In the 1999 animated TV show Futurama, the pilot episode begins with the main character being cryogenically frozen and waking up in the year 3000 a.d. Being unfamiliar with this radically changed world, he steps into a phonebooth to try to call his only living relative. Unfortunately for him, it is not a phone booth, but rather a suicide booth, which politely asks him to select his mode of death: “quick and painless or slow and horrible.” Accidently selecting “slow and horrible,” the terrified character has to dodge an assortment of blades, saws, and knives attempting to dismember him. Though he survives, the automated booth informs him that “You are now dead. Thank you for using stop-and-drop, America’s favorite suicide booth since 2008.”
What was satire only twenty years ago is quickly becoming a reality. Assisted suicide has become increasingly accepted across the world. In the U.S., the states of California, Colorado, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington, as well as the District of Columbia, all have laws allowing for some form of assisted suicide.[1] Other countries where some form of assisted suicide is legal include Austria, Belgium, Canada, Luxembourg, the Netherlands, New Zealand, Spain, Switzerland, and parts of Australia. Within the past year, several major organizations have come out in support of the practice, including the editors of the British Medical Journal and The Economist.[2]
Nitschke’s Pod
While in most of these places assisted suicide is legally controlled and can only be carried out with certain medications, there are those who desire to expand the practice even further and give people seeking to kill themselves a non-medical option. One of the people pushing for this new reality is Dr. Philip Nitschke. Sometimes referred to as “Dr. Death” or “the Elon Musk of assisted suicide,” Nitschke has for a number of years been creating devices that people can use to kill themselves. An early model was something he called an “exit bag,” a breathing mask that gave the user carbon monoxide instead of oxygen.[3] In 2017, he unveiled a new method: the Sarco suicide pod.
Nitschke’s suicide pod has gone through multiple iterations, and in December 2021 his latest version was publicized and promoted in Switzerland. Nitschke hopes to actively market it there this year. While his original exit bag was not “aesthetically pleasing” (using it was reminiscent of dying with a plastic bag over one’s head), the sleek, futuristic suicide pod is meant to overcome that particular obstacle. It consists of a 3D-printed capsule which can be transported anywhere the user wishes. Once inside, the user lies down, answers a few automated questions, and when he or she is ready, pushes a button that floods the capsule with nitrogen. Death follows in approximately thirty seconds.
In contrast to the satirical suicide booth in Futurama, the Sarco pod supposedly induces an extremely peaceful death, in which the one committing suicide “will feel a little disoriented and may feel slightly euphoric before they lose consciousness. . . . There is no panic, no choking feeling.”[4] Once the user has died, the top part of the pod can be removed and double as a coffin.
Part of the impetus for creating the suicide pod is to “de-medicalize” assisted suicide. According to Exit International, an organization founded by Nitschke, any adult with decision-making capacity can “accept or reject the involvement of the medical professional at the end-of-life.”[5] Nitschke’s goal for the Sarco pod is to have an AI screening system that a person can use to prove his or her capacity for informed consent; he wishes “to remove any kind of psychiatric review from the process and allow the individual to control the method themselves.”[6] In other words, as long as an adult has the capacity to make his own decisions, there should be no barriers between him and assisted suicide.
If one agrees with Nitschke that a person who wishes to kill himself should have assistance in doing so, then Nitschke’s goal of removing the gatekeepers to what he sees as a fundamental right is, in theory, benevolent. In reality, though, he is not removing gatekeepers, but simply becoming a gatekeeper himself. Ostensibly, he wants to promote personal autonomy, allowing people to make a decision without pesky doctors getting in the way. However, since his algorithm is the one that will determine whether a person has the capacity to kill himself, that person is not gaining autonomy; rather, the decision-making power is simply being transferred from doctors and psychiatrists to Nitschke and his algorithm.
Two Major Concerns
From a Christian perspective, assisted suicide must be opposed as a practice that attempts to usurp God’s sovereignty (a perspective that Nitschke’s group explicitly rejects—according to their website, “Exit rejects religious-based arguments that a person’s life belongs to God”[7]). But even from a non-religious perspective, Nitschke’s suicide pod and his vision for assisted death raise at least two major concerns.
First, even if Nitschke succeeds in “de-medicalizing” the dying process, it will still be impossible for those seeking suicide to make truly informed or autonomous choices. Ronald Pies and Cynthia Geppert have argued that, in the case of physician-assisted suicide, autonomy is a “myth.” In addition to the myriad ways in which patients must depend on physicians for diagnosis, prognosis, prescriptions, etc., those near the end of life face numerous cognitive and emotional pressures such that “genuine rational autonomy and authentic voluntarism are frequently undermined.”[8] Even if Nitschke’s attempts to remove doctors and psychiatrists from the equation were successful, these cognitive and emotional pressures would remain, and in fact could be heightened.
Cognitively, people facing end-of-life decisions frequently have false beliefs and assumptions that impact their decision-making ability—for example, they may believe that they are beyond help or that their family would prefer it if they were no longer a burden. Emotionally, end-of-life decisions are fraught with complicating factors; depression, hopelessness, grief, or despair often cloud a person’s decisional capacity. As Pies and Geppert argue, current legislation is deficient in accounting for the full extent of these pressures. Nitschke seems to believe that removing psychiatric review of those seeking to end their lives will make their decisions more autonomous, but in reality, it might actually make them less so.
Second, Nitschke’s vision of an expansion of assisted suicide places the most vulnerable members of society at risk. Should his vision come to pass, and assisted suicide become common and easily accessible, it is not difficult to imagine that the number of suicides in a society will increase and that making use of assisted suicide will quickly become not just an option, but an expectation.
This expectation will disproportionately affect the most vulnerable, such as the elderly and people with disabilities. For both of these groups, care can be expensive and time-consuming, placing burdens on family members, healthcare systems, and society at large. Even those who are healthy fear being a burden to others;[9] how much more might those deemed unhealthy, whether terminal or not, feel this burden? If assisted suicide becomes more common, it is likely that societal pressures will mount for the elderly and disabled to avail themselves of it rather than allow themselves to be cared for.
Ripe for Abuse
Ironically, Nitschke’s interest in granting people greater autonomy regarding end-of-life decisions might actually result in their having less autonomy. When physicians and psychiatrists are removed from involvement in these decisions, it actually becomes harder for those considering assisted suicide to make an informed, autonomous choice. And by pushing for widespread societal acceptance of the practice, Nitschke is making conditions ripe for abuse, in that people may be coerced into ending their own lives to avoid being a burden to others.
Nitschke’s suicide pod and his desire to remove any safeguards except the ones he deems acceptable should deeply concern us. While high-minded rhetoric about people having the “right” to determine their own time and manner of death can be made to sound noble, it does not address the deleterious effects this practice will have on the most vulnerable in society, and it fails to account for the many pressures those making end-of-life decisions will be put under. Most importantly, it claims for humans a power over life and death that belongs to God alone.
How to approach end-of-life decisions, especially for those with terminal illnesses, is an important topic that no society can ignore. The most compassionate approach is not to encourage the dying to end their lives prematurely. Rather, it is to recognize that, as human beings, we have a responsibility to care for one another, especially when one of us is suffering or nearing the end of life. Such care, selflessly given, demonstrates the love of God and can lead to a death more peaceful than any suicide pod exit could ever be.
Notes
[1] Compassion and Choices, https://compassionandchoices.org/resource/states-or-territories-where-medical-aid-in-dying-is-authorized (accessed December 20, 2021).
[2] Richard Hurley, Tessa Richards, and Fiona Godlee, “Assisted dying: A question of when, not if,” BMJ 374, no. 2128 (Sept. 9, 2021): https://doi.org/10.1136/bmj.n2128; “The Welcome Spread of Assisted Dying,” The Economist (Nov. 13, 2021): https://www.economist.com/leaders/2021/11/13/the-welcome-spread-of-assisted-dying.
[3] Nicole Goodkind, “Meet the Elon Musk of Assisted Suicide, Whose Machine Lets You Kill Yourself Anywhere,” Newsweek (Dec. 1, 2017): https://www.newsweek.com/elon-musk-assisted-suicide-machine-727874.
[4] Clare O’Dea, “Sarco suicide capsule hopes to enter Switzerland,” SWI (Dec. 11, 2021): https://www.swissinfo.ch/eng/sci-tech/sarco-suicide-capsule-hopes-to-enter-switzerland/46966510.
[5] “Exit Vision, Mission & Values”: exitinternational.net/about-exit/our-philosophy (accessed Dec. 22, 2021).
[6] Ibid., note 4.
[7] Ibid., note 5.
[8] Ronald W. Pies and Cynthia M. A. Geppert, “Physician-Assisted Suicide and the Autonomy Myth,” Psychiatric Times (Oct. 27, 2021): https://www.psychiatrictimes.com/view/physician-assisted-suicide-and-the-autonomy-myth.
[9] Phillipa J. Malpas, Kay Mitchell, and Malcolm H. Johnson, “‘I Wouldn’t Want to Become a Nuisance under any Circumstances’—A Qualitative Study of the Reasons Some Healthy Older Individuals Support Medical Practices That Hasten Death,” The New Zealand Medical Journal 125, no. 1358 (2012), 9–19: https://pubmed.ncbi.nlm.nih.gov/22864152.