Category: Media

Alabama carried out the first American execution using nitrogen gas on Thursday evening, killing a convicted murderer whose jury had voted to spare his life and opening a new frontier in how states execute death row prisoners.

The execution of the condemned prisoner, Kenneth Smith, 58, began at 7:53 p.m. Central time, and he was pronounced dead at 8:25 p.m. in an execution chamber in Atmore, Ala., according to John Q. Hamm, the state prison system’s commissioner. The U.S. Supreme Court allowed the execution to move forward over the objections of its three liberal justices and concerns from death penalty opponents that the untested method could cause Mr. Smith to suffer.

Mr. Smith, who was strapped to a gurney with a mask placed on his head, appeared conscious for several minutes after the nitrogen gas started flowing into the mask, depriving him of oxygen, according to a pool report from five Alabama journalists who witnessed the execution. State lawyers had previously claimed in court filings that an execution by nitrogen would ensure “unconsciousness in seconds.”

He then “shook and writhed” for at least two minutes before beginning to breathe heavily for several minutes. Eventually, the journalists said, his breathing slowed until it was no longer apparent.

Mr. Hamm said it looked like Mr. Smith had tried to hold his breath as long as he could, and he downplayed Mr. Smith’s body movements, saying “nothing was out of the ordinary from what we were expecting.”

Before he was executed, Mr. Smith gave a lengthy final statement from the execution chamber in which he said, in part, “Tonight, Alabama caused humanity to take a step backward,” according to the witnesses.

Lee Hedgepeth, a reporter in Alabama who witnessed the execution, said Mr. Smith’s head moved back and forth violently in the minutes after the execution began.

“This was the fifth execution that I’ve witnessed in Alabama, and I have never seen such a violent reaction to an execution,” Mr. Hedgepeth said.

It was the second time Alabama had tried to kill Mr. Smith, after a failed lethal injection in November 2022 in which executioners could not find a suitable vein before his death warrant expired. Mr. Smith’s lawyers and the state’s attorney general, Steve Marshall, said Thursday’s execution was the first that had been carried out by nitrogen anywhere in the world.

Other states have looked to Alabama’s experience as they face mounting problems obtaining lethal injection drugs because of pressure from medical groups, activists and lawyers. Mississippi and Oklahoma have authorized their prisons to carry out executions by nitrogen hypoxia, as the method is known, if they cannot use lethal injection, though they have never tried to do so.

“Our proven method offers a blueprint for other states and a warning to those who would contemplate shedding innocent blood,” Mr. Marshall said, suggesting that the availability of an “efficient” execution method could act as a deterrent to criminals.

The Supreme Court’s order allowing the execution to go forward did not give an explanation, as is often the case when the justices decide on emergency applications. The court’s three liberal members disagreed with the majority’s decision.

In a strongly worded dissent, Justice Sonia Sotomayor voiced concerns about Alabama’s new method. “Having failed to kill Smith on its first attempt, Alabama has selected him as its ‘guinea pig’ to test a method of execution never attempted before,” she wrote. “The world is watching.”

Kenneth Eugene Smith with Philip Nitschke

EXIT PHOTO: Kenny Smith & Philip Nitschke, Holman Prison, 13 December 2023

Justice Elena Kagan, in a separate dissent joined by Justice Ketanji Brown Jackson, wrote that she would pause the execution to give the court time to examine the “exceptional circumstances” surrounding Alabama’s new method of execution and Mr. Smith’s challenges.

“The state’s protocol was developed only recently, and is even now under revision to prevent Smith from choking on his own vomit,” Justice Kagan wrote.

Nitrogen hypoxia has been used in some assisted suicides in Europe and elsewhere, though the precise method that Alabama used differs from common practice. Lawyers for the state had argued that such a death was painless and quick. They also noted that Mr. Smith and his lawyers had themselves identified the method as preferable to the troubled practice of lethal injection in the state.

But in their last-ditch petition to the Supreme Court, Mr. Smith’s lawyers argued that Alabama’s protocol would create a substantial risk for suffering.

Dr. Philip Nitschke, a pioneer in assisted suicide who estimated that he had witnessed roughly 50 deaths by nitrogen, had said that the use of a mask could lead to problems that might involve substantial distress and pain.

Gov. Kay Ivey of Alabama said she had chosen not to exercise her clemency power to spare Mr. Smith.

“The execution was lawfully carried out by nitrogen hypoxia, the method previously requested by Mr. Smith as an alternative to lethal injection,” Ms. Ivey said in a statement.

The Supreme Court on Thursday allowed the first American execution using nitrogen gas to move forward, with the court’s three liberal members publicly dissenting.

A day earlier, the Supreme Court had also declined to intervene in the lawyers’ appeal of a separate case, in which they had argued that trying to execute Mr. Smith a second time amounted to unconstitutional cruel and unusual punishment, partially because of how harrowing the 2022 execution attempt had been.

Mr. Smith’s case is unique in part because the jury that convicted him of murder in 1996 also voted 11 to 1 to sentence him to life in prison rather than death, but the judge overruled their decision. Alabama has since made it illegal for judges to overrule juries that have recommended a life sentence — a prohibition that now exists in every state — but the new law does not apply to previous cases.

Mr. Smith’s spiritual adviser, the Rev. Jeff Hood, was in the room during the execution and said that he had watched “minutes of someone struggling for their life.” He said earlier on Thursday that Mr. Smith was gravely afraid of the execution going wrong. “He’s terrified that this thing is going to completely torture him,” Mr. Hood said before the execution.

Mr. Smith, he said, ate his last meal on Thursday morning: a T-bone steak, hash browns and eggs, all from Waffle House and slathered with steak sauce. Prison officials said that to reduce the likelihood of Mr. Smith vomiting during the execution, he would not be permitted to eat after 10 a.m.

Before the execution on Thursday, a White House spokeswoman declined to comment on it.

“This is a state-level case and I won’t speak to the details of this particular case,” said the spokeswoman, Olivia Dalton, adding that President Biden had broad concerns about how the death penalty “is implemented and whether or not it’s consistent with our values of fairness and justice.”

Mr. Biden campaigned on ending the federal death penalty after it was resurrected by President Donald J. Trump. Under Mr. Biden, the Justice Department has instituted a moratorium on federal executions, but the department also said this month that it would seek the death penalty against the white gunman who fatally shot 10 Black people in a racist attack at a Buffalo, N.Y., grocery store.

Alabama’s first use of nitrogen gas comes after several botched or difficult lethal injections in which executioners struggled to find veins on the men they were trying to put to death.

In 2022, executioners tried for hours to access Joe Nathan James’s veins, ultimately slicing into one of his arms in what is known as a “cutdown” in order to administer the fatal drugs, according to a private autopsy. Since 2018, three death row prisoners in the state, including Mr. Smith, have survived execution attempts because of difficulty inserting intravenous lines.

Four days after failing to execute Mr. Smith in 2022, Governor Ivey, a Republican, halted all executions in the state and asked the prison system, the Alabama Department of Corrections, to review its procedures. The state resumed executing people in 2023, killing two men by lethal injection.

After Thursday’s execution, one of the murder victim’s sons, Michael Sennett, who witnessed it, spoke briefly to reporters.

“Nothing that happened here today is going to bring Mom back,” he said. “It’s kind of a bittersweet day. We’re not going to be jumping around, hooting and hollering ‘hooray’ and all that. That’s not us. We’re glad this day is over.”

Ms. Sennett was stabbed 10 times in the attack by Mr. Smith and another man, according to court documents. Her husband, Charles Sennett Sr., had recruited a man to handle her killing, who in turn recruited Mr. Smith and a third man. Mr. Sennett arranged the murder in part to collect on an insurance policy that he had taken out on his wife, according to court records. He had promised the men $1,000 each for the killing.

Mr. Sennett later killed himself; one of the other men involved in the murder was executed by lethal injection in 2010, and another was sentenced to life in prison and died in 2020.

The Sarco Pod Promises a Humane Death within 5 to 10 Minutes reports De Volkskrant.

The Sarco is viewed intently at the 50th anniversary celebration of the Dutch Society for a Voluntary End of Life (NVVE).

Without hesitation, he stretches out on the black cushions of the Sarco Pod, a futuristic machine some call a suicide coffin. The man folds his hands solemnly over his abdomen. Then the lid closes. Is this it, then?

No, he does not press the red blinking button to start the process by which nitrogen is added to the airtight capsule and the oxygen content drops from 21 to 1 percent within 30 seconds. Nor can he, because this is a demonstration model.

Then he knocks on the window – he wants out. ‘I found it terrifying,’ says Berd Stapelkamp (75) a moment later.

‘I’m claustrophobic and wanted to know what it’s like to lie in it. As a challenge. With a chuckle, “I didn’t know how fast to get out again!

‘My life, my end’

Stapelkamp is a longtime member of the Dutch Association for a Voluntary End of Life (NVVE), which celebrates its 50th anniversary Friday. In the halls of Gooiland in Hilversum, there will be lectures on living wills, a conversation about death in 2073 (when the NVVE celebrates its 100th anniversary) and a theater play about euthanasia titled “My life, my end!

The Sarco Pod is also part of the program and is gleaming in the main hall. The audience – without exception graying or balding – shuffles around it in fascination. Despite his claustrophobic experience, Stapelkamp is enthusiastic about the device, which promises a peaceful death within five to 10 minutes.

‘For a certain category of people who can’t get euthanasia and don’t want to resort to gruesome methods, this is a wonderful solution,’ he says. ‘It’s painless, there are no cumbersome procedures ánd you don’t have to burden others with it. They just have to lift you out.’

Although Stapelkamp is still in good health, he is actively dealing with the ever-approaching death. He dislikes the prospect of decay; he wants to be able to decide for himself when he dies. ‘The other day I met my new family doctor.

My first question was: how do you feel about euthanasia?

At home, he already has the drugs lying around, should a doctor still fail.

‘Middel X,’ he says, referring to the chemical promoted by the Coöperatie Laatste Wil (CLW) as a humane means of suicide. That idea gives peace of mind, he says.

‘One of the options’

Not everyone is so well prepared on this day, but almost all those present, especially from the baby boomer generation, share the belief that they may decide their own end, in complete autonomy.

‘They grew up with the idea of being the master of their own belly,’ says NVVE chairman Fransien van ter Beek. ‘And now they want an end of life in their own control.’

Many here have a similar experience: they have seen friends or family die in a terrible way and want to prevent that themselves. ‘I’ve seen up close how someone stopped eating and drinking,’ says Annie Mets (66). ‘That’s horrible. It can take a few weeks.’

She has been a member for 10 years and is seeing the Sarco for the first time. ‘I see it as one of the options, yes, should it come to that.’

Philip Nitschke, the Australian inventor of the Sarco, watches people react to his creation. ‘When I suggested the idea in Switzerland a few years ago, someone said to me: no one in Europe will use a device that will kill you by gas. The association with the Holocaust would be too strong. That doesn’t seem to be so bad after all.

Nitschke (75) emigrated to the Netherlands in 2015, the country where he says there is the most progressive thinking about the end of life. Since then, he has been fighting for more information about self-chosen death. He sells a very popular handbook describing methods of suicide and collects documentation on the subject worldwide.

The Sarco Pod Promises a Humane Death within 5 to 10 Minutes

Since he launched the Sarco as a concept in 2017, he says he receives a daily request from someone around the world to use the device. The plastic sarcophagus should eventually be able to be 3D printed by anyone who wants it. Nitschke: “We put the software online for free. There is also no patent on the design. I have no commercial motive whatsoever.’

Three questions

The third prototype was made in Rotterdam by Iranian designer Javid Jooshesh. ‘We will test on Monday whether everything works,’ says Nitschke. ‘We measure how the oxygen content goes back. And we measure the temperature, pure nitrogen is very cold. It should feel like a cool breeze. I also lie down in it myself – with oxygen in my nose – to experience the sensation.’

It’s an end he says is similar to death when cabin pressure suddenly drops on an airplane and you don’t grab the oxygen mask fast enough. ‘From people who have survived that, we know it gives a slightly euphoric and confused feeling. It doesn’t feel like suffocation. You just fall away.

He plans to test the device on people in Switzerland. There, there is no ban on assisted suicide, as there is in the Netherlands. ‘

We think it should succeed legally, hopefully this year. All you have to do as a patient is answer three questions to determine your presence of mind. Who are you? Where are you? And do you know what happens when you push the red button?’

After that, Nitschke says. ‘You can place the Sarco anywhere, for example overlooking Lake Geneva. You lie down, close the flap, wave a bit more and then press the button.

How an Australian came up with the idea of a suicide capsule

Philip Nitschke, who says he has watched more than 200 people die, says he rarely thinks about his own death.

When asked what a last day should be like, he thinks long and hard. In the best case scenario, Nitschke says, he would be sitting on a hill in the Australian outback with a bottle of beer, his last meal would be Thai food.

He would watch the sunset, and when it was time, he would climb into the capsule. Then he would press the button, and after a few minutes it would be over. “Beautiful, isn’t it?” says Nitschke. 

Nitschke, 74, a man with a soothing voice, is a former doctor who sicb for the right to euthanasia. The British newspaper The Independent once called him “Dr. Death.”

He describes himself as a humanist and inventor. You can talk to Nitschke on the phone and he will tell you about his latest invention, the “Sarco”.

The Sarco is a suicide capsule. It looks like the cockpit of a Tesla, and its sole purpose is to kill the occupant. 

The Sarco consists of two parts: a generator as a base and an attachment in which the suicidal person sits down. The interior looks cozy, there are soft cushions and a touch screen in it.

When someone sits down in the cockpit, three questions appear on the screen: Who are you? Where are you? Do you know what happens when you press the button?

If the person answers the first two questions correctly and the third one in the affirmative, they can driick on another button. Then the capsule closes, like a jet before takeoff. 

Death occurs by hypoxia. The generator produces nitrogen, the nitrogen displaces the oxygen in the capsule, and after 30 seconds you lose consciousness. After five minutes at the latest, you are dead.  “No yuk” factor, Nitschke says.

Nitschke comes from Ardrossan, a town of 1,000 people in southern Australia.

Like many young men, he spent several years searching for meaning in his life, he says. Before Nitschke turned to death, he was a cab driver and a ranger in a national park.

At that time, he was not yet campaigning for euthanasia, but for the rights of the Australian aborigines. Nitschke says his time with the Aborigines awakened his need for freedom. 

His commitment to assisted suicide began after medical school, and Nitschke worked as a general practitioner. He says he was surprised by how many of his patients expressed a wish to die.

Terminally ill patients, but also healthy ones. Nitschke doesn’t want to go into too much detail. He says he “helped” some of them.

In Australia, euthanasia is prohibited. The authorities revoked Nitschke’s license to practice medicine in 2014 [Editor’s note – an act which the Supreme Court of the Northern Territory would later find to be unlawful and would immediately reverse], and he and his wife moved to the Netherlands, where assisted suicide is legal under strict conditions.

He became a full-time activist and wrote a book called “Peaceful Pill Handbook.” It explains many ways to kill yourself, from pill overdoses to carbon monoxide poisoning to pulling a plastic bag over your head.

When you talk to Nitschke, he seems less like a freedom fighter and more like someone who wants to be a visionary. Someone with a groundbreaking !idea, like Elon Musk or Jeff Bezos.

The inventors of Tesla and Amazon like to portray themselves as humanitarians, as philanthropists, like Nitschke. They promise to make the world a little easier and better. But most of the time, you get the impression that they’re more concerned with themselves.

That they really only want to fly into space with their rockets to make their mark in the history books.

Nitschke has many opponents; he is very controversial even among death activists. Some accuse him of aestheticizing death with the futuristic design of the Sarco.

Others say that if suicide were to become legal, it should take place with professional assistance and not in isolation in a plastic capsule from a 3-D printer. Nitschke is convinced of himself and of Sarco.

Listening to him, you sometimes think he hasn’t invented a suicide machine, but his own little rocket. Just like Musk and Bezos. 

Nitschke says he didn’t invent the Sarco to make money with it. He is concerned with his idea. He hopes for the liberalization of euthanasia in Europe, especially in Germany. The Sarco is not yet approved anywhere in the world.

But in 2020, the Federal Constitutional Court in Karlsruhe annulled an article in the Criminal Code that criminalized “businesslike promotion of the suicide of others.” The Bundestag must now find a new regulation. That gives Nitschke hope.

The pod, known as Sarco, was conceived as a way for people to end their lives without involving a doctor. A plan to introduce it in Switzerland has raised alarm even among right-to-die advocates.

A Sarco prototype at Venice Design in 2019. Its inventor,Dr. Philip Nitschke, says it offers people a way to end their lives painlessly and without a doctor’s help, but some right-to-die supporters said they found it appalling.Credit…Sarco

By Christine Hauser

Dec. 16, 2021

Trouw Newspaper – the Netherlands

People who want euthanasia in Switzerland could soon do so with a new method: they can take a seat in a 3-D printed capsule that, according to the maker, can painlessly end someone’s life in a few minutes.

Trials with the Sarco will start in early 2022, with real participants trying the device, Philip Nitschke, the maker of the capsule, told The Washington Post.

At the touch of a button, the capsule is filled with nitrogen gas, causing the oxygen content to drop rapidly.

The user becomes unconscious within a minute, experiences no distress, but dies from lack of oxygen after falling asleep.

Nitschke describes the capsule as a “stylish and elegant” way to die, as the user can choose where it will be placed.

A legal analysis, requested by Nitschke through his nonprofit Exit International, shows that the use of the capsule does not violate Swiss assisted suicide laws. According to those laws, anyone can assist in suicide, as long as it is not done for ‘selfish motives’. In addition, people must be mentally competent, which is usually determined by a psychiatrist. And they must ultimately take the final step that leads to their death.

The machine has also been criticized. Daniel Sulmasy, director of the Kennedy Institute of Ethics at Georgetown University, says the almost luxury car-like design “glorifies suicide.” But Nitschke insists that use of the capsule is responsible. In fact, he likes Sarco so much that he will eventually use it himself.

By Julian Mark December 9, 2021 at 7:25 a.m. EST
 
 People wishing to end their lives in Switzerland — one of a handful of countries that give the option — could soon have access to a new method: a 3-D-printed pod that its creator says can painlessly end someone’s life in a matter of minutes.
 
Real-life participants will start trying the coffin-like “Sarco” during trials set to begin in early 2022, the capsule’s creator, Philip Nitschke, told The Washington Post this week.

A legal analysis commissioned by his nonprofit, Exit International, recently concluded that use of the pod will not violate Switzerland’s assisted suicide laws, he said.

At the push of a button, the pod becomes filled with nitrogen gas, which rapidly lowers oxygen levels, causing its user to fall unconscious within a minute, Nitschke said.

A person does not suffocate or experience distress, he said, but rather dies of oxygen deprivation after they’ve fallen asleep.

In theory, the capsule can be towed to a place of someone’s choosing, said Nitschke, who described the machine as a “stylish and elegant” way to die.
 
“It provides that sense of occasion by its look,” Nitschke said. “It looks good, and it’s a thing that I would like to get into.”

But since Nitschke introduced the concept four years ago, it has been met with varying degrees of bewilderment and condemnation, with some critics arguing the Sarco’s appearance is one of its biggest problems.

Daniel Sulmasy, the director of the Kennedy Institute of Ethics at Georgetown University, said the capsule’s sleek, almost luxury-car-like design “glamorizes suicide.”

He also said he takes issue with Nitschke’s plan to post the 3-D printing instructions online, noting that it could lead to suicide contagion — a phenomenon in which hearing about suicide can lead to more people dying that way.
 
“That’s a real worry … that a machine like this glamorizes suicide and makes it easier for people who are vulnerable and mentally ill,” Sulmasy told The Post.

 Even those who support assisted suicide say they have concerns. In an opinion piece published this week in the Independent, Stephen Duckworth, a disability advocate who says he believes in the right to assisted dying, wrote that he is “appalled” by the Sarco.
 
“Safety should always be at the forefront of any efforts to enable greater choice at the end of life, and there are serious safety concerns here,” Duckworth wrote.

“What if it is accessed by someone not in their right mind? Or a child? Or if it is used to abuse others? What if it doesn’t result in immediate or peaceful death and the individual is left alone without any recourse to call for help? I could go on and on.”
 
Nitschke argues that the pod is safe and will deliver painless deaths — and he expects no surprises during the trials that will be held at a Swiss clinic for assisted suicide, using about a half-dozen volunteers. “We’ll be comfortable after we have the first few” successful trials, he said.
 
Responding to criticism about suicide contagion, Nitschke said Exit International will print the Sarco’s plans in a book his nonprofit distributes with methods on assisted dying, which is restricted to people over the age of 50 who are “of sound mind or seriously ill.”

“Not saying it will always protect everyone,” he said, “but we want the information freely available to rational adults.”
 
Euthanasia and assisted suicide are legal in only a handful of countries. In the United States, 10 states and the District of Columbia allow medically assisted suicide for terminally ill, mentally capable adults with a prognosis of six months or less to live, The Post reported.

In Colombia, where euthanasia has been decriminalized since 1997, officials abruptly halted the procedure of a woman suffering from a debilitating disease, arguing that her condition had improved too much for her to legally undergo the process, The Post reported in October.

She was ready to die. Now an 11th-hour decision by health officials has halted her euthanasia bid.

While countries like the Netherlands and Belgium permit assisted suicide for patients with unbearable physical or psychological suffering, Switzerland has no such requirements written into its law, according to the British Medical Association.
 
Per Swiss law, anyone can assist in a suicide, so long as it is not performed for “selfish motives,” meaning it is illegal to assist out of malice or for profit.

Moreover, people choosing to end their lives must be mentally competent — a determination typically made by a psychiatrist — and must ultimately initiate the final step leading to their deaths.
 
The law, in effect since the early ’40s, has allowed a handful of assisted suicide clinics to operate in the country, and has led to an increasing number of “suicide tourists” who visit the country to end their lives. “People come into Switzerland every day to die,” Nitschke said.

Those assisted suicides are typically administered via the injection of a barbiturate, prescribed by doctors, that will cause a person to lose consciousness and die relatively peacefully.

Yet many doctors are loath to prescribe the medication to people who are not sick, Nitschke said, and he argues that there are categories of people — such as elderly individuals who are “tired of life” — who want the assistance.
 
That is one of the reasons Nitschke has introduced the Sarco. Because the capsule does not administer drugs, it takes some of the decision-making power away from the medical establishment.
 
Daniel Hürlimann, a law professor at the University of St. Gallen in Switzerland, conducted the legal assessment for Exit International’s use of the Sarco.

He told The Post that while Swiss law “does not explicitly authorize the use of Sarco, it simply does not regulate it and thus does not prohibit it.” That assessment was good enough for Nitschke.

“It’s taken quite a while to get it into a final designed and manufactured form,” he said of the machine. “But we’ve done that now, and we’re at the stage now where it needs to be trialed.”

Nitschke said he likes Sarco so much he may ultimately use it himself, and added that death should not “be shrouded by misery and gloom” but rather a moment of “celebration.”
 
Sulmasy, the ethicist, sharply disagreed. “Death can sometimes be very welcome for people, but it should never be anything we celebrate,” he said.

“We’re always losing a unique, special human being, whenever any one of us dies.”

 
By Tom Bateman  •  Updated: 09/12/2021 – 12:48
 
A 3D-printed “suicide capsule” has passed a legal review in Switzerland, potentially clearing the way for the technology to be put into use in the country’s legal assisted suicide clinics.

The Sarco capsule’s creator, Dr. Philip Nitschke, told Euronews Next that his aim was to allow anyone to download the design and print it themselves.

In the future, an AI screening process will allow Nitschke’s assisted dying advocacy organisation, Exit International, to “demedicalise” the dying process by removing the need for medical professionals to be involved, he said.

He told Euronews Next that an Exit International-commissioned review carried out by Swiss legal academic Professor Daniel Hürlimann had confirmed that the Sarco did not break any regulations governing medical products, narcotics, dangerous chemicals or weapons.

The review also concluded that “assisting the suicide of a competent person by means of Sarco does not constitute an offence under the Criminal Code,” Hürlimann told Euronews Next via email.

“The review commissioned reassured us that there were no legal issues that we were missing and that – from a Swiss legal viewpoint – that is no problem either with the use of Sarco at a euthanasia clinic, or by a Swiss individual who wishes to print and use the machine themselves,” Nitschke said.

The organisation aims to offer the Sarco to users in Switzerland early next year.

What is Sarco?

The Sarco capsule can only be operated from the inside. Users will be able to press a button, blink or gesture to release nitrogen gas that induces a state of hypoxia and eventually, death.

Prototype versions of the Sarco have been exhibited at museums and art galleries in the Netherlands and GermanyExit International

It also features an emergency stop button and an escape hatch, according to a video featuring its designer Alexander Bannink.

Exit International does not plan to offer Sarco for sale, choosing instead to distribute the design to people who will have to 3D print it themselves, as well as working with assisted suicide clinics in Switzerland.

Providing the design alone could also help Exit International avoid legal trouble in the vast majority of countries where assisted suicide remains against the law.

“If you make something by hand, which we normally do, you can be held accountable because you are helping someone in dying,” Bannink said.

“Legal use of a machine we have produced is not possible in countries other than Switzerland,” said Nitschke.

Philip Nitschke – nicknamed ‘Dr Death’ – has advocated for assisted dying since the early 1990s

While in theory anyone could print the Sarco, Exit International will not provide the blueprints to anyone aged under 50 years old, and even once printed access to the capsule will remain restricted, according to information on the organisation’s website.

Democratising death

Nitschke has a long history of advocating for the right to die, even running for political office in his native Australia on a platform of euthanasia reform.

In 1996, he became the first medical doctor to legally administer a voluntary lethal injection, using a self-designed machine that allowed the man, a prostate cancer patient named Bob Dent, to press a button on a laptop by his bedside to deliver the drugs.

“The main issue is one of control,” Nitschke said. When Australia’s Northern Territory briefly legalised assisted dying from 1996 to 1997, the law still required a doctor to consent to the procedure.

PHOTO: DAVID HANCOCK/AFP

“This caused problems, for example with couples who had been together all their lives, when one became sick and their partner said they wished to die at the same time,” Nitschke said.

“It really is about democratising the dying process. We consider it a right for all rational adults to be able to divest themselves of their life, it is not just some privilege decided by others that can be granted to the very sick”.

But Nitschke and Exit International’s direct approach has raised concerns among Switzerland’s big players in assisted suicide.

The non-profit organisation Dignitas told Euronews Next that it doubted the Sarco’s do-it-yourself method would find acceptance in Switzerland, which has a 35-year history of non-profits and doctors working together to help facilitate assisted suicides.

Established organisations also understand the legal framework of assisted dying in Switzerland, which required every death, voluntary or not, to be reported to the authorities for investigation, Dignitas said.

“This practice is approved, and supported by the vast majority of the public and politics,” the organisation said.

“In the light of this established, safe and professionally supported practice, we would not imagine that a technologised capsule for a self-determined end of life will meet much acceptance and/or interest in Switzerland”.

However, a 2017 report by UK campaign organisation Dignity in Dying found that following the established route might be out of reach for many, putting the average cost of an assisted death in Switzerland for a UK resident at almost €12,000.

Screening by software

In order to fully remove outside intervention from the assisted dying process, Nitschke has suggested in a recent interview with news site Swissinfo that Sarco would use AI to screen users before granting access to the capsule.

“Our aim is to develop an artificial intelligence screening system to establish the person’s mental capacity. Naturally there is a lot of scepticism, especially on the part of psychiatrists. But our original conceptual idea is that the person would do an online test and receive a code to access the Sarco,” he said.

While assisted suicide is legal in Switzerland, the current process requires the participation of medical professionals who prescribe the drugs used in the process and carry out psychological checks.

“The proposed AI review to remove this medical involvement is part of the next stage in the Sarco project,” Nitschke told Euronews Next.

‘A black box’

The potential involvement of artificial intelligence in Sarco has rung alarm bells at Algorithmwatch, a non-profit organisation that researches the impact of automation technologies.

“This clearly ignores the fact that technology itself is never neutral: It is developed, tested, deployed, and used by human beings, and in the case of so-called Artificial Intelligence systems, typically relies on data of the past,” said Algorithmwatch policy & advocacy lead Angela Müller.

“Relying on them, I fear, would rather undermine than enhance our autonomy, since the way they reach their decisions will not only be a black box to us but may also cement existing inequalities and biases,” she told Euronews Next.

It’s possible that the debate over AI will remain academic.

While Nitschke plans to make the Sarco capsule available in Switzerland next year, the software required will not be ready in time.

“In the early stages of Sarco use in Switzerland we will be ensuring that all people choosing this option have had a thorough review by Swiss medical professionals to remove any possible question over their capacity. We have the support of Swiss psychiatrists to provide this service,” he said.

“As the AI screening is further developed we hope to run dual testing of subjects using medical services and the AI software screen so that the efficacy of the AI program can be established,” he added.

According to Swiss law experts, the Sarco suicide capsule ‘passes legal review’ in Switzerland.

A 3D-printed capsule, destined for use in assisted suicide, may legally be operated in Switzerland, according to advice obtained by Exit International, the organisation that developed the ‘Sarco’ machine.

Some 1,300 people died by assisted suicide in Switzerland in 2020 using the services of the country’s two largest assisted suicide organisations, Exit (no connection to Exit International) and Dignitas. The method currently in use is ingestion of liquid sodium pentobarbital.

After taking the drug, the person will fall asleep within two to five minutes before slipping into a deep coma, followed soon afterwards by death. Sarco offers a different approach for a peaceful death, without the need for controlled substances.

The Interview

SWI swissinfo.ch spoke to Dr Philip Nitschke, founder of Australia-registered Exit International, about his innovation, the coffin-like Sarco capsule, and what place he expects it will have in the Swiss assisted dying sector.

SWI swissinfo.ch: What is Sarco and how does it work?

Philip Nitschke: It’s a 3-D printed capsule, activated from the inside by the person intending to die. The machine can be towed anywhere for the death. It can be in an idyllic outdoor setting or in the premises of an assisted suicide organisation, for example.

The person will get into the capsule and lie down.  It’s very comfortable. They will be asked a number of questions and when they have answered, they may press the button inside the capsule activating the mechanism in their own time.

The capsule is sitting on a piece of equipment that will flood the interior with nitrogen, rapidly reducing the oxygen level to 1 per cent from 21 per cent. The person will feel a little disoriented and may feel slightly euphoric before they lose consciousness. The whole thing takes about 30 seconds. Death takes place through hypoxia and hypocapnia, oxygen and carbon dioxide deprivation, respectively. There is no panic, no choking feeling.

SWI swissinfo.ch: What stage are you at in developing the machine and making it available for use?

P.N.: Last year, we sought senior advice on the legality of using Sarco in Switzerland for assisted dying and were pleased when the Sarco suicide capsule ‘passes legal review’ in Switzerland. This review has been completed and we’re very pleased with the result which found that we hadn’t overlooked anything. There are no legal issues at all.

There are two Sarco prototypes in existence so far, and the third Sarco is now being printed in the Netherlands. If all goes well, the third machine should be ready for operation in Switzerland in 2022.

The first Sarco is being displayed at the Museum for Sepulchral Culture in Kassel, Germany from September 2021 to February 2022. The second turned out not to be aesthetically pleasing. For that and various other reasons it’s not the best one to use.

Several of Sarco’s supplementary projects have been delayed due to the [Covid-19] pandemic. For instance, the development of a camera that allows the person to communicate with the people outside. There needs to be a recording of the person’s informed consent. This has been commissioned and the next step is to get it manufactured.

SWI swissinfo.ch: Your stated goal is to de-medicalise the dying process. What does that entail?

P.N.: Currently a doctor or doctors need to be involved to prescribe the sodium pentobarbital and to confirm the person’s mental capacity. We want to remove any kind of psychiatric review from the process and allow the individual to control the method themselves.

Our aim is to develop an artificial intelligence screening system to establish the person’s mental capacity. Naturally there is a lot of scepticism, especially on the part of psychiatrists. But our original conceptual idea is that the person would do an online test and receive a code to access the Sarco.

SWI swissinfo.ch: You are based in the Netherlands. How will you potentially enter the Swiss market?

P.N.: We have been talking with various groups in Switzerland, including those we have worked with before on individual assisted suicide cases, with a view to providing Sarco for use in the country. This would be in collaboration with a local organisation.

Barring any unforeseen difficulties, we hope to be ready to make Sarco available for use in Switzerland next year. It’s been a very expensive project so far but we think we’re pretty close to implementation now.

The Printable Coffin of ‘Doctor Death’, the Australian Guru of Euthanasia

“It’s not for sale, but anyone can print it out at home and assemble it by following the instructions,” says Nitschke.

He presented it in 2019 at the Venice Biennale and several people, he says, have been interested from Spain in his futuristic sarcophagus to die.

“I was captivated by the civil disobedience and social activism that surrounded the death of Ramón Sampedro in 1998”

In the summer of 1996, Philip Nitschke became the first physician in the world to administer a lethal injection in the first ever case of assisted legal euthanasia.

Only four people from the Australian state of Northem Territory were eligible for the new law, which was repealed nine months later. “Against public opinion, the Australian Medical Association and the Church, it was my turn to make the law work,” confesses the 73-year-old activist.

“To do this, I invented the Deliverance machine, a software connected to the patient’s arm that allows him to self-administer lethal drugs into a vein using a computer-assisted procedure.”

That artifact is now on display in the London Science Museum as an engineering milestone in the fight for the right to a dignified death.

But it is not the only one.

Nitschke has spent the last three years creating Sarco (the printable coffin of Doctor Death), a revolutionary 3D printable coffin that provides a quick, painless and peaceful death.

“It is designed to lower the oxygen and CO2 levels inside the capsule, which ends up producing hypoxia, loss of consciousness and, ultimately, death,” explains its inventor.

“The sensation is similar to that generated by a sudden depressurization in an airplane: placid sleep, vertigo, disorientation and even euphoria.”

The printable coffin of Doctor Death, which was presented at the 2019 Venice Biennale, cost €300,000, part of which is being used to develop artificial intelligence software that analyzes the mental capacities of the occupants.

“It is not for sale, but anyone can print it at home and assemble it afterwards. You will be able to follow the instructions in the .

If all goes well, it will be used in Switzerland for the first time at the end of this year.”

Sarco was conceived as an “ethically and aesthetically effective alternative” to the suicide kits (such as the nitrogen bag) promoted by Exit International, the non-profit organization that Nitschke founded in 1997.

Because the machine is portable, it allows for the planning one’s death in a desired place: in the mountains, next to a lake or on a paradisiacal beach.

You can also choose a dark or transparent view.

The mission of this “object of artistic beauty”, exhibited at the Cube Design Museum in Limburg in the Netherlands in 2020 and at the Museum for Sepulkralkultur in Kassel Germany in 2021, is twofold: to minimize the agony (the process lasts five minutes) and to demedicalize the death process.

Many people found the practice of the plastic bag with gas repulsive.

Since Sarco does not require controlled drugs, it eliminates the need for a psychiatric evaluation and can be used in some countries without medical involvement.

And he adds: “The only way to control the coffin is from the inside, so it is not possible to kill someone with it.”

In his early days as a euthanasia guru, Nitschke sold nitrogen cylinders so that people could self-deliver, and he also helped them get Nembutal.

“Actually, this was not exactly the case.”

In the year 2000 I founded with a friend a company of accessories for brewing beer, one of my passions.

We do not commit any illegality, since nitrogen dispensing cylinders have multiple applications.

As for Nembutal, in my book, The Peaceful Pill Handbook (La Pildora Apacible – in Spanish), I offer detailed instructions on how to obtain it in countries such as Mexico and Peru, or via the internet.

The purchase of this drug without a prescription could be legal in South America, but not bringing it back to Europe.

I limit myself to providing that information, but what people do with it is their business.

The Nickname Dr Death

These practices at the limit of legality earned him the nickname of Doctor Death.

“At first it bothered me that they called me that, but then I appropriated it as a sign of identity.”

So much so that in 2015 at the Edinburgh Fringe Festival he had a comedy show about euthanasia titled ‘Dicing Dice with Dr. Death’.

Although Nitschke has taken many precautions to ensure the good practice of pro-euthanasia activism (such as thoroughly tracking of his patients and not selling his book to those under 50 years of age) he has been involved in various controversies, such as when he was linked to the assisted death of a 45-year-old man, Nigel Brayley, who was being investigated for two murder crimes.

“Nigel attended one of the Exit workshops and shared his anguish with me. He seemed knowledgeable and thorough.

When, in the wake of that case, I defended the right of a rational adult to suicide, the Australian Medical Board decided to disqualify me.

A court returned his medical license. The Medical Board demanded he remove his name from the cover of his book.

“That seemed unacceptable to me. So I burned my license and fled Australia in search of a more hospitable political environment.”

Since 2015 he lives in Ámsterdam.

“Here the debate goes beyond assisted death for sick people to more and encompasses what is known as a complete life”.

Healthy old people who do not want to continue in this world any more.

The digital version of The Peaceful Pill Handbook, the first volume was banned by the Australian authorities, the only Australian book to be banned in the last 50 years, is updated every month.

“We have recently included information on the new anti-covid helmets as an alternative to gas bags and the latest data on deaths from ‘Middel X’, a deadly powder without a prescription distributed among 20,000 members of a Dutch cooperative.

The Keys of Ramon Sanpedro

Nitschke does not hide the emotion he experienced in March this year when he learned that Spain was joining the exclusive club of the five countries (together with the Netherlands, Belgium, Luxembourg and Canada) that regulate Euthanasia.

“I was totally captivated by the social activism and civil disobedience that surrounded the death of Ramón Sampedro in 1998″, he tells me.

“In fact, Exit copied the strategy of the keys to his apartment distributed among several friends in the famous case of Nancy Crick in Australia.”

Doctor Death says that several people have been interested in Spain for its futuristic sarcophagus for euthanasia.

“With a bit of luck, Sarco will contribute to improve the conditions of people who, in a rational, free and informed way, decide to end their life.”

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