Shuffling off this mortal coil is not always pleasant


The dying process is an under-examined aspect of euthanasia and assisted suicide. Most people assume that it is swift and painless, but this is not always the case. In Oregon, for instance, which publishes very informative statistics about its “Death with Dignity Act”, the longest reported time to die was 104 hours – 4 days and 8 eight hours.

Known complications over the years include regurgitation and seizures, although in more than half the cases, no record was kept even if anything had happened. In eight instances, since 1998, the patient recovered consciousness – which must have been terrifying.

A letter to the BMJ last month from an Irish pharmacist reviewed the literature on complications with the dying process of euthanasia and made some surprising observations. In the Netherlands, it seems, the rate of non-reporting of euthanasia is strongly related to the type of drugs used. Standard drugs were mostly reported; opioids were mostly not reported.

As far as assisted suicide goes, it is potentially very unpleasant. The author, Bernadette Flood, writes:

There is currently an international scarcity of lethal drugs suitable for oral administration during an assisted suicide. On occasions when oral barbiturate drugs are administered there are reports of patients being unable to self-administer a complex cocktail of lethal medicines. Family members have reported having to scrape powder from 100 plus capsules with toothpicks to produce bitter powder to be mixed with sugar syrup. Medication for nausea and vomiting must be consumed before and during the process. In some countries, lethal cocktails have been ‘experimented’ with due to difficulties sourcing licensed medicines for the purpose of assisted suicide and/or euthanasia.

As she points out, there is also a puzzling disconnect between lethal injections for executions in the United States and lethal injections for euthanasia. “A number of medicines used in assisted suicide and/or euthanasia were previously used in executions. Use of medicines during executions has been described as ‘inhumane’ with reports of people feeling ‘burning’ sensations throughout their bodies prior to death.”

Perhaps because euthanasia cases are shielded from intense media scrutiny, there is less information about how euthanised people actually die.

Dr Flood concludes: “The process of assisted suicide and/or euthanasia cannot guarantee a peaceful, pain-free, dignified death.”

Michael Cook is editor of BioEdge




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