(Received 30 October 1989; accepted 4 December 1989)
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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.
Chemist, University Hospital, Groningen,
Forensic and clinical toxicologist, University Hospital, Groningen,
Stock #: JFS12978J