{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T14:11:18Z","timestamp":1767276678938,"version":"build-2065373602"},"reference-count":58,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T00:00:00Z","timestamp":1550620800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    A decision by a society to sanction assisted dying in any form should logically go hand\u2010in\u2010hand with defining the acceptable method(s). Assisted dying is legal in several countries and we have reviewed the methods commonly used, contrasting these with an analysis of capital punishment in the\n                    <jats:styled-content style=\"fixed-case\">USA<\/jats:styled-content>\n                    . We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used. However, the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined. In voluntary assisted dying (in some\n                    <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>\n                    states and European countries), the common method to induce unconsciousness appears to be self\u2010administered barbiturate ingestion, with death resulting slowly from asphyxia due to cardiorespiratory depression. Physician\u2010administered injections (a combination of general anaesthetic and neuromuscular blockade) are an option in Dutch guidelines. Hypoxic methods involving helium rebreathing have also been reported. The method of capital punishment (\n                    <jats:styled-content style=\"fixed-case\">USA<\/jats:styled-content>\n                    ) resembles the Dutch injection technique, but specific drugs, doses and monitoring employed vary. However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7\u00a0days), and re\u2010awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane, and we have used lessons from the most recent studies of accidental awareness during anaesthesia to describe an optimal means that could better achieve unconsciousness. We found that the very act of defining an \u2018optimum\u2019 itself has important implications for ethics and the law.\n                  <\/jats:p>","DOI":"10.1111\/anae.14532","type":"journal-article","created":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T20:00:43Z","timestamp":1550692843000},"page":"630-637","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying"],"prefix":"10.1111","volume":"74","author":[{"given":"S.","family":"Sinmyee","sequence":"first","affiliation":[{"name":"Department of Anaesthesia Northwick Park Hospital London North West Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V. 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