The execution scheduled for Thursday evening of a death row inmate by the state of Alabama will be carried out using a procedure that has never been used for capital punishment in the United States.

The inmate, Kenneth Smith, convicted of a stabbing murder in 1988, will be put to death by inhaling nitrogen gas, a method known as nitrogen hypoxia.

Proponents of the method say it is quick and painless. But earlier this month, the Office of the United Nations High Commissioner for Human Rights urged Alabama to stop the execution, saying that it could amount to torture and constitute a violation of human rights treaties to which the United States has agreed.

Alabama would be the first state to use nitrogen hypoxia, but other states are interested in using this method.

Hypoxia is a medical term for a state of insufficient oxygen in the body. Nitrogen, a colorless and odorless gas, makes up about 78% of the air humans inhale. But under the nitrogen hypoxia method, the person only inhales nitrogen, which leads within a few minutes to loss of consciousness and then death from lack of oxygen.

According to protocol Released by Alabama prison officials, members of the “execution team” will strap Mr. Smith to a gurney in the state’s execution chamber in Atmore. A mask will be placed on his head and nitrogen will be released, depriving him of oxygen. Many experts compare this process to putting a plastic bag over a person’s head, although in this situation the person would be inhaling carbon dioxide rather than nitrogen.

The standard method of execution since the 1980s has been lethal injection of heart-stopping drugs. But states have had problems with lethal injections for years.

Some states have struggled to obtain sufficient quantities of drugs for lethal injections.

Even when the dosage is adequate, many executions have been botched because the team administering the injection failed to locate the appropriate veins.

This is what happened to Mr. Smith in Alabama. He was scheduled to be executed by lethal injection in November 2022, but a team of people failed to properly insert an intravenous line several times.

This problem often occurs because medical ethics rules prohibit doctors and other medical professionals from witnessing an execution. The injections are therefore usually administered by inexperienced prison officers, he explained. Dr Joël Zivotassociate professor of anesthesiology at Emory School of Medicine and an expert on physician involvement in lethal injection.

Lethal injection also involves medications that, if administered incorrectly, can cause significant pain and suffering.

Proponents of nitrogen hypoxia believe it is a simpler and more humane alternative because it does not require an injection and is quick and painless.

Several years ago, Dr. Philip Nitschke, an Australian physician and founder of Leave international, which advocates physician-assisted suicide, developed a capsule in which a patient could flip a switch and release the flow of nitrogen. He recently told the New York Times that he had witnessed about 50 deaths from nitrogen hypoxia.

Very little, which is why some believe it should not be used in state executions. Most reports in medical journals focus on nitrogen exposure from leaks and industrial accidents that killed workers, as well as from suicide attempts.

In an experiment conducted in 1963 to study the effect of brief hypoxia on three healthy volunteers, “most of them had seizures within 15 to 20 seconds after breathing pure nitrogen,” Dr. Zivot said.

Doctors say the prisoner could vomit into his mask, which would not only cause him to choke, but also loosen the seal, allowing oxygen to rush into it, diluting the nitrogen.

Mr. Smith’s lawyers argued that this is a likely scenario for Mr. Smithwho, they say, has been vomiting continuously in recent days, which they associate with the PTSD he suffered after the botched 2022 execution.

Alabama Corrections Officers said Mr Smith would not be given food after 10am on Thursday morning to reduce the risk of vomiting while on the stretcher.

Mr. Smith’s head and body will be tightly strapped to the stretcher to prevent blows and displacement of the mask. It is unclear whether he will be given a sedative before his execution, which would further reduce the risk of being beaten. But Dr. Zivot noted that sedating a patient is a medical procedure and usually requires a doctor’s intervention.

Veterinarians have generally stopped using nitrogen to euthanize animals that showed serious signs of distress. Critics and proponents of the method strongly disagree on whether a human would experience nitrogen-related distress.

“No one really knows what’s going to happen,” said Dr. Jeffrey Keller, president of the American College of Correctional Physicians. “So, is he going to choke?” Will I throw up? Will the mask fit or will the nitrogen escape? Will this nitrogen harm anyone else nearby? Nobody knows any of this. “It’s an experience.”

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