(HealthNewsDigest.com) – SACRAMENTO, Calif. — Voluntary physician-assisted suicide, as well as capital punishment in the U.S., is intended to bring about a painless and humane death by administering various drugs that induce unconsciousness, cause respiratory and neuromuscular paralysis, and disrupt the heart’s beating to rapidly cause death.
But a review of the common methods used to achieve unconsciousness at the time of death published in the journal Anaesthesia has identified serious shortcomings in all current methods used to assist dying.
Assisted death without pain or distress
“While most individuals lose consciousness within 5 minutes of taking a strong oral sedative and die from cardiopulmonary arrest about 90 minutes later, about one-third of cases can take longer, sometimes up to 30 hours,” said David A. Lubarsky, co-author of the study and vice chancellor of human health sciences at the University of California, Davis, and CEO of UC Davis Health.
“Failure to achieve unconsciousness can occur from inadequate dosing, due to swallowing difficulties or the vomiting of drugs,” he said. “With other techniques, such as high-dose opioids and insulin administered intravenously, there can be difficulties with IV access, resulting in a prolonged death, of up to 7 days, or individuals re-awakening from a coma.”
“In fact, the failure to achieve unconsciousness is approximately 190 times higher in assisted dying than in patients undergoing surgery who are intended to awaken and recover,” he said. “Surgery patients’ rate of significant awareness is approximately 1 in 19,000.”
Similarly, condemned prisoners have been reported to be awake and in distress during some recent executions, which has led to reviews of the sedation methods used during execution as being in violation of the U.S. Constitution’s Eighth Amendment clause against cruel or inhumane punishment.
More reliable methods to achieve unconsciousness in assisted death
To induce and confirm unconsciousness, the authors have identified essential components necessary to achieve the desired outcome. These include continuous intravenous infusion of an anaesthetic agent at very high doses, simultaneous monitoring of specific brain functions with electroencephalogram (EEG), and testing for a lack of response to verbal command or arousing stimulus.
These conditions are, in fact, part of what anesthesiologists do prior to surgery to ensure the patient is safely prepared and ready for the procedure.
“Alternative methods that do not include these elements bring a higher, and possibly unacceptable, risk of individuals remaining conscious while trying to end life, and so by definition, are suboptimal,” Lubarsky said.
“As a society that sanctions assisted dying in any form, it is essential that we work toward defining better methods to induce and confirm unconsciousness before any intervention that attempts to cause death is introduced,” he said.
Other authors of the paper “Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying” include S. Sinmyee, V.J. Pandit, J. Pascul, A. Dahan, T. Heidegger, G. Kreienbuhl and J.J. Pandit. The paper is published in the journal Anaesthesia (doi.org/10.1111/anae.14532).