The U.S. Supreme Court on Monday ruled against a Missouri death row inmate with a rare medical condition, clearing the way for his execution by lethal injection.

The court split 5-4 along ideological lines in upholding a ruling from the 8th Circuit Court of Appeals. The justices ruled the inmate, Russell Bucklew, failed to present evidence indicating an alternative to the state’s lethal injection protocol would reduce his risk of pain.

Justice Neil Gorsuch wrote for the majority, and he was joined by the four other conservative justices.

“[H]is suit in the end amounts to little more than an attack on settled precedent, lacking enough evidence even to survive summary judgment — and on not just one but many essential legal elements set forth in our case law and required by the Constitution’s original meaning,” Gorsuch wrote. “The people of Missouri, the surviving victims of Mr. Bucklew’s crimes, and others like them deserve better.”

Gorsuch noted that Bucklew committed his crimes more than 20 years ago and has “managed to secure delay through lawsuit after lawsuit.”

But Justice Stephen Breyer, a vocal opponent of the death penalty, wrote in his dissent that "executing Bucklew by lethal injection risks subjecting him to constitutionally impermissible suffering."

"[T]his case adds to the mounting evidence that we can either have a death penalty that avoids excessive delays and 'arguably serves legitimate penological purposes,’ or we can have a death penalty that ‘seeks reliability and fairness in the death penalty’s application’ and avoids the infliction of cruel and unusual punishments,” Breyer wrote. “It may well be that ‘we cannot have both.’”

Bucklew, 50, was convicted in 1998 of first-degree murder, kidnapping, rape, and other crimes and was sentenced to death.

He was scheduled to die by lethal injection in March 2018, but because he has a rare medical condition, Bucklew’s lawyers argued his disease would cause him to experience “the excruciating pain of prolonged suffocation” while undergoing Missouri’s lethal injection protocol, in violation of the Eighth Amendment.

The medical condition, cavernous hemangioma, causes blood-filled tumors to grow in Bucklew’s head, neck, and throat, which can rupture and bleed. If he does receive Missouri’s lethal injection method, Bucklew will likely struggle to breathe throughout the procedure, causing a tumor in his throat to rupture.

His lawyers said his mouth and airway will subsequently fill with blood, causing him to “choke and cough” on his own blood throughout the process.

Rather than undergo Missouri’s lethal injection protocol, Bucklew proposed death by lethal gas.

But a three-judge panel on the 8th Circuit Court of Appeals ruled the execution by lethal injection was not considered cruel and unusual because Bucklew did not show an alternative method would reduce his risk of needless suffering.

The Supreme Court stayed Bucklew’s execution in July and agreed to hear Bucklew’s appeal in August. Justice Anthony Kennedy, who retired last summer, joined with the court's liberal wing in blocking the execution.