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Often dying is not easy

In an interview in the Volkskrant (important Dutch paper, October 23, 2021) I said that I had provided sodiumazide to more than a hundred people. I spoke with them about, among other things, the associated dying process with the symptoms of natural dying: change in consciousness, restlessness, confusion, panic, feelings of anxiety, a pointed nose, sunken eyes, rattling, fever and/or heavy sweating, change in breathing, and incontinence. It makes a great impression to experience the dying of a loved person.

On July 18, 2023, A. S. was convicted for supplying sodiumazide. According to the Public Prosecutor and the judge, sodiumazide does not cause a quick and humane death. That’s right, because dying can be difficult. It’s not some kind of cardiac arrest in your sleep. “A beautiful death,” we say, even though we don’t know how the death throes went. And yet, we sign up for a death like that. Unfortunately, as mortal beings we usually face a more difficult death.

After taking an antiemetic, paracetamol (painkiller) and Valium (soothing, muscle relaxing and anti-anxiety medication) and later sodiumazide, a coma and a dying process with more or less dying symptoms will follow. Death is not always quick and painless, but often it is. After all, (ten?) thousands of people obtained sodiumazide. Many probably used it, after which the doctor diagnosed a natural death. If dying with sodiumazide structurally leads to serious complaints, indignant relatives would often have sought publicity, and that is not the case. Apparently the sodiumazide procedure ensures a natural dying process.

By the way: end-of-life assistance by the doctor with pentobarbital is also not easy and can take a long time. The patient must drink a dirty, soapy solution and may vomit some of the pentobarbital. The guideline of the KNMG (Royal Dutch Society of Medicine) states that an infusion should be established in advance and that euthanasia be administered in the event of vomiting. It is also agreed with the applicant and/or relatives how long the dying process may last (for example two hours) before euthanasia takes place, if it takes too long. Euthanasia or terminal palliative sedation (dying in reduced consciousness without food and drink, where stimuli such as sound, touch, pain and thirst can be perceived[1]) can also be difficult. Motivaction (an independent research agency) investigated on behalf of the chairman the experiences of relatives with euthanasia and terminal palliative sedation[2]. Terminal palliative sedation (in the Netherlands in 2022 approximately 38,500 patients) is uncomfortable for 18% and restless for 17%. That is approximately 6,700 patients! Of the approximately 9,000 euthanasia cases: 12% uncomfortable and 9% restless. This is one out of ten patients. I know of no (published) research on this topic. Fortunately, with euthanasia the dying process is short and that is why euthanasia is the ‘royal road’. Although dying with sodiumazide is not always quick and painless, someone may still prefer it. After all, the person concerned is faced with a dilemma: either fall into a coma with sodiumazide and die in a short time, or endure prolonged suffering due to refused euthanasia, or face the threat of palliative sedation or of a senseless continuation of life. It is the choice of the lesser of two evils.

In the case of suicide with sodiumazide, the suicidal person cannot inform virtually anyone in advance. In the Netherlands the Public Prosecutor Service fiercely prosecutes people who help someone to die. Some choose to die alone so that loved ones who want to help, do not risk prosecution. That is a loving choice. I hope that all relatives can accept that loving gesture. Those who have difficulty with this hopefully understand that the suicidal person unfortunately wanted to die alone. Relatives are important, but they should not be self-centered. The focus is on the person who wants to die. We can easily prevent the provision of sodiumazide. With fellow supporters, I wrote the Proposal of the End-of-Life Management Act, an alternative euthanasia law. This proposal does justice to optimal self-determination and autonomy and to careful medical care because the doctor administers the euthanatic drug. The Proposal makes the provision of sodiumazide unnecessary. Wim van Dijk, psychologist. August 2, 2023, Den Bosch.

[1] Coma – Neurochirurgisch Centrum Zwolle (neurochirurgie-zwolle.nl); Coma / Lichamelijke gevolgen / Gevolgen | Hersenletsel-uitleg.nl; Sederen en coma | IC Connect; Het meten van pijn met de REPOS bij de non-communicatieve patiënt. | CATdatabank.nl

[2] Marktonderzoek & advies | Motivaction International 13 juli 2023