Monday, October 9, 2017

Will assisted suicide always provide a quick and gentle death?

This article was originally published in BioEdge, on October 7, 2017


By Michael Cook

The gold standard for human experimentation is a randomly-assigned double-blind placebo-controlled study. Unfortunately for researchers, organising such a study to assess the effectiveness of the lethal medications used for executions in the United States and for physician-assisted suicide (PAS) has significant ethical issues. They need to rely upon historical data.

In the latest issue of the Journal of Law and the Biosciences, Sean Riley, an end-of-life researcher currently studying in the Netherlands, reviews the patchy record of the drugs used in executions and PAS. He summarizes his findings as follows:

The pervasive belief that these, or any, noxious drugs are guaranteed to provide for a peaceful and painless death must be dispelled; modern medicine cannot yet achieve this. Certainly some, if not most, executions and suicides have been complication-free, but this notion has allowed much of the general public to write them off as humane, and turn a blind eye to any potential problems. Executions or PAS have never been as clean as they appear, even with the US’s medicalization efforts during the 1980s.
He discusses several issues:

Supplier boycotts. Under pressure from anti-death penalty activists, pharmaceutical companies refused to supply prisons with lethal medications. Efforts to circumvent this by going to shady middlemen eventually failed. Most states have ceased to import the key ingredients needed for executions.

Price gouging for PAS drugs. Because of the drought of lethal medications for executions, the price of secobarbital or pentobarbital for PAS has skyrocketed. “Before 2012, patients would pay about $500 for a sufficient lethal dose of the drug, but by 2016, prices had inflated to figures upwards of $25,000.”

Compounding pharmacies. Faced with the huge cost of assisted suicide, prisons and patients began to turn to compounding pharmacies where pharmacists create the drugs from raw materials. “As the past 3 or so years have seen a dramatic increase in the use of compounded drugs,” writes Riley. “There has been a corresponding rise in ‘botched’ executions, though the secrecy laws have neutered most attempts to link failed executions to compounded drugs.”

The drugs made in compounding pharmacies risk being too powerful, not powerful enough, or contaminated. In Massachusetts a former pharmacist is currently on trial for supplying contaminated drugs which caused a nationwide outbreak of meningitis. Prosecutors told the court that he had used expired ingredients, falsified documents, neglected cleaning, failed to properly sterilize the drugs, shipped products before they were tested and ignored mould and bacteria in manufacturing areas. So buying from small firms has its issues.

Last-minute complications. It is difficult to define what a “botched execution” is, but the last moments of some prisoners were clearly agonizing. And for complications with PAS, there is a lack of clear data. “According to data published by Oregon, 5% of patients experienced difficulties, such as regurgitation or seizures, after ingestion of the medication, since the inception of the law in 1997,” says Riley. However, in only 51% of the cases were the details reported. And “there are six reported instances where patients ingested the lethal medications, went unconscious, and awoke sometimes days later.” This is not a feature of assisted dying which supporters speak much about.

Riley concludes that “The processes of death will always, to some extent, be a mystery. For now, whether a death is peaceful and painless can only be assumed.”

Michael Cook is editor of MercatorNet. This article was originally published in BioEdge, which he also edits.

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