Tennessee’s failed execution highlights risks in assisted suicide practices

Commentary by ‘Ala Pomelile

On 30 September, the state of Tennessee tried to execute Christa Pike. It failed. Officials gave her both doses of pentobarbital allowed under the state’s protocol, and she was still alive. She was taken to hospital and put on a ventilator. The Governor called it “deeply disturbing“, ordered an independent review, and postponed the one other execution the state had scheduled this year.

Let me be clear about who Christa Pike is. She was sentenced to death for the torture and murder of 19-year-old Colleen Slemmer in 1995. Nothing here lessens what was done to Colleen or what her family has endured for three decades. And this is not an article about the death penalty.

It concerns a promise. The case for euthanasia rests on the assertion that the State can bring about death in a clean, clinical, and peaceful manner. Tennessee has recently demonstrated how quickly that promise can fall apart. The review has not reported, and the cause is not yet settled. Ms Pike’s lawyers say the team struggled for about an hour to place IV lines. They believe the drug then leaked into the tissue of her arms instead of her bloodstream, leaving both arms badly injured. The State says it followed its protocol.

Pentobarbital is a barbiturate, the same class of drug used for assisted suicide and euthanasia in countries where it is legal. But the lesson is bigger than one drug. No drug delivers a “dignified” death by itself. Everything depends on fallible people, fallible systems, and a human body that does not always cooperate.

The evidence is not reassuring

Euthanasia advocates will say an execution chamber is nothing like a bedside. The circumstances are different. The evidence from assisted suicide and euthanasia themselves, however, offers little comfort.

A 2019 review in the journal Anaesthesia examined the methods used in assisted dying and compared them with capital punishment. It reported vomiting in up to 10 per cent of cases, deaths prolonged for up to seven days, and patients re-awakening from coma in up to 4 per cent. Those are upper figures, and the most common method reviewed was patients swallowing barbiturates themselves. The authors still concluded that some of these deaths may be inhumane.

Oregon is the model euthanasia advocates point to. Yet for 68 per cent of Oregon’s assisted suicide deaths in 2024, the state does not know whether complications occurred. Across all deaths since 1997 the figure is 62 per cent. You cannot call a method safe when nobody is recording what happens.

New Zealand differs in one respect, and it is not a comforting one. Research on the first years of the End of Life Choice Act found that the vast majority of patients choose the intravenous route. Our system therefore relies on the very step that appears to have failed in Tennessee: finding a vein, placing a line, and keeping it there.

That step fails in euthanasia too. Ontario publishes its complications. In 2023, the most common one reported was difficulty starting or keeping IV access. The second most common was the IV line slipping outside the vein, which is what Ms Pike’s lawyers say happened to her.

So how often does it happen here? The End of Life Choice Act requires the Registrar to report only the number of deaths and the method used. Anything else is at the Registrar’s discretion. The 2023 annual report told us there had been no major complications. That is an assurance. It is not data.

Ms Pike’s lawyers say they warned the state and the courts months in advance that her small veins and a blood disorder would make the injection difficult. They say those warnings were ignored. If that is right, a system built to deliver death gathered momentum and stopped listening to the person in front of it.

That should trouble anyone who has been told that “safeguards” will protect the vulnerable here.

Yes, there is a difference. Ms Pike did not consent. Our law requires a competent and informed decision, and a practitioner who suspects pressure must stop the process.

But a form does not detect pressure. Coercion is rarely a hand on the shoulder. It is the elderly mother who does not want to be a burden. It is the family under financial strain. It is the patient who cannot get decent palliative care and is offered a lethal dose instead.

Consent means little unless a person is told the truth about the method, what can go wrong, how long death may take, and what real alternatives exist. On each of those points, New Zealanders are being asked to trust the “system”.

The push to go further

The End of Life Choice Act was sold to voters as tightly limited. A person must be 18 or over and a citizen or permanent resident. They must have a terminal illness likely to end their life within six months, and be in an advanced state of irreversible decline in physical capability. They must be experiencing unbearable suffering that cannot be relieved in a way they find tolerable, and be competent to make an informed decision. Two doctors must agree, with a psychiatrist called in if either doubts competence.

Those limits are already under attack. The Ministry of Health completed its statutory review of the Act in November 2024. ACT MP Todd Stephenson then re-lodged a member’s bill that adopts the review’s recommendations and goes further.

His bill would scrap the six-month requirement. In its place would be a diagnosed condition that is “advanced, progressive and expected to cause death”. Mr Stephenson insists no safeguard is being weakened. Removing the six-month limit is removing a safeguard, whatever it is called.

Opponents who have examined the bill say it goes further still. They say it would let practitioners raise euthanasia with patients, and would drop the requirement for consent on the day.

The bill has not been put to a vote. Mr Stephenson has said he will keep pursuing it after the election, and he now describes the six-month limit as “arbitrary”.

This is how it goes. Voters are told the limits are firm. A few years later, the limits are deemed arbitrary, yet we see Canada demonstrating what can happen when limits are arbitrary, and safeguards are gradually removed under the guise of accessibility.

Before Parliament considers expanding anything, it should be able to answer a basic question. What is actually happening in the deaths already taking place?

The choice New Zealanders are not being given

Assisted dying in New Zealand is a free service. Good and quality palliative care depends on where you live and how much your local hospice can raise.

Health New Zealand’s own National Palliative Care Steering Group has acknowledged inequity in access to, experience of and outcomes from palliative care. Hospices care for around one in three New Zealanders who die each year. Yet Hospice New Zealand says the government provided only $114 million of the $226 million it cost to run hospice services. Communities raised the other $112 million through donations and op shops.

The Government’s own figures tell the same story. It says it covers about 64 per cent of hospice operating costs on average. For individual hospices, the share ranges from 22 per cent to 91 per cent.

A $12 million funding uplift for 2026/27 is welcome. Hospice New Zealand has said the sector needs $80 million to $100 million more each year to be sustainable.

That is not choice. A country that provides death free of charge while leaving care to the cake stall has its priorities dangerously upside down. Before anyone calls an assisted death a choice, palliative care must be a real choice too.

Every human life has value. That includes the sick, the elderly, the disabled and the dying. A person’s worth does not depend on how independent, useful or free of pain they are. The right response to suffering is to care for the person, not to end the person’s life. We opposed this law, and we still do. But while it remains on the books, New Zealanders deserve the truth about how it operates.

Euthanasia advocates promise “death with dignity”. Tennessee’s failed execution reminds us that such assurances depend on the people and systems responsible for carrying them out, and those systems do not always disclose when things go wrong. Real dignity is not found in a lethal dose. It is found in being cared for, valued and never abandoned, right to the end.

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