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The painful truth about assisted suicide Lethal drugs don't promise dignified deaths

'Do not reanimate, I am 91+' Michel Porro/Getty Images

'Do not reanimate, I am 91+' Michel Porro/Getty Images


November 13, 2024   5 mins

There is a popular image of assisted suicide: a swift, straightforward procedure, backed by the awesome authority of modern science, sure to send you off in a comfortable doze. Dignity in Dying, for instance, claim that assisted suicide can ā€œguaranteeā€ a calm and peaceful death. Terry Pratchett expressed his wish to die ā€œsitting in a chair in my own garden with a glass of brandy in my hand and Thomas Tallis on the iPodā€.

Now compare the experience of Linda van Zandt. In 2016, on the day of her auntā€™s assisted suicide in California, an Uber arrived bearing thousands of dollars worth of lethal medication. That included 100 capsules which had to be crushed, dissolved and swallowed within the hour. Wearing latex gloves and wielding toothpicks, the family frantically scraped the white powder from the capsules, combining it with a sugar syrup to make a bitter sludge so ā€œvileā€ that van Zandt broke down in tears. Afterwards, she sat at her kitchen table wondering: ā€œWho wrote this law?ā€

That, to be clear, isnā€™t everyoneā€™s experience ā€” but then nor is the romanticised picture presented by assisted-suicide advocates. The vision of people like Pratchett ā€œis not the clinical realityā€, says Mark Taubert, palliative care consultant and professor of medicine at Cardiff University. Claud Regnard, a retired consultant, points out that only two studies have compared ā€œquality of deathā€ by assisted suicide and by nature taking its course. Both studies, one in Oregon, one in the Netherlands, concluded that they were as good, or bad, as each other.

Assisted suicide relies on lethal drugs. But how reliable are the medications themselves? An article in a leading medical law journal remarks: ā€œThe pervasive belief that these, or any, noxious drugs are guaranteed to provide for a peaceful and painless death must be dispelled; modern medicine cannot yet achieve this.ā€ On every point ā€” the supply chain, the means of administration, the risk of complications ā€” the reality is far from straightforward. But that reality is about to hit Britain as the Leadbeater Bill on assisted dying is being debated by MPs on 29 November.

Take Mehdi Alavi’s Dream Pharma ā€” which operated out of the Elgone Driving Academy in Acton. In 2011, this one-man firm was suddenly placed under the spotlight of an international human rights story, as it emerged that it was supplying Arizonaā€™s death penalty system withĀ deadly chemicals.

Why did Arizona have to rely on a man at a driving school in Acton? Welcome to the strange world of lethal drugs, a shadow world largely unmonitored by health authorities, where supply chains can suddenly disappear, where new experimental mixtures come and go, and where best practice remains decidedly unclear.

When it comes to the physical stuff doctors depend on, assisted suicide and the death penalty are entwined. In the early 2010s, European companies launched tough new restrictions on the export of certain drugs to the US because the drugs were being used for capital punishment. That explains the emergence of individual suppliers such as Mehdi Alavi. But these small-scale alternatives were soon banned by American courts too. US pharma companies also stopped making the drugs used in assisted suicide ā€” possibly because there are few other medical uses for them.

“US pharma companies also stopped making the drugs used in assisted suicide ā€” possibly because there are few other medical uses for them.”

The shortage caused problems for penitentiaries and assisted-suicide clinics alike. One chemical, until then a popular choice in assisted-suicide states, practically disappeared from the market. Assisted-suicide doctorsā€™ groups scoured America looking for the drug, but to no avail. Next they turned to another chemical which was supplied by a company called Valeant. The company was plagued by scandal and investigated for price gouging; the price of the drug rose from around $400 to almost $3,000 per lethal dose between 2010 and 2016.

In the end, American assisted-suicide doctors had to come up with their own solutions. But the blend of toxic substances caused ā€œsevere painā€ , so physicians tried out other combinations, tweaking the formula half-a-dozen times. Across the globe, meanwhile, there are countless variations: more than 30 chemicals are used in the different forms of oral or intravenous assisted suicide.

As with death penalty procedures, then, there is no gold standard, but rather a great variety of options, none of which has established itself as the most appropriate. According to an article in The Lancet, complication rates with assisted suicide may be even more frequent than those with the death penalty.

How serious are those complications? The data is extremely patchy, but some have attempted statistical estimates. With oral methods, a third of assisted suicides take between 90 minutes and 30 hours. Up to 9% have trouble swallowing the dose; up to 10% vomit it up; up to 2% re-emerge from their coma. There are also horror stories, such as the Dutch woman with Alzheimerā€™s who recovered consciousness and was held down by her daughter and husband while a doctor finally euthanised her.

Then there are the unknowns. Baroness Finlay, a palliative care specialist, told the parliamentary committee on assisted suicide last year that during executions by lethal injection, ā€œfour-fifths probably regained a degree of consciousnessā€. Finlay said that though there is an obvious need for more research on consciousness in euthanasia and assisted suicide, nobody has ever done a proper study.

Not everyone is so sceptical. As Silvan Luley of Dignitas has claimed: ā€œThere has been not one case that did not work, in the sense of the person not reaching the goal in a dignified way.ā€ Dr Lonny Shavelson, of Bay Area End of Life Options, has made similar claims. ā€œThese,ā€ he says, ā€œare lovely deaths.ā€

But every claim and counterclaim should be qualified by the fundamental point: the evidence base is inadequate. No drug regulatory authority anywhere has approved any drugs for use in assisted suicide. The 2019 protocol from the Canadian Association of MAiD Assessors and Providers acknowledged that there had been ā€œlittle to no researchā€ on their recommended combinations, and ā€œno peer-reviewed literature to guide best practiceā€.

In the British context, meanwhile, supporters of assisted suicide seem conscious of the need for more research. Dignity in Dying told me in a statement that assisted-suicide drugs ā€œare under constant review amongst clinicians and that best practice is constantly developingā€, and that the UK procedure would depend on ā€œengagement with healthcare bodies and regulatorsā€, drawing on other jurisdictions ā€œwhere they are confident that the drugs used are safe, effective and provide dying people with a dignified deathā€.

Which drugs might a future UK assisted suicide programme adopt? The Leadbeater Bill mentions none specifically, simply stating that the ā€œSecretary of State must, by regulations, specify one or more drugs or other substancesā€. Leadbeater has not given any view on the subject; her chief of staff Lance Price tells me that it would be a matter for NICE and other regulators. NICE didnā€™t respond to a request for comment. For their part, UK doctors themselves seem unaware of the challenges. As a 2016 report by the British Medical Association found, some physicians were ā€œsurprisedā€ to learn that assisted suicide could come with complications.

Dr Regnard, who is not against assisted dying per se, told me that the introduction of such unevidenced drug combinations would be completely unprecedented. ā€œI think it puts us back 100 years to when there was no regulation, basically people could do pretty well what they wanted.”

In the end, the assisted suicide debate will hinge less on these questions, though, and more on the familiar trade-offs between personal autonomy and threats to the vulnerable. Yet that shadow world of lethal drugs suggests a broader point: that taking life is, at the very least, an awkward fit with healthcare ā€” and that when these cocktails are introduced into a medical system, the system itself inevitably changes. You can call Kim Leadbeaterā€™s proposal brave or reckless. But it would surely be the biggest experiment ever conducted on the NHS.

You can call Samaritans for free on 116 123, email them atĀ [email protected], or visitĀ www.samaritans.orgĀ to find your nearest branch.


Dan HitchensĀ writes the newsletter ‘The Pineapple’ and is former editor of the Catholic Herald

ddhitchens

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Seb Dakin
Seb Dakin
8 days ago

Without commenting at all on the pros and cons of Assisted Suicide, it does seem like nonsense to me to claim that there are no drugs available that can deliver a painless death.
Even before fentanyl, there was heroin. And there are drugs to knock you out for operations.
There are serious discussions to be had about Assisted Suicide, but a pharmaceutical or technological inability to achieve it is absolutely not an issue.

Bernard Brothman
Bernard Brothman
6 days ago
Reply to  Seb Dakin

Well put. When we go in for a medical operation we often receive a general anesthetic and we’re. I usually say I’m going to count down from 100 and never even make it to 99. At that point someone can terminate the patient, who should feel nothing.

James Davis
James Davis
5 days ago

If ā€œsomeoneā€ terminates the patient, that would be murder.

Billy Bob
Billy Bob
4 days ago
Reply to  James Davis

At that point I wouldnā€™t care personally. Whether I drink it myself or the doctor sticks it in me itā€™s the same end result

Thomas Wagner
Thomas Wagner
3 days ago
Reply to  James Davis

It is certainly homicide. But is it murder?

Nathan Sapio
Nathan Sapio
5 days ago
Reply to  Seb Dakin

Your “should” statement is divorced from the reality of what “is” being done. For example, the Canadian drug cocktail for MAID apparently is a lovely combination of a paralytic with a drug that causes the… patient(?) to be inadvertantly drowned by fluid forming on their lungs, while being incapable of physically expressing that torture for the 30 minutes to many hours that it takes for them to die.

Typical progressive thought: mess with essential forces that are massively consequential and are against the grain of all of human history, and then wonder why things go terribly, tragically wrong.

Last edited 5 days ago by Nathan Sapio
Billy Bob
Billy Bob
4 days ago
Reply to  Nathan Sapio

What a load of tripe. Where did you read this rubbish?

Paddy Taylor
Paddy Taylor
8 days ago

Personally, I could probably be persuaded to support the idea of assisted suicide for the terminally ill who are in pain and want to go with some dignity at a time of their own choosing. But when looking at the unforseen consequences in countries where it has been legalised, we should be very wary indeed. The process should never become easy, and certainly should not ever be considered commonplace
Canada legalised assisted dying in 2016 – initially only for the terminally ill. In 2021 that was extended to those with a chronic physical condition. Canada now has some of the worldā€™s most permissive euthanasia laws, allowing all adults to seek medically-assisted suicide if they choose.
In 2022, more than 14 THOUSAND people availed themselves of this new legislation ā€“ thatā€™s over 4% of all deaths in Canada that year. It is one thing for the law to permit the withdrawal of life support in the face of agonizing pain. But Canada instituted a system that allows people to choose doctor-assisted death for depression and other mental health issues, simple old age and even, most controversially, financial worries.
More sinister still was an advert on Canadian TV extolling not merely the morality but “the beauty” of assisted suicide, as though the policy is virtuous enough to be in line with the “brand values” the company wishes to promote.
(It won’t let me link to the ad – but it’s on YouTube. Search for Assisted Suicide Promoted by Canadian Retailer Simons – if it doesn’t terrify you, I’d be shocked)
Imagine, say, a John Lewis advertisement that reassured you that they are on your side, that they understand how difficult the cost of living crisis is for their customers, and that if only Granny would forego her expensive medical care and agree to being pushed off her perch then the rest of the family could get that lovely new sofa in the January sales, not to mention freeing up a house for the kids to sell.
We’re not quite there, yet – but this is where it starts. Normalising assisted suicide is the first step to pressuring people that it’s the responsible choice to take. If anyone had suggested just a few years ago corporations advertising their support for euthanasia, it would have seemed the stuff of dystopian sci-fi. Perhaps the scariest thing is just how readily believable such a practice is now.
Which celebrity would be shameless enough to front such a campaign, I wonder? Now that the BBC has finally tired of that grinning Toby-jug of woke, St Gary might do it. ……
“Dignitas. Because …. why be a burden?”

Hilary Easton
Hilary Easton
7 days ago
Reply to  Paddy Taylor

I was in favour of assisted suicide until I saw a documentary by a disabled British actress. In Canada, poverty and homelessness are now legitimate qualifications for state suicide.

Then there is the uncomfortably honest words of Wes Streeting that with three current state of palliative care in this country, it could not be a fair choice. He should know.

Billy Bob
Billy Bob
7 days ago
Reply to  Paddy Taylor

You say that 4% of deaths in Canada are now assisted suicide, yet you you donā€™t say how many of those people were terminally ill and would have been dead within a year anyway.
Without that info the statistic is rather meaningless

Paddy Taylor
Paddy Taylor
7 days ago
Reply to  Billy Bob

Billy,
No offence meant but Iā€™m slightly horrified that you focus on that and rather gloss over the idea that the state would sanction assisted suicide due to ā€˜financial worriesā€™!
That is truly chilling.

Billy Bob
Billy Bob
6 days ago
Reply to  Paddy Taylor

You cited the 4% of deaths being via assisted suicide as an implication of the system being far too lax and the state bumping people off willy nilly. However if 99% of those would have been dead within 6 months anyway and have simply chosen to end it earlier rather than face a slow decline then Iā€™d argue then thatā€™s the system working as most people would want it to.
Without knowing the statistics behind the 4% and why theyā€™ve chosen assisted suicide itā€™s impossible to know if that figure is higher than most would be comfortable with

Jerry Carroll
Jerry Carroll
7 days ago
Reply to  Billy Bob

Wrong, it is fraught with meaning. Justin Trudeau is the love child of the murderous Fidel Castro to put things in perspective.

Martin M
Martin M
7 days ago
Reply to  Paddy Taylor

Maybe: “Dignitas. Because….why hang around with these tools any longer than you have to?”

John Riordan
John Riordan
6 days ago
Reply to  Paddy Taylor

Your last line reminds me of a spoof tagline someone once came up with for our “envy of the world” National Health Service:
“The NHS – because you’re going to die anyway.”

Always made me giggle.

Last edited 6 days ago by John Riordan
Martin M
Martin M
6 days ago
Reply to  John Riordan

Maybe “The NHS – because if you’re going to die anyway, you might as well do so in a crumbling building that smells vaguely of boiled cabbage”.

John Kang
John Kang
6 days ago
Reply to  Paddy Taylor

In the US states where assisted dying is legal, both the drugs involved and the process are highly suspect. In the example cited, the law was actually broken because the family members assisted in crushing the barbiturates. The law specifies drugs and processes that are simply untenable for most people where assisted dying makes the most sense. People in extremis are for the most part simply unable to fulfill the requirements set out for the process of dying. The intention of the law, ie, to provide a dignified and painless method to end one’s life, is mostly not possible given the process.
In order to provide a truly humane method, you need trained professionals who are psychologically equipped to terminate life and who are given the correct drugs and methodology to administer.
Sadly, the US method of assisted dying is one that is sure to make humane dying extremely difficult for most people who are in most need of it.

Carmel Shortall
Carmel Shortall
3 days ago
Reply to  John Kang

“trained professionals who are psychologically equipped to terminate life”

They sound nice…

Billy Bob
Billy Bob
3 days ago

Soldiers?

MJ Reid
MJ Reid
3 days ago
Reply to  John Kang

And yet in a number of states in the US, the state successfully manages to assist in the early death of prisoners who get to the end of the appeal process by injecting the prisoner with a cocktail of drugs. Surely with assisted dying, the same cocktail of drugs could be given to the person who wants to die in a suitable syringe…

Bedders
Bedders
7 days ago

I am a consultant anaesthetist. Every working day I render unconsciousness, manipulate the circulation and control cerebral oxygen supply. Nobody dies, because of the doses I use and the physiological/pharmacological support I provide. That the medical profession can provide a painless death, barring cannula insertion and the extremely infrequent risk of equipment failure, is a non-issue raised by scare mongers. More important are the moral issues and then the design of compassionate and safe processes up to the point of no return. The former are rightly to be thoroughly examined by parliament. If passed, the latter should be given to the legal profession with medical witnesses. But extreme views and scary stories are unhelpful.

Ex Nihilo
Ex Nihilo
1 day ago
Reply to  Bedders

I agree. I am an anesthesiologist in the U.S. The technical limitations of effective drug-induced euthanasia are entirely a matter of the skill set of the executioner. The moral questions are far more important. For one example: what incentives would induce an assisted-suicide practitioner to explore the provenance of the patient’s wish for suicide? Might there be cases where the patient’s suicidal motive might be to induce distress in the mind of a family member with whom they had issues and, if so, how carefully would the practitioner screen for clues of that? And if the executioner is paid to kill, would they be biased toward that which rewards them both materially and philosophically? Health care providers dedicated to saving lives sometimes do an analogous thing when they render care that might be better withheld? So too could executioners bring death where the will and desire to live are not gone but merely muted. Some executioners might do diligence before rendering death, but let’s be honest: many would pocket their fee, do the deadly deed, and be on to the next one without a thought.

Alex Lekas
Alex Lekas
7 days ago

We are capable of putting people under anesthesia for surgery. We are capable of putting down animals with no apparent discomfort to them. But it’s somehow impossible to have a formula that works to stop the human heart? I’m a bit skeptical.

Andrew Wise
Andrew Wise
7 days ago
Reply to  Alex Lekas

Try a Brompton Cocktail, tried & tested on royalty I believe

Gareth Rees
Gareth Rees
8 days ago

Every day in the UK there are tens of thousands of operations performed that require the client to be placed under a general anaesthetic. The process after inserting a canula into the back of the hand takes less than 10 seconds. If a professional clinician is incapable of then facilitating the delivery of KCl to stop the heart, for example, then they should be struck off for incompetence.

Mark O'Neill
Mark O'Neill
7 days ago
Reply to  Gareth Rees

Gareth, the problem is that the patient would only *probably* die.

MBP Phillips
MBP Phillips
7 days ago
Reply to  Gareth Rees

If that is the case why are there so many ā€œbotchedā€ lethal injections in the US when the condemned man does not die easily?

Billy Bob
Billy Bob
7 days ago
Reply to  MBP Phillips

Because doctors refuse to carry out lethal injections for execution, meaning theyā€™re having to be done by people not trained to do so.
Many pharmaceutical companies also refuse to sell prisons the drugs needed to carry out the execution, so they often improvise with random cocktails of the drugs that theyā€™re able to get theyā€™re hands on

Claire Lessore
Claire Lessore
7 days ago
Reply to  Gareth Rees

The Bill currently before Parliament requires the patient to SELF-ADMINISTER the lethal dose. Difficult to see how they can manage that after being fully sedated.

Jeanie K
Jeanie K
7 days ago
Reply to  Claire Lessore

In that case is it not badly named to be debated as “Assisted dying”?

Martin M
Martin M
7 days ago
Reply to  Claire Lessore

There would seem no reason why the “self administration” couldn’t be mechanical. I once saw a doco about the process in (I think) the Netherlands. The clinician hooks you up to the machine, which contains the drugs, and gives you a button, and says “If you push this button, you will die”. If you push, the machine does the rest.

sal b dyer
sal b dyer
7 days ago

Palliative Care is pretty good these days. Most people with terminal illnesses have a relatively pain free death in surroundings of their choosing. More of a problem is dementia. No one with dementia is going to ask for an assisted death because they don’t understand what’s happening to them, almost by definition. Denial, delusions and paranoia are pathognomonic. The higher cognitive functions are the first to degenerate. So insight, judgement, decision making etc are impaired. Exactly the functions needed to consent to an assisted death. Just visit a “secure” psycho-geriatric unit, watch perplexed, agitated patients wandering around and around a sterile hospital ward smelling of urine, not recognising staff or family anymore. Experiences differ of course, but it often looks like a living hell. There appears to be no enjoyment of life at all. The idea of ending life like that is unbearable. But an increasing percentage of us will succumb to dementia because we’re not dying from heart disease, strokes and cancers like we used to. Not only that, but demented patients are living longer due to improved care. They are shielded from harm, fed and cleaned well, and not “chemically restrained” ie not sedated, so they get to experience the full force of their persecutory delusions. I wish I could leave a living will asking for an assisted death in the event of a dementia diagnosis. But no one will agree to it because the very mechanism of the disease will preclude informed consent at the time. In fact it’s likely to be aggressively opposed by the person who may have actively wished for it just a few months earlier. It’s a conundrum that no assisted dying authorities have addressed. Interested to hear other people’s views.

William Amos
William Amos
7 days ago
Reply to  sal b dyer

This is the interesting ‘other side’ of the conversation and you put your points well.
Choice, consent, life, death. Shakespeare made a sonnet cycle out of these themes which still baffles the intelligent reader.
“To this I witness call the fools of time,
Which die for goodness, who have livā€™d for crime”
The artificial extension of life beyond the seeming natural point of human continence and into that vale of “labour and sorrow” which attends advanced senesence must also be borne in mind.
Consent as well, as you mention, is another vexed question. It appears to be the last shared juridicial standard in our society and yet it is so very frail.
Can the present ‘Will’ bind the future? Trammel up the consequence and leap the world to come? “Regret, like an April Violet” is just as real as the will to consent, just as true – and how can we possibly know if a suicide regrets?

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
7 days ago
Reply to  sal b dyer

So, you have to plan ahead of time how you will kill yourself before your cognitive faculties fail – that is, when you appear and possibly still feel pretty on the ball.

UnHerd Reader
UnHerd Reader
3 days ago
Reply to  sal b dyer

You are talking about human beings here, with immortal souls and a vivid inner life. How do you know that the patient does not experience both joy and sadness in his inner life, as reward for his virtues and expiation for his sins? How can you consider them as being other than fully human?
We are not defined by our minds, but by our souls. Dismiss my opinion as that of a religious bigot if you wish, but ponder it if you have the moral courage to face it.

MJ Reid
MJ Reid
3 days ago
Reply to  sal b dyer

Palliative care failed my partner completely. For the last 5 days of his life he was screaming in pain whenever anyone had to touch him. Have you any idea what it is like to sit with the person you love and know if you hold his hand it will cause him excrutiating pain. I gave him one last hug on the last evening I saw him alive and he could only whimper as he was so tired and in so much pain. He had said over and over in the hospice, “If I was a dog, H would have put me out of my misery by now!”. H is a vet. He just wanted to die, to be pain free. If he had got home when we were waiting for hospice care, he told me he would kill himself. And I would have held his hand while he did it. But it was never to be as we couldnt get the hospital bed he needed into our home, so he went through another 6 weeks of agony when he only wanted to die.

John Riordan
John Riordan
6 days ago

What I don’t understand about this is that heroin addicts kill themselves every day through overdoses they give themselves accidentally in pursuit of a high.

I’ve never done heroin myself and it seems to me that it’d be quite nice to leave it until the day I intend to die, if I find myself in the situation where life has become not worth living any more and I’m capable of making the decision to end it all. Why doesn’t a massive heroin overdose simply do the job?

Hilary Easton
Hilary Easton
6 days ago
Reply to  John Riordan

It does

Martin M
Martin M
4 days ago
Reply to  Hilary Easton

“Heroin” has massive stigma attached to it. Better to use “diamorphine” instead (same thing, but less stigma).

MJ Reid
MJ Reid
3 days ago
Reply to  Martin M

But if you want to die, what does stigma matter… And heroin is probably easier to score in most towns and cities than diamorphine.

Hilary Easton
Hilary Easton
7 days ago

In the eighties I had several friends who managed to die quite easily, by mistake, with heroin or morphine. Surely this is the drug of choice for a painless death.

Martin M
Martin M
7 days ago
Reply to  Hilary Easton

Exactly! It’s not hard!

William Amos
William Amos
6 days ago
Reply to  Hilary Easton

How do you know it was painless?

Hilary Easton
Hilary Easton
6 days ago
Reply to  William Amos

Because I know people who have nearly gone that way and been brought back from a coma. They report no pain, just quietly slipping away.

Martin M
Martin M
6 days ago
Reply to  William Amos

I take it you don’t know any intravenous heroin users….

William Amos
William Amos
5 days ago
Reply to  Martin M

I see them from time to time near where I live in London being resucitated on the street. It doesn’t look painless to me, with the vomiting and coughing. Perhaps it is the resuscitation which causes pain? I am here to learn.
My own position is slightly more nuanced or hypocritical and confused perhaps. Some things should be illegal, even if they are winked at in a society. Self-Murder should always be formally illegal. Assisting it should be illegal. We must live to the very end for the protecton of the weakest among us.
But there is no justice without mercy and no righteousness without grace.

Last edited 5 days ago by William Amos
Martin M
Martin M
4 days ago
Reply to  William Amos

I have known a number personally. What you describe is invariably a result of adulterants (“cutting agents”), and would not occur with pharma grade drugs.

MJ Reid
MJ Reid
3 days ago
Reply to  William Amos

It is the naloxone that is administered by paramedics and police to counteract the effects of the opiods that cause the coughing, sweating and vomiting. As a friend who was treated with naloxone told me, “I wanted to punch his (paramedic) lights out, he spoilt my high and made me puke my life up!”

J Bryant
J Bryant
8 days ago

The huge victory obtained by those opposed to assisted suicide is banning of direct, instantaneously effective means of assisted suicide as “cruel.” If a person wants to die instantly, and doesn’t have the physical ability, or emotional resolve, to do the job themselves, they should be able to ask another person to shoot them in the head, and the law should permit that option.
No doubt this comment will attract many downvotes. But I say if a person is truly committed to dying, a bullet (or two) to the brain is quick and as close to foolproof as you can get.
Of course, opponents will brand my suggestion “barbaric” etc. But is it really preferable to subject people to injection with noxious chemicals that might not work?

AC Harper
AC Harper
7 days ago
Reply to  J Bryant

And you can make the grisly argument that some people, determined to kill themselves, are willing to involve or kill others, without their permission, by jumping off motorway bridges or train platforms.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
7 days ago
Reply to  AC Harper

They can only do this if they are physically capable of doing so.
In addition, there are the “clean up” concerns – the people who have to clean up the physical mess this variety of suicide leaves behind.
There are other pretty reliable methods available of course, involving only the individual concerned and leaving minimal clean up problems, provided that you avoid firearms and make sure you evacuate both bladder and bowels before offing yourself.

Derek Smith
Derek Smith
7 days ago
Reply to  J Bryant

Itā€™s not a very ā€˜dignifiedā€™ way to go though, is it?

A guillotine would be better.

Martin M
Martin M
7 days ago
Reply to  Derek Smith

Or the samurai sword, as in seppuku (without the disemboweling, of course).

Claire Lessore
Claire Lessore
7 days ago
Reply to  J Bryant

If someone else is pulling the trigger, that is not suicide any more (even ā€˜assistedā€™); thatā€™s murder.

Hilary Easton
Hilary Easton
7 days ago
Reply to  J Bryant

There is always the choice to stop eating, of course.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
7 days ago
Reply to  Hilary Easton

And drinking any fluid – quicker but very hard. Individuals who have tried this method (with or without liquid) truly require an iron will.

Nick Wade
Nick Wade
7 days ago
Reply to  J Bryant

I think the easiest way is to put someone in a hypobaric chamber. Put them on oxygen, take the ā€œaltitudeā€ to 35,000 feet and then they can take their oxygen mask off. Theyā€™ll be unconscious in less than a minute and dead soon after. They wonā€™t feel a thing or be aware of anything. A nice way to go.

Martin M
Martin M
8 days ago

It seems strange that vets put down animals with no problems every day, but the author would have us believe that the same cannot be done for humans.

Brett H
Brett H
7 days ago
Reply to  Martin M

Interesting point, but do we actually know about the perceived thoroughness of putting down animals.

Martin M
Martin M
7 days ago
Reply to  Brett H

Well, all the animals that I have seen go through the process just “go to sleep”. No signs of discomfort involved.

Brett H
Brett H
6 days ago
Reply to  Martin M

ā€œgo to sleepā€. 
Its all so childishly simple. Iā€™ve also had dogs put down. They do seem to ā€œgo to sleepā€ and Iā€™ve spent time with them then left. But I have no idea if the animal is actually dead.

Martin M
Martin M
6 days ago
Reply to  Brett H

I take mine home and bury them in my garden. They are definitely dead (hint: cold = dead).

Brett H
Brett H
5 days ago
Reply to  Martin M

Well if youā€™re right, and I have no reason to doubt it, then it does seem a little absurd how we complicate it.

MJ Reid
MJ Reid
3 days ago
Reply to  Brett H

People complicate it because we “have souls and conscience”! At the end of the day, we are animals too…

Billy Bob
Billy Bob
4 days ago
Reply to  Martin M

If they werenā€™t they will be after being buried

Peter B
Peter B
7 days ago
Reply to  Martin M

Quite. And no doubt many of the opponents of assisted dying are quite happy to have their pets put to sleep.
This is classic “problem selling” behaviour. Just throwing out FUD with no attempt to actually find solutions. Which, as you say, are known to exist.

UnHerd Reader
UnHerd Reader
7 days ago
Reply to  Martin M

Strange you see no difference?

Lancashire Lad
Lancashire Lad
7 days ago
Reply to  UnHerd Reader

The article suggests there’s a problem with ‘methodology’.
The point about having pets humanely put down is it demonstrates there is no problem with methodology. Strange that you’ve chosen to use a different idea – i.e. human v animal, to try to distort the very point the article is based upon.

Billy Bob
Billy Bob
7 days ago
Reply to  UnHerd Reader

The difference is that the system we use for humans is much more cruel

Martin M
Martin M
7 days ago
Reply to  UnHerd Reader

There is no difference in the process. Humans are after all just large-ish mammals. Obviously consent is an issue for humans but not animals.

Lancashire Lad
Lancashire Lad
7 days ago
Reply to  Martin M

One look at who he writes for in the footnotes tells us all we need to.know.

Alan Tonkyn
Alan Tonkyn
7 days ago
Reply to  Lancashire Lad

No, it doesn’t. The fact that he has written for a Catholic paper doesn’t invalidate the points he’s making. Deal with those, rather than making a superficial ad hominem comment.

Lancashire Lad
Lancashire Lad
7 days ago
Reply to  Alan Tonkyn

The superficiality exists entirely within the article itself, which is disingenuous, and for reasons i’ve suggested elsewhere.

In terms of “ad hominem” the author is very much culpable of that in respect of seeking to undermine the dignity of those suffering from terminal illness and their loved ones.

Virginia McGough
Virginia McGough
6 days ago
Reply to  Lancashire Lad

Hospice care, either in the hospice or at home, upholds the dignity of the patient and supports their loved ones both during and after the patient’s death.

MJ Reid
MJ Reid
3 days ago

Nope, it doesnt! Maybe for some people but not for all. I know. My partner had no dignity left at the end of his life… In a hospice!

Virginia McGough
Virginia McGough
6 days ago
Reply to  Lancashire Lad

Catholics have centuries of experience in looking after the dying, and their families. It was a Catholic, Dame Cicely Saunders, who pioneered the establishment of hospices. My mother and my brother-in-law both died in one, surrounded by family and with excellent pain relief – genuinely dignified deaths.

Billy Bob
Billy Bob
4 days ago

They also have centuries of touching up the choir boys

Alex Lekas
Alex Lekas
7 days ago
Reply to  Martin M

I had the same thought.

William Amos
William Amos
7 days ago
Reply to  Martin M

Interesting thought.
Perhaps in future the idea of a natural death will be as remote and terrifying for the well conditioned model citizen as a ‘natural birth’ is now.
Still better it will be presented as ‘reckless’ and ‘selfish’ when the State is willing o manage it all for us.

Billy Bob
Billy Bob
7 days ago
Reply to  William Amos

By natural birth are you referring to being in favour of no medical intervention at all? Presumably youā€™re happy with the much higher rate of infant and mother fatalities that would inevitably follow?

Brett H
Brett H
6 days ago
Reply to  Billy Bob

Are you asserting that the mortality rate with ā€˜natural birthsā€™ is higher than medical intervention?

Billy Bob
Billy Bob
5 days ago
Reply to  Brett H

Yes I am. Look at the number of mothers and babies who die during childbirth in countries without a free healthcare system, compared to the number who due when medical intervention is freely available

Brett H
Brett H
5 days ago
Reply to  Billy Bob

Playing games as usual. Weā€™re not talking about countries without a health system, people who live in sub-standard conditions. Weā€™re talking about numbers between natural birth and medical intervention in a country that has both.
https://chriskresser.com/natural-childbirth-i-is-home-birth-more-dangerous-than-hospital-birth/

William Amos
William Amos
6 days ago
Reply to  Billy Bob

Presumably? Do not presume too much upon my love, I may do that I shall be sorry for”
The Pasquinade of online anonymity seems to invite on false presumption.
Friend, I have two children, both safely delivered in the bosom of a first world hospital.
I merely point out the curiousity that the idea of a home birth, without medical intervention was, presumably, the unquestioned norm for for all of human history in the West until he last 80 years.
And now it has become, for all responsible parents, something to be avoided as reckless and irregular.
Could the same happen, in 80 years time, with death? “Planned pregnancy”, “birth plan”, will we see death plans and planned deaths?
It seems inevitable.

Billy Bob
Billy Bob
5 days ago
Reply to  William Amos

It was the main method of delivery I agree, and the numbers of babies and mothers who died as a result was much higher than today

Billy Bob
Billy Bob
7 days ago
Reply to  Martin M

It sounds as if the first example in the article bought the assisted suicide kit from Temu

UnHerd Reader
UnHerd Reader
7 days ago
Reply to  Martin M

Rather, if we know humans cannot be reliably executed swiftly, seamlessly, and painlessly in 2024, what makes you think vets have *ever* been doing so for animals?

Andrew Roman
Andrew Roman
8 days ago

There is a fundamental difference between the US law and Canadian law. US law requires self-administration by the patient, at the patient’s expense. Canadian law permits the physician to administer first an anaesthetic medication to put the patient to sleep and then the lethal injection to stop the heart. The cost to the patient is zero because it is covered by Medicare. The procedure is usually performed with family and friends present.

Hilary Easton
Hilary Easton
7 days ago
Reply to  Andrew Roman

Two words: slippery slope. The Canadian law didn’t start out that way, once the principle is established it the qualifying criteria are easily expanded.

Martin M
Martin M
7 days ago
Reply to  Andrew Roman

The Canadian law sounds good to me.

James Davis
James Davis
5 days ago
Reply to  Andrew Roman

There is no Medicare in Canada. Medicare is the United States program.

Sue Sims
Sue Sims
7 days ago

Most of the comments here confuse ‘assisted dying’ with ‘euthanasia’. The former is actually assisted suicide: the patient administers it himself. The latter is permitted killing by a second party, generally a doctor. The difference is important. Almost all commenters here are talking about euthanasia, comparing it to anaesthesia or ‘putting to sleep’ pet dogs and cats, and focusing on the probably lack of pain. But Kim Leadbetter is trying to introduce assisted suicide, and specifically excludes euthanasia in her bill.

Andrew Wise
Andrew Wise
7 days ago
Reply to  Sue Sims

The difference is important but I donā€™t see how it impacts the choice of drugs used.

Gordon Arta
Gordon Arta
3 days ago

The author is a former editor of the Catholic Herald. If his god says you’ve got to suffer a long painful and demeaning death, then that’s what you’ve got to do. His god isn’t against you playing god by giving life-saving surgery, or restarting a stopped heart, or drugging you to insensibility, so long as, somehow, if there’s the tiniest flicker of ‘life’, nothing should be done to stop it.

Martin M
Martin M
3 days ago
Reply to  Gordon Arta

Given that his god was apparently content for his son to suffer a long painful and demeaning death whilst nailed to a cross, that isn’t surprising.

Brett H
Brett H
8 days ago

Mmm, looks as if, once again, the authorities have not given us the whole truth. What a surprise. But why? Why has the information been so vague or misleading?

Douglas Redmayne
Douglas Redmayne
7 days ago

This is about choice. Mind your own business.

Brett H
Brett H
7 days ago

It might be simply about choice to you, but to others itā€™s much more.

Martin M
Martin M
7 days ago
Reply to  Brett H

Yes, because they have a problem with others exercising free will.

John Riordan
John Riordan
6 days ago
Reply to  Brett H

Quite. Whose choice? The problem with the legislation around this is that once the lawyers and bureaucrats got involved, procedure will take over, and than after that the accountants and economists will start to treat the old and infirm as cost burdens that are avoidable in the event they choose instead to die. It’s not hard to see where it leads.

William Amos
William Amos
7 days ago

One can neither ‘choose’ to die or ‘choose’ to live.
One can only damage the physical body, with bare bodkin or poison, up to and only up to the farthermost rung of this mortal coil. Death is not an event in life, as the philosopher once said.
As it stands, self harm in almost every other context is rightly legislated against.
The question is a substantive one, it cannot be conjured away.
So its not quite as simple as an appeal to ‘choice’.

Delta Chai
Delta Chai
7 days ago
Reply to  William Amos

> As it stands, self harm in almost every other context is rightly legislated against.

Is it? In which country?

William Amos
William Amos
6 days ago
Reply to  Delta Chai

I believe in Britain self harming or expressing suicidal thoughts can lead to you being sectioned. It may not be encouraged or assisted in either.

Delta Chai
Delta Chai
5 days ago
Reply to  William Amos

Yes, you can be sectioned because it’s taken as a sign of mental illness, and we assume that people can be helped. As far as I’m aware you wouldn’t face criminal prosecution, and there is plenty of low-level self harm that is ignored.

Neither assumption holds when someone wants to end their life because they’re in a bad state and there is objectively very little chance of improving.

Martin M
Martin M
7 days ago
Reply to  William Amos

Seems perfectly simple to me. When life stops being fun, I’m out. You get no say in the matter. Fortunately I have the means to do this without the need to resort to VAD, but not everyone does.

c hutchinson
c hutchinson
7 days ago

My body, My choice.

Brett H
Brett H
7 days ago
Reply to  c hutchinson

As long as you pay for it. And it doesnā€™t involve a public health system.

Martin M
Martin M
6 days ago
Reply to  Brett H

Why, because the public health system operates according to “Christian principles”? You’ll be saying it should start fiddling kiddies next (then it can be really “Christian”).

Brett H
Brett H
5 days ago
Reply to  Martin M

Youā€™re a little obsessed with ā€œfiddling kiddiesā€.
Why? Because youā€™re expecting something funded by tax payers that not everyone agrees with. Nothing to do with any religious thought. This is in relation to ā€œmy body, my choiceā€. If youā€™re demanding assisted suicide under those conditions then youā€™re challenging the right of ā€œmy choiceā€ to those who oppose it. Itā€™s not their choice to pay for AS and yet you expect it. Why?

Martin M
Martin M
4 days ago
Reply to  Brett H

No. I’m a little obsessed with the fact that Christian clergymen seem to think fiddling kiddies is their God given right. It seems entirely wrong to me (although not to a lot of Christians, it would seem). As to your other point, your “logic” is non-sensical. If I was the High Priest of the Church of Baal, and demanded that your children be sacrificed as a means to ensure a could harvest, I could use your very point in opposition to your attempt to stop me. After all, surely a bountiful harvest is a good thing?

AC Harper
AC Harper
7 days ago

To the State taking a life is easy and unremarkable. Deny people adequate heating or food and they will die. It may take some time but, miraculously, the State’s hands remain clean.

MBP Phillips
MBP Phillips
7 days ago

Not true re vets. In the last three years I have had to have two dogs put down. In each case it was an horrific procedure. In one the vet tried to get the canule into all 4 legs. Before he managed the dog was screaming in pain. In the other, similarly, the vetā€™s assistant insisted on stretching out the paw of a dog which was in severe arthritic pain causing it even more pain.

Billy Bob
Billy Bob
7 days ago
Reply to  MBP Phillips

Iā€™d go to a different vet if I were you

Martin M
Martin M
7 days ago
Reply to  MBP Phillips

Never encountered a problem in my long life, having outlived many pets.

Huub B
Huub B
7 days ago

Any anesthesiologist can tell you how patients should be put into deep sleep, with the inability to breathe, and on top of that, what substances should be injected to stop the heart. That it is handled so frenetically in the USA is a shortcoming, from which many people will suffer. It is purely a lack of legal options.

Andrew Wise
Andrew Wise
7 days ago

But it would surely be the biggest experiment ever conducted on the NHS.

oh really? And the whole Covid fiasco wasnā€™t?

Lindsay S
Lindsay S
7 days ago
Reply to  Andrew Wise

I remember when pharmaceutical companies had to pay to experiment on people, now the NHS pays them!

UnHerd Reader
UnHerd Reader
7 days ago

If we know humans cannot be reliably executed swiftly, seamlessly, and painlessly in 2024, what makes us think vets have ever been doing so for animals?

UnHerd Reader
UnHerd Reader
7 days ago

A former editor of the Catholic Herald has concerns about assisted dying- whoā€™d have thought? The reality of assisted dying for the vast majority of those who choose it, is a dignified peaceful end surrounded by chosen family and friends. This is virtually guaranteed with regimes that allow clinician assistance. This article suggesting otherwise, is a web of deception.
Those who believe it to be morally wrong should say so and choose not to be involved in any way. The vast majority of the population who want this option should be allowed to excise their freedom of choice which decades of experience around the world show can be offered safely and with huge benefits.
Dr Graham Winyard CBE FRCP FFPH

UnHerd Reader
UnHerd Reader
7 days ago

I am 82 and am concerned about eventually developing age dementia.
How to arrange assisted suicide assistance before the advanced outset?
Many thanks

Brett H
Brett H
6 days ago
Reply to  UnHerd Reader

Concerned or have it?

Philippa Kelly
Philippa Kelly
6 days ago

Harold Shipman managed to kill over 200+ people in under 5 minutes each. You can easily do it with ONE injection of either diamorphine, potassium or insulin, to name just a few. The author of this article clearly knows nothing about pharmacology. American executions are done in that manner as a punishment, not to give a quick death.

Brett H
Brett H
5 days ago
Reply to  Philippa Kelly

American executions are done in that manner as a punishment,
Really? Can you give us some more information about that?

Agnes Aurelius
Agnes Aurelius
4 days ago

The UK’s assited suicide bill is written so that people will have died naturally by the time they have found 2 doctors who will agree to their wishes and persuaded a judge to let the doctors help them.

Martin M
Martin M
4 days ago
Reply to  Agnes Aurelius

Maybe, but at least it’s a step in the right direction.

Victoria Cooper
Victoria Cooper
3 days ago

I do not understand the motivation behind this article, all I can say is I have had to put to sleep several pets over my lifetime – I have always been present and they were all un-traumatic and peaceful.

Mark Kennedy
Mark Kennedy
3 days ago

“…that taking life is, at the very least, an awkward fit with healthcare ā€” and that when these cocktails are introduced into a medical system, the system itself inevitably changes.”
 
Really? In the end, humans are mortal: health care–medical intervention and its ‘systems’–can’t save us; health care providers can only help us manage our inevitable decline. Insisting that interventions which take us all the way to the final exit suddenly stop qualifying as such management, just short of the finish line, is entirely arbitrary. What ethical ground would justify medicine relinquishing responsibility for its patients and leaving them on their own at that point, and where exactly does this point lie? Why is it ‘health care’ when a drug spares someone pain from a toothache or broken leg, but not when, later on, a drug spares that same someone pointless terminal cancer pain?

To insist that interventions are caring and beneficial only when they smooth the path to recovery, never when they smooth the path to death, seems a clear example of question begging. From the point of view of a patient who has no hope of recovery, it’s a matter of indifference whether we preface the word ‘care’ with the word ‘health’ or not: his/her only interest is in the quality of the experience itself. And if health care doesn’t ultimately share this interest, what’s it for?

Last edited 3 days ago by Mark Kennedy
David Colquhoun
David Colquhoun
3 days ago

Anyone who has had a general anaesthetic will know that the picture painted in this article is untrue. When a syringe of propofol goes into a vein, you are asleep before you see the end of the injection. It is totally painless and very fast.

Peter Johnson
Peter Johnson
8 days ago

Given that Health Authorities have merrily carried out gruesome experiments with drugs and surgeries on ā€˜transā€™ youth with frequent disastrous outcomes – the complete lack of evidence supporting these procedures isnā€™t really shocking at all.

Stuart Sutherland
Stuart Sutherland
7 days ago

Surely the quickest way to kill someone would be a bullet into the brain. Messy but quick!

Ben Scott
Ben Scott
7 days ago

Guillotine!

Billy Bob
Billy Bob
7 days ago

The cleaning bill would be horrific

Martin M
Martin M
7 days ago

Definitely messy. You wouldn’t wish the clean up on your next of kin.

Jerry Carroll
Jerry Carroll
7 days ago

Why not have a robot guided by AI fire a bullet into the brain of the person who wants death?

Pedro Livreiro
Pedro Livreiro
3 days ago

The picture at the head of this article is unhelpful – it has nothing to do with assisted dying, but more to do with the Living Will, which is also important.

Citizen Diversity
Citizen Diversity
7 days ago

One of the proponents of this Bill has described assisted dying as ‘shortening death’.
Wasn’t that where Jesus of Nazareth rose from the dead on the third day. Even Jacob Marley was only dead to begin with.

Jeanie K
Jeanie K
7 days ago

What an evil country this country has become since she gave up Christianity.

Lancashire Lad
Lancashire Lad
7 days ago
Reply to  Jeanie K

Did you ever hear about the 17th & 18th century witch trials, torture and murder, all.in the name of Christianity?

Billy Bob
Billy Bob
7 days ago
Reply to  Jeanie K

We should go back to burning witches

Martin M
Martin M
7 days ago
Reply to  Jeanie K

You don’t consider the rampant molestation of children by Christian priests to be evil?