In states with the death penalty, medical professionals almost always avoid involvement in executions, adhering to their professional ethical guidelines to "do no harm". Many pharmaceutical companies also restrict the sale and importation of drugs used in lethal injections, one of the most common forms of execution, leading to a scarcity of suitable drugs and the reliance on drugs that can cause more suffering to the prisoner (e.g. using sedatives that don't render the prisoner fully unconscious during execution).