Assisted death or 'torture'?: Controversy erupts over suicide capsule's use in Switzerland

Though assisted suicide is legal in several nations around the world, when it comes to "suicide tourism," Switzerland is often the top destination as it allows residents of countries where assisted suicide is illegal to end their lives in the Alpine nation.

Over 1,000 people with serious diseases or disabilities end their lives in this way in Switzerland, as being terminally ill is not a requirement when enlisting the help of established assisted suicide organizations like Exit or Dignitas.

A total of 1,252 people chose to end their lives through Exit in Switzerland's German-speaking regions last year.

Suicide capsule Sarco, expected to start being used in the Alpine country this year, offers a different approach to the current method for assisted suicide, which is the ingestion of sodium pentobarbital.

In that method, the user loses consciousness within two to five minutes of ingestion, falling into a deep coma and dying shortly thereafter.

According to assisted suicide organization The Last Resort, with Sarco, users do not need to have a doctor prescribe assisted suicide drugs or mental checks. It says the procedure is "painless" and "free" of charge.

How does Sarco work? Who can use it?

The inventor of the futuristic coffin-like capsule, Philip Nitschke, explained that the interior of the pod is flooded with nitrogen, rapidly reducing the oxygen level from 21% to 1% in 30 seconds after the button inside the capsule is activated by the individual who wants to end their life.

Nitsche said that before activating the system, the patient must answer three questions to determine their presence of mind: "Who are you? Where are you? Do you know what happens when you push the red button?"

An individual who decides to use the pod will experience a brief period of disorientation and may feel a slight sense of euphoria before slipping into consciousness, according to Nitschke. In this case, the cause of death is a lack of oxygen and carbon dioxide which leads to hypoxia and hypocapnia.

He claims that users do not feel panic or a choking feeling during the process. After losing consciousness, death occurs in about five to 10 minutes, he says.

According to The Last Resort, advanced old age, poly-pathologies of old age, serious, chronic, or terminal illness, and early dementia — as long as mental capacity is retained — are acceptable reasons to seek assisted suicide with the use of the capsule.

The organization says it does not provide young people with assisted death services unless they have a serious physical illness.

It has also reportedly said that there are "no legal barriers" to using Sarco in Switzerland.

First user

In a press conference on Tuesday, Florian Willet, The Last Resort's co-president, announced that the first use of Sarco would "take place pretty soon."

A date, time, and location for its first use have yet to be determined and it remains unknown who its first user would be.

Details will be made public after the assisted suicide is finalized, as there is a desire to avoid media attention, said lawyer Fiona Stewart, who is part of the organization's advisory board.

The first use of the capsule is expected to take place "this year," Stewart added.

How 'peaceful' could dying with nitrogen be?

Though Sarco's inventor and the organization where it will be used, The Last Resort, defend the method as "dignified" and involving no suffering, some questions remain unanswered, particularly since the UN human rights office has called death by nitrogen hypoxia "novel and untested" after an initial use to end the life of an inmate in a US execution.

After the execution of Kenneth Smith in Alabama, the office took a clear position against "suffocation by nitrogen gas," saying it "may amount to torture, cruel, inhuman or degrading treatment."

Similar concerns were also voiced by UN experts as they said the use of nitrogen hypoxia would "result in a painful and humiliating death."

While Swiss regulations lack any specific classification for which methods can be used for assisted suicide — and while execution and assisted suicide are fairly different contexts — it is worth noting that suffocation by the nitrogen method is considered possibly "cruel and inhuman."

Euthanasia vs assisted suicide in Switzerland

To be clear about the difference between euthanasia and assisted suicide, it is important to note that while euthanasia requires the active involvement of doctors to end the life of a patient, assisted suicide leaves that responsibility fully to the individual.

That is why euthanasia is prohibited in Switzerland, while assisted suicide has been permitted since the 1940s.

"Any person who, out of respectable motives, namely out of compassion, kills a person at that person's earnest and insistent request shall be liable to a custodial sentence not exceeding three years or to a monetary penalty," Art. 114 of the Swiss Criminal Code says.

For permissible assisted suicide, the person wishing to die must perform the act leading to death themselves. The doctors involved in the process are responsible for checking the capability of judgment and determining if the desire to die is well-considered, permanent, and comprehensible in view of the circumstances and the available treatment options.

If all the criteria are ticked, then they can prescribe the drug to the patient.

However, the next article of the Swiss Criminal Code indicates that if this is not the case, and an individual induces or assists someone else to commit suicide for "selfish motives," this could carry a jail penalty of up to five years.

As the first use of Sarco approaches, it is likely to reignite discussions on the balance between personal autonomy and ethical considerations in assisted death. The global community will be watching closely as Switzerland navigates these complex issues, potentially setting precedents for other nations grappling with end-of-life policies.