Clarification about the medications used in a MAID provision 

News & Updates | May 24, 2024 | Dying With Dignity Canada

Home / News & Updates / Clarification about the medications used in a MAID provision 
An image of a syringe resting on four medication vials

(Updated June 7, 2024)

There are three medications used in a MAID provision:  

The first drug is midazolam. It is a benzodiazepine (like “valium”). It is a sedative and anxiolytic. This means it places the patient into a deep state of relaxation. Sometimes the person will fall asleep with this medication. 

Often, MAID providers will provide lidocaine next to numb the vein. This is because the following drug, propofol, can irritate the vein and providers want the process to be as comfortable as possible. 

The next drug is propofol. This drug is commonly used for operations or for sedating patients for emergency procedures. It will place the patient into a deep coma. The doses used in MAID are far larger than those used in surgeries or emergency procedures so we can rest assured that patients do not experience distress when in this deep coma. Sometimes, the coma is so deep that patients stop breathing at this stage. 

It is worth noting that this is not a distressing experience for the patient; the reason they stop breathing is because the coma is so deep that their body no longer cares about breathing. We know this because people who wake up after surgeries or emergency procedures can tell us that the propofol sedation was so deep that they were not distressed by what happened when they were in the medical coma.  

The final drug is rocuronium. This drug paralyzes the muscles in the body. If the patient hasn’t stopped breathing already, they will now stop breathing. Once the body stops breathing, the organs can no longer receive oxygen and one by one the organs will shut down until the heart finally stops beating and the patient dies. 

In 2021, the Senate’s legal and constitutional affairs committee heard from Dr. Joel Zivot, an associate professor of anesthesiology and critical care at Emory University in Atlanta, Ga., who has never provided MAID or witnessed the procedure. He claimed, based on his study of the autopsies of criminals in the United States who were executed by lethal injection including Phenobarbital, that a MAID provision could be painful and a death similar to drowning.   

In the same Senate hearing, Dr. Tim Holland, a MAID assessor and provider and the head of the department of bioethics at Dalhousie University disproved Dr. Zivot’s claims. He explained that Phenobarbital is not used in MAID procedures and Midazolam is not used to end life, as in U.S. executions, but only in small doses to relax the patient. 

Further Dr. Holland told the committee, “Of the medications that Dr. Zivot describes, the main one (Phenobarbital) is not used in our regimen at all. The second one, Midazolam, is not being used in high doses and not being used to end lives. It is being used as a relaxation medication in a much smaller dose for a completely different intention. Of the ones we use to end life (Propofol and Rocuronium), neither of those medications have highlighted any research on causing drowning of lungs. These are things that we have used extensively in other aspects, and people go under and wake up.   

Propofol is used to anesthetize patients for surgeries, resetting broken bones or intubation. In fact, we know precisely how it feels for the patients because, when they regain consciousness, they have no memory of (the procedure they just underwent) and have had no sensation. It’s trying to liken two things that are not the same at all. The medications we’re using are extensively used throughout many countries and there are many experts on this who would back me up on it.” 

Those who have attended a MAID death – family, loved ones, nurses and clinicians – describe the provision as peaceful, calm and that the person drifted off to sleep. While it is always sad because someone is dying, a MAID death is a choice the person made because of an underlying medical condition causing them intolerable suffering and because they were found eligible under the law. 

Read Dr. Holland’s full testimony to the Senate committee in February 2021 here

Read more about the medications used in the MAID provisions in this CTV article

Research paper: Outcomes of lung transplantation from organ donation after medical assistance in dying: First North American experience

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