The trial court was concerned with the State's lack of a written protocol specifying the chemicals and doses, the lack of consistency in its administration, the total discretion give to Dr. Doe I, and the lack of oversight over the doctor. The trial court fashioned a remedy that required the Department of Corrections to prepare a written protocol requiring the participation of a board-certified anesthesiologist, at least 5 grams of thiopental, and certification that an inmate has achieved sufficient anesthesia before administering the next two chemicals. The court required that it certify the protocol and stayed all executions till it was approved. The State submitted a plan, which was not approved by the court. The State then appealed the trial court's decision. Rule of Law: A State's lethal injection protocol did not violate the Eighth Amendment, because the protocol required a sufficient dose of thiopental to eliminates an inmate's risk of pain, required a properly functioning IV, and a check of the IV site and test of consciousness prior to the admission of the paralyzing and lethal drugs.

Issue and decision: Did Missouri's written lethal injection protocol violate the Eighth Amendment? The Court reversed the trial court's decision, finding that Missouri's lethal injection protocol was constitutional and did not wantonly inflict cruel and unusual punishment in violation of the Eighth Amendment.

Reasoning: The Court did not consider whether the death penalty was moral or a good policy; merely whether the specific punishment considered violated the...

Wilson v. Seiter, 501 U.S. 294, 296-97 (1991), requires a two-part inquiry into whether a punishment is excessive. "First, the punishment must not involve the unnecessary and wanton infliction of pain. Second, the punishment must not be grossly out of proportion to the severity of the crime." Id.
The question was limited to whether the State's lethal injection process involved the unnecessary and wanton infliction of pain. First, the Court determined that a risk of unnecessary and wanton infliction of pain would be sufficient to make a procedure unconstitutional, and saw no error in the trial court's consideration of whether there was an unnecessary risk that the State's protocol would cause the unnecessary and wanton infliction of pain.

The Court was not concerned with the risk of accident, but whether the written protocol inherently imposed a constitutionally significant risk of pain. In fact, the Court reiterated the concept that the risk of accident could not and did not have to be eliminated from the execution process to pass constitutional muster. Therefore, the Court determined that if Missouri's written protocol did not involve an inherent substantial risk of the wanton infliction of pain, any risk that the procedure would not work as designated in the protocol was merely a risk of accident, and, therefore, insignificant in a constitutional analysis. Furthermore, the Court determined that the trial court did not err by failing to require appellee to prove deliberate indifference on the part of prison officials, because the protocol involved was part of appellee's official penalty. Therefore, the Court determined that the propriety of the proposed protocol depended upon whether the protocol as written would inflict unnecessary pain. The Court determined that lethal injection was commonly believed to be the most humane form of execution. The Court determined that the State's written protocol did not violate the Eighth Amendment.

Significance: The case established that the risk that an execution might cause an inmate pain if carried out improperly was not enough to render the method of execution unconstitutional. Instead, a court is to determine whether the protocol itself establishes a constitutionally significant risk of pain.