Editing Assisted suicide (section)

==Methods==

===Using medications===
Assisted suicide is typically undertaken using medications.<ref>{{Cite journal|url=https://bmjopen.bmj.com/content/10/7/e036054|title=Provision of medical assistance in dying: a scoping review|first1=Max|last1=Zworth|first2=Carol|last2=Saleh|first3=Ian|last3=Ball|first4=Gaelen|last4=Kalles|first5=Anatoli|last5=Chkaroubo|first6=Mike|last6=Kekewich|first7=Paul Q.|last7=Miller|first8=Marianne|last8=Dees|first9=Andrea|last9=Frolic|first10=Simon|last10=Oczkowski|date=1 July 2020|journal=BMJ Open|volume=10|issue=7|pages=e036054|via=bmjopen.bmj.com|doi=10.1136/bmjopen-2019-036054|pmid=32641328|pmc=7348461 }}</ref><ref name="auto6">{{Cite web|url=https://www.stuff.co.nz/national/health/euthanasia-debate/300073069/euthanasia-referendum-what-drugs-are-used-in-assisted-dying-and-how-do-they-work|title=Stuff|website=www.stuff.co.nz}}</ref>

====Ingestion method====
In most jurisdictions the drugs are normally swallowed, with the patient becoming unconscious after a few minutes and then dying within c.2 hours. In Canada drugs are taken by intravenous infusion, with dying normally occurring within minutes.<ref name="auto8"/>

====Medications used====
In Canada a sequence of [[midazolam]], [[propofol]] and [[rocuronium]]
is used.<ref>{{Cite web|url=https://www.dyingwithdignity.ca/blog/clarification-about-the-medications-used-in-a-maid-provision/|title=Clarification about the medications used in a MAID provision|first=Sarah|last=Dobec|date=24 May 2024|website=Dying With Dignity Canada}}</ref>

In the Netherlands very high-dose barbiturates were recommended by the Netherland's Guidelines for the Practice of Euthanasia.<ref name=Worthington/><ref>{{Cite web|url=https://www.government.nl/topics/euthanasia/euthanasia-assisted-suicide-and-non-resuscitation-on-request|title=Euthanasia, assisted suicide and non-resuscitation on request in the Netherlands - Euthanasia - Government.nl|first=Ministerie van Justitie en|last=Veiligheid|date=4 September 2011|website=www.government.nl}}</ref>

In Oregon, in 2022, more than 70% of ingestions used the drug combination DDMAPh ([[diazepam]], [[digoxin]], [[morphine]] sulfate, [[amitriptyline]], [[phenobarbital]]),<ref>{{Cite web |title=Aid in Dying Medications & the Clinical Competencies of Prescribing |url=https://cme.cityofhope.org/sites/default/files/May%20End%20of%20Life%20Symposium%20Webinar%20Series%20Presentation%20Slides.pdf |access-date=2025-05-16}}</ref><ref>{{Cite web|url=https://www.discovermagazine.com/health/medical-aid-in-dying-a-comprehensive-breakdown|title=Medical Aid in Dying: A Comprehensive Breakdown|website=Discover Magazine}}</ref> and 28% used the drug combination DDMA (diazepam, digoxin, morphine sulfate, amitriptyline). These medication combinations have largely replaced the use of individual medications in previous years. Over 2001–22, the median time to death for DDMAPh was 42 minutes and for DDMA 49 minutes.<ref>p9 and p18 of the Oregon Death with Dignity Act 2022 data summary https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year25.pdf</ref>

Other US states also use drug combinations in assisted suicide programs.<ref name=Worthington>{{Cite journal|title=Efficacy and safety of drugs used for 'assisted dying'|first1=Ana|last1=Worthington|first2=Ilora|last2=Finlay|first3=Claud|last3=Regnard|date=4 May 2022|journal=British Medical Bulletin|volume=142|issue=1|pages=15–22|doi=10.1093/bmb/ldac009|pmid=35512347|pmc=9270985}}</ref>

In the [[Dignitas (non-profit organisation)|Dignitas]] program in Switzerland,  after taking an anti-emetic, the person ingests sodium [[pentobarbital]] (NaP), usually 15 grams. This is normally drunk in water, but may be ingested by gastric tube or intravenously.<ref name="auto5"/> In the Swiss [[Pegasos Swiss Association|Pegasos]] program, sodium pentobarbital is taken intravenously.<ref>{{Cite web|url=https://pegasos-association.com/faqs/|title=FAQs|website=Pegasos Swiss Association}}</ref>

[[File:Secobarbital DOJ.jpg|thumb|[[Secobarbital]] was one of the most commonly prescribed drugs for physician-assisted suicide in the United States.<ref>{{cite journal | vauthors = Hedberg K, Hopkins D, Kohn M | title = Five years of legal physician-assisted suicide in Oregon | journal = The New England Journal of Medicine | volume = 348 | issue = 10 | pages = 961–964 | date = March 2003 | pmid = 12621146 | doi = 10.1056/NEJM200303063481022 | doi-access = free }}</ref>]]
Medications that have been used in assisted suicide include
* [[Barbiturate]]s, particularly [[Secobarbital#Use in assisted dying|secobarbital]] (brand name Seconal)<ref name="auto">{{cite web | url=https://www.npr.org/sections/health-shots/2016/03/23/471595323/drug-company-jacks-up-cost-of-aid-in-dying-medication | title=Drug Company Jacks up Cost of Aid-In-Dying Medication | work=NPR | date=23 March 2016 | vauthors = Dembosky A }}</ref><ref>{{Cite news |last=Bryden |first=Joan |date=November 17, 2017 |title=Newly available drug secobarbital could boost number of self-administered assisted deaths |url=https://www.cbc.ca/news/politics/secobarbital-canada-assisted-dying-1.4406784 |access-date=2025-05-16 |work=[[CBC News]]}}</ref> and [[pentobarbital]]<ref>{{Cite news|url=https://www1.racgp.org.au/newsgp/clinical/victoria-confirms-access-to-medication-for-volunta|title=Victoria confirms access to medication for voluntary assisted dying|website=NewsGP}}</ref><ref>{{Cite news|url=https://www.abc.net.au/news/2017-10-20/assisted-dying-what-is-need-from-drugs-for-voluntary-euthanasia/9069896|title=Dying a good death: What's needed from voluntary euthanasia drugs|newspaper=ABC News |date=20 October 2017|via=www.abc.net.au}}</ref>
* [[Propofol]]<ref name="auto1">{{Cite journal|url=https://www.cmajopen.ca/content/10/1/E19|title=Medications and dosages used in medical assistance in dying: a cross-sectional study|first1=Igor|last1=Stukalin|first2=Oluwatobi R.|last2=Olaiya|first3=Viren|last3=Naik|first4=Ellen|last4=Wiebe|first5=Mike|last5=Kekewich|first6=Michaela|last6=Kelly|first7=Laura|last7=Wilding|first8=Roxanne|last8=Halko|first9=Simon|last9=Oczkowski|date=1 January 2022|journal= CMAJ Open|volume=10|issue=1|pages=E19–E26|via=www.cmajopen.ca|doi=10.9778/cmajo.20200268|pmid=35042691|pmc=8920593 }}</ref>
* [[Midazolam]]<ref name="auto1"/>
* [[Rocuronium]]<ref name="auto1"/>
* Combinations of medications are sometimes used.<ref name="auto"/>

Other medications and medication combinations have been considered.<ref>{{Cite web|url=https://www.theatlantic.com/health/archive/2019/01/medical-aid-in-dying-medications/580591/|title=The Doctors Who Invented a New Way to Help People Die|first=Jennie|last=Dear|website=[[The Atlantic]] |date=22 January 2019}}</ref><ref>{{Cite web |title=Assisted Suicide Deaths Are Not Peaceful as Patients Take High Doses of Experimental Drugs Which Generate Complications |url=https://patientsrightsaction.org/wp-content/uploads/2022/04/PRAF-Assisted-Suicide-Deaths-Not-Peaceful-4-25-long.pdf |access-date=2025-05-16}}</ref>

====Research====
Little research has been done on brain activity, blood levels or lung impacts during dying by these medications.<ref>{{Cite journal|title=Efficacy and safety of drugs used for 'assisted dying' - PMC|date=2022 |pmc=9270985 |journal=British Medical Bulletin |volume=142 |issue=1 |pages=15–22 |doi=10.1093/bmb/ldac009 |pmid=35512347 | vauthors = Worthington A, Finlay I, Regnard C }}</ref>

===Using gases===
[[Inert gas asphyxiation]] by nitrogen has been used in assisted suicide<ref>{{Cite web|url=https://www.thetimes.com/world/europe/article/suicide-pod-boss-detained-amid-strangulation-mark-claims-r23n0zrq9|title=Suicide pod boss detained amid 'strangulation mark' claims|first=Adam Sage|last=Paris|date=29 October 2024|website=www.thetimes.com}}</ref> (and also in legal execution<ref>{{Cite news|url=https://www.theguardian.com/us-news/2024/jan/26/what-is-nitrogen-gas-execution-risks|title=Nitrogen gas execution: how it works and why it's controversial|first=Gloria|last=Oladipo|date=26 January 2024|newspaper=The Guardian}}</ref>).

===Medical staff, provider or other person may be present===

Medical staff may be involved as 'gatekeepers'. Volunteers may be present. However, in the Oregon programme in 2022, no provider or volunteer was present in 28% of cases when meds were ingested, and in 55% of cases at time of death.<ref>p14 of the Oregon Death with Dignity Act 2022 data summary https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year25.pdf</ref>

===Duo-euthanasia===
In duo-euthanasia partners die together. In the Netherlands 66 people (33 couples) died by duo-euthanasia in 2023.<ref>{{Cite web|url=https://www.bbc.co.uk/news/articles/c0jjq2vynq7o|title=Duo euthanasia: Why a happily married couple decided to die together|date=28 June 2024|website=BBC News}}</ref><ref>{{Cite news |date=2024-02-13 |title=‘Duo euthanasia’: In the Netherlands, a famous couple chooses to die together |url=https://www.washingtonpost.com/world/2024/02/13/netherlands-duo-euthanasia-dutch-prime-minister/ |archive-url=http://web.archive.org/web/20240213080905/https://www.washingtonpost.com/world/2024/02/13/netherlands-duo-euthanasia-dutch-prime-minister/ |archive-date=2024-02-13 |access-date=2025-05-16 |work=Washington Post |language=en}}</ref><ref>{{Cite news|url=https://www.theguardian.com/world/2024/feb/10/duo-euthanasia-former-dutch-prime-minister-dies-wife-dries-eugenie-van-agt|title=Duo euthanasia: former Dutch prime minister dies hand in hand with his wife|first=Senay|last=Boztas|newspaper=The Observer |date=10 February 2024|via=The Guardian}}</ref>

===Organ donation===
In the Netherlands assisted dying followed by organ donation is legal.<ref name="auto6"/>