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Background In Switzerland, right-to-die organisations assist their members with suicide by lethal drugs, usually barbiturates. One organisation, Dignitas, has experimented with oxygen deprivation as an alternative to sodium pentobarbital. Objective To analyse the process of assisted suicide by oxygen deprivation with helium and a common face mask and reservoir bag. Method This study examined four cases of assisted suicide by oxygen deprivation using helium delivered via a face mask. Videos of the deaths were provided by the Zurich police. Dignitas provided protocol and consent information. Results One man and three women were assisted to death by oxygen deprivation. There was wide variation in the time to unconsciousness and the time to death, probably due to the poor mask fit. Swiss law prevented attendants from effectively managing the face mask apparatus. Purposeless movements of the extremities were disconcerting for Dignitas attendants, who are accustomed to assisting suicide with barbiturates. None of the dying individuals attempted self-rescue. Conclusions The dying process of oxygen deprivation with helium is potentially quick and appears painless. It also bypasses the prescribing role of physicians, effectively demedicalising assisted suicide. Oxygen deprivation with a face mask is not acceptable because leaks are difficult to control and ir may not eliminate rebreathing. These factors will extend time to unconsciousness and time to death. A hood method could reduce the problem of mask fit. With a hood, a flow rate of helium sufficient to provide continuous washout of expired gases would remedy problems observed with the mask. doi:10.1136/jme.2009.032490

In traumatic brain injury research the process of neuronal cell death and the role neuroprotective agents can play are being investigated. Neuroprotective agents should be given soon after injury to inhibit waves of mediators that bring on secondary injury. No FDA-approved drugs now exist for the indication. A number of investigational agents are being evaluated in clinical trials. Phase II and III drug studies are being conducted in brain-injured patients to evaluate the safety and effectiveness for cutting down mortality and improving functional outcome., Introduction Current researchers are discovering the intricate process of neuronal cell death and establishing the role of neuroprotective agents in improving outcomes following acute traumatic brain injury. Neuroprotective agents are [...]