as of August 2024 - look for updated protocols at ACAMAID

The medications (DDMAPh):

• Digoxin 100mg

• Diazepam 1000mg

• Morphine 15,000mg

• Amitriptyline 8000mg

• Phenobarbital 5000mg

WARNING: These medications are extremely toxic. Once reconstituted, extreme care must be taken so that no one can willfully or accidentally ingest ANY amount of it as it can result in loss of consciousness, heart rhythm disturbance, brain damage or death. This has been known to happen even after a small sip of the medication or even using the same spoon that has been in the patient’s mouth following ingestion. All equipment ( cups, spoons, and/or the original bottle containing the medication) should be washed with soapy water and then discarded.

24 hours before taking aid-in-dying medications:

1. Continue all of your usual medications unless you’ve received specific other instructions.

2. Starting after dinner, the night before you take aid-in-dying medications: Do not eat any solid foods. Water and other clear, non-fatty fluids are fine, but don’t take in large volumes of liquid.

3. Continue to not eat any solid foods on the aid-in-dying day. No breakfast or lunch on that day, only clear liquids.

4. 30 minutes prior to taking MAiD medications, take the anti-nausea medications:

   • 8 mg of Zofran (Ondansetron)

   • 20 mg of Reglan (Metoclopramide)

5. Just prior to swallowing the bottle of the lethal medication, gradually pour the 2 ounces of liquid into the bottle containing the medication using:

   • 2 ounces of warm (not hot) water OR

   • 2 ounces of clear juice (Apple juice or Gatorade)

6. Suck on an ice pop or a spoonful or two of sorbet (not frozen yogurt or sherbet) until your mouth feels as frozen as you can tolerate

7. Swallow the lethal medication dissolved as above

   • All the liquid lethal medication be swallowed within 2-3 minutes.

   • It will taste bitter. Sometimes sips of water/juice or sorbet (not sherbet) between swallows of meds can be helpful so long as it is done quickly

   • Follow immediately with either sips of juice/Gatorade or water, or bites of ice pop/sorbet to wash the bitter taste away

   • Keep the dying person in a sitting position for at least 20 min, to reduce the risk of regurgitation (after the person loses consciousness)

   • After 20 min they can be lowered to a semi upright position (with the back at 30-45 degrees relative to horizontal) and turned to the right side. Positioning is not required but may help absorption of the life-ending medicine in the small intestine. If you are unable to reposition the person, leave them in a seated position

8. Loss of consciousness occurs within 3 to 5 min, in most cases

   • The time to death after taking the medications varies depending on the person's condition and ability to absorb the medication. The dying person stays unconscious until a peaceful death occurs

9. Once the patient is unconscious and unarousable, supplemental oxygen may be turned off.

10. Ingesting through a feeding tube:

    • For people with feeding tubes, including nasogastric tubes and tubes directly through the skin into the stomach or small intestine, it is generally easy to administer the solutions.

    • After administering the anti-nausea medications, mix the medications with 3 ounces of water or juice and then pour the prescribed mixtures into 1 funnel tip 100cc syringe. This may be done by the patient, a caregiver, or a hospice nurse.

    • When the patient is ready, insert the syringe into the feeding tube and the patient depresses the plunger to empty the syringe. Someone can help to insert and hold the syringe into the tube, but the patient must be the one to press the plunger. The tube should be flushed with water. Afterwards the tube should be clamped as usual.

    • Alternatively, the medication can also be ingested through the tube using a gravity feed bag to which the life ending medication has been added. Note that the patient must self-administer the medication by opening the valve or a clamp.

11. Documentation — Write down the following information, which the attending (prescribing) physician will need for the reporting process.

    • Time anti-nausea medications were taken:

    • Time life ending medications were taken:

    • Time the person lost consciousness:

    • Presumed time of death:

    • Bitterness or burning: none/mild/moderate/severe