Assisted suicide by infusion of thiopental. A toxicological examination of case reports from the years 2021-2023

As a consequence of the ruling of the Federal Constitutional Court on euthanasia in 2020, a series (n = 23) of assisted suicides from the years 2021-2023 were investigated in the Berlin State Institute for Forensic and Social Medicine. All cases had identical circumstances (sequence, documentation, persons involved, drug used). In each case the assisting medical person inserted an intravenous access. After a self-administered opening by the person wanting to die, thiopental was infused in lethal doses (5-10 g). The present paper describes these cases from a toxicological point of view and presents the results of the toxicological investigations. Concentrations ranging from 3.2 to 174 mu g/ml of thiopental were detected in postmortem femoral blood and additionally heart blood and liver fluid were examined in two cases. In addition to effects of postmortem redistribution and incomplete drug distribution, factors such as the dosage used, physical constitution and duration of death are discussed as reasons for the wide range of concentrations. In the majority of autopsies, reddish-brown, reticular skin discoloration originating from the vascular access sites and crystal-like endocardial changes were found that were attributable to intravenous thiopental administration.