Suicide pods have “useful and proper place” in assisted dying discussion, creator tells Committee

The creator of the controversial Sacro suicide pod has told the Joint Oireachtas Committee on Assisted Dying that such devices have “a proper and useful place” in the discussion on introducing assisted suicide in Ireland.

Philip Nitschke, founder of Exit International, said that such options “should not” be excluded in any proposed legislation regarding assisted suicide in Ireland. 

The Committee, which met on Tuesday, was formed in January to consider and make recommendations around possible legislative and policy changes relating to a statutory right to assist a person to end his or her life (assisted dying) and a statutory right to receive such assistance. The recommendations are set to be published in the Spring.

It held two meetings on Tuesday at Leinster House, where during a first afternoon meeting, speakers focused on the topic of safeguarding medical professionals. The second meeting, held on Tuesday evening, focused on the topic of assisted dying in New Zealand and Australia.

Irish doctor Sinéad Donnelly, Consultant in Internal Medicine and specialist in Palliative Medicine, Wellington Regional Hospital, New Zealand, was also present and gave evidence at Tuesday’s second meeting. 

She took a different view to Nitschke and a number of other speakers, telling the Committee that she had observed many people living on their own availed of assisted dying, and that the practice  She also said that the vulnerable were “being exploited,” and in addition,  the standard of palliative care services had “diminished” in New Zealand, where assisted dying became legal in November 2021.

Nitschke, the world’s best-known advocate for assisted suicide and euthanasia, is the creator of the controversial 3D-printed euthanasia machine – which sent shockwaves across the world when it was unveiled in 2021. Invented by Nitschke in 2017, the device, also known as Pegasos, is mounted on a stand, and contains a canister of liquid nitrogen to die by suicide through inert gas asphyxiation. 

This is used in conjunction with an inert gas – nitrogen – which lowers oxygen level rapidly inside the pods, while the name “Sarco” derives from “sarcophagus” – a stone coffin or a container to hold a coffin.

The 76-year-old is an Australian former physician who has been referred to in the media as ‘Dr Death’ said he had sought and received legal advice about the coffin-shaped 3D pods legality in in 2021. After commissioning a Swiss legal expert, Sarco said the machine was not in any breach of the laws in Switzerland, where  assisted suicide has been allowed in law since 1942.

The pod which releases a fatal nitrogen dose, has been met with pushback from some, who have deemed it “the slipperiest of slopes” and have accused inventor Nitschke of “glamorising” suicide through the pod. When the pod made international headlines in 2021, some went as far as to decry the machine as “a glorified gas chamber.”

Nitschke, who campaigned successfully to have a legal euthanasia law passed in Australia’s Northern Territory – and assisted four people in ending their lives before the Australian government overturned the law – who founded and directs Exit International, who created the pods. At present, the only place the devices can be used is in Switzerland. 

Speaking to The Daily Mail last month, Nitschke said “we’re ready to use” the pods – adding that the suicide capsules would be used for the first time this year.

“The person will climb into the machine, they will be asked three questions and they will answer verbally – ‘Who are you?’, ‘Where are you?’ and ‘Do you know what happens if you press the button?” he told the newspaper, as he explained:

“And if they answer those questions verbally, the software then switches the power on so that the button can then be pressed.

“And if they press the button they will die very quickly.” 

He said the pods work by rapidly reducing oxygen levels, stating:

“When you climb into Sarco the oxygen level is 21 per cent but after you press the button it takes 30 seconds for the oxygen to drop to less than one per cent.”

He told the publication that the machine will offer people “the option of a peaceful death whether they’re sick or not.”

Speaking before Tuesday’s Oireachtas Committee – which will make a recommendation for or against advising for a change in Irish law – the controversial euthanasia advocate turned his focus on the device, raising the possibility of using the pods in Ireland if the law is changed to allow for euthanasia or assisted suicide.

He described Ireland as having “a golden opportunity” regarding assisted dying, while raising “concerns” around the actual means that would be used to bring about an assisted death.

IRELAND ‘SHOULD NOT EXCLUDE’ SUCH OPTIONS

“Devices such as this have a useful and proper place in this discussion. Providing a reliable death within a responsible legal framework should not exclude such options in any proposed Irish legislation.”

Mr Nitschke went into detail before the Committee, as he recalled the deaths of four patients in 1995 under the Rights of The Terminally Ill Act in his native Australia. Nitschke’s patients were the only four people to die under the Act, before it was repealed the following year, after it provoked a furor in Australia and beyond.

“In 1995, as I was preparing for the implementation of the Rights of the Terminally Ill Act, I could have employed any method of death.

“With only Switzerland existing as an example (if one excludes the protocols of capital punishment in the US), I had to figure things out for myself: what drug(s) would be best and in which combination and potency,” Mr Nitschke told the Oireachtas Committee.

He continued: “Back then the barbiturate, pentobarbital, was still on the prescribing schedule. The ‘Deliverance Machine 3’ which I had built for my four patients to allow them to initiate the process that would end their lives used the drug combination of pentobarbital, a curare analogue, and potassium chloride to provide the peaceful, elective death of my four patients. 

“This machine allowed the patient to control the process, changing ‘euthanasia’ (where I would do the killing) into assisted suicide. This machine is now on permanent display in the British Science Museum in London.”

He told the Committee hearing that the shift away from such drugs had been driven by a global lack of availability because of the use of one of the drugs in capital punishments in the US, adding:

“This shift in the US has been driven by the global lack of availability of pentobarbital because of its use in capital punishment lethal injections.”

He further advocated for an Irish law which would allow euthanasia for those who are not physically ill – stating: “Ireland is well placed to make laws that benefit the majority, rather than the select few who are sick enough to qualify for a law which by its very nature is exclusionary, rather than inclusionary.”

Mr Nitschke argued for an approach based on the law in Switzerland – where there have been large year-on-year increases in assisted suicide deaths. A 2023 article published in the British Medical Journal detailed how there has been a doubling of deaths every five years over a twenty year period under the law. Because Switzerland does not have a medical model, assisted suicide is allowed for those with non-terminal illness or chronic disability, and for physically healthy older people. 

“An approach based on the Swiss model would serve Ireland well in the longer term,” Nitschke said.

“Ireland has a golden opportunity to do better,” he further claimed.

The Committee heard from a range of international speakers. Among them was Dr. Sinéad Donnelly, a Consultant in Internal Medicine and specialist in Palliative Medicine at Wellington Regional Hospital, New Zealand. Dr Donnelly, a physician who has trained and worked in Ireland, the USA and Scotland, shared her objection to the proposals to change the law, which she said was informed by her extensive experience of palliative care.

Palliative care, she argued, was something which was able to “satisfactorily address people’s physical and existential needs and fears at the end of life.without ending their lives prematurely.”

The Irish doctor, who currently works in New Zealand, told the Committee that doctor’s involvement in assisted death would send a message that “the patient’s life is no longer worth living.”

“My starting point is that assisted dying is not part of medicine. Assisted dying sets up a conflict within medicine and for palliative care in particular.

“We cannot expect doctors to be advocates for life and direct providers of immediate death – whether offering the option of a premature death, or acceding to a patient’s request for such, doctors’ involvement in the decision sends an existential message that the patient’s life is no longer worth living even if, doctors see themselves as a neutral party,” Dr Donnelly said.

“In NZ 1,800 doctors signed an open letter that doctors should not be included in the practice of assisted dying citing that” crossing the line to intentionally assist a person to die would fundamentally weaken the doctor-patient relationship which is based on trust and respect,” she continued.

“In New Zealand, where legislation mirrored on Canadian law has been in effect exactly 2 years, it is far too early to derive lessons. This is particularly so based on the limited data being gathered despite our protracted discussions with the Ministry of Health advising them to collect data similar to Oregon or Canada.”

She drew from observations made by palliative medicine physicians, where she said that patients were being granted euthanasia on the basis of their request, and the fact they were likely to die within six months.

“But, the feedback from doctors is: there was no attempt as far as I could see from the documentation, to explore why. And no sign in those notes of intractable suffering,” she said.

‘ASSISTED DYING IS BEING CHOSEN BY THOSE WHO LIVE ALONE’

“The practice of palliative care has deteriorated with less engagement on the tough subject of suffering and its meaning for individual patients which is core work of palliative care. All of this means that true choice for patients and those who work in palliative care has been reduced. 

“Patients with delirium deemed lacking in capacity by an experienced palliative medicine doctor are undergoing euthanasia. Many have proceeded with assisted dying on the basis of feeling a burden.”

She shared one example of a man who lived alone, and whose sister suggested euthanasia for him.

“He felt completely devastated in the fact that she thought that that might be an option. He has proceeded with it but that rift between him and his sister was palpable. Assisted dying is being chosen by those who live alone,” she said.

Another example she shared involved a man with a recent cancer diagnosis, who also lived alone, and didn’t have anyone to care for him.

“An external family member initially said ‘We’ll do everything we can to support you’. After a week put her hands up and said ‘We can’t support you’,

“Rather than go to a rest home, he chose assisted dying. Coercion is subtle and happening everyday.”

The Irish doctor said one problem was “inadequate funds” needed to provide a good palliative care service – adding that assisted dying “takes huge resources in time and energy from palliative care.”

“There are concerns about the grief of children and teenagers of parents or grandparents who choose Assisted dying,” she continued. “Paediatricians have serious concerns about 18 year olds choosing Assisted dying when it is known that an 18 year old may have adequate cognitive development but not emotional development.”

“I have referred to the negative impact on palliative care. Many are seeking assisted dying because they feel a burden. People are requesting and receiving assisted dying without objective signs of suffering. People whose capacity to consent is questionable are receiving assisted dying. 

“The vulnerable are being exploited and the standard of palliative care services has diminished,” she said.