Currently, the Senate of Canada is reviewing Bill C-7 with the goal of understanding the implications of expanding physician-assisted dying, known as MAID.
Some of the proposed changes contained in Bill C-7 are in response to the 2019 Quebec Superior Court ruling in Truchon c. Attorney General of Canada. As a Canadian physician and anesthesiologist working in the United States, this debate interests me. I witnessed these Senate hearings because I am an expert in opposing lethal injection, the most common form of execution in the United States. in essence, but because the pharmaceutical and medical methods used are quite similar.
More often than not, death from lethal injection is a rather bloodless event. The witnesses do not see much. I speak from experience: I witnessed an execution at the detainee’s request since I had been an expert in his legal defense, and death seemed peaceful.
My perception of this changed, however, when I was given a dossier of autopsy reports on inmates executed by lethal injection. Upon examination, I noticed a striking and surprising finding: almost all autopsies revealed that the lungs had filled with foamy fluid. This has happened if the execution was carried out by an injection of pentobarbital or midazolam. I examined the autopsy of the execution that I had witnessed and found that, although I saw no external struggle, the inmate had developed the striking pulmonary congestion that I had noticed in d ‘others.
Since then, I have reviewed a number of published MAID protocols and found another striking factor: MAID involves the use of a drug that paralyzes the body, making it impossible to breathe or to move. These drugs do not block the feeling of pain or the awareness of being paralyzed. Notably, the use of paralytics in execution by lethal injection has generally been discontinued due to its obvious cruelty.
Pentobarbital has become increasingly difficult to obtain by death row states due to its association with execution – drugmakers have simply chosen to stop making it. The state of Missouri intended to use propofol for execution when pentobarbital was unobtainable. At the last minute, this was stalled when the main European supplier of propofol threatened to stop supplying the US market. The manufacturer decided that propofol was for treatment, not for death. Yet this is precisely the drug currently used in the MA to try to make the dying person feel insane.
As an anesthesiologist, I have injected propofol into thousands of patients. Very often 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 the amount I would use in the operating room.
Like running on pentobarbital, propofol will most likely burn its way through the lungs and cause the frothy fluid buildups seen with a lethal injection. The experience of this is akin to death by drowning. Waterboarding, widely understood as torture, creates the same effect. Injecting a paralytic after propofol will make every death seemingly trivial – and according to MAiD supporters, even beautiful in its tranquility.
Canadians who choose to die by MAID should be made aware of the real possibility that their death may be very different from that described by advocates of MAID. It is time to perform autopsies on everyone who has died on MAID, so that we can determine if MAID protocols are producing foamy fluid in the lungs. It is time to stop the use of paralytics in MDA, so that we can be sure that we are not covering the potential for a painful drowning-like death. It is time to accept what the evidence available to date shows: MAID can very likely result in death from torture.
Joel Zivot, MD, is Assistant Professor of Anesthesiology / Critical Care at Emory University School of Medicine in Atlanta. His clinical expertise and research interests include the care of critically ill patients in operating rooms and intensive care, education and academic work in bioethics, anthropology of conflict resolution, pharmacoeconomics and a variety of topics related to anesthesiology / intensive care monitoring and practice. .
Last updated on February 16, 2021