Tennessee is scheduled on Tuesday morning to execute a prisoner who has a heart implant, even as the case has raised ethical concerns that lethal injection without turning off the implant may result in a torturous death.
Lawyers for the prisoner, Byron Black, who was convicted in 1989 of killing his onetime girlfriend and her two young daughters, had already argued that Mr. Black’s intellectual disability should exempt him from the death penalty.
But the fact that his heart implant, which functions as both a pacemaker and a defibrillator, will continue to operate during his execution has added another ethical quandary. Mr. Black’s lawyers and some medical experts have warned that the device may shock him repeatedly as the lethal drug is injected.
“That’s purposes at odds,” said Arthur Caplan, a top bioethicist at the New York University Grossman School of Medicine. “They’re trying to make this guy die, and you have technology attached that’s trying to keep him alive.”
Given that Mr. Black is intellectually disabled and has dementia, Dr. Caplan added, Mr. Black may not understand what is going on beyond the searing pain of repeated shocks.
Mr. Black, 69, is scheduled to die by lethal injection at 10 a.m. on Tuesday at the Riverbend Maximum Security Institution in Nashville.
The U.S. Supreme Court on Monday refused to intervene in the case, rejecting four separate petitions. Shortly after, Gov. Bill Lee of Tennessee, a Republican, said he would not approve Mr. Black’s request for clemency.
“The courts have universally determined that it is lawful to carry out the jury’s sentence of execution,” Mr. Lee said in a statement.
Mr. Black has been on death row for more than 35 years, after a jury found him guilty of the brutal 1988 murders of his onetime girlfriend, Angela Clay, and her two young daughters, Lakeisha, 6, and Latoya, 9. He was sentenced to death for one daughter’s death.
Mr. Black has maintained his innocence, but his appeals have repeatedly been denied.
“Our office will continue fighting to seek justice for the Clay family and to hold Black accountable for his horrific crimes,” said Jonathan Skrmetti, the Tennessee attorney general, in a statement released after the latest ruling by the Tennessee Supreme Court last month. He cited testimony from an expert witness called by the state that “refutes the suggestion that Black would suffer severe pain if executed.”
In an interview with the local TV station WKRN last month, Linette Bell, Ms. Clay’s sister, asked, “What about the pain he left them suffering in?”
Polls have shown that a narrow majority of Americans — 53 percent — favor the death penalty, but that they overwhelmingly oppose it for those who have an intellectual disability or struggle with mental illness. Mr. Black, his lawyers said, will be the first intellectually disabled prisoner executed since the 1970s, when the death penalty became a legal option again in Tennessee.
Mr. Black was first scheduled for execution in 2022, but it was delayed after an investigation was opened into why the state did not properly test its lethal injection drugs. He is also among the inmates who have sued Tennessee over its new injection procedure, which was put in place this year.
In a letter to Governor Lee asking that he commute the sentence to life in prison, Mr. Black’s legal team outlined not only his current health problems but also the documentation surrounding Mr. Black’s intellectual disability. The letter said that he had never scored higher than 70 on an I.Q. test, that he repeated second grade at a segregated elementary school in Nashville, and that he struggled as a child to learn simple games or to remember to do basic chores.
During an evaluation this year, he could not make change for a $5 bill. He now uses a wheelchair.
If convicted today, Mr. Black would not be eligible for the death penalty under the current clinical standards. But because his legal team challenged whether his intellectual disability made him ineligible under the previous standards, the state courts refused to revisit his case and apply the new standards.
“It is a violation of the law and the Constitution to execute him,” said Kelley Henry, chief of the capital habeas unit at the federal public defender’s office in Nashville. And, she added, “if they’re going to execute him, they don’t have the right to torture him.”
Mr. Black has had a heart implant in place since 2024 because of heart failure and heightened cardiac risk. In the case of lethal drug injection, the device may prevent his heart from slowing down and then begin shocking the heart, something that might be repeated over and over.
Ms. Henry, in one legal document, warned that it would be “a grotesque spectacle,” one that would cause Mr. Black “extreme pain and distress” and weigh on the conscience of the witnesses.
The implant would have to be deactivated by a medical professional. But Nashville General Hospital, which did not respond to a request for comment, told Tennessee officials that staff members would not willingly assist in the deactivation of the device, according to court documents.
The Tennessee Supreme Court said late last month that the execution could proceed without medical intervention
Kitty Bennett contributed research.