October 15, 2024
The Doctor Behind ‘Suicide Pod’ Wants AI to Assist EOL
The Doctor Behind the ‘Suicide Pod’ Wants AI to Assist at the End of Life
The death of an American woman inside Philip Nitschke’s latest invention reveals the next frontier in the right-to-die debate.
The world’s first assisted suicide pod wraps around the human body like a space capsule, tilting gently toward the sky.
The device is designed to look as if the person inside were embarking on a journey, says its inventor, the Australian right-to-die activist Philip Nitschke. “It gives you the idea you’re saying goodbye to the world.”
Last month, the 3D-printed pod was used for the first time. In a forest on the Swiss-German border, an unnamed 64-year-old American woman pressed the pod’s button to release deadly nitrogen gas.
She died seven minutes later, estimated the Swiss assisted suicide group The Last Resort, whose president Florian Willet was present at her death and was later detained for “aiding and abetting” the woman’s suicide. Nitschke tried to watch by video link, although he describes the signal as patchy.
For three decades, Nitschke has tested society’s limits for assisted suicide.
His efforts to make deadly drugs more accessible, whether the people who want them are terminally ill or not, caused his medical license to be temporarily stripped in 2014, a book he wrote to be banned, and for people to publicly blame him for the death of their loved ones.
The New Age of Medicine
Now he is using his latest device—called Sarco, named after an ancient sarcophagus—to provoke a new debate about the role of doctors in countries where assisted suicide has been made legal.
In most places, the process is treated as part of the medical system.
Patients rely on medical professionals—first to assess whether they meet the criteria (in many countries, patients must be terminally ill; in others, they must prove they are mentally fit to consent to their decision).
Then, doctors often administer the treatment, for example, either injecting or handing over the drugs.
With the Sarco pod, Nitschke proposes taking the assessment process out of the hands of medical professionals—whom he calls “gatekeepers”—and eventually delegating the task to machines.
“I think a machine could do it better,” he tells WIRED.
The Sarco machine has the ability to ask its users three simple questions, says Nitschke: Who are you? Where are you? Do you know if you press this button, you will die?
If the person inside the pod responds to the questions with the correct preprogrammed answers, a blue button lights up.
During its first deployment in the Swiss forest, the Sarco’s question-asking software was not enabled, according to Nitschke, and he admits the technology at this moment is not nearly sophisticated enough to replace a medical assessment.
The American woman was still assessed by a medical professional before she stepped into the machine.
“It’s really to show what could be in the future, to show that that technology has the ability to do some basic screening, that it gets around the idea that there needs to be some other person there standing in their way.”
To the problem of machine-bias, he has no immediate answer. It should be looked into, he says.
Once the Sarco’s button is pressed from the inside, nitrogen begins to fill the chamber. “Within 30 seconds, [the air] drops from 21 percent oxygen down to less than 0.4 percent,” Nitschke explains.
The pod’s setup encourages its users to take deep breaths, which would result in a “peaceful death,” he claims—unlike the Alabama prison execution of inmate Kenneth Smith earlier this year, when witnesses reported him violently shaking after breathing in nitrogen through a mask.
Due to the ongoing legal case over the Sarco machine—police raided his office in the Netherlands last week—Nitschke declined to answer any questions on what happened in the forest.
But one thing is clear: Nitschke is not finished.
The pod costs around $15,000 to 3D print, and he’s hoping to drive that cost down, while attempting to integrate machine learning to make the Sarco’s assessment of a person’s consent more sophisticated—a prospect others in the right-to-die movement are deeply skeptical about.
“We really want to develop that part of the process so that a person can have their mental capacity assessed by the software, rather than … spending half an hour with a psychiatrist,” he says.
The 371 people who were in the process of applying to use the Sarco in Switzerland have had their applications suspended, as part of the ongoing criminal investigation.
He argues that machines give people true agency by enabling them to initiate the process of dying themselves, without relying on “prejudiced” medical professionals to judge whether their reason for wanting to die is legitimate.
He believes the people who come to him for help must meet only two criteria: “You’ve got to be of sound mind and you’ve got to be an adult.”
One of the most common non-medical reasons people approach him, he says, is because their husband or wife is terminally ill. One woman he met said she didn’t want to live beyond 80, he claims.
“I see [technology] as important in democratizing the process and demedicalizing the process,” says Nitschke, adding the Sarco is not reliant on heavily restricted drugs to operate.
“So all of those issues are ways to make the process more equitable.”
In Switzerland, where the Sarco was used, Nitschke’s arguments about access to assisted suicide are not particularly radical.
Residents and visitors can already access assisted suicide even if they are not terminally ill.
But in Nitschke’s adopted home country of the Netherlands, the Sarco reflects an ongoing debate about assisted suicide’s place in a medical system that dictates only people facing unbearable suffering or an incurable condition can proceed.
Nitschke also believes the promise of machines is to take the burden away from the doctor.
“I’m passionate about a person’s right to have access to help-to-die, but I don’t see why they should turn me into a murderer,” says Nitschke, who earned a medical degree in 1989.
Theo Boer, who spent nine years assessing thousands of assisted suicide cases on behalf of the Dutch government, disagrees that gatekeepers are a bad thing.
“We cannot just leave this to the market,” he says, “because it is dangerous.” Yet he is more sympathetic to Nitschke’s point that doctors should not be burdened with the emotional stress in countries where assisted suicide is legal.
“Even though what he does is weird, it contributes to the much-needed discussion in the Netherlands, whether or not we need this heavy involvement of doctors,” says Boer, who is now a professor of health care ethics at the Groningen Theological University.
“We cannot burden the doctor with solving all our problems,” he says.
For three decades, Nitschke has been an agitator in the right-to-die debate.
“He’s a provocateur,” says Michael Cholbi, a philosophy professor at the University of Edinburgh and founder of the International Association for the Philosophy of Death and Dying.
Cholbi is skeptical about whether the Sarco would ever become normalized, but he believes Nitschke’s creation, even if it strikes some as irresponsible, raises important questions.
“He’s trying to catalyze a perhaps difficult conversation around people’s right to access suicide technologies,” he says.
Now 77, Nitschke first explored the idea of delegating assisted suicide to machines in the 1990s.
After Australia’s Northern Territory became the world’s first jurisdiction to legalize the process, Nitschke was preoccupied with the risk people would see him or his colleagues as “some evil doctor delivering lethal injections to a moribund patient who didn’t know what was happening,” he says.
That’s how he came up with the euthanasia machine he called Deliverance, which connected a laptop with a syringe. Answering “yes” to a series of questions—Do you know that if you press this button you’ll die? Are you sure you know this?—on the computer would trigger the syringe to release a fatal dose of drugs.
Four people used the machine to die, Nitschke claims, before the territory’s law was repealed.
An image of Philip Nitschke with machinery for his euthanasia machine in 1996.
For the next 10 years, Nitschke continued his mission to “democratize” access to suicide, using drugs instead of machines. He ran “workshops,” public meetings where he advised attendees about lethal drugs for a “peaceful” death.
At least one attendee, a 45-year-old man who was not suffering from a terminal illness, illegally imported a lethal drug into Australia and took his own life in 2014. A year later, an Australian mother, Mary Waterman, testified in Parliament that Nitschke’s book about lethal drug combinations was found on her son’s iPad after he died by suicide. “He was physically fit,” Waterman told the committee, “but in retrospect he was suicidal and depressed.”
Nitschke says he’d prefer it if the book were only used by people over 50. But the proliferation of his work in suicide chat rooms is not enough to persuade him to stop publishing. “If we didn’t publish, we’d have an awful lot of 80-year-olds who would be sitting around very upset because they don’t have access to the best information,” he says. Americans aged 85 and over had the highest rates of suicide in 2022, according to the CDC, the US public health agency.
He claims the book’s proceeds, combined with donations, bankrolled the development of the suicide pod, which he estimates cost close to €1 million ($1.1 million) over 10 years.
Nitschke says he got the idea for Sarco after he was contacted by the lawyers of a seriously disabled right-to-die activist searching for a machine to help end his life. As his new invention progressed, he realized it would have to be 3D-printed.
“If I were to go around printing these devices and giving them or selling them to people, I would be immediately in breach of the legislation in most countries,” he says.
He is also experimenting with his next project, an implantable switch aimed at people with dementia.
The idea is that a person can set the implant to release deadly drugs into their bloodstream in a year’s time if they have deteriorated too much to stop it.
The switch would start making a ticking sound, to warn its wearer that the moment it will release the drugs is approaching. If the person cannot remember what the ticking is or how to physically turn the device off, the implant will release drugs that eventually kill them.
To test the idea, Nitschke says he plans to implant a test version, with saline solution, in himself once the prototype is ready.
“We’re all terrified of dementia and it’s a feature of living too long,” says Naomi Richards, director of the End of Life Studies Group at the University of Glasgow in Scotland.
She has heard others in the speculative design movement—where designers create hypothetical products to provoke debate on the direction society is heading—discuss similar implant ideas.
Yet actually creating the device oversimplifies a disease which affects people very differently, she says. “There isn’t an easy answer to caring for people with dementia. There isn’t a technological fix to these things.”
For Richards, Nitschke exists on the fringe of the right-to-die debate. Still, she believes a lot of people support what he is advocating for—giving people more control over the end of their lives.
“A lot of older people fear dying. They fear protracted dying experiences where they are going to lose control,” she says, adding this feeling appears heightened among the baby boomer generation.
“They’ve had a lot of control over their life and they really, really want to have control over the last bit of their life as well.”
Editor’s Note: Philip Nitschke is a member of the Baby Boomer Generation having been born in 1947.
His first social activist issue was his opposition to the Vietnam War. He was grateful to avoid Australia’s draft. Issues since that time for which he has advocated have included Aboriginal land rights, opposition to nuclear weapons and the peace movement.