title: Assisted suicide by oxygen deprivation with helium at a Swiss right-to-die organisation.
abstract: BACKGROUND
  In Switzerland, right-to-die organisations assist their members with suicide by lethal drugs, usually barbiturates. One organisation, Dignitas, has experimented with oxygen deprivation as an alternative to sodium pentobarbital.
  
  
  OBJECTIVE
  To analyse the process of assisted suicide by oxygen deprivation with helium and a common face mask and reservoir bag.
  
  
  METHODS
  This study examined four cases of assisted suicide by oxygen deprivation using helium delivered via a face mask. Videos of the deaths were provided by the Zurich police. Dignitas provided protocol and consent information.
  
  
  RESULTS
  One man and three women were assisted to death by oxygen deprivation. There was wide variation in the time to unconsciousness and the time to death, probably due to the poor mask fit. Swiss law prevented attendants from effectively managing the face mask apparatus. Purposeless movements of the extremities were disconcerting for Dignitas attendants, who are accustomed to assisting suicide with barbiturates. None of the dying individuals attempted self-rescue.
  
  
  CONCLUSIONS
  The dying process of oxygen deprivation with helium is potentially quick and appears painless. It also bypasses the prescribing role of physicians, effectively demedicalising assisted suicide. Oxygen deprivation with a face mask is not acceptable because leaks are difficult to control and it may not eliminate rebreathing. These factors will extend time to unconsciousness and time to death. A hood method could reduce the problem of mask fit. With a hood, a flow rate of helium sufficient to provide continuous washout of expired gases would remedy problems observed with the mask.
authors.affiliation: Groningen University, Groningen, The Netherlands. rdogden@telus.net
authors.forename: Russel D
authors.initials: RD
authors.lastname: Ogden
authors.forename: William K
authors.initials: WK
authors.lastname: Hamilton
authors.forename: Charles
authors.initials: C
authors.lastname: Whitcher
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000369:Aged, 80 and over; D001237:Asphyxia / Q000209:etiology*; D001293:Attitude to Death; D005260:Female; D006371:Helium / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008397:Masks; D008875:Middle Aged; D010817:Physician-Patient Relations / Q000941:ethics*; D012297:Right to Die / Q000941:ethics* / Q000331:legislation & jurisprudence; D017236:Suicide, Assisted / Q000941:ethics* / Q000331:legislation & jurisprudence; D013557:Switzerland
chemical_list: D006371:Helium