Is assisted suicide always peaceful?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The question of whether or not assisted suicide poison cocktails actually lead to a peaceful death has been examined and studied by several researchers and medical professionals.

Manuela Callari just added to the debate with an article that was published in Medscape on February 3, 2026. Callari writes:

The scene was meticulously set for a final, serene farewell. Family and friends gathered, champagne was poured, and a pianist played softly in the background. In this atmosphere of profound emotion, Arjen Göbel, MD, a general practitioner in Amstelveen, Netherlands, began the procedure that would bring a planned and peaceful end to his patient’s life.

Following the standard protocol, he began by injecting a coma-inducing drug. The 48-year-old patient with breast cancer closed her eyes and a deep hush fell over the room as her breathing grew shallower.

But the expected stillness did not come. The family noticed that the patient continued to breathe. Göbel, maintaining an outward calm, saw it too.

Callari reports that the woman didn't die. Göbel fetched an emergency kit and injected her again, but she still didn't die. Callari reports:

Göbel called an ambulance service while he fetched two more emergency kits from a nearby pharmacy. The paramedics helped him inject the lethal cocktail directly into a vein in her groin, but nothing happened. They then injected the fourth dose into the artery in her neck. It wasn’t until half an hour later at 6 o’clock in the evening — 4 hours after the first injection — that she finally died. The planned, beautiful farewell had become a prolonged and traumatic ordeal. “It was the worst thing in my life,” Göbel told Medscape News Europe.

Callari continues by explaining that unlike other "procedures" there are very studies or protocols concerning euthanasia and assisted suicide.

Similar stories of long drawn-out deaths can be witnessed in the Oregon assisted suicide data which indicated that one death, in 2023, took 137 hours to be completed.

Callari then defines euthanasia and assisted suicide for clarity.

Euthanasia is the intentional, direct administration of a lethal substance by a physician to end a patient’s life at their voluntary request to end unbearable suffering.

Assisted dying (suicide) is the voluntary, self-administered ingestion of lethal drugs prescribed by a physician. Crucially, the patient, not the doctor, performs the final, fatal act.

Notice how Callari uses pro-death definitions by implying that the wish to be killed is based on ending unbearable suffering, when the data in nearly every jurisdiction that allows death by lethal poison indicate that only a minority seek death based on ending unbearable suffering.

Callari then explains how euthanasia was first legalized in the Netherlands. Callari comments on the lack of protocols by stating:

It wasn’t until around 2010 — 8 years after the Dutch Termination of Life on Request and Assisted Suicide Act was officially introduced — that physicians approached pharmacists to develop a joint guideline. This collaboration resulted in the first combined protocol in 2012, with its most recent major update in 2021.

Today, the Dutch standard for euthanasia is a two-step intravenous (IV) process: a high dose of a coma-inducing barbiturate (typically propofol) followed by a neuromuscular blocker (usually rocuronium) to paralyze the respiratory muscles. A small dose of lidocaine is often injected prior to the process to reduce the burning sensation of the barbiturate.

Without going into further descriptions around killing it is important to note that the Callari suggests that the complications rate is generally under-reported and states that the 2023 Oregon data indicates a 9.8% complications rate.

Callari also comments on studies on the effect of the poison drug regimen on the body, particularly the lungs, and states:

Philippe Camus, MD, professor of pulmonology and respiratory intensive care at Dijon University Hospital in Dijon, France, has studied the effect of drugs on the lungs since 1972, when he began collecting data as a medical student at the University of Burgundy. Over five decades, he has compiled more than 200,000 references into a global database tracking drug-induced respiratory disease.

Even at therapeutic dosages, he explained, anesthetics such as propofol can cause ventilatory depression, a deep coma, peripheral vasodilation, and myocardial dysfunction. At therapeutic doses, however, these risks are minimal and promptly managed. “The poison is in the dose,” he said.

Callari quotes Didier Cataldo, MD, PhD, pulmonologist at the University of Liège in Liège, Belgium who explains:

These drugs shut down the brain’s drive to breathe, the patient becomes comatose, and breathing slows and becomes shallow. A deep coma can lead to loss of airway reflexes, which means the patient is no longer able to cough or gag. The tongue falls back, blocking the upper airway and causing effort during inhalation. This creates a vacuum inside the chest. As the diaphragm contracts to draw air into the lungs against a closed glottis, the pressure inside the alveoli drops rapidly and becomes significantly lower than the pressure in the surrounding blood vessels. This pressure difference acts like a suction pump. It forces fluid, and sometimes red blood cells, out of the pulmonary capillaries and across the thin membrane into the alveoli, resulting in negative pressure pulmonary edema. This is why, in standard surgery, patients are sometimes intubated and connected to a ventilator before the full anesthetic load is delivered. Anesthetics can also cause vasodilation and myocardial dysfunction. This causes a drastic drop in blood pressure, making it impossible for the heart to pump blood to the rest of the body.

While Cataldo claims that pulmonary endema is rare he does refer to a case of an 18-year-old male who ingested a lethal overdose of pentobarbital, the same barbiturate used in the oral method for assisted death. When emergency teams arrived, they found the patient in cardiac arrest. But as they attempted to intubate him, they found a “substantial quantity of frothy, bloody secretions” discharging from his throat. A postmortem CT scan confirmed severe bilateral pulmonary edema. His lungs were sodden with fluid. The patient, sedated but perhaps not yet dead, might have struggled to breathe against a blocked airway, drowning himself from the inside.

Similar research by Dr Joel Zivot who researched autopsies of people who died by lethal injection capital punishment. Zivot found that the lungs were filled with fluid likely resulting in death by drowning.

Callari continues with comments by Philippe Camus:

Camus said that experiencing pulmonary edema would be like drowning on dry land. It feels like being forced to breathe through a narrow straw. Every attempt to inhale draws not air but a mixture of blood and fluid that churns into a thick, pink froth. This foam rises up the trachea, blocking the windpipe. The brain, starved of oxygen, triggers a state of panic. “We need to decide whether that’s pain,” Camus said. “It’s not physical pain but can be extremely distressing.”

Callari then interviews several euthanasia doctors who suggest that pulmonary edema is unlikely, but even if it is happening, that the amount of drug that is used causes the person to be in a deep coma and unlikely to experience pain or distress.

Nonetheless, Callari concludes by stating that we simply don't know if assisted suicide is always peaceful.

More articles on this topic:

• Death by assisted suicide is not what you think it is (Link). 
• Assisted suicide: Proceed with caution (Link). 
• Assisted suicide is the wrong prescription (Link). 
• Assisted suicide. It's not that simple (Link). 
• Assisted suicide deaths are not what you think they are (Link). 
• Assisted suicide is neither painless nor dignified (Link).