In the 2011 documentary Terry Pratchett: Choosing To Die, the final 10 minutes show a man at a Dignitas clinic in Switzerland drinking a lethal dose of Nembutal. There are a number of camera/editing cuts, and it’s not entirely clear whether they are portraying evengs in real time. He shows the first symptoms of inebriation after about 60 seconds, and roughly 30 seconds after that, he appears to be fully unconscious.
Question: Have they edited out any significant amount of time between administration of the Nembutal and onset of symptoms, or does it really work that fast?
The entire documentary is on YouTube, and the man’s suicide can be seen at the link below:
My wife has worked as a vet tech, where pentobarbitol is used for both euthanasia and anaesthesia. She says that an animal will go limp within seconds of injection.
That makes sense, since you’re dumping it right into the bloodstream. But in the video, the man takes it orally, which presumably results in a delay before blood levels reach useful levels. Just wondering how long that is.
From this link, Machine Elf, it looks like it takes 10-30 minutes for onset after oral administration. As opposed to “almost immediately” after IV administration. FWIW, I found a study comparing efficacy of oral pentobarbitol with chloral hydrate, and the onset of sedation time for pentobarbitol in infants was 19 +/- 14 minutes. So I’m guessing there’s a bit of variance between individuals, along with variance due to fasting, other food in the gut, etc…
Last I heard he had already started the process of getting everything order for his own assisted death for when his Alzheimer disease makes him no longer capable of making that decision. That was in 2011. I don’t know if he has changed his mind since then but I doubt it.
One of these days I’m going to have to watch that documentary.
Seeing that Alzheimers and Parkinsons both run, nay gallop in my family I have similar plans. [I also have debilitating arthritis in over half the joints in my body and it is just getting worse all the time. I figure I probably have another 20 years before shuffling off my mortal coil.]
Your link is not specific, but I’m guessing the whole page applies to therapeutic doses. Moreover, I’m guessing that it applies to pentobarbital delivered orally in pill (i.e. solid) form.
Is it possible that a lethal dose (9-10 grams) delivered orally as a liquid solution might act considerably faster? As fast as the documentary suggests (i.e. unconsciousness in ~90 seconds), or is that not likely?
I don’t know from first principles whether a massive liquid oral overdose would rapidly lead to sufficient blood concentrations to enable CNS and respiratory depression. I’m neither an M.D., nor a Pharm. D., and it’s been a long time since I had to model simple pharmacokinetics in school.
I can however, link to this 2005 article in the New England Journal of Medicine, by Dr. Susan Okie, where she cites data from Oregon’s assisted suicides. FTA at 1628:
This link is to a wiki which mentions two tables of time-to-death after Nembutal solution ingestion. The data ostensibly came from Dutch and Swiss euthanasia cases. Total number of cases for both were 380, and 264 of those were dead within 30 minutes after ingestion. It doesn’t mention time to onset of unconsciousness, however. The gist I get from reading various right-to-die sites is that unconsciousness happens much more rapidly than death. Further, as the infant sedation study I linked to in my earlier post shows, the onset of effects is really dependent on the individual, what’s in their stomach, any drugs they’re taking along with the barbiturate, any tolerance to the barbiturate, etc…
This link mentions a 1996-1997 report by Dr. Meinrad Schaer, the president of a Swiss euthanasia advocacy society, on individual cases of assisted suicide in Switzerland. (Scroll down to the individual cases) While he’s clearing cherry-picking the successful cases, a brief scan of his cited cases listed the onset of unconsciousness after oral administration, to be anywhere from two minutes to fifteen minutes, with a median of around five minutes. 90 seconds therefore seems a bit fast, and more in line with the cases of intravenous administration he mentioned.
My money is that the filmmakers did some helpful editing, but I’m not at all certain in that assessment.
I can attempt to answer any questions here, though in reference to what I said above all I have is vaguely remembered, off-the-cuff, second hand knowledge.
There are also some veterinarians and doctors on this message board that might be able to better answer any questions you have (though they won’t give you actual medical advice!) If your question isn’t directly related to this thread you’ll probably get better answers if you start a new one.