Use of Insulin in Physician Assisted Suicide

Some of my followers ask me that insulin is such a common drug used in treatment of Diabetes Mellitus nowadays, why can it be used in Physician Assisted Suicide? It sounds disturbing for them to receive such kind of information from my article. I will explain here its mechanism of leading to death and a number of renowned insulin murder cases worldwide. But please be reassured that proper and careful use of insulin can improve the health of the diabetic patients. I explain it here just because I want to make it clear that it must be used juidiously.

Mechanism of Iatrogenic Hypoglycemia Induced Sudden Cardiac Death

According to an article written by Professor PE Cryer, the Irene E. and Michael M. Karl Professor of Endocrinology and Metabolism in Medicine at the Washington University School of Medicine, iatrogenic hypoglycemia causes hypoglycemia-associated autonomic failure (HAAF). The components of HAAF are defective glucose counter-regulation (a result of absent decrements in insulin, absent increments in glucagon, and attenuated increments in epinephrine), hypoglycemia unawareness (a result of attenuated increments in sympathoadrenal activity), and decreased baroreflex sensitivity. Cardiovascular HAAF that is decreased baroreflex sensitivity results in increased vulnerability to ventricular arrhythmia and subsequently sudden death. Defective glucose counter-regulation and hypoglycemia unawareness lead to recurrent hypoglycemia and sympathoadrenal activation which in turn cause prolonged corrected QT interval of the heart, increase in intracellular calcium, increase in oxygen consumption, increase in platelet function, increase in coagulation, increase in cytokines and decrease in vasodilation. With these effects, it causes ventricular arrhythmia and sudden death. This is the biochemical mechanism of action of hypoglycemia in causing cardiac arrest and it also explains why the patient develops cardiac arrest after injection with excessive dose of insulin.

Cases of Insulin Murder

The first documented case of murder by insulin happened when Kenneth Barlow of the Bradford, Yorkshire of the Northern England discovered his wife, Elizabeth Barlow, unconscious in the bath on 4 May 1957. The Police searched his home and found a couple of used syringes in the kitchen but did not find vials of insulin or other injectable medications. Two hypodermic injection sites were identified on each buttock on 8 May 1957. Measurable quantities of insulin were found in tissues taken from Elizabeth’s buttock. Kenneth was charged with murder but he denied but he could not explain the insulin found inside Elizabeth’s body apart from suggesting that she injected herself. The improbability of self-injection into the buttock brings Kenneth Barlow to a sentence of life imprisonment on 13 December 1957. He was released from the prison 26 years later.

The second case related to the insulin murder I would like to bring your attention to happened in the United States of America. The murderer named William Dale Archerd (also known as James Lynn Arden). He was found guilty on 15 March 1968 of murdering his nephew and two of his seven wives. He presumably stole or bought the insulin as the weapon to kill. He used to work as salesman, mental hospital attendant and serial matrimonialist. For much of the time he was unemployed. It begins when he contacted the police on 24 July 1956 to report an alleged robbery at his home in Los Angeles. He said the robber was armed with guns and hypodermic syringes and used it to inject him and his third wife, Zella, in the buttocks. Zella later turned into coma and convulsion and died next day without regaining consciousness. The police searched the house and found a hypodermic needle and a half-used vial of long-acting insulin in the bathroom. Zella’s death was attributed to bronchopneumonia because no poisonous substances found in her body and there was no method of measuring insulin available at that time. The suspicion of murder remained. The second death was William’s fifth wife, Juanita. She was found to be in coma on 12 March 1958. She was taken to hospital but died only a few hours after being found and without regaining consciousness. She had a low blood sugar without obvious medical explanation. Her death was almost certainly due to insulin but the crucial test was not done. The death of his sixth wife’s ex-husband on 17 March 1960 drew the Police attention once again. On 21 August 1961, William had taken his nephew to the hospital in a semi-comatose state. His nephew was involved in hit-and-run traffic accident in Nevada. His nephew turned into fully comatose state during the evening and night of 23 August 1961, shortly after a visit from William and he never regained consciousness and died 10 days later on 2 September 1961. The only laboratory abnormality recorded in his clinical notes was a low glucose concentration in his cerebrospinal fluid. In view of Kenneth Barlow’s case in the United Kingdom, the investigator had considered the coma was due to insulin. But they had no means of proving it and the death was put down to the car accident that had brought him into hospital. William‘s seventh wife, Mary Brinker Arden, became bankrupt one year after their marriage. They separated and when Mary had a traffic accident on 28 October 1966, William went to her house to console her and two days later Mary was found coma and admitted to the hospital and she died next day without recovering consciousness. Blood tests showed she had a very low blood glucose level. With the development of the new technology, immunohistology, they were able to identify abnormally high quantities of insulin from Mary’s brain tissue. William was found guilty by the presiding judge on three counts of first-degree murder for the deaths of his nephew, Zella and Mary on 15 March 1968 at the age of 55. He was sentenced to death. In 1972, William’s sentence was commuted to life imprisonment after US Supreme Court had ruled that the death penalty was a ‘cruel and unusual punishment’. He died of pneumonia at the age 65.

Every drug carries its side effects and when it is used judiciously, it often benefits the patients instead of causing bodily harms.