Euthanasia and physician assisted suicide E-book Flashcards Preview

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Passive euthanasia involves altering support or ‘letting nature take its course’. Examples might include:

• Turning off respirators
• Withholding food and water
• Stopping medication
• Not resuscitating


Euthanasia - legal in

The Netherlands


Physician Assistant Suicide - legal in

The Netherlands


levels of pharmacist engagement

•For yourself or friends / family??

•Influencing law makers

•Dispensing medicines
•Member of MDT
•Influencing policy of professional regulators and professional bodies e.g. GPhC, RPS
•Complying with employer organisation


The role of the pharmacist may include

Medication issues such as dispensing, dose and selection issues, or maybe affordability issues for the patient (in non-universal healthcare systems). It also may include patient education on how to use the euthanising drugs or considering their choice in ending their life. This might include:
• Detailed advice
• Pre-printed instructions
• Dispensing without information
• Dispensing with information sheet on alternatives to physician assisted suicide / euthanasia


There are three steps to the euthanasia process:

• Pre-medication
o With midazolam 2.5mg IV if patient does not wish to be aware of moment of comma induction
o Midazolam can make some patients restless – a 2nd dose should not be administered, physicians should proceed to coma induction

• Coma induction
o The patient must be induced into a coma before neuromuscular blockers are administered.
o Thiopental (2000 mg) or propofol (1000 mg) are used for the induction of the coma.
o Both medications can cause pain when injected intravenously. Due to this pain, 2 ml of lidocaine 1% injected intravenously.
o With thiopental, a lethal effect cannot be guaranteed, although it is suitable for inducing a deep coma.
o Propofol, as well as respiratory depression and vasodilation, also causes cardiac depression.
o The coma induction medication can be administered by injection, elastomeric pump (not to be used for propofol) or by intravenous infusion. All are equally effective.

• Neuromuscular blocker
o Once a coma is induced a neuromuscular blocker is administered which causes complete paralysis of all striated muscles excluding the heart. (This must only happen once patient is in coma!)
o This causes respiratory arrest and death by anoxaemia
o Rocuronium (150 mg) is the neuromuscular blocker of choice as it is the most commonly used medication in the Netherlands
o Atracurium (100 mg) or cisatracurium (30 mg) are alternatives.
o The neuromuscular blocker should always be administered, even if it appears death has occurred with administration of the coma inducer.


most commonly used medications in the USA for
physician-assisted suicide



Physician Assisted Suicide

In Physician Assisted Suicide, the patient must take the drug. The drug is administered orally, so they must be able to swallow a sufficient volume, not be nauseous, dehydrated or have any gastrointestinal transit disorders. The patient must be sitting up in bed when they take the drug – in order to limit any risk of not making it back to bed in time.

The drug used is a high dose of barbiturate e.g. pentobarbital or secobarbital. They are lipophilic and pass through the blood brain barrier relatively quickly, resulting a quick effect. The high dose of barbiturate causes respiratory depression, leading to respiratory acidosis. This, with vascular and / or cardiogenic shock, results in