One thing that I feel that I need to make very clear is that there is absolutely no comparison between the Canadian Medical Assistance in Dying protocol and the American death penalty.
I can already hear the anti-M.A.i.D. crowd clutchin’ their pearls about the twice botched execution of Christa Pike.
The American justice system has retribution as one of its core tenets.
The American justice system believes that death itself isn’t enough of a punishment. The American justice system believes that suffering should also be part of the death experience.
Medical Assistance in Dying is the polar opposite of what the American justice system believes death should feel like.
M.A.i.D. is about ending pain and needless suffering.
The American death penalty is all about suffering and getting an “eye for an eye”. The Americans argue that If the victim of a murder suffered, then murderer must also suffer, but to a greater degree. The American justice system is after all based on early American Puritan / Protestant beliefs that crime is a moral failing and not the result of societal influences and societal failings.
The M.A.i.D. procedure in Canada utilizes three or four drugs.
| Order | Agent | Purpose | ED95(mg/kg) | MAiD Dose |
| #1 | Midazolam | Sedation | 0.033 | 10mg |
| #2 | Propofol | Induce Coma | 2.56 | 1000mg |
| #3 | Rocuronium | Paralysis | 0.305 | 200mg |
| #4 (optional) | Bupivacaine | Cardiac Arrest | 500mg | |
| #5 | Lidocaine | Reduce injection pain | 40mg |
Usually drugs #1, #2, and #3 are more than enough to allow a person pass away peacefully.
Sometimes Bupivacaine is used to absolutely ensure that the heart stops. But this is at the discretion of the practitioner administering M.A.i.D. to a patient. There are no specific guidelines in the M.A.i.D. protocol that determine when bupivacaine must be used.
Lidocaine is used if it’s believed that the patient may be sensitive to the injection of propofol. Lidocaine is sometime required in regular surgery as some people are more sensitive to propofol at the injection site than others.
| Issue | Canadian MAID anaesthetic/paralytic protocol | Single-drug pentobarbital execution |
|---|---|---|
| Initial sedation | Yes | Drug itself initially sedates |
| Purpose-built general anaesthetic | Yes, propofol | Pentobarbital ultimately causes coma |
| Unconsciousness deliberately established before respiratory paralysis | Yes | No separate pharmacological step |
| Neuromuscular paralysis | Rocuronium after anaesthesia | No |
| Mechanism toward death | Anaesthesia → paralysis/apnea → cardiac arrest | Progressive barbiturate toxicity |
| Injection discomfort | Can occur, especially propofol; local anaesthetic can reduce it | Possible, including irritation from alkaline pentobarbital |
| Pulmonary edema concern | Not a characteristic intended mechanism | Documented concern in lethal-injection autopsies |
| Consciousness during terminal physiological effects | Designed specifically to prevent it | Greater uncertainty |
| Administration | Medical practitioner within a clinical protocol | Correctional execution team under state protocol |
And, as the above table shows, pulmonary edema is almost always present in a single drug execution, and is typically never present in a death brought about by M.A.i.D.
In the most recent execution attempt in Tennessee, the only drug administered was pentobarbital.
In the American penal system, sedating the prisoner and then rendering them unconscious prior to administering a lethal drug is anathema.
The pentobarbital wasn’t even administered by a medical professional. It was instead administered by a “specially trained” corrections personnel.
Whether this “specially trained” person was the facility janitor or an office assistant is anyone’s guess.
The fact that Christa Pike survived two attempts to bring about her death shows that the single drug method does not work reliably.
The Christa Pike affair also illustrates another fear of mine. And that is surviving a suicide attempt.
Sure, she was being executed by the state, which isn’t the same as a suicide attempt, but nonetheless she survived.
And the truth is, the vast majority of people that attempt suicide survive.
Christa Pike is now connected to a ventilator in a hospital. She is expected to recover, but will probably have brain damage. How much brain damage is anyone’s guess. Regardless, she is now trapped inside of a brain that no longer functions properly.
I remember going to see my grandmother’s husband Andy Anderson in the Misieracordia hospital in the weeks after his fall in the bathtub. Tubes and everything coming out of his skull and his spine with talks about brain bleeds, shunts, strokes, and heart attacks.
When Andy was moved to the Mewburn Veterans Nursing home grandma would periodically take Scott and I down to the nursing home to see Andy.
The nursing staff would always tell grandma that it was inappropriate to bring Scott and I there.
I swore that I would never end up in a place like that.
And this is one of the reasons why I feel so frustrated when it comes to M.A.i.D..
To have something like M.A.i.D. within my grasp after so many years of living with diagnosed but untreated mental illness gives me hope that I can finally be free. Sadly I have the fucking do-gooder brigade telling me that I have to endure another 15 to 20 years of this life because it allows them to score feel-good points with their deity of choice.
If your deity tells you that M.A.i.D. is a sin, fine, don’t get M.A.i.D..
Just leave me alone.
