By Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition
I was cleaning up my emails and found a report that was published in the Journal of Emergency Medical Services on November 29, 2022 titled: Death with Dignity: When the Medical Aid in Dying cocktail gets into the Wrong Hands.
The report concerns an emergency whereby a 35-year-old man in Colorado self-administered part of a lethal cocktail of assisted suicide drugs. The report states:
Ambulance 64 is dispatched to a 35-year-old male with possible alcohol overdose. Upon arrival, the crew is directed to a back bedroom where they find two fully clothed males with their legs hanging off a bed. One is elderly, the other is middle aged. Both are unconscious and unresponsive with shallow respirations. A bystander hands a medicine bottle to the attending paramedic frantically saying, “They drank this! They drank this!” The bottle contains digoxin 100 mg, diazepam 1,000 mg, morphine 15,000 mg, amitriptyline 8,000 mg and phenobarbital 5,000 mg. She remarks that the older man “should be dead” and the younger one “should be alive.”
The bystander states that the older man is a “death with dignity” patient who invited loved ones to be present while he consumed the MAID medication. After his first swallow, he remarked, “Man that burns!” The younger man said, “Let me see,” and then also took a swallow. The attending paramedic directs rescuers to begin ventilating the younger man while requesting evidence of advance directives for the older man. Care was not rendered to the death with dignity patient because he had a valid Medical Orders for Scope of Treatment (MOST) form stating he wanted no lifesaving measures performed on him. The medication bottle was prescribed to the patient. Hospice was contacted to verify he was a terminally ill patient of theirs. Medical control was also contacted for a consult because this was not a typical call.
The younger male patient is found to be atraumatic. His skin signs were significant for cyanosis but otherwise warm and dry. Pupils were constricted, equal and reactive. Without ventilations, his respiratory effort is 6; Sp02 was 72%. The patient is placed on a cardiac monitor and the heart rate is recorded at 144 bpm, blood pressure is auscultated and found to be 134/96 mmHg. Blood glucose is 172 mg/dl. Intravenous access is achieved with a 16-gauge catheter placed in his right external jugular vein. After there is no change in the patient’s presentation following Narcan 2 mg via IV, he is endotracheal intubated. End tidal carbon dioxide is then measured at 56 mmHg. The receiving facility is notified that a patient with a massive polypharmacy ingestion is en route.
…This challenging case is an excellent illustration of the importance of prehospital providers to have an understanding of end-of-life-care as it pertains to advanced directives and to be aware they may practice in an area where they encounter patients who may be in a MAID program. In this case, the paramedic had to juggle a complicated scene with two potential patients who both were near death. Education regarding such programs should be a priority to EMS agencies, as is how to handle instances where family members are requesting that no resuscitation be attempted and either advance directives are not in place, or copies of them cannot be located.
The report continues with information about the recovery of the man who self-administered the lethal cocktail without legal permission and it then concludes:
Should accidental ingestion occur, care is mainly supportive. The patient should be placed on a cardiac monitor and have a 12-lead rhythm strip to evaluate for QRS prolongation and consideration of sodium bicarbonate administration. Continuous pulse oximetry monitoring and assisting ventilation as necessary is indicated. If necessary, placement of advanced airway with assisted ventilations with BVM and confirmation by end-tidal CO2 is appropriate. Intravenous or intraosseous access should be obtained and intravenous fluids can be administered if the patient is hypotensive. Naloxone can be trialed, although may not have much effect given the high dose of opiates in the compound. Consideration may be made for transport to an ECMO capable facility.
The US states that have legalized assisted suicide have done so in a completely irresponsible manner. Prescribing a lethal cocktail of drugs for suicide is always ethically wrong, but to do so without monitoring is irresponsible.
Is it possible that a grandchild could find the lethal assisted suicide cocktail by the bed side or in the medicine cabinet? What happens to the lethal drugs that are not consumed?
The concept of freedom to choose to die is a lie. People don’t ask for a lethal drug cocktail to express their freedom but rather it is a reaction to a social abandonment that has left them feeling that there is no hope, purpose or value to continuing life.