A convicted murderer who argued blood filled tumours in his throat could burst if he is given the lethal injection has lost his fight for a "painless death".
On Monday the United States Supreme Court ruled against Russell Bucklew, who had asked for a gas execution rather than a lethal injection for medical reasons.
The 50-year-old had argued Missouri state's preferred method amounted to "cruel and unusual punishment" which is outlawed in the Eighth Amedment.
The 5-4 ruling had the court split along its idealogical grounds, with President Donald Trump's second judicial nominee Bret Kavanaugh eventually siding with the other Republican picked justices after indicating he might join his liberal colleagues.
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In 1996 Bucklew was sentenced to death for rape, murder and kidnapping in an attack on his ex-girlfriend along with her new partner and his six-year-old son.
In recent court filings he argued the congenital condition he has, cavernous hemangioma, would cause him excessive pain if he received the lethal injection.
Blood filled tumours in his throat, neck and face would pop during the execution, Bucklew argued, causing him extreme pain and suffocation.
Lethal injection is the preferred method of execution in Missouri, where he is jailed.
The conservative justices accused the condemned man of stalling tactics and said he had failed to present an alternate method which would "reduce a substantial risk of severe pain".
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Justice Neil Gorsuch, the President's first selection, argued: "The eighth amendment forbids 'cruel and unusual' methods of capital punishment but does not guarantee a prisoner a painless death.
"As originally understood, the eighth amendment tolerated methods of execution, like hanging, that involved a significant risk of pain, while forbidding as cruel only those methods that intensified the death sentence by 'superadding' terror, pain or disgrace."
The outcome in the case was not surprising in the context of previous Supreme Court rulings.
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The nation's top court has long held that the death penalty is constitutional, and has never barred a state's chosen method of execution on the grounds that it violated the eighth amendment's prohibition of "cruel and unusual" punishment.
Last spring, then Justice Anthony Kennedy voted with the court's four liberals to put the execution on hold.
This week's ruling marked the end of the first major death penalty case since Justice Kavanaugh replaced him.
