Document ID: ./input/supremecourt_opinions/opinions/14pdf/14-7955_aplc.pdf
Page Number: 3.0

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

3 

Syllabus 

an  inmate  will  not  feel  pain  associated  with  the  second  and  third 
drugs,  and  petitioners’  experts  acknowledged  that  they  had  no  con-
trary scientific proof.  Expert testimony presented by both sides lends 
support to the District Court’s conclusion.  Evidence suggested that a 
500-milligram dose of midazolam will induce a coma, and even one of 
petitioners’ experts agreed that as the dose of midazolam increases, it 
is expected to produce a lack of response to pain.  It is not dispositive
that  midazolam  is  not  recommended  or  approved  for  use  as  the  sole
anesthetic  during  painful  surgery.    First,  the  500-milligram  dose  at
issue  here  is  many  times  higher  than  a  normal  therapeutic  dose.
Second, the fact that a low dose of midazolam is not the best drug for 
maintaining  unconsciousness  says  little  about  whether  a  500-
milligram  dose  is  constitutionally  adequate  to  conduct  an  execution. 
Finally,  the  District  Court  did  not  err  in  concluding  that  the  safe-
guards  adopted  by  Oklahoma  to  ensure  proper  administration  of
midazolam serve to minimize any risk that the drug will not operate
as intended.  Pp. 18–22. 

(3) Petitioners’ speculative evidence regarding midazolam’s “ceil-
ing  effect”  does  not  establish  that  the  District  Court’s  findings  were
clearly erroneous.  The mere fact that midazolam has a ceiling above 
which an increase in dosage produces no effect cannot be dispositive,
and  petitioners  provided  little  probative  evidence  on  the  relevant 
question,  i.e.,  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 caused by 
the second and third drugs.  Petitioners attempt to deflect attention
from their failure of proof on this point by criticizing the testimony of 
the State’s expert.  They emphasize an apparent conflict between the
State’s  expert  and  their  own  expert  regarding  the  biological  process 
that produces midazolam’s ceiling effect.  But even if petitioners’ ex-
pert  is  correct  regarding  that  biological  process,  it  is  largely  beside
the point.  What matters for present purposes is the dosage at which
the ceiling effect kicks in, not the biological process that produces the 
effect.  Pp. 22–25.

(4) Petitioners’ remaining arguments—that an expert report pre-
sented in the District Court should have been rejected because it ref-
erenced  unreliable  sources  and  contained  an  alleged  mathematical
error,  that  only  four  States  have  used  midazolam  in  an  execution,
and  that  difficulties  during  two  recent  executions  suggest  that  mid-
azolam is ineffective—all lack merit.  Pp. 26–29. 

776 F. 3d 721, affirmed. 

ALITO, J., delivered the opinion of the Court, in which ROBERTS, C. J., 
and SCALIA, KENNEDY, and THOMAS, JJ., joined.  SCALIA, J., filed a con-