Executive Director, Euthanasia Prevention Coalition
I have written on this topic in the past. If Zivot is correct, assisted death may be torturous not peaceful.
In his Op-Ed Zivot writes:
As a Canadian physician and anesthesiologist working in the United States, this debate is of interest to me. I was a witness in these Senate hearings because I am an expert in the opposition to lethal injection, the most common form of execution in the U.S. To be clear, my expertise is relevant to MAiD (Medical Aid in Dying) not because it is considered akin to the execution of prisoners in its essence, but because the pharmaceutical and medical methods used are quite similar.
Most often, death by lethal injection is a rather bloodless event. Witnesses can't see much. I speak from experience: I was witness to an execution at the request of the inmate since I had been an expert in his legal defense, and the death appeared peaceful.
My perception of this changed, however, when I was given a file of autopsy reports on inmates executed by lethal injection. Upon review, I noticed a striking and surprising finding: almost all autopsies revealed that the lungs had filled with frothy fluid. This occurred if the execution was by an injection of either pentobarbital or midazolam. I reviewed the autopsy of the execution that I had witnessed and found that, although I had seen no outward struggle, the inmate had developed the striking lung congestion I had noted in others.Zivot explains why certain drugs have become difficult to obtain and then expresses his concern with the use of the drug propofol.
Since then, I have reviewed a number of published MAiD protocols and found an additional striking factor: MAiD includes the use of a drug that paralyzes the body, making it impossible to breathe or to move. These drugs do not block the sensation of pain or the awareness of being paralyzed. Notably, the use of paralytics in execution by lethal injection generally has been abandoned because of its obvious cruelty.
As an anesthesiologist, I have injected propofol into thousands of patients. Very commonly, patients complain of a burning sensation. I learned to block this painful sensation with a prior injection of a local anesthetic. MAiD uses a dose 10 times greater than what I would use in the operating room.Zivot concludes by explaining that an assisted death is not a peaceful death:
Like pentobarbital execution, propofol will very likely burn its way through the lungs and cause the frothy fluid accumulations seen in lethal injection. The experience of this will be akin to death by drowning. Waterboarding, widely understood as torture, creates the same effect. The injection of a paralytic after the propofol will make every death appear outwardly unremarkable -- and according to MAiD proponents, even beautiful in its peacefulness.
Canadians who choose to die by MAiD must be informed of the real possibility that the death they experience may be very different from that which is described by MAiD advocates. It is time to perform autopsies on everyone that dies by MAiD, so we can determine if MAiD protocols produce frothy fluid in the lungs. It is time to cease the use of paralytics in MAiD, so we can be certain we are not covering the potential for a painful death akin to drowning. It is time to accept what the evidence available to date shows: MAiD may very likely provide a torturous death.Links to similar articles:
Informative article. I wish you had written out what the acronym "MAiD" meant for this layman. I had to look up the meaning to understand the article.
ReplyDeleteVery informative article and one that everyone should hear! The message is clear and decisive and should be listened to by one and all.
ReplyDeleteI didn't have a very high opinion of propofol before, having watched them use this drug to turn a loved one into a zombie. Now my opinion is way down in the cellar. I would never agree to take that drug myself.
ReplyDeleteYou are making a leap that merely the presence of fluid on autopsy means the individual died of drowning. I agree that paralytics are a bad idea however a dose of pentobarbital induces unconsciousness in minutes. In hundreds of these assisted deaths not once has the patient complained of asphyxiation prior to falling asleep. This is because the barbiturate induced a deep coma prior to shutting down the breathing Center of the brain. Once the lung action ceases it’s not crazy to think secretions will build up in the lungs. The individual is not conscious at this point. I oppose capital punishment and midazolam is just amateur hour, but for those with serious illness a death from pentobarbital overdose is likely a blessing. Yes propofol can burn but such pain would last seconds as again the person loses consciousness. What I feel you’re missing is what happens after consciousness is lost is not felt. Otherwise we would not do surgery now would we ? I will grant you the argument that paralytic agents should be banned for use in assisted deaths… just in case ! Besides they are not needed. Btw the concept of flash pulmonary edema from barbiturate overdose dates back to autopsies in the 50s. As a final point, there is no perfect way to die, however pentobarbital injection is probably the easiest death a human can experience outside of sudden cardiac arrest in one’s sleep. I’m also interested in why you are not concerned about the horrific deaths experience by those with dread disease in palliative care ? I have nightmares to this day of the screaming, the writhing the howls of pain. If I had it I would have certainly administered pentobarbital. Death is a fact of life and using our scientific knowledge to trim off the final weeks of unimaginable pain is a good thing. So long as the patient is willing. I would like to engage you in debate. I admire your compassion for people but I just think your wrong here. And good for you in your aversion to capital punishment. Midazolam is not strong enough as it’s not a direct gaba A agonist but a benzo (modifier) so yes the paralytic can be a nightmare scenario. Paralytics NO. Pentobarbital YES.
ReplyDelete