Euthanasia: What happens if the drugs don’t work?

What happens if a patient doesn’t die during a euthanasia attempt?

That’s one of a number of ethical and legal questions being asked by palliative care experts who say we are woefully unprepared to introduce assisted dying.

Senior nursing leaders are also concerned New Zealand won’t be ready when the law takes effect on 7 November.

The nurses union said its request for legal advice had been ignored by the Ministry of Health and nurses fear they could face disciplinary action and be struck off if they go too far discussing euthanasia with a patient.

Palliative care professor Rod MacLeod said ending a life was not always a simple matter.

“I think the public has this idea that assisted dying is quite clear cut – you take the drugs and you’re dead,” MacLeod said.

“But death doesn’t necessarily follow within minutes or even hours, it can take a lot longer and well-documented cases of stuff not working.”

It was not yet known which drugs would be used for euthanasia in New Zealand and under the law it would be an offence punishable by a fine of up to $20,000 to reveal the method by which the drugs were administered to the patient.

“You assume that it’s the same as the United States [which] uses for lethal injections for the death penalty,” MacLeod said.

“We know that doesn’t always work. It’s not always that comfortable. It’s not like flicking a switch.”

University of Otago bioethics researcher and palliative care physician Dr Janine Winters presented an international literature review to the Ministry of Health in February.

It included a 2000 study from the Netherlands wherein 21 of 114 cases, the patient did not die as soon as expected or woke up and the physician had to give a lethal injection.

“When it’s given orally the person can throw up or they can have a long period between swallowing the medication until death and that can go on for many hours.”

“Death doesn’t necessarily follow within minutes or even hours, it can take a lot longer and well-documented cases of stuff not working.”

Palliative care professor Rod MacLeod

Medical Council Chairman Dr Curtis Walker said the New Zealand law required that the doctor stay with the patient until they had died.

“What the Act envisages is that somebody doesn’t get a cocktail of medicines and then the person disappears and they don’t have that immediately available support.”

But Dr Winters said there were other legal and ethical issues such as whether the patient would again have to give consent – something she believed the New Zealand law had not contemplated.

“It’s one of a very long list of difficult and troubling issues that can be expected to occur that are going to need guidelines before provision begins,” Winters said.

Minister of Health Andrew Little said he had not considered that issue before RNZ raised it.

“Failed administration of medication to achieve assisted dying – I haven’t thought through and, look, the system will have to think that through,” Little said.

He did not think medical practitioners would need to get legal consent again after an initial failed attempt.

“If you’ve given your consent, you’ve given your consent. Unless there’s some sort of proximity of time between a failed administration of a lethal dose and an attempt to do so again I would have thought that consent is enduring, at least for for a short period of time.”

Palliative specialist Dr Catherine D’Souza said that still left questions about how to handle a patient whose initial euthanasia attempt had failed.

“Say you get to the home and then you try to put in an IV line and you can’t get an IV line in. Often when people are frail that’s a very real issue. So what then? Do we transfer them to hospital?.

“Is that what they want? Do they want to die in a cubicle in hospital? That’s probably not how they were imagining it. They were maybe thinking it’d be at home surrounded by family.” Continue reading

  • Guyon Espiner is an investigative reporter for RNZ
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