Death ‘is not a medical process. It shouldn’t be made one’: Suicide pod stirs controversy among right-to-die proponents

Last September, in a quiet Swiss forest at the edge of the German border, an anonymous 64-year-old American woman climbed into Sarco, the world’s first suicide pod, pressed a button to release nitrogen gas and died. Sarco’s Australian inventor watched the proceedings from a safe distance in Germany. As darkness fell, a swarm of policemen arrived to arrest the sole witness.

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In 1996, Philip Nitschke became the world’s first doctor to legally administer a lethal injection. Nitschke rigged a laptop to let his cancer-ravaged patient in Darwin, Australia, trigger the flow of drugs into his veins. Nitschke was so nervous about whether his “Deliverance Machine” would work that he had to peel his perspiration-soaked shirt away from his chest afterward. He’s been inventing suicide machines ever since.

Nitschke, who earned a physics PhD before entering medicine, leads the 40,000 member right-to-die society Exit International. He’s devoted 10 years to developing the sleek capsule he calls Sarco (short for sarcophagus, the stone coffin used by ancient civilizations). Sarco is illegal in Canada and many jurisdictions. Its long-awaited launch, marred by Swiss homicide charges and its confiscation by authorities, means the 300-or-so people, including six Canadians, on Exit’s waiting list for death must wait a bit longer.

Nitschke now spends almost as much time clashing with his fellow right-to-die advocates as he does with euthanasia opponents. “Some of these groups,” he says, “have not said the most flattering things about the Sarco, which is a bit hurtful.”

He highlights their philosophical differences: his detractors, he says, cling to an outdated model in which doctors adjudicate the autonomy of competent adults. He’d rather wrest control away from physicians. He believes death “is not a medical process. It shouldn’t be made one.”

In 2015, Nitschke burned his medical licence over what he considered overly restrictive conditions attached to his reinstatement by the Medical Board of Australia, which had suspended him on suspicion of being a threat to public safety. He then decamped to the Netherlands in disgust.

Swiss palliative care physician Erika Preisig runs Life Circle, an assisted-suicide association, near Basel. She says she can’t understand why this ex-doctor keeps pushing for technology to replace the human touch dying patients need.

In the Netherlands, euthanasia is legal. In Switzerland, it’s a crime. Swiss doctors can’t kill their patients but since 1942, they’ve been allowed to help them die. In 2003, there were 187 assisted suicides in the country. That figure rose to 1,729 in 2023.

A representative for the Swiss Doctors Federation attributed this increase partly to the rapidly waning influence of religion in Swiss society. But there’s no right to assisted suicide, the spokesman assured me by email. Only a minority – 40 doctors in a population of nine million – define it as a medical duty. They conduct two consultations, at least 14 days apart, before concluding that a mentally competent adult is suffering unbearably from functional or medical limitations. The standard 15-gram dose of the barbiturate sodium pentobarbital is strong enough, Preisig told a 2022 webinar audience, to kill an elephant.

Foreign applicants follow similar steps. They also submit two medical reports plus a certificate of capacity. Once approved, they pay a fee of 3,000 Swiss francs (about C$4,700). They can wait as long as they like before travelling to die.

In 2006, Preisig’s 82-year-old father, debilitated by a stroke, threatened to jump in front of a train. She held him as he swallowed the bitter barbiturate instead. He died, and she became a champion of assisted suicide.

Now 75, Preisig calls life a wonderful gift. “You’re allowed to give it back, well reflected … I’m afraid that with Sarco, too many people (will) throw their life away.”

Her five-doctor team has helped more than 600 people die. Now, Preisig lobbies reluctant Swiss physicians to integrate assisted suicide into their practices.

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Sarco’s Sept. 23 inauguration went spectacularly awry. After being notified of the American woman’s death as stipulated by Swiss law, police arrested Florian Willet, the director of The Last Resort, the Swiss non-profit Nitschke set up to debut the capsule. Willet was held for 10 weeks while tight-lipped authorities refused to comment. The unexpected fallout of that silent death in the forest stunned Nitschke, whose legal team had confirmed Sarco’s legality.

Prosecutor Peter Sticher told the newspaper Blick: “‘We warned them … that if they came to Schaffhausen and used Sarco, they would face criminal consequences.’” Sticher, citing the ongoing investigation, declined to speak with me.

Willet was released in early December. He got his passport back but remains in a “fragile” state, says Nitschke.

Five months later, there’s still no autopsy report to address the accounts of strangulation marks on the woman’s neck. This puzzles Preisig.

“I’m sure Nitschke didn’t do something wrong with the Sarco,” she says, “and Willet didn’t strangle that lady.” Only the missing report can tell whether the dead woman suffered. If so, she says, we “must stop people” from using Sarco.

Only the missing report can tell whether the dead woman suffered.

Preisig wonders why anybody would invent a Sarco. Given the efficacy of sodium pentobarbital, “the best medication you can have,” there’s no need for it, she says. She doesn’t trust Nitschke’s claims that patients die peacefully: “I cannot believe it … How can he say people in his Sarco will not cramp?”

She cites the 2024 execution of Alabama death-row prisoner Kenneth Smith. Eyewitnesses reportedly saw him “writhe and convulse” on the gurney after being forced to inhale pure nitrogen through a mask. “You can’t let people die like that,” says Preisig. “(Nitschke) is crazy.” Besides, she insists, pushing a button while encrypted in a shiny futuristic capsule is a lonely, meaningless way to die.

Nitschke, who has testified against the cruelty of using nitrogen in executions, counters that such executions can’t be compared to a Sarco suicide. Capital punishment involves people “who don’t want to die.” But when the willing inhale deep lungfulls of nitrogen gas to embrace death, their co-operation “makes a world of difference.”

Both Nitschke and Preisig are secular humanists who reject religious dogma and advocate for the right to die. But she supports the physician-gatekeeper role, saying that trust between doctor and patient prevents suicides when patients are in crisis. But with Sarco, “you can just push a button” without a living being to guide you out of despair.

For Nitschke, scarred by his brief and unhappy tenure as a physician, Sarco’s advantage is that it bypasses medical oversight, including the need for barbiturate prescriptions. He insists doctors have no business making end-of-life decisions. But, Preisig says, “it’s not about power. It’s about safety.”

Neither believes doctors should take the final step by opening an IV line or feeding someone pentobarbital. They believe in assisting suicide, not committing homicide.

Preisig says patients must take responsibility for their decisions. They must ingest the barbiturate, as her father did. Or she’ll set up an IV drip, which patients must activate. This safeguard prevents doctors from killing patients who don’t want to die. “I am willing to set an IV that they can open. I’m not willing to do the injection myself. I don’t want to kill anybody.”

Although the media christened him “Dr. Death” years ago, Nitschke too says, “I don’t want to be an executioner.” He’ll insert tubing into the vein, but the patient pushes the plunger. “The decision is not mine.”

Nitschke’s first collaborator was the Dutch industrial designer Alexander Bannink, who, according to Nitschke, suffered some sort of crisis and “suddenly decided he wanted nothing more to do with the project … and severed contact.” Bannink confirmed that he quit four years ago but says he’s bound by a mutual confidentiality agreement.

Nitschke, 77, is a polarizing figure with a penchant for self-promotion who performed the comedy routine Dicing with Dr. Death at the Edinburgh Fringe festival in 2015 – a performance London’s Telegraph skewered as “witlessly infantile.”

Some detractors call him a publicity hound who has solicited free advertising by continually hawking Sarco prototypes at trade shows. Others see him as an entrepreneur-inventor. He calls himself an activist.

He has no immediate plans to die, though he’s long stocked Nembutal in his cupboard. He speaks of his Sarco in reverential tones, describing it as a “vehicle going somewhere, with a certain degree of style, a bit of elegance.” He’s not sure where it takes you, but its clean aesthetic pleases him. At an Amsterdam funeral fair in 2018, spectators clambered in and donned virtual reality goggles to experience the sensation of rising from the earth post-suicide.

Nitschke says you can “look back down and you can see the capsule becoming smaller and smaller and then you see the curvature of the earth as you sort of disappear into the stratosphere.”

He may be more of a death-idealist than anything else. He’s pragmatic, too.

He promised this first Sarco to a Dutch museum. Now that it’s been impounded, he’s refining Sarco’s next iteration so his adherents can die when they want, on their own terms.