As an estate planning attorney, end of life decisions are part of the process of creating legal documents such as the living will. But the living will only goes so far, as it legally allows the process of dying to take place uninhibited by otherwise life-prolonging procedures. The legal document does not call or allow for euthanasia. Many, however, assert that the right to die should go beyond refusing medical care and allow for assisted suicide.

Dr. Philip Nitschke considers himself the Elon Musk of assisted suicide and his latest death machine, the Sarco, is his Tesla. Nitschke performed his first assisted death in 1996 in Australia–when it was briefly legal–only to be outlawed for two decades before recently becoming legal there again.

As a young medical school graduate, Nitschke found himself drawn to the world of euthanasia and the work of Dr. Jack Kevorkian, the most famous euthanasia proponent in the United States. Inspired by Kevorkian’s death machine, Nitschke set out to create an updated version that he called “The Deliverance”. The machine was rudimentary, comprising only of a laptop hooked into an IV system, but it worked. A computer program would confirm a patient’s intent to die and then trigger a lethal injection of barbiturates. It successfully ended four lives before Australia repealed the euthanasia bill in 1997.

The repeal of the euthanasia bill didn’t dissuade Nitschke. He has aided in hundreds of what he refers to as “rational suicides”. He founded a non-profit in 1997 by the name of Exit International, and in 2006 he published The Peaceful Pill Handbook, which instructs on the most painless and efficient ways to commit suicide.

Meanwhile, Nitschke continued to invent death devices. He created an “exit bag”–a breathing mask that replaced oxygen with carbon monoxide. The bag was highly effective but unappealing, as it was akin to dying in a plastic bag. People didn’t want to leave the world in such an aesthetically displeasing way.

His latest machine, the Sarco, is the answer to the problem. It is sleek and appears luxurious. It resembles a spaceship and is intended to convince its user that he or she is journeying to the great beyond. Its base contains canisters of liquid nitrogen and a removable capsule compartment that can be repurposed as a casket. The whole operation can be 3-D printed anywhere in the world.

Potential users fill out an online test of mental fitness, and if they pass, they receive an access code that works for 24 hours. After the code is entered and additional information is provided, the Sarco capsule will replace the oxygen with the liquid nitrogen. The user passes out once the oxygen level falls to 5 percent or below, and a few minutes later, death occurs.

The machine cannot be operated from the outside. The canisters are activated by a button from the inside. A user who has second thoughts can also hit an escape button opening the machine and allowing oxygen to take over all the way up to the time that he or she passes out.

Nitschke indicates that the user feels a sensation similar to being drunk or high before passing out and that the death is relatively painless. There is no asphyxiation as the user breathes easily, comparing it to an airplane cabin depressurizing. Suicide clinics in Switzerland are expected to license the machine sometime in 2018.

Nitschke believes that the right to die is a human right and not a medical or legal privilege. He states that no one should be subject to rules about whether a person is sick enough to choose to die. Not everyone agrees. “I think it is bad medicine, ethics, and bad public policy,” Dr. Daniel Sulmasy, a Georgetown University professor of biomedical ethics says. “It converts killing into a form of healing and doesn’t acknowledge that we can now do more for symptoms through palliative care than ever before.”

Sulmasy believes that assisted suicide violates the bedrock of all ethical thinking, which is that people have value simply by being human. He argues that assisted suicide sends a message to disabled and dying individuals that society urges them to choose death if they become too much of a burden. He also worries about the contagious effect that suicide can have on a population, pointing to various episodes in human history.

Sulmasky also points to the process called the double rule effect, which allows doctors to ethically help patients find the ultimate relief in their final days. The rules says that if a patient agrees to the risks, a physician is allowed to keep increasing the dosage of pain medication until the pain is completely under control, which may mean administering enough to render the patient unconscious or kill them.

The counter argument to this, Nitschke says, is that palliative care isn’t for everybody, and that some can’t direct more morphine be administered because of their end-of-life condition. He also says that even healthy individuals should have the option of ending life when they believe the time is right, so long as they are old enough to make that choice.

The ethical issues are numerous. I know many, myself included, who struggle with these issues after watching someone die a particularly painful end. As medical advances allow for longer life, we also have to think about how medical technology also brings into question the end of life. I don’t know what the answers are, but it appears that we now have more questions to consider.

The Sheppard Law Firm is located in Fort Myers and Naples by appointment.

© 2017 Craig R. Hersch. Originally published in the Sanibel Island Sun.