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Kenneth Smith’s execution by nitrous oxide asphyxiation raises ethical issues and asks us to rethink whether health professionals should participate in capital punishment On 25 January 2024, Kenneth Eugene Smith was killed in Alabama in the first state sanctioned nitrous oxide execution. In his last moments, he was strapped to a gurney and hooked up to a pulse oximeter, electrocardiography pads, and a full face air respirator. Nitrous oxide was touted as a humane, peaceful execution method that would put people to sleep in mere seconds, followed by a swift and calm death.1 According to witnesses, though, Smith “writhed and convulsed” for minutes, thrashing violently as he seemed to struggle for breath. He was pronounced dead after 28 minutes.23 This method of execution deemed “effective and humane” by Alabama’s attorney general Steve Marshall4 was a last resort after a failed execution attempt on Smith months previously, when the state’s execution team failed to find a

United statesKenneth smithSteve marshallLaura bairettEmily wangA jay chapmanKenneth eugene smithAmerican medical associationAmerican college of correctional physiciansDeath penalty information centerAmerican public health associationAmerican veterinary medical associationWorld medical associationAmerican society of anesthesiologistsAmerican college of physiciansJay chapman