Euthanasia and physician assisted suicide E-book

Question 1

Passive euthanasia involves altering support or ‘letting nature take its course’. Examples might include:

Answer 1

• Turning off respirators
• Withholding food and water
• Stopping medication
• Not resuscitating

Question 2

Euthanasia - legal in

Answer 2

Belgium
Luxembourg
The Netherlands
Columbia

Question 3

Physician Assistant Suicide - legal in

Answer 3

Belgium
Canada
Finland
Germany
Luxembourg
The Netherlands
Switzerland

Question 4

levels of pharmacist engagement

Answer 4

Personal
•For yourself or friends / family??

Citizen
•Influencing law makers

Professional
•Dispensing medicines
•Member of MDT
•Influencing policy of professional regulators and professional bodies e.g. GPhC, RPS
•Complying with employer organisation

Question 5

The role of the pharmacist may include

Answer 5

Medication issues such as dispensing, dose and selection issues, or maybe affordability issues for the patient (in non-universal healthcare systems). It also may include patient education on how to use the euthanising drugs or considering their choice in ending their life. This might include:
• Detailed advice
• Pre-printed instructions
• Dispensing without information
• Dispensing with information sheet on alternatives to physician assisted suicide / euthanasia

Question 6

There are three steps to the euthanasia process:

Answer 6

• Pre-medication
o With midazolam 2.5mg IV if patient does not wish to be aware of moment of comma induction
o Midazolam can make some patients restless – a 2nd dose should not be administered, physicians should proceed to coma induction

• Coma induction
o The patient must be induced into a coma before neuromuscular blockers are administered.
o Thiopental (2000 mg) or propofol (1000 mg) are used for the induction of the coma.
o Both medications can cause pain when injected intravenously. Due to this pain, 2 ml of lidocaine 1% injected intravenously.
o With thiopental, a lethal effect cannot be guaranteed, although it is suitable for inducing a deep coma.
o Propofol, as well as respiratory depression and vasodilation, also causes cardiac depression.
o The coma induction medication can be administered by injection, elastomeric pump (not to be used for propofol) or by intravenous infusion. All are equally effective.

• Neuromuscular blocker
o Once a coma is induced a neuromuscular blocker is administered which causes complete paralysis of all striated muscles excluding the heart. (This must only happen once patient is in coma!)
o This causes respiratory arrest and death by anoxaemia
o Rocuronium (150 mg) is the neuromuscular blocker of choice as it is the most commonly used medication in the Netherlands
o Atracurium (100 mg) or cisatracurium (30 mg) are alternatives.
o The neuromuscular blocker should always be administered, even if it appears death has occurred with administration of the coma inducer.

Question 7

most commonly used medications in the USA for

physician-assisted suicide

Answer 7

Pentobarbital

Question 8

Physician Assisted Suicide

Answer 8

In Physician Assisted Suicide, the patient must take the drug. The drug is administered orally, so they must be able to swallow a sufficient volume, not be nauseous, dehydrated or have any gastrointestinal transit disorders. The patient must be sitting up in bed when they take the drug – in order to limit any risk of not making it back to bed in time.

The drug used is a high dose of barbiturate e.g. pentobarbital or secobarbital. They are lipophilic and pass through the blood brain barrier relatively quickly, resulting a quick effect. The high dose of barbiturate causes respiratory depression, leading to respiratory acidosis. This, with vascular and / or cardiogenic shock, results in
death