The Sarco Pod is a new example of an end-of-life technology which are designed for assisted
suicide—and it was approved for use in Switzerland where assisted suicide is legal [1]. The
proposed method for the Sarco Pod—which can be delivered anywhere—is flooding it with
nitrogen gas, while reducing oxygen [1]. This creates a loss of consciousness that is followed by
death within 10 minutes [1]. Not only is the pod self-activating from the inside, but it has an
emergency button if the individual were to change their mind and wish to exit [1].
The capsule’s inventor, Dr. Philip Nitschke, pledged to make the blueprints of the design free and
accessible for anyone to download, which would improve the public’s understanding of his
technology,and in his words, “demedicalize the dying process” [1]. Blueprints were distributed
by the nonprofit organization The Last Resort—a collective of human rights advocates with a
variety of backgrounds in order to “diversify and democratize the dying process” [3]. The Sarco
Pod is not for sale but is instead made available based on patient qualifying information and is
3D printed (taking about 1250 hours) for €650,000 [3].
In Switzerland, the criteria for assisted suicide can be for a number of reasons including old age,
poly-pathologies associated with old age, chronic or terminal illnesses, as well as early dementia
[3]. Switzerland requires that mental capacity be retained, those assisting are altruistic in their
motives, and they outline a concept called ‘Tatherrschaft.’ Tatherrschaft requires that the person
who is dying must bring about their own death (be the one performing it) [3]. The Last Resort
also requires individuals to be over 50 years old [3]. The Sarco Pod was used for the first time by
a 64 year-old woman who was experiencing long term challenges with her immunity on
“September 24, 2024” [2]. In the United States, individuals living in Colorado, California, the
District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont and
Washington and who are terminally ill or have six months or less to live are able to exercise their
right to physician-assisted suicide [4]. Unlike Switzerland, the United States requires it to be
performed by a licensed physician where people are often given an aid-in-dying medication [4].
The exact method depends on the state, as well as the individual’s condition [4]. Therefore, the
applicability of this technology is varied depending on the country and its respective laws.
Nonetheless, this technology is being discussed on a global scale, posing implications for those
who desire to use the Sarco Pod or wish to meet its criteria.
The Sarco Pod is an alluring idea because it can be used anywhere, and is encouraged to be used
in places of beauty like various outdoor locations (beach, mountains etc) [3]. This offers a more
peaceful alternative to windowless and bleak hospital rooms. Additionally, another proposed
benefit is a fast and dignified death that is mediated by the patient itself. If the patient is suffering
and is mentally competent (having passed a psychiatric evaluation), shouldn’t the patient be able
to dictate the way in which they die? Some would argue this would be no different from suicide
that is not asssited, which may be more painful for family, friends, and the individual. If someone
intends to end their own life and will have to endure long term suffering, this provides a unique
opportunity for a peaceful death without the agonizing pain for them and their loved ones who no
longer have to see them pass in discomfort.
However, the Sarco Pod is not without controversy. The first patient ,an immunologically-ill 64
year-old American woman,who recently used it this Fall was found to have strangulation marks
on her neck discovered during an autopsy [2]. This brought up questions about the cause of
death, as well as a possible malfunction. Elisabeth Baume-Schneider, the Swiss Minister of
Health, said that Sarco Pod failed to meet product safety requirements, and uses nitrogen that
was “not legally compliant” [5]. Four arrests have been made so far, including members of The
Last Resort. This has brought into question if the Sarco Pod is a successful step forward in the
world of patient autonomy and dignified death. The prosecution of these individuals brings up
questions regarding how we can adequately gauge the intentions of those who are assisting in
this kind of death. Is there any true measure to determine if this technology is altruistic? Beyond
this, how can we truly determine if a death is dignified if there are potential systems and
structural malfunctions that might impair this process?
One of the significant arguments against physician-assisted death or end-of-life technologies is
the devaluation of human life [6]. Many would argue that by giving people the option to choose
their own premature death, this may inadvertently glamorizing suicide based on critera for
determining ‘acceptable candidates.’ In other words, even though this may be a more viable
option for terminal illnesses, could this technology also devalue individuals with severe mental
illnesses like treatment-resistant depression? Acceptance of this new technology may lead to
more agency for those who may not be deemed mentally fit to make these decisions, but feel
they have no quality of life or hope for a better future. This raises the question of if we should
listen to people’s self-perceptions of their own lives or force them to continue to endure a failing
treatment for our own moral self-comfort instead of them taking control of their own deaths. At
what point is suffering considered great enough where it would be acceptable for one to engage
in dignified suicide? The ambiguities associated with death present a challenge in deciding who
is truly worthy of participating—is it those actively suffering in a merely physical way, because
one could argue that mental illness is also heavily embodied and physical, or can it offer
preemptive action after a devastating diagnosis?
There are still many gray areas that present themselves in these scenarios, and there may not be
an objective way to measure who would be a good candidate for the Sarco Pod. However, this
represents a growing discourse valuing patient autonomy. One of the Hippocratic Oath’s most
important pillars is “doing no harm,” and this includes respecting patient decisions regardless if
they pose internal ethical challenges for the practicing physician. I would argue that the
avoidance of death is not always in the best interest of the patient if it poses extreme physical or
mental strife—especially for the elongation of a life that they know is already coming to a
premature end. Patients should instead be afforded the opportunity to live their last days, not
with pain, fugues created by medication and tears, but as a celebration of the life that they have
lived on their own terms with the ones that they love. Although a physician’s job is to actively
work in preventing death, there is a constant balance between preserving life and preserving
dignity. Discourses surrounding end-of-life proceedings provide another avenue for patients to
exercise one last gift of self-determination in the face of crippling disease and suffering.
Ultimately, although something like the Sarco Pod may be a useful tool in the future for ill
people to die on their own terms, structural and legal challenges continue to persist. End-of-life
technologies and advocacy movements provide an opportunity to continue conversation
surrounding the role of technology in the preservation of life and the ability to die with grace.
Regardless of these advancements, there continue to be ethical questions that remain largely
unanswered, but boil down to how much we accept and value patient voice as we work towards
freedom from suffering.
References:
1. BBC News. (2021, December 22). The technology behind Switzerland’s “suicide pod”.
BBC News. https://www.bbc.com/news/technology-59577162
2. NDTV. (2024, October 25). First woman who died in Sarco suicide pod may have been
strangled: Report.
NDTV.https://www.ndtv.com/world-news/first-woman-who-died-in-sarco-suicide-pod-m
ay-have-been-strangled-report-6940975
3. The Last Resort. (n.d.). About us. The Last Resort. https://www.thelastresort.ch/
4. CNN. (2014, November 26). Physician-assisted suicide: Fast facts. CNN.
https://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/index.html
5. CNN. (2024, September 24). Switzerland arrests man involved in Sarco suicide capsule
project. CNN.
https://www.cnn.com/2024/09/24/europe/switzerland-arrests-sarco-suicide-capsule-intl-h
nk/index.html
6. McLellan, F. (2016). The ethics of assisted suicide and euthanasia: A review of current
literature. Journal of Medical Ethics, 42(5), 299–305.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5102187/#:~:text=Lay%20Summary%3A%20
Presented%20here%20are,modern%20therapeutics%20more%20and%20more