In general, health care aims to relieve pain and suffering.
This is also the motivation for euthanasia – ending one’s own life, usually in the case of a terminal illness associated with unbearable pain.
In Victoria, there has been a debate about what drugs should be used to end life if euthanasia is legalised.
So what medicines can be used to ensure that the best possible medically assisted death is possible?
Medicine as poison
When it comes to the question of which medicines can or even should kill us, one must remember above all the old adage “the dose makes the poison”.
The entire discipline of toxicology and medicine is based on this concept.
This is the meaning of the well-known symbol of the snake coiled around the bowl of Hygeia (the Greek goddess of health), which stands for medicine and is seen in pharmacies and medical centres all over the world.
The intertwining of poison and health care is a long-standing concept in the therapeutic use of medicines.
This is a very complicated science and the reason why we do clinical research. We need to test different doses of new drugs to establish a safe but effective threshold for use.
In practice, this means that too high a dosage of a drug can cause harm.
Take the humble paracetamol, for example. When taken according to the right guidelines, it is a perfectly safe, effective painkiller used by millions of people worldwide.
However, if taken in excessive amounts, it can cause irreparable liver damage, and if the patient is not given an antidote in hospital, it can lead to death.
Which drugs are used in euthanasia?
The group of drugs most commonly used to end life are barbiturates. They cause the activity of the brain and nervous system to slow down.
These drugs, which are used medically in small doses, can be used in the short term to treat insomnia or seizures in emergencies.
In different doses and methods of administration, these drugs can also be used as anaesthetics to keep us asleep during surgery.
An overdose of barbiturates is fatal. At a high dose, the brain slows down to a point where it no longer tells the body to keep the respiratory system going and stops breathing.
Both secobarbital capsules and pentobarbital (usually known by the brand name Nembutal) in liquid form (not to be confused with the epilepsy drug phenobarbital) have been used either alone or in combination for physician-assisted suicide or euthanasia. They are also used in injectable form for euthanasia of animals.
Their safety and efficacy in inducing a peaceful, rapid and uneventful death have been proven worldwide. They are the preferred drugs in the Netherlands, Belgium, Switzerland and some US states where euthanasia is legal.
There are other options, either in combination or alone, but their use in euthanasia has limited evidence. Some drugs that cause excessive muscle relaxation and respiratory distress can end life, as can some painkillers that are often used in palliative care.
Drugs can also be used that fatally lower blood sugar levels, cause heart attacks or block messages from the brain to the muscles, leading to paralysis.
All of these drugs, while legal in Australia, can cause a long, drawn-out death with many other side effects that can lead to anxiety and suffering at the end of life.
Nembutal and its relatives are less likely to do this, and there is more evidence from international practice than any other medication that can end life.
The “best” death
In Australia, Nembutal and Secobarbital can be used for animals but are illegal for human use. This makes the implementation of Victoria’s newly proposed euthanasia law somewhat more difficult.
The proposed legislation does not aim to legalise the use of Nembutal and its relatives, but proposes to have a “cocktail of drugs” prepared by a pharmacist.
According to reports, the Victorian government has asked the Monash University Faculty of Pharmacy to study the type of pill that could be developed if the law is passed. As a result, no final description of this product has been released.
It is thought that it will be a powder containing painkillers that induce coma and eventually lead to respiratory arrest.
It is also possible that sedatives and muscle relaxants, a drug to slow the heartbeat and an anti-epileptic to prevent seizures and relax the muscles will be used. The ingredients and dosages have yet to be determined.
At this early stage, it is difficult to predict how this concoction would work and whether it would be easier or safer to use than drugs that have already been tested.
The proposed product would need to be tested and the results compared, as is the case with all new medicines.
What we need is a drug or a mixture of drugs that will allow a painless, relatively quick and peaceful passing.
We do not want further suffering in the form of seizures, prolonged agony and pain.
If there is no safe solution, it would be wise to simply resort to legalising what has already been tried and tested.