Mr. Garry R. Thompson wrote an informative letter about his experience observing Maid (Moose Jaw Express, April 10). Ms. Angelina Ireland responded on April 20, repeating the same widely reported incorrect statements she voiced in her talk on this subject, informing us: “... when a person dies by lethal injection, they basically drown. Their lungs fill with fluid, and I would describe that the experience of dying under that circumstance is more akin to death by water boarding, which we recognize as cruel.”
As I mentioned previously, this wildly incorrect statement (assuming pulmonary edema even happens in MAID) completely ignores the fact that the patient has by that time lost consciousness and will be totally unaware of events and sensations. Let’s have a look at the doses of medications involved to throw some light on the subject. ED95 is the dose of a medication needed to give the desired effect in 95% of the population. In the case of anaesthetic agents, this desired effect is loss of consciousness.
The recommendation is that, at the start of the procedure, the person requesting MAID be given (among others) the following two drugs:
Midazolam. The ED95 for this drug is 0.033 mg/kg, therefore an 80 kg person should receive approximately 2.7 mg. MAID recipients, however, will receive 10 - 20 mg.
Propofol to induce loss of consciousness. The ED95 is 2.56 mg/kg, or 200 mg. for an 80kg patient. A MAID recipient, however, will be given 1000 mg, five times the ED95, enough to fell the proverbial horse. It will produce loss of consciousness within about 10 seconds, followed by coma in 1-2 minutes. Also, propofol in such high doses is by itself cardiotoxic and will very likely contribute to rapid death. Loss of consciousness will occur way before the person experiences pain or discomfort.
Other drugs such as bupivacaine (500 mg) may also be used to cause immediate cardiac arrest. This massive dose is administered after the MAID recipient has lost consciousness.
“What is most distressing about this is the fact that MAID includes in its protocol the use of a paralyzing drug. Once a paralyzing drug is given, a person can no longer move. To claim that this is a death that is peaceful, well, it can be nothing else because now a person is unable to move in any way.”
And: “Paralytics are not even used in the U.S. as part of euthanizing animals, so the fact that we are using them in medical assistance in dying is most distressful.”
These statements are not only totally, completely and utterly misleading, but I can come to only one conclusion: they were intended to sow confusion and fear.
Whether these drugs are used for euthanizing animals is irrelevant. The fact is simply this: for ordinary, everyday surgical procedures requiring a general anaesthetic (ie not involving MAID), an induction agent such as propofol is given, (and please note, in much smaller doses than recommended for MAID but still sufficient to cause loss of consciousness).
Anaesthetists will then, in many, many cases also administer the above mentioned paralyzing drugs. Nothing extraordinary about it at all.
This is common practice in operating rooms worldwide, tens of thousands of times a day, if not more. Unremarkable, so much so that nobody even discusses it afterwards in the tearoom.
In fact, I would be very – and I mean very – surprised if Dr. Zivot himself has not given multiple similar anaesthetics during his career. If he has not, well, that would be most extraordinary.
I must ask myself: do his patients suffer after receiving propofol and a muscle relaxant? I would be rather surprised if that was the case. Why then would MAID recipients suffer?
The bottom line here is quite simply this: there is little or no difference between the drugs used for inducing an ordinary general anaesthetic and initiating MAID.
The difference lies in the doses used, which, in the case of MAID, are more than sufficient to quickly and with no or minimal discomfort reach the endpoint desired by the person requesting the procedure.
As Paracelsus told us more than half a millennium ago: “All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison."
To therefore imply that MAID recipients are conscious, in pain, suffocating but unable to move or to cry out for help is not only risible, it is much more than that, but I shall refrain from stating my thoughts on the impression purposely given to mislead readers.
Leon Retief
The views and opinions expressed in this article are those of the author, and do not necessarily reflect the position of this publication.
