The study warns there's "a risk that vulnerable citizens may be killed by suboptimal, or even cruel, means."
​This tears some huge holes in the arguments for assisted suicide
International researchers have warned that any discussion of legalising assisted suicide must include reference to the proposed methods to be used, as "there is a risk that vulnerable citizens may be killed by suboptimal, or even cruel, means."
One of the key arguments put forward for assisted suicide and euthanasia is that its legalisation will relieve suffering and to ensure deaths free from pain and distress. However, a study published in the journal Anaesthesia says that an optimal way of ensuring a patient is unconscious before death has not been found and patients may currently be dying in an "inhumane" way.
Trial and error
The authors of the study lament that although "the ethical dilemmas [of assisted suicide] are widely debated, the precise means to achieve unconsciousness are rarely a focus of discussion."
"Discussions regarding the ethics of assisted dying assume that an optimum method to achieve unconsciousness and subsequent death already exists, and all that is required is to sanction this in law," they continue. "If only painful methods were available, it is unlikely the question ‘Should assisted dying be legalised?’ would ever be asked."
However, they found that these assumptions are not backed up by the data.
"We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used," they write. "However, the considerable [differences] in methods suggests that an optimum method of achieving unconsciousness remains undefined."
Distressing method failure
Under Dutch protocols, patients are either prescribed a highâ€dose barbiturate which they take themselves (active participation) "such that death occurs slowly as a result of cardiorespiratory collapse and asphyxia", or a physician administers a high dose of intravenous anaesthetic, followed by a neuromuscular blocking drug.
The report found complications including difficulty in swallowing the prescribed dose (up to nine per cent) and vomiting in 10 per cent of cases, both of which can prevent dosing appropriate to the end aimed at. 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. "Each of these potentially constitutes a failure to achieve unconsciousness, with its own psychological consequences."
Taking days to die
Strikingly, ‘failure of unconsciousness’ is approximately 190 times higher in assisted suicide when it is intended the patient be unconscious when death occurs, as opposed to during medical surgery, where the intention is that the patient later be conscious and benefit from the operation.
Although unconsciousness is generally achieved within five minutes, death takes far longer. Death occurs within 90 min in two thirds of cases, 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).
Cruel and inhumane punishment
The researchers also looked at data from executions in the US, "because the method used is designed to be ‘humane’ and bears technical similarities to a method used in voluntary assisted dying." They noted that the Supreme Court has heard petitions arguing that the use of some of these drugs constitutes "cruel or inhumane punishment" as the person being executed might be awake but paralysed at the point of death. The study states that "although similar agents are used as during clinical anaesthesia, conduct in their administration falls well short of being able to satisfy the requirement of achieving unconsciousness at the point of death. Expressed another way, the lesson from these unfortunate experiences is that any optimum method used to achieve unconsciousness in voluntary assisted dying must be tangibly different from, and superior to, all the methods currently used in capital punishment."
No cosy death at home
The researchers attempted to define their own "optimum" method of achieving unconsciousness, which they admit is overly "medicalised (involving use of infusion pumps and brain monitors as well as the involvement of physicians).This report tears huge holes in some of the key arguments for assisted suicide. It has been legalised in many countries without an agreed way of ensuring the death is free from suffering. Any way of ensuring the death is pain-free will involve intensive medical input - something many are trying to avoid.
The authors warn in their conclusion: "Any decision by society to sanction assisted dying should go hand in hand with defining the method or methods to be used. Otherwise, there is a risk that vulnerable citizens may be killed by suboptimal, or even cruel, means." It appears that those intent on legalising killing under medical guise have not even shown cursory concern that the suffering of those whose lives they deem without sufficient value be minimised.
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