Snoring, grunting, vocalizations (agonal breaths) are NOT signs of suffering...

[Barack_America]

In reference to the McGuire execution in Ohio. This is not a commentary on the death penalty or the particular method used in Ohio.

This is only to state that such respirations and vocalizations are commonly observed during death. They are a normal symptom of the body shutting down, and tend to represent the respiration centers in the brainstem responding to insufficient cardiac output.

They can be observed in patients receiving every measure to ensure their comfort. They are not voluntary and should not be interpreted as a sign of someone "trying" to breathe. There is no indication that the dying are aware of them or that they represent conscious discomfort in any way.

I just don't want DUers to sit with a dying relative in the future (or reflect on having done so in the past) and worry that this breathing pattern means their relative is suffering. They don't. Medications are sometimes given to reduce this breathing, but this is generally for the benefit of the family present.

[hlthe2b]

1. In chronically ill, debiliated, dying patients administered appropriate levels sedation & analgesia

Last edited Sat Jan 18, 2014, 01:16 PM - Edit history (2)

consensus is that this is true. They are generally unconscious or very very heavily sedated and pain has been well managed. Gasping reflects agonal brainstem reflex to lack of oxygen in the blood and the hypoxia alone normally renders unconsciousness. There is a good peer-reviewed article in the British Medical Journal available without charge on the issue and the ethics surrounding use of neuromuscular blockade (paralytic agents) on top of high dose opioids and sedatives for those that want to understand the issue better. ( http://jme.bmj.com/content/28/3/164.full ). On this point, some euthanasia solutions used in veterinary medicine formerly added a respiratory center paralytic agent. It is probably important to note, though this is highly controversial and such solutions are no longer licensed in the US (e.g., T-61 licensed in Canada). Further, use of these paralytic agents are no longer considered acceptable in veterinary medicine for use in euthanasia, which makes it even more controversial that the use is being considered in human execution or end-of- life care.

In this situation,however, use of two drugs--opioid analgesia and sedative--was being used to actively execute an otherwise healthy individual and is likely a very different situation. The issue comes when inadequate doses of sedation and pain relief--opioids are used (as the anesthesiologist consulting in the legal proceedings prior to execution believed to be the case). I do believe there is reason to be concerned (for those who believe suffering should be limited or eliminated in conduct of capitol punishment) that this lethal drug protocol may have been inappropriate. Legally, I think this case will be studied. Unfortunately, hard to prove a lot of the questions that will be raised.

[Barack_America]

3. Personally...

I was surprised by the drugs used in this execution (and not in a good way). I also feel pretty badly for the family in this instance, and hope someone prepared them for what they might see.

But what I've seen in many media reports of this event is that the agonal respirations are proof the prisoner suffered. I think that's a harmful message to put out there. In most instances, they are not.

[hlthe2b]

4. I agree, not "proof", but if there was a delay in unconsciousness,

Last edited Sat Jan 18, 2014, 03:47 PM - Edit history (1)

which could be the case using this combination in an otherwise healthy person, questionable dosing, and by an intramuscular injection of drugs, rather than intravenous, there should be concern that suffering occurred.

Barbiturate effects on both consciousness and respiratory centers are far more predictable and thus the method of choice in veterinary medicine (for humane euthnasia). That narcotic opioids with sedation is used in end-of-life care in humans is both an attempt to assure as much pain management as possible and to draw a fine line behind easing death and causing it. Thus, choosing opioids plus sedation to actively end life in an execution is a highly questionable decision, imo.

[kestrel91316]

2. THANK YOU. I see these things sometimes during euthanasia in my job.

I even had to deal with a nutball client complaint about such to the state veterinary board (who found I did nothing improper on investigation - in record time). I explained as best I could what she might expect to witness during the emergency euthanasia of her massively cancer-riddled cat (which I had never laid eyes on prior to her walking in with it unannounced) - but she chose to ignore every word and claim I abused the cat.

[El_Johns]

5. We don't really know.

[Barack_America]

6. Patients with zero cortical function do the exact same thing.