The state of Tennessee, part of the southern United States, has executed a man with an implanted defibrillator despite concerns that the medical device could attempt to restart his heart, thereby prolonging his death.

On Tuesday, state officials administered a lethal injection to Byron Black, a 69-year-old man convicted for a 1988 triple homicide.

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Black’s death came after his lawyers failed in a last-ditch effort on Monday to halt the execution, on the basis that the defibrillator would continually try to shock his heart as he died.

The Eighth Amendment of the US Constitution bars cruel and unusual punishment, and Black’s lawyers argued that executing him without first disabling the defibrillator would violate that prohibition, as the shocks would cause him extreme pain.

But the US Supreme Court allowed the execution to proceed, as did the state’s governor, Republican Bill Lee, who could have offered clemency.

Prison officials confirmed that Black died at 10:43am local time (15:43 GMT).

The Associated Press reported that witnesses observed Black looking around the room and breathing heavily as the execution started. Shortly afterwards, he reportedly told a spiritual adviser he was hurting.

An increase in capital punishment

Black’s death marks the 28th court-ordered execution in the US this year, and the second in Tennessee since May.

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Executions in the state had been on hold for the past five years, first because of the COVID-19 pandemic and later because of revelations that lethal injections had failed to undergo necessary testing to ensure their safety.

The state responded by commissioning an independent investigation to follow up on the concerns, which revealed loopholes in the protocol for acquiring and administering the injections.

The number of executions nationwide in 2025 is slated to be the highest since at least 2015, when 28 people overall were put to death.

At least eight other people are scheduled to die this year as part of court-mandated executions, and US President Donald Trump has signalled his support for expanding the use of the death penalty during his second term.

On January 20, his first day back in office, Trump signed an executive order reversing a moratorium on the federal death penalty implemented under former US President Joe Biden

The order also said his administration would pursue the punishment “for all crimes of a severity demanding its use”.

Trump cited as examples the murder of law enforcement officers and capital crimes by undocumented immigrants as appropriate instances for the death penalty.

“Capital punishment is an essential tool for deterring and punishing those who would commit the most heinous crimes and acts of lethal violence against American citizens,” Trump wrote.

The executive order added that the US attorney general would ensure each state had “a sufficient supply of drugs needed to carry out lethal injection”, should they choose to do so.

Capital punishment is legal in 27 states, as well as on the federal level. The US is the only developed country in the West to use the death penalty.

Inside Byron Black’s case

Opponents of the death penalty have long argued that the practice violates basic human rights and risks doing irreversible damage to people later found to be innocent.

In Black’s case, lawyers pointed to the 69-year-old’s numerous health conditions as reasons not to execute him.

He reportedly suffered from dementia, brain damage, kidney failure and heart damage that necessitated his use of an implantable cardioverter-defibrillator.

Critics argued Black’s intellectual disabilities alone should have made him ineligible for the death penalty.

Black had been convicted on three counts of first-degree murder for the 1988 shooting deaths of his girlfriend Angela Clay and her two daughters, Latoya and Lakeisha Clay, who were nine and six years old, respectively.

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The murders took place while Black was participating in a work-release programme, after he shot and wounded Clay’s estranged husband, Bennie Clay, in 1986.

For years, Black’s defence team has sought to delay and annul his execution. Black has been on death row for more than three decades, and his execution was initially scheduled for 2022.

But in 2021, Black’s lawyers filed a motion to have the courts acknowledge his intellectual disabilities and review his sentence. Then, in 2022, Nashville District Attorney Glenn Funk filed a petition to remove Black from death row, citing a similar rationale.

Black’s execution was delayed that year when Tennessee put all its executions on hold to allow for its investigation into lethal injection practices.

But Black’s petition to be removed from death row was ultimately not successful. In July, however, Davidson County Chancery Court Judge Russell Perkins ruled that his defibrillator would have to be removed for the execution to proceed, to avoid the risk of “irreparable harm”.

The state of Tennessee, however, argued that it was difficult to find a medical professional who would agree to remove or deactivate the defibrillator, given the Hippocratic oath to avoid patient harm. It also argued that the pentobarbital used in the lethal injection would render Black unresponsive.

Tennessee’s Supreme Court ultimately sided with the state, saying that Perkins’s decision amounted to a “stay of execution”. The US Supreme Court, meanwhile, has declined petitions to take up the case.

Witnesses at Tuesday’s execution told US media that Black groaned as he died and appeared to be in distress.