What Bob Orleck has written below (in italics) is very similar to his testimony at the public hearing before the House Human Services and Judiciary Committees on Tuesday, April 16. A similar essay appeared briefly on this blog last Sunday, but Bob asked us to take it down temporarily so that he could revise it. Here is the revised version. Why is the House ignoring his concerns, as well as those of doctors, the disability rights community, and many, many Vermonters? We will be posting more from Bob over the next few days.
Robert L. Orleck
Pharmacist
P.O. Box 174
Randolph, VT 05060
802-728-9806
Re: Physician Assisted Suicide S77 (as originally proposed)
- secobarbital and pentobarbital use problems in Physician Assisted Suicide
Two drugs are mentioned as the primary ones used to provide the lethal medication. One is pentobarbital and the other is secobarbital.
In the recent hearings before there was testimony from Katherine Tucker, Compassion and Choices of Oregon, that there had been advancement in the science that would allow these medications to be more easily administered. She said that they have made pentobarbital available in a liquid that makes it easier to administer orally. That is not the case. Pentobarbital was not made as an oral medication but as an injectable medication and is not recommended by the manufacturer for oral use. The problems associated with oral use of this drug are similar to those that would be encountered with secobarbital which is discussed.
There is no question that a drug like secobarbital, if taken in sufficient quantity can cause death. There are many variables (patient age, sex, weight, overall medical condition, recent food or other medications ingested, individual sensitivity to medication and more) that will necessitate differing amounts of the drug. Potential tolerance must be taken into account. However, physicians have not been schooled on how to take the many patient variables into account when writing a lethal prescription. They will make mistakes which will cause patient suffering. In some cases, this shortcoming will result in prescriptions written that are insufficient to cause death. The patient will not die but will experience exaggerated responses to the drug because they are receiving a larger dose than is recommended for “intended” purposes.
Patient medication dosing compliance has been such a problem that the practice of pharmacy has evolved over the years to require that pharmacist offer each patient getting a prescription the opportunity to be counseled on its use. Even the simplest instructions and directions can create major compliance problems for some people. It is not uncommon that there is a caregiver to handle the patient’s medication to insure compliance. This is even more needed with the elderly. In nursing homes and other extended care facilities, nurses use established procedures to insure the patient is compliant. It is not difficult to imagine any of these above described persons getting a lethal dose of medication and having major difficulty in taking it. Yet the Oregon law, recognizing possible coercive problems, requires the medication to be administered by the patient without assistance. As naively understandable as that rationale might be, it leaves most patients very vulnerable to some real and serious practical dangers.
It is reasonable to assume the patient who has received a lethal prescription will have their mind filled with many thoughts as they prepare to surrender their life. If they would have had compliance problems without such a stress, it is not difficult to imagine that the problem is compounded by their state of mind. There are physical limitations some have as well that would affect compliance. Many patients for no apparent reason have swallowing problems when it comes to medication and others have certain neurologic illnesses that create swallowing difficulties. Others may have problems using their hands. They may have tremors or severe weakness that while they may be able to begin taking the drug, they may not be able to complete the ingestion of the total lethal dose.
Can there be any doubt that there will be botched suicide attempts? If a physician is not present to deal with the complications which of course might require them to finish the job (something that would be unacceptable at least at this point in time), there will be much suffering that will come from these botched suicide attempts. If the patient does not die, there will be exaggerated reactions or major side effects from the drug. Imagine the effect on a family member who might be there alone with a patient who experiencing such a scenario.
| If not dosed properly the patient might have problems such as gasping or muscle spasms causing them to suffer greatly. They may lose consciousness before they complete the dosing. They may then awake experiencing some of the many major side effects of the drug. The drug may cause them to feel panic or terror. It can cause confusion. They can experience orthostatic hypotension, fall and hit their head. They may end up in a coma and not die at all from the drug.
The drug can cause them to vomit. They can inhale the vomitus causing much suffering and complications. If they vomit before the medication is absorbed they may now not have the sufficient death dose and the major side effects can kick in. Vomiting is not an uncommon side effect for many drugs including drugs like secobarbital. It is possible that the person who starts to ingest this medication is already feeling ill and if cancer is involved, has nausea and other physical upsets in the first place. It is not hard to imagine that they would begin to take the medication, gag, possibly swallow some or all of it then gets so sick before the drug kills them that they vomit. In their weakened state they may be unable to deal with the vomiting, some will aspirate the fluids that come up. This can create pneumonia and at a minimum will cause much suffering and distress. They might even die from this violent reaction after much suffering. They may have an allergic reaction to the medication resulting in difficulty breathing, rashes, edema and suffering, all happening without them dying. Some people experience agitation, irritability or excitability and even increased sensitivity to pain. Others may lapse into a coma and linger and suffer for a prolonged period.
Strange reactions have occurred to people under the influence of large doses of this drug. There are cases where an individual has gotten out of bed and has “sleep driven” a car or has done other unconscious activities. If taken with alcohol or other drugs, these side effects can be more exaggerated. You may be aware of drugs such as amphetamines that can cause hyperactivity in some and in others can cause sedation. People do have varying responses to different drugs and that is a very real possibility for those who take drugs like secobarbital, get an overdose, don’t die and then become conscious.
The death envisioned by the Oregon law is one of an effective, humane, quick and final departure. This will not be the case, however. Many will fail in their suicide attempt. They will botch it and it will result in great suffering. It will prolong a life of misery and may result in the person not ever dying from the use of the medication. It will be more than the patient who will suffer. Families will be devastated when this happens when they see their love one linger in such a way. The effects on the health care workers are hard to imagine.
It really is hard to cause death sometimes. There will be those times when the body will not allow it to happen. The lungs and heart will keep working, the drug will wear off and the horror of the overdose side effects will begin. Then what will the loved ones who are with the patient do?
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