Sarco: Why disruptive techniques in assisted suicide are problematic

"Sarco", a suicide capsule developed by assisted suicide activist Philip Nitschke, also known as the "Elon Musk of assisted suicide", could lead to criminal investigations in Switzerland. Public prosecutors from various cantons have announced investigations in the event that the capsule is used for assisted suicide. This is reported by the Neue Zürcher Zeitung (NZZ), among others.

"Compulsory comprehensive criminal proceedings" in the event of use

Rolf Jäger from the Zurich public prosecutor's office told NZZ that if Sarco is used in the canton of Zurich, "comprehensive criminal proceedings on suspicion of criminal acts against life and limb (homicide)" would have to be initiated. Other public prosecutors expressed similar views.

The suicide capsule "Sarco" (short for sarcophagus) received widespread media attention and met with public skepticism when its launch was announced in Switzerland. The capsule, which was produced using a 3D printer and described as the "future of euthanasia", is supposed to fill with nitrogen at the touch of a button, thus enabling a painless death within a few seconds. Critics have doubts about the promise.

Questionable marketing

There are also concerns about Nitschke's marketing strategy. The first planned use of the capsule in Switzerland was canceled after the person who wanted to die, a 55-year-old American woman, felt mistreated by Nitschke's team. She accused those responsible of not respecting her privacy and wishes. Nitschke and his team reject these accusations. It is currently unclear if and when the capsule will be used in Switzerland.

The topic of assisted suicide is also the subject of controversial debate in Germany. There was actually supposed to be a legal regulation on assisted suicide last year, but two bills in the Bundestag failed. The laws were also intended to make it possible for lethal medication to be prescribed for assisted suicide, albeit with different hurdles. The first bill was intended to criminalize assisted suicide. According to the draft, a psychiatric assessment would also be required.

The second proposal envisaged removing the right to euthanasia from criminal law and relying on a counseling network. After the Federal Constitutional Court overturned the ban on "commercial euthanasia" in the German Criminal Code in 2020, there is no legal regulation. Accordingly, the right to self-determined dying also makes it possible to make use of assisted suicide. Since then, there has been legal uncertainty regarding assisted suicide. There could soon be a new attempt at a legal regulation to provide legal certainty and protection for all those involved.

Only recently, the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) therefore called for doctors who provide expert opinions on the use of assisted suicide to be prohibited from also carrying out assisted suicide. The medication should be issued by a state agency. The German Medical Association is also calling for suicide prevention to be the first priority, for which Health Minister Karl Lauterbach presented a strategy in the middle of the year.

According to the BÄK, a social debate must also be held before the issue of assisted suicide can be tackled. As there is currently no regulation for assisted suicide, the use of a system such as Sarco would therefore also be conceivable in Germany, provided no one intervenes.

We spoke to psychiatrist Prof. Thomas Pollmächer from the DGPPN about the details. He is Director of the Center for Mental Health at Ingolstadt Hospital and Adjunct Professor of Psychiatry and Psychotherapy at Ludwig Maximilian University in Munich. He is also a member of the ethics committee of the European Psychiatric Association and on the scientific advisory board of the Federal Association of Relatives of People with Mental Illness.

heise online: Can a system like Sarco actually be used in Germany?

Thomas Pollmächer: If someone in this country offers something like this and it is taken up, it is possible in principle. There could certainly be criminal charges afterwards, similar to what is currently being discussed in Switzerland.

Regardless of whether it is implemented or not, the idea is interesting and somehow incredible. The fact that people want to turn something as existential as self-induced death into something like this is outrageous and very provocative. The claims that it would all work without any problems are not correct. It is doubtful that people will fall asleep peacefully in this capsule within a very short time. When this method – was used on death row inmates in the USA, of course without this capsule –, they suffered massive respiratory distress. We don't know how suicidal people react when they suddenly can't breathe, because such a capsule has not yet been tested.

What does it mean for our society to use systems like Sarco?

The fact that the Federal Constitutional Court overturned the legal ban on assisted suicide, Section 217 of the German Criminal Code, means that there are currently no legal regulations.

The Federal Constitutional Court does impose a clear restriction, namely that only those who are truly able to decide freely and responsibly about their own death may exercise this right. However, this is not a triviality. Doctors have already been sentenced to prison in the first instance because they had not sufficiently examined the question of free responsibility.

It could be, for example, that a person is assisted in suicide who is not in a position to make such a decision in a freely responsible manner. In this case, various investigations are required to ensure that people are actually capable of doing so.

BVerfG overturns ban on assisted suicide for business purposes

In 2020, the Federal Constitutional Court declared Section 217 of the German Criminal Code to be unconstitutional because the ban on the commercial promotion of suicide violates the general right of personality. This right also includes the right to take one's own life in a self-determined manner and the freedom to seek help from third parties if it is offered. The court argued that the ban on commercial euthanasia restricts the possibilities of assisted suicide to such an extent that it becomes de facto impossible to exercise this right. Furthermore, the ban is not proportionate, as it inadmissibly restricts the free decision of the individual on an existential issue.

In response, the organization behind Sarco has proposed AI as a decision-making aid to replace psychiatrists. What do you think of that?

I think that's unrealistic. Apart from the fact that there is a lack of data, you would have to find suicidal people who are willing to talk to a chatbot on the one hand and an expert on the other. But how would this data then be validated?

What is crucial, however, is how we as a society deal with suicides. Whether we declare them to be a matter of course and accept them with a shrug of the shoulders or whether we see them as something that needs to be fundamentally prevented. It doesn't matter whether it involves AI and a space capsule, people hanging themselves or taking a drug. Suicides should remain the absolute exception. The decisive factor is that anyone who wants to take their own life should be offered help. And assisted suicide should be a real rarity.

Unlike in the Netherlands or Belgium, where around 5 percent of deaths are already caused by assisted suicide. Even children are among them and 95 percent of the 5 percent die through active euthanasia, which is still strictly forbidden here.

Is that a good thing or a bad thing?

I'll leave that to your personal decision, but there's more. There are individual cases in the Netherlands where dementia patients are killed against their currently expressed will in the sense of active euthanasia because they have expressed the wish to be "euthanized" at an earlier stage when they become demented.

Would you like a state agency to be involved in the process?

Yes, we demand that a state agency takes over the organization of the process and also provides the medication. We do not believe it is appropriate to impose the prescription of a lethal drug on the medical profession.

If assisted suicide is to become the norm in society, then it should be clearly separated from the medical profession. The details must be clarified by the legislator.

The advantage of a state organization would also be that business-like assisted suicide would no longer be necessary. This is because it is to be feared that such private associations and companies – with or without profit orientation – will not provide open-ended advice. Many such organizations downright glorify suicide, if only by calling it "suicide".

Note: In Germany, you can find help and support for all kinds of problems, including questions about bullying and suicide, at telefonseelsorge.de and by calling 0800 1110111. The number against grief (Kinder- und Jugendtelefon) is 116 111. In Austria, there are also free help services, including the children's helpline on 0800 567 567 and Rat auf Draht on 147, especially for children. The same telephone number in Switzerland leads to Pro Juventute.

(mack)