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Last year I published the article: Do euthanasia drugs cause a painful death? The article was based on research on autopsies of people who died by lethal injection in capital punishment.  

The research indicated that lethal injection usually results in death by pulmonary edema (similar to drowning). This research is important because the same and similar drugs are used for euthanasia.

After publishing the article a physician, who opposes MAiD [Medical Assistance in Dying], told me that these drugs rarely cause death by pulmonary edema.

On September 21 I read a report by Noah Caldwell, Ailsa Chang and Jolie Myers that was published by NPR which further outlined the research from the autopsies of people who died by capital punishment. The report explains:

It was 2016, and the autopsy reports had been given to him (Dr Joel Zivot) by lawyers representing inmates on death row. He had received simple instructions: Interpret the levels of an anesthetic in the blood to determine whether the inmates were conscious during their execution. As an anesthesiologist at Emory University Hospital in Atlanta, Zivot specialized in reading these levels. But as he looked beyond the toxicology reports, something else caught his eye. The lungs were way too heavy.

He checked another autopsy. Again, heavy lungs. The average human lung weighs about 450 grams. Many of these lungs weighed twice that, sometimes more. His best guess was that they were filled with fluid — but he needed a second opinion. 

His colleague Mark Edgar, an anatomical pathologist at Emory, agreed to help. Zivot didn't mention the lungs at all, to see if Edgar would catch the same aberrations. He did. And he confirmed that Zivot's hunch had been correct — the lungs were filled with a mixture of blood and plasma and other fluids. 

It was a severe form of a condition called pulmonary edema, which can induce the feeling of suffocation or drowning. 

Maybe it was a fluke? Zivot and Edgar needed more autopsies to be sure. Lawyers in other states shared autopsies of former clients who had been executed. The evidence explained why multiple inmates in recent years had gasped for air after their executions began.

Eventually, Zivot and Edgar found pulmonary edema occurring in about three-quarters of more than three dozen autopsy reports they gathered.

When selling euthanasia to legislators and voters (New Zealand referendum) the euthanasia lobby claim that death by lethal injection is a quick and painless death. This research is important because people often support euthanasia based on fear of a painful death.

The NPR article continued:

"The autopsy findings were quite striking and unambiguous," says Zivot. He had imagined that lethal injection induced a quick death and would leave an inmate's body pristine, or at least close to it. But the autopsies told another story. 

"I began to see a picture that was more consistent with a slower death," he says. "A death of organ failure, of a dramatic nature that I recognized would be associated with suffering." 

In some cases, there was even froth and foam in the airways: "Frothy fluid present in the lower airways," read one report. 

The froth was a clue: It meant that the inmates were still alive and trying to breathe as their lungs filled with fluid, because froth could form only if air was still passing through the lungs. It also meant that the pulmonary edema was being caused by the first drug given during a lethal injection, since the second drug, a paralytic, stops the inmate's breathing altogether.

Euthanasia and capital punishment both use a three drug system. The first drug is to anesthetize; the second paralyzes; the third stops the heart. Dr Zivot's asked the question:

"How do we ask an inmate whether or not they experience their own death as cruel?"

This question also applies to euthanasia.

In response to the question that these drugs rarely cause death by pulmonary edema, Zivot's has extended his research to 200 autopsy reports with 84% of those reports indicating signs of pulmonary edema. 

The autopsies were on deaths by capital punishment and not euthanasia, nonetheless, the drugs and protocols to cause death are the same or similar to euthanasia.

The article continued:

Philippe Camus, a pulmonologist in Dijon, France ... has spent decades studying and compiling the various ways that drugs can negatively affect the lungs. He says that when a high dose of drugs is rapidly injected into the body, it pushes a concentrated "front" through the bloodstream. Doses vary slightly by states, but many inmates receive 500 milligrams of midazolam; for comparison, in a hospital setting patients may receive 1 or 2 milligrams.

"The quicker the injection, the denser the front, and the higher the risk of causing damage," Camus says.

Specifically, that concentrated front of drugs damages the thin barrier between blood vessels and air sacs in the lungs. Jeffrey Sippel, a pulmonologist who reviewed autopsies obtained by NPR, likens this phenomenon to a river flooding its banks.

"Water is supposed to be in the river, and the banks are supposed to be dry," he says. In this case, the dry banks are the lungs' air sacs, and the river is a network of capillaries; in healthy lungs, they are separated by a thin membrane. "When there is pulmonary edema, that normal relationship is awry. There's water on the banks where it doesn't belong."

When that membrane breaks, fluid from the capillaries enters the air sacs, impeding one's ability to breathe.

"It would be a feeling of drowning, a feeling of suffocation — a feeling of panic, imminent doom," says Sippel.

Based on the autopsy research from capital punishment deaths, death by lethal injection is usually caused by pulmonary edema, which is similar to drowning.

Covering the inhumane symptoms associated with dying by euthanasia with drugs to anesthetize; and drugs to paralyze does not change the nature of the death.

Furthermore, people have the right to know before consenting to euthanasia.

Alex Schadenberg is Executive Director of the Euthanasia Prevention Coalition