Document ID: ./input/supremecourt_opinions/opinions/14pdf/14-7955_aplc.pdf
Page Number: 111

Cite as:  576 U. S. ____ (2015) 

15 

SOTOMAYOR, J., dissenting 

opinion  regarding  the  efficacy  of  Oklahoma’s  planned  use 
of the drug represented “essentially an extrapolation from 
a  toxic  effect.”  Id.,  at  327  (emphasis  added);  see  id.,  at 
308.  Thus,  Dr.  Evans  appeared  to  believe—and  again,  I 
say  “appeared”  because  his  rationale  is  not  clear—that
because  midazolam  caused  some  deaths,  it  would  neces­
sarily  cause  complete  unconsciousness  and  then  death  at 
especially  high  doses.  But  Dr.  Evans  also  thought,  and 
Dr.  Lubarsky  confirmed,  that  these  midazolam  fatalities 
had  occurred  at  very  low  doses—well  below  what  any 
expert  said  would  produce  unconsciousness.   See  id.,  at 
207,  308.  These  deaths  thus  seem  to  represent  the  rare,
unfortunate side effects that one would expect to see with 
any  drug  at  normal  therapeutic  doses;  they  provide  no 
indication  of  the  effect  one  would  expect  midazolam  to
have  on  the  brain  at  substantially  higher  doses.    Deaths 
occur  with  almost  any  product.    One  might  as  well  say 
that because some people occasionally die from eating one 
peanut,  one  hundred  peanuts  would  necessarily  induce  a
coma and death in anyone.3 

In  sum,  then,  Dr.  Evans’  conclusions  were  entirely
unsupported  by  any  study  or  third-party  source,  contra­
dicted  by  the  extrinsic  evidence  proffered  by  petitioners,
inconsistent  with  the  scientific  understanding  of  midazo­
lam’s properties, and apparently premised on basic logical 
errors.  Given  these  glaring  flaws,  the  District  Court’s 
—————— 

3 For all the reasons discussed in Part II–B, infra, and contrary to the 
Court’s claim, see ante, at 20, n. 4, there are good reasons to doubt that
500 milligrams of midazolam will, in light of the ceiling effect, inevita­
bly kill someone.  The closest the record comes to providing support for
this  contention  is  the  fleeting  mention  in  the  FDA-approved  product 
label that one of the possible consequences of midazolam overdosage is 
coma.  See ante, at 21, n. 5.  Moreover, even if this amount of the drug
could kill some people in “under an hour,” ante, at 20, n. 4, that would 
not  necessarily  mean  that  the  condemned  would  be  insensate  during 
the approximately 10 minutes it takes for the paralytic and potassium 
chloride to do their work.