Journal Published Online: 01 November 1990
Volume 35, Issue 6

Euthanasia: A Challenge for the Forensic Toxicologist

CODEN: JFSCAS

Abstract

People die daily in the hospital. Mostly, they die because their illnesses were no longer treatable (natural death). Unfortunately, some people die an unnatural death, in particular, as the result of euthanasia. In contrast to the situation in most countries, in the Netherlands euthanasia is accepted by the courts under strict conditions. It can be very difficult for the legal authorities to establish whether a person has died from natural causes or from suicide, euthanasia, or murder. In addition to the pathologist and the lawyer, the toxicologist also has a number of problems in showing whether euthanasia has been carried out. These can consist of the following analytical problems:

(a) interactions—the patients involved have frequently been receiving a large number of toxic and nontoxic drugs simultaneously;

(b) identification—not all drugs administered are included in general screening procedures;

(c) metabolites—a large number of metabolites may have accumulated toward the end of a long therapeutic regimen; and

(d) determination—determination of quaternary muscle relaxants and their various metabolites, as well as other drugs, can be problematic.

There are also toxicokinetic problems: because of poor kidney and liver function, low serum albumen, general malaise, and interactions between these factors and other drugs, the kinetics of a given drug can differ from normal. This makes it all the more difficult to determine whether the patient died from an accumulation of medication or from a so-called “euthanetic” drug mixture.

The case report of a 79-year-old man who died as a result of either pneumonia or a high pentazocine blood concentration (2200 µg/L) is discussed as an example of these problems. Using a pharmacokinetic calculation, it can be shown that the patient died as the result of an overdose of pentazocine rather than as a result of normal medication.

Author Information

Uges, DRA
University Hospital, Groningen, The Netherlands
Greijdanus, B
University Hospital, Groningen, The Netherlands
Pages: 7
Price: $25.00
Related
Reprints and Permissions
Reprints and copyright permissions can be requested through the
Copyright Clearance Center
Details
Stock #: JFS12978J
ISSN: 0022-1198
DOI: 10.1520/JFS12978J