Newly minted justice Brett Kavanaugh heard oral arguments Tuesday morning in his first death penalty case, a controversial subject that is almost perpetually before the High Court.

The case, Bucklew v. Precythe, is the latest of many appeals by multiple murderer Russell Bucklew to delay his execution—he was convicted and sentenced to death more than 20 years ago. This latest appeal (called an “as applied” challenge) is concerned with the method of execution used by the state of Missouri as applied to Bucklew but represents yet another instance of the Supreme Court’s justices being forced to grapple with the strange contours of lethal injection.

Bucklew suffers from a rare disease called cavernous hemangioma, which “has caused unstable, blood-filled tumors to grow in his head, neck, and throat.” These tumors are known to burst, causing Bucklew’s airways to be flooded. He argues there is a very real risk that while undergoing lethal injection, one will burst, causing him to effectively drown on the table, a fate he contends violates the Eighth Amendment’s prohibition on cruel and unusual punishment.

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