— It may look peaceful, but closer examination may tell different story
by Joel Zivot, MD
Originally published February 16, 2021 https://www.medpagetoday.com/publichealthpolicy/ethics/91214?xid=nl_secondopinion_2021-02-16&eun=g994451d0r
Currently, the Senate of Canada is reviewing Bill C-7 as it seeks to understand the implications of further expanding medical assistance in dying, known as MAiD.
Some of the proposed amendments contained in Bill C-7 are in reply to the 2019 decision of the Quebec Superior Court in Truchon v. Procureur général du Canada. As a Canadian physician and anesthesiologist working in the United States, this debate is of interest to me. I was a witness in these Senate hearings because I am an expert in the opposition to lethal injection, the most common form of execution in the U.S. To be clear, my expertise is relevant to MAiD not because it is considered akin to the execution of prisoners in its essence, but because the pharmaceutical and medical methods used are quite similar.
Most often, death by lethal injection is a rather bloodless event. Witnesses can't see much. I speak from experience: I was witness to an execution at the request of the inmate since I had been an expert in his legal defense, and the death appeared peaceful.
My perception of this changed, however, when I was given a file of autopsy reports on inmates executed by lethal injection. Upon review, I noticed a striking and surprising finding: almost all autopsies revealed that the lungs had filled with frothy fluid. This occurred if the execution was by an injection of either pentobarbital or midazolam. I reviewed the autopsy of the execution that I had witnessed and found that, although I had seen no outward struggle, the inmate had developed the striking lung congestion I had noted in others.
Since then, I have reviewed a number of published MAiD protocols and found an additional striking factor: MAiD includes the use of a drug that paralyzes the body, making it impossible to breathe or to move. These drugs do not block the sensation of pain or the awareness of being paralyzed. Notably, the use of paralytics in execution by lethal injection generally has been abandoned because of its obvious cruelty.
Pentobarbital became harder and harder to obtain by death penalty states as a consequence of the association with execution -- drug manufacturers simply chose to stop making it. The state of Missouri intended to use propofol for execution when pentobarbital was unobtainable. At the last minute, this was blocked when the major European supplier of propofol threatened to stop supplying the U.S. market. The manufacturer reasoned that propofol was for treatment and not for death. Yet this is precisely the drug currently used in MAiD in an attempt to render the dying person insensate.
As an anesthesiologist, I have injected propofol into thousands of patients. Very commonly, patients complain of a burning sensation. I learned to block this painful sensation with a prior injection of a local anesthetic. MAiD uses a dose 10 times greater than what I would use in the operating room.
Like pentobarbital execution, propofol will very likely burn its way through the lungs and cause the frothy fluid accumulations seen in lethal injection. The experience of this will be akin to death by drowning. Waterboarding, widely understood as torture, creates the same effect. The injection of a paralytic after the propofol will make every death appear outwardly unremarkable -- and according to MAiD proponents, even beautiful in its peacefulness.
Canadians who choose to die by MAiD must be informed of the real possibility that the death they experience may be very different from that which is described by MAiD advocates. It is time to perform autopsies on everyone that dies by MAiD, so we can determine if MAiD protocols produce frothy fluid in the lungs. It is time to cease the use of paralytics in MAiD, so we can be certain we are not covering the potential for a painful death akin to drowning. It is time to accept what the evidence available to date shows: MAiD may very likely provide a torturous death.
Joel Zivot, MD, is an assistant professor of anesthesiology/critical care at Emory University School of Medicine in Atlanta. His clinical expertise and research interests include care of critically ill patients in the OR and ICU, education, and scholarly work in bioethics, the anthropology of conflict resolution, pharmaco-economics, and a variety of topics related to anesthesiology/critical care monitoring and practice. Last Updated February 16, 2021 https://www.medpagetoday.com/publichealthpolicy/ethics/91214?xid=nl_secondopinion_2021-02-16&eun=g994451d0r