Tennessee has called off its remaining 2026 execution after the state failed to complete the lethal injection of Christa Gail Pike on Wednesday night, Sept. 30. Gov. Bill Lee ordered "a comprehensive, third-party review to determine exactly what occurred," and Pike was taken to a hospital by ambulance, NewsChannel 5 and The Associated Press reported.
It is the state's second failed execution attempt this year. It also follows a warning from more than 40 Tennessee doctors and nurses, who told the governor that requiring health professionals to take part in executions conflicts with the ethics codes of their professions.
The case raises practical questions beyond the death penalty debate: what clinicians may ethically do, who fills these roles when most professionals refuse, and how much the public can learn when a state-run medical procedure goes wrong.
A Second Failed Attempt in Four Months
Pike, 50, was scheduled to be executed at 10 a.m. Wednesday for the 1995 murder of Colleen Slemmer. A federal appeals court paused the execution that morning, and the U.S. Supreme Court lifted the pause that evening over the dissent of Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson, the Tennessee Lookout reported. Pike would have been the first woman executed in Tennessee in about 200 years.
Pike's attorneys said in court filings that officials gave her two doses of pentobarbital, the drug used in Tennessee's lethal injection protocol. In an emergency filing described by CBS News, they said she had not lost consciousness and still had a heartbeat more than 40 minutes after the final dose. The Tennessee Department of Correction said it "followed every step of the State's lawful, established execution protocol approved by the Attorney General's Office."
Lee, who denied Pike's clemency request on Sept. 28, said Tennesseans expect a lawful sentence to be carried out in a way that is "not only legal and constitutional, but is effective." He added, "The remaining scheduled execution will not be carried out this year."
In May, a different execution failed. Health workers spent more than an hour trying to place an IV line in Tony Carruthers before Lee ordered the procedure stopped. Lee later granted Carruthers a one-year reprieve, KFF Health News and WPLN reported.
Officials have not explained what went wrong on Wednesday. They have not said who gave the drug, which medical staff was present, or whether the problem involved the drug, the IV line, or something else.
The Ethics Rules Health Workers Say Tennessee Ignores
Two months after the Carruthers attempt, more than 40 doctors and nurses wrote to Lee asking him to pause executions and redesign the protocol to remove health workers from the process. The letter argued that Tennessee's reliance on pharmacists, physicians, and other clinicians conflicts with their professional ethics.
"This means that the health care professionals who agree to take part in Tennessee's executions are those willing to set aside their professional ethics," the letter reads.
Responding to the letter this summer, Lee said he did not want a pause. "The Department of Correction did exactly what they should. It should not affect executions in the future," he said.
The American Medical Association's Code of Medical Ethics states that a physician "must not participate in a legally authorized execution." The code defines participation broadly. For lethal injection, it includes selecting injection sites, starting IV lines, prescribing, preparing, giving, or supervising the drugs, and inspecting or repairing equipment. It also covers monitoring vital signs and giving technical advice. A physician may certify death only after another person has declared the prisoner dead.
Pharmacists follow a similar standard. In 2015, the American Pharmacists Association adopted a policy discouraging participation because such activities are "fundamentally contrary to the role of pharmacists as providers of health care." The association said the policy aligned it with the AMA, the American Nurses Association, and the American Board of Anesthesiology.
These codes are professional standards, not laws. Tennessee can still require medical tasks in its protocol, which puts willing clinicians at odds with the groups that set ethical expectations for their fields.
Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado, told KFF Health News that modern medical ethics took shape after World War II. "We came out of World War II with a whole bioethics and medical ethics enterprise that is really strongly opposed to medicine serving as an arm of the state," he said.
Dr. Mark Fowler, the contract physician involved in the Carruthers attempt, said in an October 2025 deposition that he had not placed a central line in the 12 years since he left emergency room work. He told NPR in September that "the only thing the doctor does is declare the person dead."
Who Is Affected and What Remains Unknown
The group most directly affected is small: clinicians and pharmacists who work with Tennessee's prison system and those weighing whether to accept such contracts. The issue reaches further, though. The death penalty is legal in 27 states, and six states have had botched lethal injections since 2020, according to Death Penalty Information Center data cited by KFF Health News.
Transparency is also at stake. Tennessee keeps a curtain over the witness window until IV lines are placed, which prevents witnesses from seeing complications during that step. The Reporters Committee for Freedom of the Press and several news outlets, including WPLN, have sued to challenge the rule.
Key facts remain unknown. The state has not said who will lead the third-party review, what it will examine, or when it will release findings. Officials have not detailed Pike's medical condition. It is also unclear whether the pause will extend into 2027 or whether the review will consider the health workers' request to remove clinicians from executions.
MedicalDaily will update this story as the review moves forward and as courts respond to new filings.
Key Questions Answered
What happened in Tennessee on Sept. 30? The state could not complete the lethal injection of Christa Pike after, according to her attorneys, two doses of pentobarbital. She was taken to a hospital, and Gov. Bill Lee called off the remaining 2026 execution.
What is Tennessee doing next? Lee ordered a comprehensive, third-party review. Officials have not said who will conduct it or when results will be released.
What did the health workers' letter ask for? More than 40 doctors and nurses asked Lee to pause executions and redesign the protocol to remove health care workers from the process.
What does the AMA say about doctors and executions? The AMA Code of Medical Ethics says physicians must not participate in executions, including starting IV lines or supervising lethal drugs. A physician may certify death after someone else has declared it.
Do pharmacists have a similar rule? Yes. Since 2015, the American Pharmacists Association has discouraged pharmacist participation, calling it contrary to the role of health care providers.
Is the cause of the failed execution known? No. Officials have not publicly explained the cause, and the review has not yet released findings.
Published by Medicaldaily.com
