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A good death beyond dignity?

According to the Australian euthanasia activist Philip Nitschke, to choose when you die is “a fundamental human right. It’s not just some medical privilege for the very sick. If you’ve got the precious gift of life, you should be able to give that gift away at the time of your choosing.” This view combines two extreme standpoints in the debate on euthanasia and assisted suicide: First, it claims that you should be allowed to end your life as you please, unbound by further qualifications such as a grim medical diagnosis; and second, it says that we should treat this decision with utmost importance, as a claim right which can hardly be overridden by conflicting considerations.

As one normative consequence of this idea, you might think that ending your own life should be as easy and comfortable as possible. To this end, Nitschke, together with the Dutch engineer Alex Bannink, has developed the ”Sarco” (from “sarcophagus”, an ancient coffin made of stone or other durable materials). On the images available online, the device looks like a means of transportation, with a futuristic design and a cockpit-like pod that rests on a stand. And indeed, its main purpose is to allow its user to make their final journey “with elegance and style”, as Nitschke put it. After successfully completing an online questionnaire which tests for mental fitness, the person seeking death gets an access code for entering the pod. When the user once more has confirmed their choice to die, nitrogen is released to bring down the oxygen level in the pod cabin, rendering the person unconscious and killing them shortly thereafter.

One common concern with these types of mental tests is that they are executed not by a psychiatric specialist, but proceed AI-driven. Also, even people whose mental health is beyond doubt make all kinds of irrational decisions: Being in the grip of a fear or feeling forced by your social environment can lead you to ill-informed decisions, even if you are perfectly healthy by any common measure. Moreover, people can make all sorts of rational, but unwise or even silly choices they later regret; and while one might think that they nonetheless have a right to do so, one still can reasonably doubt whether this supports the kind of fundamental human right Nitschke has in mind: After all, nothing less than your very existence is at stake when you are about to enter Sarco, so one would have wished for a few more safety measures, all the more because the developers plan to make the design plans publicly available in 2019.

While I believe that personal autonomy certainly has a role to play in any promising conception of a good death, I am much more doubtful whether a dignified end really comprises nothing more than the end each individual would choose for themselves.

These considerations notwithstanding, let’s focus on yet another issue. One of the self-proclaimed aims of the Sarco is to bring the idea of a peaceful death to a new level: While euthanasia activists usually equate a “peaceful death” with a “dignified death”, Nitschke thinks that we can do ‘better.’ He asserts that his suicide machine elaborates on “the possibility of feeling not just dignity at the end, but of feeling euphoric. […] In a creative twist on my previous ‘have the best death you can’ proposition, the Sarco adds the extra layer of ‘feel your best.’” In line with this idea, the Sarco homepage welcomes its visitors with the tagline “What if we had more than mere dignity to look forward to on our last day on this planet?”

The picture suggested here is one of two variables for a good death, where a euphoric death of the sort Nitschke has in mind improves upon a dignified death. There are good reasons, however, to believe that not only severe suffering and pain may prevent people from having a “death with dignity”, but also that a death as envisaged by Nitschke and his co-designer will do the same. For the euphoric mood that the Sarco induces in its users is not the kind of contentment you experience when you are comfortably surrounded by your loved ones in the final moments of your life. On the contrary, Sarco’s killing mechanism allows you to feel good at the price of mental clarity and orientation. Nitschke compares this feeling with an experience he had during his Air Force days: “I was asked to write a letter to a friend while they lowered the oxygen level in my training chamber. I wrote rubbish, but it seemed like happy euphoric rubbish when I was re-reading it at ground oxygen level.”

However, this feeling of mental disorientation is precisely what many people associate with an undignified death. In a survey conducted in 2006 by Harvey Chochinov and colleagues, 211 patients with terminal cancer in its final stage were asked about their “sense of dignity”. One of the items in the researcher’s list that the vast majority of patients (77.3 %) identified as a negative factor relating to dignity was “Not being able to think clearly.” If these people are right, we might question how dying by hypoxia – being poisoned due to the exposure of nitrogen – can assure a dignified end when the state of mind accompanied by this counts as undignified in the eyes of many.

Perhaps Nitschke would admit this: “The Sarco will not be for everyone, that’s clear.” Maybe he would argue that what counts as a dignified death, or at least certain aspects of it, is also subject to the subjective attitudes of the affected person. And maybe this is explained by the assumption that a dignified death is a death that conforms with a person’s authentic values and wishes. While I believe that personal autonomy certainly has a role to play in any promising conception of a good death, I am much more doubtful whether a dignified end really comprises nothing more than the end each individual would choose for themselves. Some good deal of research has been done on this topic over the last years, and with some notable exceptions, the majority of the results deny that we should simply equate a dignified death with an autonomous one.

Featured image credit: Ocean Sunset Photo by Gabriel Garcia Marengo. Public Domain via Unsplash.

Recent Comments

  1. Bradley Williams

    Correction there is no medical supervision or witness required at the time of the flaunted “self administration “ in the US.
    The laws/bills that the international euthanasia monopoly crafts are not OK. Amending the CA euthanasia law is sorely needed (and OR, WA, CO and HI). Even as they proclaimed that the poison must be self-administered to divert normal scrutiny they did not provide for an ordinary witness. The difference is that without a witness it allows predators to force euthanasia but with a witness they would up hold individual choice.
    Amendments would include not allowing an heir to be part of the process, requiring a witness to self-administration, restore the illegality of falsifying the death certificate, require the posting of the poison applied in the medical record, register organ/tissue trafficking, reveal commissions and memorials paid to the corporate facilitators to guard against the profiteering that is of public record in the industry.

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