Medical Assistance in Dying (MAID) - a cruel way to die but not to the onlooker

Caryn Lipson

July 20, 2024

No harmful effects during a MAID death - Senators

Proponents of euthanasia or medical assistance in dying (MAID), the euphemism used in Canada for its form of assisted suicide/legalized murder, paint a picture of a peaceful departure. Indeed, that's the way it appears to the observer and what the establishment would like citizens to believe.

In February 2021, several Canadian senators wrote a brief to explain the difference between Canada's legalized murder of disabled people to the U.S. prison system's lethal injections in carrying out state death penalties. Senator Kutcher, Senator Mégie, Senator Moodie, and Senator Ravalia wrote that the two procedures are very different.

This procedure and use of midazolam for MAID in Canada is completely different from that used in lethal injections in the USA. Although State execution protocols in the USA vary from State to State and may change within a State over time, midazolam is not usually used to carry out death, although it has been used in some States at some point as the agent for causing death. In cases where midazolam was used as the drug causing death, the dose used is at an extremely high amount: 500 mg given IV. At that extremely high amount the drug can potentially cause problematic breathing problems before breathing stops. This is the issue that has raised concerns about using these extremely high amounts of this drug for that purpose in the USA.

It is essential to understand that this is not how midazolam is used for any purpose (including in palliative care or MAID) in Canada and this toxic effect does not occur in MAID protocols that apply the doses of this drug as described above.

They further state that Midazolam, the first drug administered, is meant to provide comfort and that they have no reports of the drug having caused any harmful effects.

Within Canada midazolam is administered for MAID in doses that are designed to provide comfort to the person, not to cause death. It is administered by highly trained health professionals (doctors and nurse practitioners) who are able to understand the intended use and possible side effects and toxic effects of the drug. In Canada, using the established protocols, there have been no reports of midazolam causing a harmful effect during a MAID death. (Emphases added.)

Anesthesiologist disputes peaceful MAID deaths

Anesthesiologist and intensive care medicine specialist Dr. Joel Zivot has used these drugs extensively in his practice of medicine. Zivot had the opportunity to review 200 autopsy reports of individuals who died by lethal injection in the U.S. (as explained below in his Tedx talk). He found that their lungs weighed at least twice as much as a normal lung would and understood that the drugs caused their lungs to fill with fluid; they drowned to death. The reason why they looked peaceful and no one could identify any problems was because of the paralytic effect of the drugs.

Zivot penned a response to the Senators' brief disputing their claims that the deaths were peaceful and painless, arguing that the only way they can refute his hypothesis that they die by drowning is to perform autopsies. Among the 20 points he made were the following:

9. In the United States, Midazolam use in lethal injection has been associated with the findings of lung congestion as seen on autopsy.

10. The report of Midazolam not causing harm in the setting of MAID is a claim without evidence and is unverifiable.

11. MAID provider reports that death by MAID appears peaceful reflects a serious lack of understanding on the part of those providers about the mechanism of action of muscle relaxants like rocuronium.

. . .

‍15. Propofol injection at a dose of 1000 mg as used in MAID very likely causes burning in the lungs and tissue destruction as can be observed with the injection of pentobarbital or Midazolam in the setting of lethal injection for execution.

16. Muscle relaxants, when injected in MAID, will produce an outwardly observed stillness as a consequence of muscle paralysis that has wrongly and repeatedly been described as a state of peacefulness.

17. Muscle relaxants when used in MAID will produce death by suffocation.

18. The MAID protocol very likely causes lung congestion in a similar fashion to that which has been shown in over 200 cases of lethal injection in the US.

19. The only way to refute the hypothesis that the MAID protocol causes pulmonary fluid accumulation and death akin drowning is by obtaining Canadian data through autopsy studies on at least 200 individuals put to death by MAID.

Deaths akin to drowning

Zivot explains what he realized about MAID in his February 2018 TedxEmory talk below.

This image, below, is a slide from his talk showing autopsy findings of people who were executed by lethal injection in the United States:

He explains that the slide shows the condition of the autopsied lungs following death by lethal injection which weigh double that of a normal lung:

What this is is a list of people that have been executed and what's important to note here . . . What I want to point out to you here is the lungs. Here there's a right and a left lung and what's listed in this column here are the weights of the lungs. Why is this important? Well, the lungs have a normal weight. We weigh them in grams and in this list what it shows you is that all of the weights here, of these lungs, are about double what the normal weight of [a] lung should be.

Zivot says that you can't see the organ failure and fluid build up in the lungs during the execution - it takes an autopsy to reveal it.

And so you ask yourself, how is it that that happened? If execution and lethal injection killed people instantly then the body would be unperturbed. There would be none of this organ failure, and I want to tell you that I've left off other organ systems here that also fail in the consequence of execution.

Organ failure and fluid buildup in the lungs are not obvious to onlookers, he realized.

So what I learned from this was lethal injection was not a kind of peaceful death but in fact, it was progressive organ failure with fluid building up in the lungs and I couldn't see it. I couldn't see the lung congestion in Marcus Wellons [whose execution he observed]. I couldn't see the congestion in his trachea, not at the time, but the post-mortem showed it.

MAID is a lot like a lethal injection and an autopsy, if done, would likely show the same, he continues.

Now medical assistance in dying is actually configured to be quite a lot like lethal injection. The same kind of medications that are used sometimes in a very similar fashion injected intravenously or taken as pills, of the same class of drugs. Now we don't of course do autopsies on people who died . . . as a consequence of medical assistance. Why would we? But if we did, I suspect that what we would see would be a picture quite similar in fact to lethal injection. Of course, I say there's no autopsy but my impression, again, is that it would be very similar to what lethal injection would show.

Proposes that doctors should assist people to live

Zivot concludes his talk with a suggestion that doctors should only help people live, not die.

And so I want to leave you at the end with this idea - that I recognize that people may believe that they want to control the way that they die. I understand this and they believe that they may want to have a doctor assist them, but I have to tell you that I'm not a very good killer. At the best, I only dabble in killing and if you need something better than what I can give you then I'm afraid that you're going to have to look elsewhere.

And I say the same thing about lethal injection, like medical assistance in dying - it's not what you think it is. I think that the autopsy really shows this.

And instead of medical assistance and dying, I would like to leave you with the idea that perhaps what a doctor might help you with is medical assistance in living.

Listen to Zivot's entire talk, including the poignant story of his own mother's death, in the video below: