Do We Know Enough About Assisted Dying Drugs?

As more countries and states legalize medical aid in dying (MAiD), discussions around ethics, legality, and access have taken center stage. However, one critical question remains underexplored: Do we fully understand the safety, efficacy, and potential complications of the drugs used in assisted dying? While these medications are meant to provide a peaceful, dignified passing, research suggests that complications, prolonged deaths, and inconsistent protocols may pose significant concerns.

Unlike most medical treatments, there is no single standardized drug regimen for assisted dying. Different countries, and even states within the U.S., use varying combinations of medications to induce death. These protocols typically involve a combination of barbiturates, benzodiazepines, opioids, muscle relaxants, or cardiac-affecting drugs, yet research on their effectiveness and potential complications remains limited. For example, in Oregon, over 70% of cases in 2022 used a combination of diazepam, digoxin, morphine sulfate, amitriptyline, and phenobarbital (DDMAPh), while 28% used a slightly modified version without phenobarbital (DDMA). Meanwhile, Canada has adopted a protocol using midazolam, propofol, and rocuronium, whereas the Netherlands primarily relies on high-dose barbiturates. These inconsistencies raise concerns about whether some regimens may be more effective or humane than others.

Despite the assumption that assisted dying is quick and painless, medical reports suggest that complications do occur. A 2024 study published in JAMA Internal Medicine found that while most cases followed expected trajectories, some patients experienced prolonged deaths, vomiting, or muscle spasms (myoclonus). In some cases, death took as long as 47 hours—raising ethical concerns about patient suffering. Other reported issues include:

• Delayed absorption of drugs, leading to extended or unpredictable time of death.
• Difficulty in maintaining IV access, requiring multiple attempts or additional interventions.
• Incomplete sedation, leading to distress before full unconsciousness.

These challenges highlight the need for more research into the pharmacokinetics and optimal drug combinations to ensure predictable, painless outcomes.

Most of the medications used in assisted dying were not originally designed for this purpose—many were repurposed from anesthesia or palliative care. Physicians administering MAiD often rely on trial-and-error adjustments to protocols based on patient response, yet there is no universally accepted "gold standard" for ensuring rapid, painless, and complication-free death. What happens when drugs do not work as expected? How often do patients experience unanticipated suffering? These are difficult but necessary questions that require more research and transparency.

Moreover, reporting on assisted dying outcomes is inconsistent. In some jurisdictions, data collection is minimal, making it difficult to assess how frequently complications occur or which protocols are most effective. A 2023 study found that in some cases, complications were significantly underreported, making it hard to develop evidence-based improvements in drug administration. As more jurisdictions legalize assisted dying, there is a growing need for clinical research into the most effective, humane, and reliable drug regimens. However, due to ethical concerns and regulatory barriers, controlled trials on assisted dying drugs remain a gray area in medical research. What are your thoughts?