By Maurice Chammah for The Marshall Project.
Broadcast version by Nadia Ramlagan for Ohio News Connection reporting for the Marshall Project-Public News Service Collaboration

Next week, Alabama prison officials plan to escort Kenneth Eugene Smith from his cell, strap a mask to his face and replace his breathing air with nitrogen gas. It would likely be the first execution of its kind anywhere in the world.

How did we get here? Lethal injection has been the dominant method in the United States for decades, but around 2010, pharmaceutical companies began refusing to sell the necessary drugs to prison agencies. States turned to new suppliers and drug cocktails under the cover of new secrecy laws. But the disruptions led to more public scrutiny of the method as journalists gave reports of prisoners screaming, choking and being cut and stabbed in the search for veins.

Some states abandoned executions entirely, leading to an overall decline in recent years, while others considered alternatives. South Carolina built a firing squad chamber, while Arizona refurbished a gas chamber.

Alabama state officials have said the goal of "nitrogen hypoxia" is for the prisoner to quickly lose consciousness as oxygen leaves his or her body. But Smith lawyer's are asking a series of federal courts to stop the execution, arguing that if something goes wrong, he might vomit, asphyxiate or be left in a persistent vegetative state. So far, they've been unsuccessful.

There were 11 gas executions in the U.S. between 1979 and 1999, according to the Death Penalty Information Center, a research group that tracks executions. Those involved filling a chamber with cyanide gas, leading to suffocation. By contrast, nitrogen has been proposed for euthanasia patients in Europe, and politicians who support it point to accidental deaths of pilots and scuba divers. Oklahoma legislators reportedly watched YouTube videos of teenagers passing out from a similar lack of oxygen after inhaling helium.

Smith was convicted of killing Elizabeth Sennett in 1988, after being hired by her husband, who was seeking a life insurance payout. Alabama attempted to execute Smith in 2022 using lethal injection, but gave up after spending four hours trying to insert an IV.

The copy of Alabama's new nitrogen protocol that appears in court records is heavily redacted, but if Smith is executed on Jan. 25 as scheduled, other states could begin using nitrogen in similar ways. The Marshall Project spoke with Dr. Jeffrey Keller, president of the American College of Correctional Physicians, which trains and represents doctors who work behind bars, about this moment in the history of executions. Our conversation has been edited for length and clarity.

Maurice Chammah: What should the average person understand about an execution by nitrogen? What might happen if this method catches on nationally?

Jeffrey Keller: I don't have much to say about how it's going to work because nobody does. It's entirely experimental. There is some concern that leaking nitrogen could affect bystanders, and I don't know if that's true, because nobody knows.

It's also proposed to be painless, and I know that is wrong: The proponents refer to people who have become nitrogen-intoxicated during airplane flights, or scuba diving, and then woke up and reported they didn't feel anything. But the incarcerated person knows exactly what's going to happen.

If I told you, at 11 a.m. tomorrow, I'm going to place a plastic bag over your head and suffocate you to death, you'd have intense anxiety and fear and the release of stress hormones, up until the moment that it happens. Is that suffering? Of course. But how much they'll feel when the nitrogen hits, I don't know - because, again, nobody knows.

MC: Veterinarians have shied away from using nitrogen for animal euthanasia, finding the gas causes distress in some mammals. Alabama proposes to fit a mask over Smith's face - similar to how an anesthesiologist would for surgery - and says there is little risk. But other medical experts say that in a hospital, you can usually assume the patient will be cooperative.

JK: This is no different from lethal injection, in that sense. Just as if you don't hold your arm still, it's harder to start an IV line, if you don't hold your head still, it's harder to get a seal. Regardless of the cooperation, we're not using medical experts, having an anesthesiologist fit the mask or titrate the nitrogen, someone who has done this hundreds and hundreds of times. This is why they've had botched lethal injections, and the lack of expertise will be no different now in terms of risk. The line you get from the prisons is that it will be peaceful and calm. But is the patient always going to be willing and have a beatific visage as they're doing this? No.

MC: Robert Jason Yong, an expert enlisted by Smith's defense team, warned that there could be vomiting or seizures, or even that the execution could fail, causing the person to go into a persistent vegetative state. What would a doctor do in that situation?

JK: If it happened in an operating room, they'd take off the mask and the whole thing would stop, and you get a medical evaluation to see how bad the vomiting was. Did they aspirate? Did any of it get into their lungs? But whoever is at the execution may not be trained to do that, and certainly won't be practiced at it. What percentage of people we're going to do this to will vomit? I don't know. Some. It's not going to be zero, I'll tell you. The assumption is often that this is going to go perfectly. But as with lethal injection, as more of these are done, everything that can go wrong will eventually.

MC: What else could go wrong with the mask?

JK: EMTs in ambulances will find someone with hollow cheeks, or who has taken their false teeth out, will have trouble forming a seal with a mask. Or talk to firefighters. If they're going to run into a burning building, they have to have their masks perfectly fitted, and it's not one-size-fits-all. A firefighter who gains or loses 50 pounds needs to get a new mask. They are not allowed to have facial hair because it interferes with the seal. So are we going to make sure the death row inmate gets a shave right before? Has anyone thought of that?

Alabama's protocol does not mention shaving, but in a court filing, a lawyer for the state wrote that if Smith is concerned about this, he can choose to shave himself. Smith's lawyers point out that if he prays aloud, his mask might slip.

MC: Why don't doctors play more of a role in executions? Your own organization has a code of ethics stating doctors should "not be involved in any aspect" of carrying them out.

JK: It goes back to the Hippocratic Oath that all physicians in the U.S. take when they graduate. Our job is to make people better. Executions are the antithesis of what being a medical professional is all about. And in medical ethics, one of the principles is that you don't do medical experiments on incarcerated people. This is an experiment being done on an incarcerated person.

MC: NPR reported that Alabama asked Smith's spiritual advisor to sign a waiver, acknowledging gas could leak from the mask and harm him. This is also true for the correctional officers, but what about the psychological risks they face with the new method?

JK: That's probably no different from lethal injection, or before that the electric chair, or cyanide, or even hangings or beheadings in the Middle Ages. Witnessing someone being killed will have profound psychological effects on some people, and nitrogen isn't going to make that better. It'll be no different from before.


Maurice Chammah wrote this article for The Marshall Project.

This collaboration is produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


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A North Carolina group hopes to help people stay out of prison by connecting them to critical resources.

Recidivism Reduction Educational Programs Services is launching a new hotline to help formerly incarcerated people with re-entry services.

Kerwin Pittman, the organization's founder, said he found it tough getting connected to the right people as a returning citizen nearly seven years ago and in 2024, he said the issue still exists.

"What we realized that across North Carolina, the connectivity wasn't happening at all," Pittman pointed out. "You would have people returning, citizens, family members, those who wanted to get help for these individuals trying to reach out for services and needed services but just couldn't find them."

The hotline connects callers to real people who essentially create a bridge directly to services in the community. Pittman noted since its launch last Monday, more than 100 people have used the call center to get connected to housing and jobs. To contact the center, call 1-888-852-0004.

In North Carolina, 44% of people are re-arrested within two years of being released from state prisons. Pittman acknowledged it can be challenging to have a successful transition when you don't know where to start and emphasized one small resource can be the key to getting on track.

"You'd be surprised how many individuals come home and don't just have simple identification," Pittman emphasized. "And we know without identification, you can't receive benefits that you may be eligible for, you can't receive a job, you can't receive housing. And so everything kind of plays into each other."

In addition to closing gaps and getting people to services, Pittman said he hopes it inspires others to find innovative ways to make connection easier for people affected by the justice system. Earlier this year at the state level, Gov. Roy Cooper signed Executive Order 303 to improve re-entry.

Mississippi prisons often lack resources to treat people who are incarcerated with substance-use disorders adequately but a nonprofit organization is offering alternative programs focused on treatment instead of incarceration.

The Magnolia State has one of the highest incarceration rates in the nation, with more than 1,000 people per 100,000 residents behind bars.

Christina Dent, founder and president of End It For Good, said they invite people to support approaches to drugs prioritizing life, preserving families and promoting public safety.

"We do education out in the community - with citizens, with advocates, with policymakers - to help them understand why a punitive criminal justice approach to drugs and addiction has not produced good results and why a health-centered approach would produce much better results," Dent explained.

It is estimated more than 578,000 people in state and federal prisons in 2022 had a substance-use disorder in the year prior to their admission, according to the Prison Policy Initiative.

Dent emphasized they recommend lawmakers look at other alternatives to stop reactionary approaches resulting in Mississippians paying harsher penalties for crimes such as drug possession.

"Shift away from increasing penalties," Dent urged. "Another thing that we could do would be to reduce penalties or recategorize penalties for something like drug possession. We would love to see a shift from treating drug possession as potentially a felony to drug possession being a misdemeanor. "

Dent noted such an alternative approach would allow individuals impacted to more easily regain employment, support their families and reintegrate into society. She added felony convictions create lifelong barriers to employment and self-sufficiency.


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April is Second Chance Month and many Nebraskans are celebrating passage of a bipartisan voting rights restoration bill and its focus on second chances.

Legislative Bill 20 restores voting rights to those convicted of a felony upon completion of their sentence, eliminating the two-year waiting period.

Jason Witmer, policy fellow at the ACLU of Nebraska, said the change will promote success for formerly incarcerated Nebraskans. He pointed out it also will increase the likelihood of the state meeting the objectives Gov. Jim Pillen and the Department of Corrections have committed to.

Nebraska became the fourth state to join "Reentry 2030," a national initiative of the Council of State Governments focused on strengthening programs and removing obstacles for those reentering society after incarceration.

"The more somebody can have their rights in place for them, the more invested they are in the society," Witmer contended. "The more invested you are in your community and your society, the more likely you are to succeed. And the right to vote is fundamentally part of reintegrating into society. It's your civil voice."

Reentry 2030 aims to have all 50 states commit to improving outcomes for formerly incarcerated people. Nebraska's goals include increasing GED completion and college coursework by those in Nebraska prisons, and reducing recidivism 50% by 2030.

Pillen allowed the measure to become law but stated it contains "potential constitutional issues" which could lead to a legal challenge.

Nebraska's recidivism rate for those who left prison between 2019 and 2022 was nearly 30%.

Witmer noted it is at least partly attributable to the challenges people face upon leaving incarceration.

"You did the time, and then you come out and find out, 'Oh, I can't vote. Oh, housing is almost impossible to get. Oh, I can't work here,'" Witmer outlined. "Suddenly you don't feel like you're a part of any of this."

Across the country, 37 other states restore voting rights to those charged with a felony either immediately after incarceration or after completing parole or probation. Two states and the District of Columbia allow people to vote while incarcerated.