Tennessee’s Planned Execution of Byron Black Raises Ethical Dilemmas as Court Battles Over Implantable Cardioverter-Defibrillator (ICD)

On Tuesday, authorities in Tennessee plan to execute Byron Black for the 1988 murders of a woman and her two young daughters, despite concerns from his legal team that an implantable device designed to restore his heartbeat could potentially shock him during the execution process.

The device, an implantable cardioverter-defibrillator (ICD), is at the center of a legal dispute that has been ongoing for several weeks. Black’s attorneys are urging the deactivation of the device prior to his lethal injection on Tuesday morning.

If the ICD remains active, they contend that the effects of the lethal injection drugs could trigger the device to deliver shocks to Black’s heart, potentially repeatedly, in an attempt to restore a normal rhythm. This, they argue, could result in a prolonged and agonizing execution, a violation of Eighth Amendment protections against cruel and unusual punishment.

Kelley Henry, one of Black’s attorneys and the chief of the capital habeas unit for the Federal Public Defender based in Nashville, has stated that her 69-year-old client’s case is unique. She expressed concern for Black, stating, “I don’t want him to suffer. I do not want him tortured.”

The complex ethical and practical dilemmas arising from the intersection of medicine and capital punishment are highlighted in this case. The American Medical Association’s Code of Medical Ethics stipulates that physicians “must not participate in a legally authorized execution” as their profession requires them to preserve life.

Tennessee officials have indicated in court filings that they do not have a medical professional available to turn off the implant after staff at a Nashville hospital refused to participate. They argue that Black would be unconscious if the ICD was activated and thus unable to feel pain.

On Friday, Black’s attorneys filed an appeal with the US Supreme Court, seeking to halt his execution following a ruling by the Tennessee Supreme Court allowing the execution to proceed without deactivating the ICD.

Henry told CNN that the appeal is not about securing a stay of execution but about devising a plan with state officials to prevent Black from experiencing a torturous death if his execution proceeds. “When you get a client with an actual execution date, you have to start looking at his end of life, and what are the issues you need to raise to protect him,” she said.

Reached for comment, the Tennessee Department of Correction referred CNN to the office of Attorney General Jonathan Skrmetti. In a statement, Skrmetti noted that testimony from the state’s experts “refutes the suggestion that Black would suffer severe pain if executed.”

“Thirty-seven years have passed since Black brutally murdered six-year-old Lakeisha Clay, nine-year-old Latoya Clay, and their mother Angela Clay,” Skrmetti said, adding that courts have repeatedly denied Black’s other appeals.

“Our office will continue fighting to seek justice for the Clay family and to hold Black accountable for his horrific crimes,” Skrmetti said.

Black was convicted and sentenced to death for the 1988 murders of his then-girlfriend, Angela Clay, and her two daughters, Latoya and Lakeisha. At the time, Clay was separated from her husband and the girls’ father. About 15 months before the killings, court records show, Black and Clay’s husband were in an altercation during which Black shot the man, who survived. Black was sentenced to two years in the Davidson County Metropolitan Workhouse, with weekend furloughs.

Prosecutors accused Black of murdering Clay and her girls early on the morning of March 28, 1988, while he was out on furlough. All three victims were found dead in their apartment around 9:30 p.m. that day, each with gunshot wounds.

At trial, a firearms expert for the Tennessee Bureau of Investigation testified bullets recovered from the scene of the murders matched those recovered from Black’s earlier shooting of Clay’s husband. The .44 caliber bullets found at Clay’s apartment and a .44 caliber bullet removed from her husband were all fired from the same weapon, the expert said.

Black was sentenced to two life terms for the murders of Angela Clay and Latoya, court records show. He received a death sentence for the murder of Lakeisha.

Bennie Clay, Angela’s husband and the girls’ father, declined to comment for this story.

Black’s attorneys claim that he is very ill, describing him as a “frail, wheelchair-bound man” suffering numerous health issues, including dementia and congestive heart failure. They are also seeking a stay of execution on grounds aside from his ICD, arguing that Black has an intellectual disability that should make him ineligible for execution under the Eighth Amendment.

Black’s attorneys have also requested clemency from Governor Bill Lee or a reprieve so they can find someone to deactivate his ICD. Black received his implant in May 2024, court records indicate. The device includes both pacemaker and defibrillator functions: The pacemaker sends electrical impulses to Black’s heart if his heart rate drops too low, while the defibrillator delivers more powerful shocks if his heart rate becomes too high.

Dr. Jonathan Groner, a professor emeritus of surgery at the Ohio State University College of Medicine, has been critical of the medicalization of capital punishment. He described the shocks delivered by the implant as “powerful” and likened them to being punched or kicked in the chest. The implant can be deactivated in one of two ways: by placing a medical instrument or a magnet above the device from outside Black’s body. Both methods require a trained medical professional.

In Black’s case, the timing is crucial, according to his lawyers: if turned off too early, they argue the device will expose their client to the risk of suffering an arrhythmia, or irregular heartbeat, that might kill him while the courts are still considering his appeals and a ruling to delay the execution could be imminent.

After hearing dueling expert testimony, Davidson County Chancery Court Chancellor Russell Perkins ruled in Black’s favor and ordered state officials to arrange for a medical professional to deactivate the implant at Black’s execution. However, subsequent rulings by the Tennessee Supreme Court have overturned this order.