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Drugs Used in Physician-Assisted Death

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Abstract

Epidemiological studies, case reports, and recommendations concerning the drugs used in physician-assisted death are reviewed in this paper. Using a MEDLINE and Cancerlit search, we found a total of 20 relevant publications. Recent research, mainly from the Netherlands, has shown that high doses of barbiturates are usually effective for physician-assisted suicide, while a combination of a barbiturate and a derivative of curare are effective for euthanasia. Opioids are less reliable drugs for physician-assisted death because of the unpredictable duration of the dying process even after high doses. The same applies to benzodiazepines. The most frequent undesired effect is an unexpectedly long dying process due to impaired uptake of the drugs. Although the evidence base is incomplete, the Dutch recommendations issued in 1994 and renewed in 1998 do not seem inappropriate.

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References

  1. Quill TE. Death and dignity. A case of individualized decision making. N Engl J Med 1991; 324(10): 691–4

    Article  PubMed  CAS  Google Scholar 

  2. Anonymous. A piece of my mind: it’s over, Debbie. JAMA 1988; 259(2): 272

    Google Scholar 

  3. van der Maas PJ, Van der Wal G, Haverkate I, et al. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990–1995. N Engl J Med 1996; 335(22): 1699–705

    Article  PubMed  Google Scholar 

  4. van der Wal G, Van der Maas PJ, Bosma JM, et al. Evaluation of the notification procedure for physician-assisted death in the Netherlands. N Engl J Med 1996; 335(22): 1706–11

    Article  PubMed  Google Scholar 

  5. van der Maas PJ, Van Delden JJ, Pijnenborg L, et al. Euthanasia and other medical decisions concerning the end of life. Lancet 1991; 338(8768): 669–74

    Article  Google Scholar 

  6. Emanuel EJ, Fairclough DL, Daniels ER, et al. Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public. Lancet 1996; 347(9018): 1805–10

    Article  PubMed  CAS  Google Scholar 

  7. Drickamer MA, Lee MA, Ganzini L. Practical issues in physician-assisted suicide. Ann Intern Med 1997; 126(2): 146–51

    PubMed  CAS  Google Scholar 

  8. Lee MA, Nelson HD, Tilden VP, et al. Legalizing assisted suicide: views of physicians in Oregon. N Engl J Med 1996; 334(5): 310–5

    Article  PubMed  CAS  Google Scholar 

  9. van der Wal G, Van Eijk JT, Leenen HJ, et al. The use of drugs for euthanasia and assisted suicide in family practice. (in Dutch). Neth Tijdschr Geneeskd 1992; 136(27): 1299–305

    Google Scholar 

  10. Laane HM. Euthanasia, assisted suicide and AIDS. AIDS Care 1995; 7Suppl. 2: S163–7

    Article  Google Scholar 

  11. Muller MT, Hertogh C, Van der Wal G, et al. Medico-technical aspects of euthanasia and assisted suicide in nursing home medicine [in Dutch]. Vox Hospitii 1992; 163–7

    Google Scholar 

  12. Chin A, Hedberg K, Higginson G, et al. Legalized physician-assisted suicide in Oregon: the first year’s experience. N Engl J Med 1999; 340(7): 577–81

    Article  PubMed  CAS  Google Scholar 

  13. Onwuteaka-Philipsen BD, Muller MT, Van der Wal G. Euthanatics: implementation of a protocol to standardise euthanatics among pharmacists and GPs. Patient Educ Couns 1997; 31(2): 131–7

    Article  PubMed  CAS  Google Scholar 

  14. Statistics Netherlands. The end of life in medical practice (1995, 1990) [in Dutch]. Den Haag: Centraal Bureau voor de Statistiek, 1996

  15. van der Wal G, van der Maas PJ. Euthanasia and other medical decisions concerning the end of life: practice and notification procedure [in Dutch]. Den Haag: SDU, 1996

    Google Scholar 

  16. Preston T, Mero R. Observations concerning terminally ill patients who choose suicide. J Pharm Care Pain Sympt Control 1996; 4: 183–92

    Article  Google Scholar 

  17. Stapczynski JS, Haskell RJ. Duration of hypoglycemia and need for intravenous glucose following intentional overdoses of insulin. Ann Emerg Med 1984; 13(7): 505–11

    Article  PubMed  CAS  Google Scholar 

  18. Cooper A. Attempted suicide using insulin by a non diabetic. Can J Psych 1994; 29(3): 103–7

    Google Scholar 

  19. Chao T, Lo D, Chui P, et al. The first fatal propofol poisoning in Singapore. Forensic Sci Int 1994; 66(1): 1–7

    Article  PubMed  CAS  Google Scholar 

  20. Arem R, Zoghbi W. Insulin overdose in eight patients: insulin pharmacokinetics and review of the literature. Medicine 1985; 64(5): 323–32

    Article  PubMed  CAS  Google Scholar 

  21. Kaminer Y, Robbins DR. Attempted suicide by insulin overdose in insulin-dependent diabetic adolescents. Pediatrics 1988; 81(4): 526–8

    PubMed  CAS  Google Scholar 

  22. Martin FI, Hansen N, Warne GL. Attempted suicide by insulin overdose in insulin-requiring diabetics. Med J Aust 1977; 1(3): 58–60

    PubMed  CAS  Google Scholar 

  23. Wetli CV, Davis JH. Fatal hyperkalemia from accidental overdose of potassium chloride. JAMA 1978; 240(13): 1339

    Article  PubMed  CAS  Google Scholar 

  24. Jamison S. When drugs fail: assisted deaths and not-so-lethal drugs. In: Battin M, Lipman A, editors. Drug use in assisted suicide and euthanasia. New York: Haworth Press, 1996: 223–45

    Google Scholar 

  25. Admiraal PV. Administration of euthanasia-inducing agents [in Dutch]. Neth Tijdschr Geneeskd 1995; 139(6): 265–8

    CAS  Google Scholar 

  26. Humphrey D. Final exit: the practicalities of self-deliverance and assisted suicide for the dying. Eugene (OR): Hemlock Society, 1991

    Google Scholar 

  27. Smith C, Docker C. Departing drugs. An international guidebook to self-deliverance. Edinburgh: 1993

  28. Inturissi C, Hanks G. Opioid analgesic therapy. In: Doyle D, Hanks G, MacDonald N, editors. Oxford textbook of palliative medicine. 2nd ed. Oxford: Oxford University Press, 1998: 166–82

    Google Scholar 

  29. Sumner DJ, Kalk J, Whiting B. Metabolism of barbiturate after overdosage. BMJ 1975; 1(5953): 335

    Article  PubMed  CAS  Google Scholar 

  30. Quill TE, Lo B, Brock DW. Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA 1997; 278(23): 2099–104

    Article  PubMed  CAS  Google Scholar 

  31. Rousseau P. Terminal sedation in the care of dying patients. Arch Intern Med 1996; 156(16): 1785–6

    Article  PubMed  CAS  Google Scholar 

  32. Onwuteaka-Philipsen BD, Muller MT, Van der Wal G, et al. Active voluntary euthanasia or physician-assisted suicide? J Am Geriatr Soc 1997; 45(10): 1208–13

    PubMed  CAS  Google Scholar 

  33. Crouch B. Toxicological issues with drugs used to end life. In: Battin M, Lipman A, editors. Drug use in assisted suicide and euthanasia. New York: Haworth Press, 1996: 211–23

    Google Scholar 

  34. Park GR, Miller E. What changes drug metabolism in critically ill patients-III? Effect of pre-existing disease on the metabolism of midazolam. Anaesthesia 1996; 51(5): 431–4

    Article  PubMed  CAS  Google Scholar 

  35. Jung D, Prasad PP. Influence of nutritional status on the pharmacokinetics and pharmacodynamics of pentobarbital. Drug Metab Dispos 1989; 17(4): 365–8

    PubMed  CAS  Google Scholar 

  36. Stavchansky S, Tung IL. Effects of hypothermia on drug absorption. Pharm Res 1987; 4(3): 248–50

    Article  PubMed  CAS  Google Scholar 

  37. Penfold N, Park G. Effects of organ failure and therapy on drug metabolism. Curr Opin Aneasth 1990; 3: 235–40

    Article  Google Scholar 

  38. Power BM, Hackett LP, Dusci LJ, et al. Antidepressant toxicity and the need for identification and concentration monitoring in overdose. Clin Pharmacokinet 1995; 29(3): 154–71

    Article  PubMed  CAS  Google Scholar 

  39. Saxena K. Clinical features and management of poisoning due to potassium chloride. Med Toxicol Adverse Drug Exp 1989; 4(6): 429–43

    PubMed  CAS  Google Scholar 

  40. Koninklijke Nederlandse Maatschappij ter Bevordering der Pharmacie (KNMP). Technical report concerning euthanatics [in Dutch]. Den Haag: KNMP, 1987

    Google Scholar 

  41. Wetenschappelijk Instituut Nederlandse Apothekers. Advices for the application of euthanatics [in Dutch]. Medisch Contact 1998; 53(43): 1366–8

    Google Scholar 

  42. Kimsma GK. Clinical ethics in assisting euthanasia: avoiding malpractice in drug application. J Med Phil 1992; 17(4): 439–43

    CAS  Google Scholar 

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Authors and Affiliations

  1. Institute for Research in Extramural Medicine and Department of Social Medicine, Vrije Universiteit, Amsterdam, The Netherlands

    Dick L. Willems & Gerrit van der Wal

  2. Department of Public Health, Erasmus University, Rotterdam, The Netherlands

    Johanna H. Groenewoud

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  1. Dick L. Willems
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  2. Johanna H. Groenewoud
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  3. Gerrit van der Wal
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Correspondence to Dick L. Willems.

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Willems, D.L., Groenewoud, J.H. & van der Wal, G. Drugs Used in Physician-Assisted Death. Drugs Aging 15, 335–340 (1999). https://doi.org/10.2165/00002512-199915050-00001

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