Washington State assisted suicide group - death may take hours.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A Washington State assisted suicide lobby group is informing its "clients" that death by assisted suicide may take many hours. 

In their document, Death with Dignity - Preparing for the last day, End of Life Washington states:

Every individual is different and time to death after taking the medication varies greatly depending on the person’s physical condition and ability to absorb the medication. Be assured that once the person is in a coma (generally within 5-10 minutes of taking the life-ending medication), they will be in a peaceful place and not experience any suffering. If they do not die as soon as expected, do not panic. There is little that can be done except to wait. Caregivers may administer any of the medications in a hospice kit, if one is available, in response to any symptoms that ordinarily would be treated.

It may be helpful to consider the additional hours as a time for a vigil, which often occurs during the last hours of a person’s life during a natural death.

The Washington State 2018 assisted suicide report indicated that of the 203 reported assisted suicide deaths that there were 8 reported complications in 2018, likely related to the new DDMA and DDMP2 lethal drug cocktails. Also, 62 deaths reportedly took more than 90 minutes with the time of death ranging from 7 minutes to 30 hours.

The Oregon 2019 assisted suicide report states that the time of death ranged from 1 minute to 47 hours but the report didn't indicate how many people died more than 90 minutes after taking the lethal drugs.

The fact that assisted suicide deaths can take many hours is directly related to the new lethal drug cocktails that have been developed to enable a cheaper way to kill.

The new lethal drug cocktails were developed through human experimentation. The results of the first two failed lethal drug trials were:

The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.

In February 2019 I published the article - assisted dying can cause inhumane deaths based on research by Professor Jaideep Pandit that was published in the British Medical Journal. Pandit researched complications with assisted suicide and capital punishment deaths and indicates that the complications include:

• difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing.
• Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said. 
• After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer. 
• But in a third of cases, death can take up to 30 hours,

The negative outcomes associated with the lethal drug cocktails and the ethics of human experimentation related to the development of these drugs should be investigated by the US government, based on the controlled substances act.

Lethal Drugs Used For Assisted Suicide and Complications for Patients.

The Patients Rights Action Fund published the following information.
 
Warning: If you are experiencing suicidal thoughts, do not read this article but call: 1-800-273 (talk) 8255.

Article: Lethal drug cocktails experimented on humans (Link).

Seconal (Secobarbital)

• A 90-100 pill dosage of Seconal (secobarbital) was widely used for assisted suicides for many years until it became too costly and in 2019 became unavailable for this use. [1]
  

Phenobarbital

• To replace Seconal, proponents of assisted suicide began experimenting with combinations of drugs to induce death. One of the drug combinations used is a mixture consisting of phenobarbital, chloral hydrate and morphine sulfate. The patient mixes the powder with water, alcohol, applesauce or juice. This drug combination lowered the cost to $400-$500. 
• In Oregon, the phenobarbital combination was used to cause the death of 65 patients. For those cases for which data on time to death after ingestion were reported, patients experienced death from 20 minutes to 72 hours. [2]
  

DDMP 1; DDMP2

• Increasingly, experimentation began with other new drug cocktails. A combination using DDP (diazepam, morphine sulfate and propranolol) took a patient 18 hours to die so 10 mg. of digoxin was added to the mix to create DDMP 1. The digoxin dosage was subsequently increased to 15 mg. to form DDMP 2. [3] 
• Researchers have described DDMP 2 as “blue-whale-sized doses…..And the mixture tastes extremely bitter. ‘Imagine taking two bottles of aspirin, crushing it up, and mixing it in less than half a cup of water or juice.’” [4]  
• In Oregon, DDMP 1 and DDMP 2 accounted for 239 deaths through 2019. For those cases for which data on time to death after ingestion were reported, patients experienced death from a range of 5 minutes to 47 hours. Two patients regained consciousness after ingesting the drugs.[5] “The median time until death was longer for the DDMP2 compound (120 min) than for secobarbital (25 min)…”[6] The drug cocktail is taken in liquid form and is ingested orally or through a tube.
  

DDMA 

• In 2019, DDMA was introduced which is a combination of diazepam, digoxin, morphine sulfate and amitriptyline. In Oregon, DDMA was used for 87 patients and for those cases for which data on time to death after ingestion were reported, the time to achieve death ranged from one minute to 19 hours. [7]
  

Morphine Sulphate 

• In Washington State in 2017, 130 out of 196 deaths (63%) were attributed to use of morphine sulfate in isolation.[8] Deaths from secobarbital and morphine sulfate lasted from 5 minutes to 35 hours in range.[9]
  

General Complications From Lethal Drugs Used In Assisted Suicide Deaths

• Experimenting with combinations of drugs is “research” which has not been approved by any ethics review committee like an "Institutional Review Board" (IRB), which appears to violate research ethics standards. 
• According to The Atlantic: “No medical association oversees aid in dying, and no government committee helps fund the research…The doctors’ work {to experiment with drugs which kill patients} has taken place on the margins of traditional science. Despite their principled intentions, it’s a part of medicine that’s still practiced in the shadows.”[10]  
• According to Kaiser Health News: “The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain.”[11] “The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients – and up to 31 hours in one case…the next longest 29 hours, the third longest 16 hours and some 8 hours in length.”[12]
•  According to the New England Journal of Medicine: “One in five Dutch patients using standard barbiturates to kill themselves experienced complications including vomiting, inability to finish the medication, longer than expected time to die, failure to induce coma, and awakening from coma.” [13]  
• According to Anaesthesia: “However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane…”[14]
•  According to the British Medical Journal: “Complications related to assisted dying methods were found to include difficulty in swallowing the prescribed dose (≤9%), a relatively high incidence of vomiting (≤10%), prolongation of death (by as much as seven days in ≤4%), and failure to induce coma, where patients re-awoke and even sat up (≤1.3%). ‘This raises a concern that some deaths may be inhumane,’ the researchers said. They had expected to find a single technique being used but said that ‘the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined.’” [15]
  

1. http://www.medscape.com/viewarticle/869023?src=emailthis#vp_2 https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 7

2. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 16

3. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

4. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

5. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdf, page 16

6. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

7. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year22.pdfm , page 16

8. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 9

9. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 10

10. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

11. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

12. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

13. Groenewoud, J.H., van der Heide, A., Onwuteaka-Philipsen, B.D., Willems, D.L., et al. (2000). Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. The New England Journal of Medicine, 342, 551-556.
 
14. Sinmyee, S., Pandit, V.J., Pascual, J.M., Dahan, A., Heidegger, T., et al. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74,557-559.

15. Torjesen, Ingrid. (2019) Assisted dying methods can lead to “inhumane” deaths. British Medical Journal. 364:1797 doi: 10.1136/bmj.1797

Lethal drug cocktails experimented on humans.

This article was published by OneNewsNow on December 20, 2019.

An anti-euthanasia group says it isn't ethical for medical personnel to perform lethal experiments on human beings, especially to expand the practice of assisted suicide.

*Prolonged painful assisted suicide deaths and human experiments with new lethal drug cocktails (Link).

Alex Schadenberg

Washington and Oregon are conducting experiments in an effort to find a lethal cocktail of drugs that is inexpensive yet effective enough to kill a patient who qualifies for assisted suicide.

"What's important about this issue is twofold," begins Alex Schadenberg of the Euthanasia Prevention Coalition. "One, of course, is it's a lie to say that this is a safe, easy death. In fact, it's not. Assisted suicide is often horrific, quite often painful, and usually it takes a long time."

Secondly, medical personnel have been doing the experiments on human beings.

"So these are what you call human experiments. I think this is possibly unethical, and if the federal government, the Controlled Substances Act people realized what was going on, they would probably have to shut it down, because you can't be doing human experiments on someone and having failures like this."

The first two sets of drug combinations failed, with victims experiencing burning throats and painful deaths, or it takes a lengthy periods of time for the cocktail to do its job. Still, a third lethal cocktail has been developed, and medical personnel are beginning to experiment with it on human beings.

Prolonged painful assisted suicide deaths and human experiments with new lethal drugs cocktails

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

An article published in the Spring Hill Insider yesterday looks at experiments being done on people to find an effective lethal drug cocktail for assisted suicide. 

The current drug cocktails have caused painful assisted suicide deaths that may take many hours to die.

The article states that assisted suicide researchers are promoting their third generation of lethal drug cocktails. The results of the first two lethal drug cocktails were:

The (first) turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain. The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients — and up to 31 hours in one case.

The first two lethal drug cocktail experiments failed to provide a painless, fast death. Remember, these experiments are being done on people.

In February I published the article - assisted dying can cause inhumane deaths based on research by Professor Jaideep Pandit that was published in the British Medical Journal. Pandit researched complications with assisted suicide and capital punishment deaths. The same lethal drugs are used for assisted suicide and capital punishment.

Pandit reports that the complications include:

• difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent, both of which can prevent proper dosing.
• Re-emergence from a coma occurred in two per cent of cases, with a small number of patients even sitting up during the dying process, the authors said. 
• After oral sedative ingestion, patients usually lose consciousness within five minutes. However, death takes considerably longer. 
• But in a third of cases, death can take up to 30 hours, and some deaths took as many as seven days to occur (four per cent).

It is shocking that New Jersey legalized assisted suicide in March and other states are considering assisted suicide, when people in Oregon are dying long and painful assisted suicide deaths.

The assisted suicide promoters and practitioners developed the lethal drug cocktail by doing human trials rather than animal trials. The team appeared concerned with the lethal efficacy and cost of the lethal drugs as opposed to the possible negative consequences. 

The negative outcomes associated with the lethal drug cocktails and the ethics of human experimentation related to the development of these drugs should cause US government, under the controlled substances act, to stop assisted suicide and prevent human experimentation with these lethal drug cocktails.

The euthanasia lobby is not concerned with a "good" death but rather the cost of the drugs. So much for dying with compassion and dignity.

More articles on this topic:

• What's cruel for incarceration is cruel for the terminally ill. The connection between lethal injection and capital punishment (Link).
• Complications with lethal drugs used for assisted suicide (Link).
• Many assisted suicide deaths are slow and painful (Link).
• Is lethal injection inhumane. Euthanasia execution drug controversy (Link).

Montréal man says that psychologist urged him to kill his wife.

This article was published by Choice is an Illusion on November 4, 2019

That's Not Assisted Suicide, That's Murder.
 

Serge Simard & Miranda Edwards

Emily Campbell with CTV news Montreal reported that a Montreal couple is calling for disciplinary measures against a psychologist they say counselled one of them to kill the terminally ill other.

When Miranda Edwards was diagnosed with an aggressive form of cancer she said she was determined to fight it.

“I want to live, I want every medical intervention possible,” she said. “I will fight to the end. I will do every treatment, everything possible to stay alive.”

Her husband, Serge Simard, struggled as his wife’s health declined and eventually sought the services of a psychologist to help manage the stress.

Simard alleges the psychologist told him to overdose his wife with morphine she had been prescribed for her pain. He secretly recorded the session on his phone and on the recording the psychologist can be heard saying: 

“at one point it will be a dose too much and she just won’t wake up. It’s the best thing that could happen, really. She won’t be suffering anymore she’ll be in a better place.”

The psychologist cannot be identified as they haven’t been charged with a crime.

Simard said he was horrified by the advice.

“That’s not assisted suicide, that’s murder,” he said. “I will not murder my wife. If Miranda voices anything I will respect her wishes. Miranda has never voiced that she wanted to pass away.”

Dr Paul Saba

Family physician Paul Saba said he feared incidents like this could occur as a result of the legalization of medically assisted suicide....

The couple said they were disappointed that both Montreal and Gatineau police refused to pursue the case and didn’t rule out a civil court case.

Good news: The Nevada assisted suicide bill died a natural death. Dr Kirk Bronander wrote an excellent article explaining why assisted suicide should not be legal.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Congratulations to the many groups and individuals who worked to defeat Nevada's assisted suicide bill SB 165. SB 165 passed in the Nevada Senate Health and Human Services Committee (3 - 2) on March 25.

A few days ago, a well researched article by Dr Kirk Bronander, a professor of medicine at the University of Nevada, Reno School of Medicine and director of academic hospitalists for UNR Med., titled: Physician assisted suicide a flawed process was published in the Reno Gazette.

Dr Kirk Bronander

In his article Dr. Bronander first challenged the concept of a six month prognosis. He wrote:

The fact is that physicians frequently make errors with diagnosis and predicting timing of death in terminal conditions. My family has personal experience with this: My father was diagnosed with a malignant brain cancer (glioblastoma) and given a prognosis of less than six months to live. He survived for almost four years after his diagnosis. This is also well-documented in the medical literature: A study of hospice patients in the Chicago area showed that of 468 predictions of timing of death, only 20 percent were accurate. Inaccurate diagnoses or prognoses coupled with PAS will result in patients dying that may have years of life remaining.

Dr. Bronander then questioned the ability to regulate the lethal assisted suicide prescriptions. He wrote:

I trust many of my colleagues but there are always going to be some physicians that are unscrupulous, incompetent or unethical. That means this type of law can easily be abused. In Reno, Dr. Robert Rand contributed to the death at least one patient by overprescribing opioids. He did this for years even though opioids are the most highly regulated medications we can prescribe. The lethal drugs used for suicide will be much less scrutinized since there is no requirement for the federal government to monitor them. The law itself will protect the identity of the prescribing doctor, so no one will ever be able to determine if abuse is occurring. Do you trust every physician in Nevada?

Dr. Bronander then examines the effect legalizing assisted suicide has on the elderly and people who become depressed. He wrote:

Unfortunately, many elderly and terminal patients feel they are a burden to loved ones and this law will encourage suicide as an answer. The statistics from Oregon in 2017 (which has a similar law to the one proposed in Nevada) are clear that the reasons stated for obtaining the lethal prescription are for reasons other than pain. “Losing autonomy” is No. 1 and “burden on family, friends/caregivers” is a more frequent reason than “inadequate pain control,” which is sixth on the list. 

Many patients diagnosed with a terminal condition are depressed and there is no requirement to refer to psychiatry or counseling in the law. The Oregon statistics show that only 3.8 percent of patients receiving lethal drugs were referred for psychiatric evaluation while a 2008 study conducted in Oregon found 25 percent of patients requesting assisted suicide were clinically depressed. Depression is a treatable condition; obviously a completed suicide is not treatable.

Thankfully, Nevada's assisted suicide bill is dead in 2019. Sadly, the assisted suicide lobby will likely introduce another bill in 2020. Hopefully Dr Bronander's research will help Nevada, and other states, defeat future assisted suicide bills.

The NCET named Dr Kirk Bronander educator of the year in 2018.

Complications with Lethal Drugs Used for Assisted Suicide

The Patients Rights Action Fund published the following information.

Warning: If you are experiencing suicidal thoughts, do not read this article but call: 1-800-273 (talk) 8255

• Many assisted suicide deaths are slow and painful.
  

Seconal

· The lethal dose prescribed to cause the death of the patient is 9 grams of seconal (secobarbital) capsules. To reach this dosage, the patient takes 100 capsules which are opened and mixed with a sweet substance to mask the bitter taste.

· The price of seconal in 2009 was estimated at around $200. The price increased over the next few years to $1,500. When Valeant bought seconal in early 2016, the price increased to $3,000 -- $7,000. [1]

Phenobarbitol

· To counter the cost increase of seconal, proponents of assisted suicide began experimenting with combinations of drugs to induce death. One of the drug combinations being used is a mixture consisting of phenobarbital, chloral hydrate and morphine sulfate. The patient mixes the powder with water, alcohol, applesauce or juice. This drug combination lowered the cost to $400-$500.

· In Oregon, the phenobarbital combination has been used to cause the death of 65 patients. For known durations, 59.1% of patients experienced deaths from one to six hours in length and 22.7 % experienced deaths over 6 hours in length. [2]

DDMP 1; DDMP2

· Increasingly, a four drug-cocktail consisting of diazepam, digoxin, morphine sulfate and propranolol (DDMP) is being used to reduce costs. DDMP 1 contains 10 grams of morphine sulfate and DDMP 2 contains 15 grams.[3]

· When a patient took 18 hours to die using DDP (diazepam, morphine sulfate and propranolol), digoxin was added to the mix and the dosage was subsequently increased to form DDMP2. Researchers have described DDMP2 as “blue-whale-sized doses…..And the mixture tastes extremely bitter. ‘Imagine taking two bottles of aspirin , crushing it up, and mixing it in less than half a cup of water or juice.’”[4]

· In Oregon, DDMP 1 and DDMP 2 accounted for 145 deaths through 2018. For known durations, 40% of patients experienced deaths from one to six hours in length and 24% experienced deaths over six hours in length. Two patients regained consciousness after ingesting the drugs.[5] “The median time until death was longer for the DDMP2 compound (120 min) than for secobarbital (25 min)…”[6]

· In Oregon in 2018, DDMP was prescribed for 38.1% of patients compared to 13.2% in previous years.[7]

Morphine Sulphate

· In Washington State in 2017, 130 out of 196 deaths (63%) were attributed to use of morphine sulfate in isolation.[8] Deaths from secobarbital and morphine sulfate lasted from 5 minutes to 35 hours in range.[9]

General Complications From Lethal Drugs Used In Assisted Suicide Deaths

· Experimenting with combinations of drugs is “research” which has not been approved by any ethics review committee like an "Institutional Review Board" (IRB), which appears to violate research ethics standards.

· According to The Atlantic: “No medical association oversees aid in dying, and no government committee helps fund the research……... The doctors’ work {to experiment with drugs which kill patients} has taken place on the margins of traditional science. Despite their principled intentions, it’s a part of medicine that’s still practiced in the shadows.”[10]

· According to Kaiser Health News, “The first Seconal alternative turned out to be too harsh, burning patients’ mouths and throats, causing some to scream in pain.”[11] “The second drug mix, used 67 times, has led to deaths that stretched out hours in some patients – and up to 31 hours in one case……the next longest 29 hours, the third longest 16 hours and some 8 hours in length.”[12]

· According to the New England Journal of Medicine: One in five Dutch patients using standard barbiturates to kill themselves experienced complications including vomiting, inability to finish the medication, longer than expected time to die, failure to induce coma, and awakening from coma.[13] 

· According to Anaesthesia: “However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane……”[14]

1. http://www.medscape.com/viewarticle/869023?src=emailthis#vp_2

2. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

3. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

4. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

5. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 15

6. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

7. https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf, page 7

8. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 9

9. https://www.doh.wa.gov/Portals/1/Documents/Pubs/422-109-DeathWithDignityAct2017.pdf, page 10

10. https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/

11. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

12. Kaiser Health News, “Docs in Northwest Tweak Aid-In-Dying Drugs to Prevent Prolonged Deaths”, February 21, 2017

13. Groenewoud, J.H., van der Heide, A., Onwuteaka-Philipsen, B.D., Willems, D.L., et al. (2000). Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands. The New England Journal of Medicine, 342, 551-556.
 
14. Sinmyee, S., Pandit, V.J., Pascual, J.M., Dahan, A., Heidegger, T., Kreienbuhl, G.,…Pandit, J.J. (2019). Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia, 74,557-559.