Document ID: ./input/supremecourt_opinions/opinions/14pdf/14-7955_aplc.pdf
Page Number: 113.0

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

17 

SOTOMAYOR, J., dissenting 

the drug will not work in the manner it claims. 

Moreover,  and  perhaps  more  importantly,  the  record
provides good reason to think this risk is substantial.  The 
Court  insists  that  petitioners  failed  to  provide  “probative
evidence” as to whether “midazolam’s ceiling effect occurs 
below  the  level  of  a  500-milligram  dose  and  at  a  point  at
which  the  drug  does  not  have  the  effect  of  rendering  a 
person insensate to pain.”  Ante, at 23.  It emphasizes that
Dr. Lubarsky was unable to say “at what dose the ceiling 
effect  occurs,”  and  could  only  estimate  that  it  was 
“ ‘[p]robably after about . . . 40 to 50 milligrams.’ ”  Ante, at 
23 (quoting App. 225).

But  the  precise  dose  at  which  midazolam  reaches  its 
ceiling effect is irrelevant if there is no dose at which the
drug can, in the Court’s words, render a person “insensate 
to pain.”  Ante, at 23.  On this critical point, Dr. Lubarsky 
was  quite  clear.4    He  explained  that  the  drug  “does  not 
work to produce” a “lack of consciousness as noxious stim­
uli are applied,” and is “not sufficient to produce a surgical
plane of anesthesia in human beings.”  App. 204.  He also 

—————— 

4 Dr. Sasich, as the Court emphasizes, was perhaps more hesitant to
reach definitive conclusions, see ante, at 19–21, and n. 5, 23–24, but the 
statements  highlighted  by  the  Court  largely  reflect  his  (truthful) 
observations that no testing has been done at doses of 500 milligrams,
and  his  inability  to  pinpoint  the  precise  dose  at  which  midazolam's
ceiling  effect  might  be  reached.    Dr.  Sasich  did  not,  as  the  Court  sug­
gests, claim that midazolam’s ceiling effect would be reached only after 
a person became fully insensate to pain.  Ante, at 24.  What Dr. Sasich 
actually  said  was:  “As  the  dose  increases,  the  benzodiazepines  are 
expected  to  produce  sedation,  amnesia,  and  finally  lack  of  response  to
stimuli  such  as  pain  (unconsciousness).”    App.  243.  In  context,  it  is 
clear that Dr. Sasich was simply explaining that a drug like midazolam
can be used to induce unconsciousness—an issue that was and remains 
undisputed—not that it could render an inmate sufficiently unconscious 
to  resist  all  noxious  stimuli.    Indeed,  it  was  midazolam’s  possible
inability to serve the latter function that led Dr. Sasich to conclude that
“it  is  not  an  appropriate  drug  to  use  when  administering  a  paralytic
followed by potassium chloride.”  Id., at 248.