In the Futurama time line, suicide booths were invented between 2006 and 2008. In the Highway to Perdition time line in which we’re living, it wasn’t until 2021 that Exit International of Australia obtained approval for its “Sarco” suicide booth to be used by what the article terms “the Swiss assisted dying sector”, whose two largest organisations, Exit and Dignitas, killed 1300 people in 2020.
Exit International founder and Sarco developer Dr Philip Nitschke describes his invention as follows:
It’s a 3-D printed capsule, activated from the inside by the person intending to die. The machine can be towed anywhere for the death. It can be in an idyllic outdoor setting or in the premises of an assisted suicide organisation, for example.
The person will get into the capsule and lie down. It’s very comfortable. They will be asked a number of questions and when they have answered, they may press the button inside the capsule activating the mechanism in their own time.
The capsule is sitting on a piece of equipment that will flood the interior with nitrogen, rapidly reducing the oxygen level to 1 per cent from 21 per cent in about 30 seconds. The person will feel a little disoriented and may feel slightly euphoric before they lose consciousness. Death takes place through hypoxia and hypocapnia, oxygen and carbon dioxide deprivation, respectively. There is no panic, no choking feeling.
Nitschke adds that In an environment where the oxygen is less than 1 per cent, after losing consciousness death would occur after approximately 5–10 minutes.
The device appears to lack the 25¢ coin slot, two-at-once capability, and “slow and horrible death” option of the Futurama booth.
Though as a physician, I am ambivalent as to such “active” euthanasia. My concerns as a physician are to a large degree bypassed by such a device, since medical professionals are unnecessary - they need not be involved at all. Taking this outside the medical system entirely eliminates ethical dilemmas for healers. I don’t understand the process itself completely, however, from a physiologic perspective.
While hypoxia and death will undoubtedly result quickly from this strategy, I don’t understand the assertion about hypocapnia (low pCO2 or low partial pressure of CO2). There is only one way hypocapnia occurs acutely: hyperventilation. They assert that there is no sense of suffocation, yet if hypocapnia does indeed result as stated, why would the subject hyperventilate? The drive to breathe, called ventilatory drive - is about 90% caused by slight increases in pCO2/pH (partial pressure of CO2) of the blood. Since only 10% of that drive results from hypoxia, and then only at markedly low levels of blood pO2, increased ventilatory drive from hypoxia would begin late in the described process. A lot depends on how fast the pN2 is raised (i.e. the pO2 reduced).
Now hypocapnia in itself is markedly un-physiologic as in that circumstance the blood becomes alkaline. Evolution has provided various protective mechanisms regarding acidosis, as acid production is a significant result of normal metabolic processes and must be buffered at all times. Not so for alkalosis, which almost never results from normal physiologic processes. It reduces the level of ionization and extracellular concentrations of several critical electrolytes, including Ca++ and K+. This results in decreased cardiac contractility and arrhythmias - which both can cause death. So, in this sense hypocarbia can be said to promote death. Why it would occur in this time interval is still not clear to me. Careful experimentation with volunteer subjects and non-life-threatening levels of hypoxia from breathing excess N2 can be - and probably have been carried out. If/when I have time, I will search this.
I can imagine the FDA’s response to a request to approve this were it a medical device: unsafe and effective.
Here is a bulletin from the U.S. Chemical Safety Board, “Hazards of Nitrogen Asphyxiation” [PDF]. It states that when oxygen content is reduced below 4 to 6 percent, coma is induced is less than 40 seconds.
On March 19, 1981, there was a high profile incident of nitrogen asphyxiation involving workers preparing the space shuttle for its first flight. The engine compartment of the shuttle was purged with nitrogen before engine start to prevent any hydrogen that entered it during the ignition process from burning or exploding. Five Rockwell International technicians entered the engine compartment after a countdown test without breathing equipment, believing the nitrogen had been flushed out. All five lost consciousness and two died. The survivors said they had no indications of anything being wrong and simply passed out without any prior symptoms.
Aerospace Medicine, the subsection that military Flight Surgeons have to take, teaches something called TUC - or Time of Useful Consciousness. It ALSO teaches that when you have ANY senses of hypoxia or dyspnea, you gang-load your respirator device in the aircraft. It is impossible to tell whether you are hypoxic or hypocarbic - the initial symptoms are the same, at least when flying as an uninitiated pilot.
One of the other things the various flying programs all do is a “chamber ride” - a “flight” in a decompression chamber. You are required to pre-breath 100% O2 for an hour to wash out all the nitrogen in your system. The “flight” then commences. At different altitudes you are asked to remove your mask and perform simple acts. At 40,000’ no one completes even these simple tasks, and their neighbor is asked to watch over them and reapply the mask as soon as it becomes obvious the person is failing. Note that these are all healthy air crew.
In the above circumstances, TUC at 25,000’ is along the lines of 2 minutes. In actuality (and I did this in our non-pressurized A-37 at 24,000’) the actual TUC is greatly reduced. I had taken off my helmet because the nape strap (in the back) was causing some discomfort and I wished to adjust it. I had had my mask off no longer than perhaps 15-20 seconds when I experienced my first signs of hypoxia - which I knew from my chamber ride. I initially didn’t think that was possible but just in case, I simply applied my mask and took a deep breath. ALL my symptoms instantly went away! It was my practical lesson that hypoxia is sudden and unrelenting. Unless you are thinking of your known opening symptoms you will likely become a victim quickly. I believe that golfer (?Pine) who died when his whole plane died of asphyxia and crashed only when it ran out of gas, being on an autopilot, is a great example. Some similar fate is postulated for all the pax on that “lost” flight of a 747 out of Indonesia.
Two perspectives, if I can be serious for a moment:
So many people now have seen a parent or grandparent get old or sick, fall into the arms of the medical profession, and have their life-spans extended … but at significant cost to their quality of life in those terminal months or years. I have lost count of the number of people who have said something like “That is not going to happen to me; I will take the Smith & Wesson way out first”.
Mortality is guaranteed to every one of us. Maybe we need to have some serious heart-searching about what is the best way to deal with that reality. Maybe focus on quality of life rather than simple length of life, and not fight so hard against the inevitable? Supposedly, about half the average person’s lifetime medical costs are incurred in the last 6 months of life.
A related factor one can’t help but notice is the lack of attention we pay to the dead today, compared even to our parents’ day. Ancient Egyptians threw up pyramids for certain of the dead. But across geographies and centuries, humans have built barrows and other structures for their dead to keep their memories ever present. Today, we burn the body, scatter the ashes, and move on. Is this limited attention to prior generations unprecedented? Is this because we live in a short attention span society, with little concern for either past or future? Have there been earlier cultures which were so quick to forget their dead? If anyone has any information, please share.
This is a difficult question and one fraught with emotion when it involves those near and dear to us. When I discuss and ask a question like “Would you cause your pet to suffer a slow and painful demise due to a terminal degenerative disease?” and then follow up with “And what about your family member?” that usually elicits a blast of opprobrium from “conservatives” that I wish I could bottle and use against “progressives”.
But, to quote Lenin, “What is to be done?” This is a real problem, and a real question, and looking the other way is not going to make it go away. It is largely a modern problem in that extreme means of life extension when no hope remains did not exist until recently. It seems callous to look at costs, but when palliative care in end-of-life situations burns through fortunes accumulated over a lifetime which might be used to give descendants a leg up in their lives, you have to ask cui bono? Especially when it’s just for a few weeks or months of life at the edge of the abyss.
Ahh!! The Josef Mengele School of Medicine. ?When exactly did you expect the majority of their medical expenses to be spent - when they’re young and healthy…
Much of medicine today is basically methods of extending life. But patients don’t come with tags, “THIS TREATMENT WILL NOT HELP”. Nor does medical progress. When I first started medicine, I recollect having to fight tooth-and-nail to get a 75 y/o cathed for coronary disease. Today it’s rather routine. SOME of that comes from the invention of PTCA, so there are far fewer CABG’s being done. But THAT came at the cost of spending money on the elderly and finding ways to keep them alive - and discovering that it worked. You can’t know unless you try.
The biggest challenge today is to figure out what to do with the demented. It is true that the elderly who appear “healthy” have far less reserves, so surgical solutions, which drain bodily resources, need be applied more sparingly. And there is evidence that anaesthesia runs increase dementia - why is unknown.
The problem is today’s doctors all too often don’t want to fight for a patient’s life. They state “statistics” that old people have poorer outcomes and give up. BUT the surgical specialties often seem driven by cash - do another hip and get your next two month’s Mercedes payments in the bank.
Our dog died this last August, one week short of 14 - a long life for a 72 lb dog. But we knew he was dying because we found a malignant melanoma on his lip, and by the time we found it, it had undoubtedly metastasized. Melanomas are every bit as nasty in dogs as in humans. Yet we did subject him to an excising surgery to reduce his tumor load - because it clearly bothered him. I don’t believe it extended his life but it did make his last days far more comfortable. We considered putting him down but he continued to be himself, so we kept on keeping on. ?What else was there to do. Grandpa and grandma are the same. We often don’t know whether one will make it or not. I have had many discussions about desperately ill old people for whom I had done everything I could to save them. I would warn the family it didn’t look good. Three or five days later I would see them leave the hospital alive and well. Way back when I remember an older guy being brought in in full arrest. We worked on him and restored a pulse and pressure. As I left the room, the PR nurse came up to me and said the family said he didn’t want anything done. “TOO BAD! I already saved him!” In the following three or so hours I got called to the ICU for an arrest. It was my guy, who because the family had said he didb’t want anything done, had been put on a T-piece. I sat down and talked to the family and said we didn’t know how things would turn out, but for darn sure if we didn’t support his ventilation, he would die. We put him on a ventilator. About 10 days later I was doing some paperwork in my office ib the ED, when a local Internist stuck his head in my door and said there was someone who wanted to talk to me. It was the patient, who wished to thank me for saving his life.
We just don’t know - and when we don’t, spending some money is better than just not helping. It isn’t what physicians are suppose to do.
Yes, that was him! He died on that private jet, along with all the others including the flight crew, because no one was wearing a mask. In airliners it once was a requirement that ONE flight officer wear an oxygen mask - because decompression can be SO sneaky you don’t see it coming until it’s too late. I’m not sure that’s the case anymore.
It is very difficult to extrapolate from the particular to the general. We can surely agree that this is a very challenging topic!
I think about a gentleman who had very expensive surgery for brain cancer, lived a soul-destroying 10 months, then died, leaving his wife forced to sell the family home and subsequently file for bankruptcy in her painful attempts to pay the bills. And there are multiple other related stories within the small circle of people with whom I have interacted over the years.
So, what’s to be done? Clearly, whatever decisions an individual wants to make about medical attention and pay for out of his own pocket are fine. If an individual chooses to use his own resources and make the decision to risk a miserable quality of life for a period of time followed by death, that is ok.
A different issue arises when someone wishes to take the same risk and pass the bill on to other people. Is that morally justified? In a world of limited resources, someone else has to forego something beneficial to pay for that person’s subsidized medical treatment.
The approach to these difficult situations in England’s National Health Service is to put individuals with serious conditions onto waiting lists for treatment – in the full knowledge that many of those people will die before their turn comes up. Is that an acceptable approach?
My current thought (certainly susceptible to revision) is that we should base our approach to life-threatening medical conditions on a solid philosophical understanding of our indisputable mortality. We are all going to die! The focus should be on quality of life, not length of life.
OK. But we just don’t know often what ”quality of life” will result. Certainly some decisions can, and should be made. My MIL lived with us for what my wife thought would be 6 months and turned into 4 years. But we were careful about what all we subjected her to. When she got ”sick” we generally treated her for a UTI, by far the most common, and easily treated old people disease. We had decided her marginal mental status would not tolerate PTCA, or lung biopsies, or abdominal surgery. But in her life, including her older years, she had had carotid surgery and a stent. We thought we were making reasonable decisions for her. She lived to 94.
The problem gets to when, like England, you simply make decisions based upon a given age. Different people have different conditions at any given age. I have seen 50’s people who were in such bad shape they were unlikely to live to see 60, and I have seen 80 y/o’s who are seemingly in perfect health. But modern medicine, and especially modern government controlled medicine, gets into dollars and cents, and does total disregard for the patient and what they might tolerate.
That is a good point. It is obvious once I read it but it had not occurred to me.
There is a problem with health care costs. It is complex. The politicians are involved so it likely won’t get solved. They have us on the health care for all problem when it is a cost problem. The health care for all problem impacts a relatively small percent of the population and the cost problem impacts an overwhelming majority. Whether Peter pays or Paul pays or they both pay, doesn’t change the cost of a meal.
Take all the non-financial benefits of working away. Do I want to work an additional 6 or 10 more to extend my life 1 to 3? Low quality or decent quality?
How about working the same time to extend someone else’s life?
Many people are already making the choice. The young with low time preference choose to have a bit better life now. Or do they? Maybe this choice is based on knowing there is a safety net.
Thankfully the vast majority of medical doctors and nurses etc are driven to improve and save lives. However, they too should be constrained by certain realities. I mean spending other’s money. Because money is or should be a translation of a person’s time. Each person should be the decider of their time.
Complexity and individual life choices call for the invisible hand of the free market. The result may be a shorter life span for all. It may be that the spending that led to improvements won’t happen in the future.
I believe the free market is the best known method to solve this type of complex problem. I also have more confidence in the probability of the free market system getting the right answer versus the government.
The synopsis Of a debate with a liberal friend: He said health care for all because poor people need treatment. I said they get treatment now when they go to the emergency room. He said that was the charity of the doctors. I said the doctor spending other people’s money wasn’t charity. It went over like a fart in church with everyone present.
This little story was meant to illustrate a couple of things. The vast majority of people don’t understand charity and the lack of understanding of what money represents. Is it fair for a doctor to force me to work longer because of their decision?
In reality it does. If Paul knows Pete is paying he may order the lobster and steak. But given the costs have already occurred, how the bill is split doesn’t impact the cost.
There is a disconnect between COST and CARE. I always ordered work-ups without looking at payment listings. I figured I really didn’t want to practice according to how someone could pay-rich people didn’t get “better” care than poor people. I would from time to time get a patient request to skip a CT, usually a standard-of-care thing. I would visit the patient and explain the pluses and minuses and let them decide. At least that way I felt they were making somewhat of an informed decision.
But as you say, there is more to it than simple economics. CT’s eg. are exorbitantly charged - because the government “allowed” it. I recollect a radiologist showing me the “allowed” charge he could levie for reading a head CT - $1350!!! I couldn’t create that kind of charge short of cracking a chest for a heart wound, yet I saved countless lives - and he didn’t. But lobbiests push for payment schedules and the best lobbiest wins. NO ONE doesn’t charge what Medicare “allows” - because there’s a penalty to do so.
I suspect the only way to fix this is to burn it to the ground and start over. Hospitals and the government currently have way too much power.
That is a peculiarity of the US health system which has always puzzled me. Big Intrusive Government ordering hospitals to provide treatment to people who cannot pay for it seems rather close to an unconstitutional taking, with an overlay of equally unconstitutional slavery. It is also an epically stupid system (i.e. normal government) since the Emergency Rooms get cluttered with non-emergency patients, delaying treatment to true emergencies.
Of course, that is not the only distortion in the US health system due to foolish government involvement. It makes no sense for anyone to get health insurance through his employer, but that is what resulted from WWII government wage controls. To echo Elon Musk, government regulations never go away.
It is interesting how quickly any discussion about health care quickly degenerates into discussion about health cost sharing. Madame Clinton’s failed Health Care initiative had nothing to do with health care, only about cost shifting. Same for ObamaCare. It might be more rational to approach the issue from the other end – from where the rubber meets the road, i.e. actual health care and a focus on quality of life rather than on forcing some people to pay to keep other people alive.
I suspect you are right. And I also suspect we will get the opportunity to rebuild our approach to health care as part of the general collapse of over-extended profligate bankrupt government.
This is exactly like that Star Trek episode about a planet where people threw a big ceremony when their life’s work was done, basked in the recognition, then voluntarily and happily underwent liquidation.
Unfortunately I can’t remember which Star Trek it was.
James T. Kirk would never have allowed this to continue; he would have yet again violated the Prime Directive.
Captain Picard would have struggled against his natural revulsion for the system but have beamed the gent back down to undergo it.
If it had been Deep Space 9, they probably woulda had a suicide pod on board the station.
(P.S.:When I think of that episode I wonder: was EVERYBODY on that planet some kinda genius? Was this kinda death just for the elite, like the Pyramids?)
