https://academic.oup.com/bmb/article/142/1/15/6580517
Evidence from jurisdictions where assisted suicide is legal reveals that some patients who ingest the prescribed lethal drugs experience distressing complications. The Canadian Association of MAiD Assessors and Providers acknowledges that patients who ingest assisted suicide drugs can experience burning, nausea, vomiting and regurgitation, especially if the patient is experiencing difficulty swallowing large volumes of liquid. Nausea, oesophagitis, gastritis, severe dehydration or pathology of the gastrointestinal tract likely interfere with drug absorption.3 This is reflected in the data published by US states such as Oregon, where annual complication rates have been as high as 14.8% and patients are reported to have experienced difficulty swallowing or drug regurgitation, seizures and have even regained consciousness after ingesting the ‘lethal’ drugs.9
One reason for such difficulties may be that ingesting sufficiently toxic dosages of the prescribed drugs can prove a significant, and often distressing, challenge. In order to achieve an ‘assisted’ death, patients in the USA have been required to ingest 90 to 100 barbiturate pills by crushing them and mixing them into a sweet solvent. The emetogenic potency and bitterness requires antiemetics prior to ingestion to prevent vomiting. Such an experience of her aunt’s assisted suicide was described by a relative in 20164:
The full ‘cocktail’ included two anti-nausea pills, an anti-seizure pill and 100 capsules of Secobarbital. It all had to be ingested within an hour... My attention turned to the kitchen table, where my husband and sister, wearing latex gloves, frantically scraped the powder from 100 capsules with toothpicks, trying to beat the clock... The mountain of powder we poured into more sugar syrup created a half-cup of sludge so bitter it literally burned my tongue. And my aunt, who could barely swallow water, had to drink all of it in <5 min to ‘ensure success.’... When we sat back down at the kitchen table, white powder everywhere, we all had to wonder, ‘Who the hell wrote this law?’ We had been forced to assist in the most bizarre fashion, jumping through seemingly random legal hoops and meeting arbitrary deadlines while my aunt suffered, and finally emptying capsules, making an elixir so vile I cried when I knew she had to drink it. This was death with dignity?
There is also evidence that the drugs used for assisted suicide do not consistently bring about death quickly. Time to death after ingesting the lethal drugs seems highly unpredictable. Of cases with available data in Oregon since 2001, time from drug ingestion to death has ranged from 1 min (too short for the cause to have been oral drugs) to 108 h. Thirty-three percent of the total deaths with recorded data have taken over an hour, and 7.6% over 6 h. Time to death has become longer since the introduction of experimental drug cocktails ‘DDMA’ and ‘DDMP’. The median time to death after ingestion has doubled since 2015. Fifty-five percent of patients given ‘DDMP2’ (containing 15 g of morphine sulfate) and 45% of those given ‘DDMA’ have experienced a prolonged dying that lasted over 1 h.9
In 2017, The Denver Post published an article about a man in Colorado who sought assisted suicide after being diagnosed with cancer. Although his wife thought he would die quickly and peacefully, after ingesting the lethal drugs he experienced distressing complications and took over 9 h to die5:
On the day of Kurt’s death, Susan mixed the liquids prescribed as directed and Kurt began drinking the compound. ‘But with every sip,’ Susan says, ‘he’s choking and coughing, choking and coughing.’ It went on for nearly 20 min... Although he never regained consciousness, the gasping, uneven breathing continued. Two hours passed. Then 4 h. ‘At 4:15,’ Susan says, ‘I started to majorly panic.’ As she tried without success to reach a doctor, a couple more disturbing thoughts crossed her mind: She feared that Kurt, despite his unconsciousness, could hear everything—the calls, the desperation in her voice. And she wondered if his choking when he first took the medication meant that he had aspirated enough to delay its effect. Around 7 p.m., she asked hospice to send a nurse. Shortly after the nurse arrived, a doctor called and suggested some additional measures. Soon after, Susan saw her husband sit up slightly and appear to retch three times. She ran to his bedside. Then he slid back into his pillows and stopped breathing.
The unpredictable efficacy of assisted suicide drugs is acknowledged by the Royal Dutch Medical and Pharmaceutical Societies and the Canadian Association of MAiD Assessors and Providers, who both recommend that clinicians obtain consent from patients to convert to euthanasia prior to ingestion of the lethal drugs in case the patient takes too long to die.8,25 In 2018, of the MAiD cases in Canada with available data, 50% were unsuccessful by 60 min and the clinician transitioned to euthanasia to complete the ‘assisted’ death.25