Content Warning: Discussions of suicide, death and terminal illness
Recent parliamentary debate and discourse saw the backing of the historic Assisted Dying Bill. Brought to parliament by Labour MP Kim Leadbeater, the passing of this bill would see terminally ill adults able to medically end their own life. With euthanasia being a common topic of ethical debate, it should come as no surprise that this particular bill has sparked outcry from both sides of the issue: calls to enact legislation and calls to strike it off.
Already having been legalised in many European countries, alongside Canada and several states in the US, assisted dying seems to be slowly becoming a hallmark of the modern medical system. The choice to end one's own life painlessly is vastly supported by the general public, with recent YouGOV polls showing that nearly three-quarters of Britons support a change in the law for terminally-ill patients. Despite this, expanded surveying that questioned both support in principle (the concept of assisted dying) and practice (the actual laws and methods around it) saw a drop in support, with 59 percent of respondents being in favour of the practice, compared with 73 percent who believed there could not be adequate safeguards put in place, but supported the principle.
A review of the pharmacology behind assisted suicide detailed two main methods: intravenous (injection into a vein) and oral administration of drugs. Medically assisted dying is carried out using a mixture of drugs. In both oral and intravenous regimens, sedatives (typically benzodiazepines, often prescribed to treat anxiety disorders) are used, alongside drugs to induce deep anaesthesia (propofol, for example) to ensure the comfort of the patient. Lethal drugs tend to be cardiotoxic agents that attack and stop the heart directly to induce death, or neuromuscular blockers that induce death via respiratory paralysis. The latter is administered intravenously and only used in the oral administration case if cardiac arrest fails.
Due to technicalities in the law that vary from country-to-country, jurisdiction prevents certain methods of assisted death. Intravenous administration of lethal drugs is only legal in countries that allow physician-assisted suicide, which is where the physician can be directly involved in the delivery of euthanasia drugs. It is the preferred method of drug delivery due to its predictability and reliability, so is often standard in countries that allow it, such as Canada, the Netherlands and Belgium. IV administration delivers the drugs directly into the bloodstream, ensuring that the full dose is immediately available for the body to use, which provides more predictable outcomes for patients and their families. One major drawback discussed in studies is the variety in the speed of death, with some patients dying almost instantly. The lack of a 'process' of dying (slow, stepwise death) can be distressing to those providing the medication, and those accompanying the patient.
Oral delivery is the standard method in countries that do not allow physician-assisted suicide, such as Switzerland and Washington and Oregon in the US. Instead, patients that wish to die must have the capacity to administer the drugs themselves, hence no physician is involved at any time. This method is incredibly unpredictable. Despite co-administration of the lethal drugs with anti-nausea medication 30 to 60 minutes prior to the lethal dose, vomiting is still a very common issue, leading to incomplete absorption of the lethal drug. Since these drugs must pass through the gastrointestinal tract in order to be absorbed, there is vast variation in metabolism and absorption. Use of this method can lead to prolonged dying, exceeding 12 hours in some cases, seizures, or failure all together. When this method fails, neuromuscular blockers are delivered intravenously as a secondary intervention.
There is no universally accepted method of administering the several drugs needed to assist dying. In the UK, the law brought forward to parliament seems only to allow self-administration of the lethal drug. It is likely that oral and intravenous methods will be used.
Despite overwhelming public support for the motion to legalise assisted death, a recent survey by the British Medical Association (BMA), a union and professional body for medical professionals and students in the UK, showed lower numbers of support for both the legalisation and the practice of assisted dying. A significantly smaller 50 percent of those surveyed (compared to the 73 percent in the YouGOV poll) personally supported the legalisation of self-admin-istrable assisted suicide drugs. 45 percent of doctors surveyed oppose any form of participation in the process of self-administered assisted dying; only 36 percent being in favour. Numbers drop even further with regards to physician-assisted suicide, with only 37 percent of doctors being supportive of the principle, and 26 percent being supportive of taking part in it.
Although a change in law might be imminent in the UK which would allow terminally-ill adults to medically end their own lives, it is clear from survey data and pharmacological reviews that this field is not unified or developed enough. Further research is needed to optimise drug protocols to ensure maximum efficacy and comfort for the patient, alongside an investigation into how to make the process more comfortable for medical providers also. An empathetic approach that places people and comfort at the forefront will likely be most successful in introducing medically assisted death to the British medical system, as death should not solely be a medical issue, but a human one.
