways. So, if you’re comparing being drawn and quartered to lethal injection, one of those is obviously better than the other. But we don’t draw and quarter people in the U.S., so that’s not a realistic way to evaluate something. And courts assume that historic acceptance of pain in executions is equivalent to constitutionality. That’s not necessarily so. Second, the Court has said executions don’t have to be painless. This is unhelpful because a vague pain standard that accepts a certain amount of pain makes it hard to draw constitutional lines and invites a great deal of subjectivity. Finally, the comparative analysis is problematic, especially because some of the data that’s needed doesn’t exist, and can’t ethically exist, because the state can hide information, and because there is no clear constitutional standard for pain.

What do we know about the psychological consequences of participating in executions? What do you mean by “moral injury,” and how is it different from other forms of trauma?

There are a number of former execution participants who have expressed that they were profoundly harmed and have asked states to consider that in making decisions about the retention and use of capital punishment.

People who have participated in executions have reported serious psychological and emotional harm, including depression, anxiety, persistent feelings of guilt and shame, PTSD, emotional numbness, detachment, and nightmares. It’s not clear what kind of support is available, and some execution participants have reported that they don’t get meaningful help or support. These harms may also include “moral injury,” which is a term first coined by Jonathan Shay in his work on combat trauma. Generally speaking, moral injury is the psychological harm that arises when a person experiences, witnesses, or participates in something that is inconsistent with their moral, ethical, or spiritual beliefs. It arises from betrayal—either because a person has betrayed their own values or witnessed someone in authority betray those values. The academic literature discusses a possible relationship between PTSD and moral injury, but the relationship is unclear.

But moral injury may be a consequence of execution—some people feel like the work is at odds with their responsibility as a correctional officer to take care of prisoners. Others question the morality of the work, describe it as demeaning and degrading. What is important, though, is that these consequences fall on the people who are doing what society asks of them. They aren’t necessarily volunteers. They may be assigned these tasks as part of their jobs. That’s a problem that I think matters: if we want capital punishment, someone has to carry out executions. But is it right to ask someone to live with those consequences? I think that’s an important question that is often overlooked and deserves more scrutiny when we think about the death penalty.

Does a failed execution potentially create a different kind of moral or psychological burden for execution-team members than an execution that proceeds as planned?

Absolutely. Executions are unquestionably traumatic for the person being executed and can be seriously harmful for execution participants. Execution protocols are designed to conceal what is happening, create a veneer of medicalization, and give participants a way to minimize their sense of responsibility using plausible deniability mechanisms, such as the blank round for a firing squad member or by spreading out tasks among a group of people. But those mechanisms don’t prevent harm to execution participants, and botched executions make it much harder.

A group of former corrections employees who had participated in an execution filed an amicus brief in a Supreme Court case, Bucklew v. Precythe, which addressed the constitutionality of executing someone with an unusual medical condition with lethal injection. Those employees emphasized that a regular execution is difficult, and a botched execution is much worse—both because it’s a failure of their obligation and because they must directly confront their participation in taking a life on behalf of the state.

Gov. Bill Lee has ordered an independent review of Tennessee’s execution procedures. What should a meaningful review examine beyond the drugs, equipment and technical procedures used during an execution?

First, it’s worth noting that this would be the second independent review of Tennessee’s execution procedures within the last five years. In 2022, Governor Lee suspended all executions after learning that the Tennessee Department of Corrections wasn’t following its own protocols for testing lethal injection drugs for certain contaminants. That report revealed there were serious problems with the way that Tennessee was conducting executions. To Tennessee’s credit, that report was conducted by an external reviewer, and the report was made public. When Alabama had a series of botched executions in 2022, it didn’t do that. Tennessee changed its execution protocols after that report, including choosing to use pentobarbital, rather than the drug cocktail it had been using. Unfortunately, it seems like there are still problems with the way Tennessee is carrying out executions after two botched executions.

Governor Lee has, once again, suspended executions in Tennessee, which is absolutely the right step at this point. Any review should absolutely evaluate every detail of the state’s protocols, including interviewing everyone involved with the execution and witnesses. It should also include an evaluation of whether the state adequately addressed Ms. Pike’s individual condition in preparing for her execution. Her attorneys were concerned about this outcome because she has a medical condition that affects her veins. I think it’s also reasonable to question Tennessee’s personnel choices and whether they have appropriate qualifications, particularly after two botches. Based on what Ms. Pike reportedly said during the execution—namely that her arm was hurting at the IV site—it’s possible there was a problem with the IV. News stories are reporting that doctor who oversaw Mr. Carruthers’s execution was also involved in Ms. Pike’s execution. It’s a little unusual to have a doctor overseeing an execution—most won’t do it for ethical reasons. Any review should also investigate whether the drugs Tennessee was using were appropriately manufactured and tested. Importantly, any investigation should assess whether there are patterns of error and risk across more than just the attempted execution of Ms. Pike.

Your research suggests that we should think about cruelty not only in terms of what the state does to the person being punished, but also what carrying out that punishment requires of other people. How would that broader understanding change the way we think about the death penalty?

I think an honest accounting of capital punishment requires understanding the harm to everyone involved: victims, the condemned, and people who experience the collateral harm of the death penalty. That includes the family of the condemned, lawyers, judges, jurors, and yes, execution participants. Regardless of one’s opinion of the death penalty, we should acknowledge and understand the costs of imposition.

When it comes to capital punishment, I think it may be easier to flatten the narrative—bad guys, good guys. Ignoring the harm of capital punishment, which is far more complex than that flat narrative, treats the people involved as instruments, to be ignored and discarded. Recognizing the collateral harm of capital punishment reaffirms the humanity of everyone involved.

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