Euthanasia device

For the fictional suicide machine, see Suicide booth.

Part of a series on
Euthanasia
Types
Animal · Child · Voluntary Non-voluntary · Involuntary
Views
Religious (Buddhist · Catholic)
Groups
Dignitas · Dignity in Dying Exit International
People
Jack Kevorkian · Philip Nitschke
Books
Final Exit The Peaceful Pill Handbook
Jurisdictions
Australia · Canada India · Mexico Netherlands · New Zealand Switzerland · United Kingdom United States
Laws
Rights of the Terminally Ill Act 1995 Oregon Death with Dignity Act Washington Death with Dignity Act
Court cases
Washington v. Glucksberg (1997) Gonzales v. Oregon (2006) Baxter v. Montana (2009)
Alternatives
Assisted suicide Palliative care Principle of double effect Terminal sedation
Other issues
Suicide tourism Groningen Protocol Euthanasia device Euthanasia and the slippery slope
v · d · e

A euthanasia device is a machine engineered to allow an individual to die quickly with minimal pain. The most common devices are those designed to help terminally ill people die by voluntary euthanasia or assisted suicide without prolonged pain. They may be operated by a second party, such as a physician, or by the person wishing to die. There is an ongoing debate on the ethics of euthanasia and the use of euthanasia devices.

Notable devices

Thanatron

Invented by Dr Jack Kevorkian, this device involved an individual pushing a button that released drugs or chemicals that would end his or her own life. Two deaths were assisted by means of this device, which delivered the euthanizing drugs mechanically through an IV. Kevorkian called it a "Thanatron" or death machine (see Thanatos).

It had three canisters or bottles mounted on a metal frame, about 6 inches (150 mm) wide by 18 inches (460 mm) high. Each bottle had a syringe that connected to a single IV line in the person's arm. The first bottle contained ordinary saline, or salt water. Another contained a sleep-inducing barbiturate called sodium thiopental, and the third a lethal mixture of potassium chloride, which immediately stopped the heart, and pancuronium bromide, a muscle relaxant to prevent spasms during the dying process. (These are the three drugs administered in the lethal injection execution protocol, but in the execution protocol, the pancuronium bromide is administered before the potassium chloride.)

1. Kevorkian or an assistant begins the saline solution flow.
2. The person who wants to die must deliver the barbiturates by throwing a switch, pushing a button or pulling a string.
3. After that, either a timer or a mechanical device triggered by the person's falling arm as the drugs take effect starts the lethal drug flowing. The idea is for the deadly chemicals to enter the bloodstream only after the person is asleep. Death usually occurred within two minutes.

Mercitron

Kevorkian assisted others with a device that employed a gas mask fed by a canister of carbon monoxide which was called "Mercitron" (mercy machine). This became necessary because Kevorkian's medical license had been revoked after the first two deaths, and he could no longer have legal access to the substances required for the "Thanatron". It was a rudimentary device consisting of a canister of carbon monoxide attached to a face mask with a tube. A valve must be released to start the gas flowing. Depending on the person's disability, a makeshift handle may be attached to the valve to make it easier to turn. Or, with the valve in the "open" position, a clip or clothespin could be clamped on the tubing. Pulling it off allows the gas to flow. By Kevorkian's estimates, this method took 10 minutes or longer. Sometimes he encouraged people to take sedatives or muscle relaxants to keep them calm as they breathed deeply of the gas.

Carbon monoxide is hazardous to others who may discover the body (family, medical workers, police).^[1]

Deliverance machine

The Deliverance Machine was invented by Dr Philip Nitschke. Four terminally-ill Australians used it to end their lives with a lethal dose of drugs after they answered "yes" to a series of questions on the laptop screen. This procedure was legal in Australia's Northern Territory between 1995 and 1997.

The "Deliverance Machine" was invented by Philip Nitschke. It consisted of a notebook computer and software titled "Deliverance", which asks the patient a series of questions, and automatically administers a lethal injection of barbiturates if the correct answers are made.^[2] In an interview^[3], Dr. Nitschke named several reasons why he developed the machine. Even if it would have been legally possible for a doctor to administer a lethal injection, he preferred that the patient initiate the process. The machine also allowed a doctor to leave the patient with the family when the button was pushed.

The machine was used legally under the Northern Territory's Rights of the Terminally Ill Act 1995, which was later overturned.

Exit's euthanasia device

The Exit International euthanasia device was invented by Dr Philip Nitschke in 2008. It used an ordinary barbecue gas bottle filled with nitrogen,^[4] a plastic suicide bag, and some plastic tubing with one end attached to the gas canister and the other fixed inside the bag by a tie held by adhesive tape.^[5] In December 2008, Nitschke released details of the euthanasia device to the media. His new device/method is a modification of the "Exit Bag plus helium" method described in The Peaceful Pill Handbook. Instead of using a pre-packaged disposable cylinder of helium, he suggested filling purchased empty LPG cylinders (rated at 3300 kPa) with compressed nitrogen and then regulating this with a jet assembly to give a flow of around 10 litres per minute into the standard plastic "Exit Bag". This equipment has some small advantages over the helium method:

• Larger amounts of nitrogen are available and flow rates last longer.
• The gas is more physiological, with no chance of adverse reaction (helium is reported to cause some twitching^[6] during death);
• If there is any leakage in the period of storage of the cylinder, it can be topped up at any time to the recommended 400 pounds per square inch (2,800 kPa). The helium party balloon cylinders cannot be refilled and, if they leak over time, must be discarded.

Nitschke called it "flawless" and "undetectable", saying the new process uses ordinary household products available from hardware stores.^[7] Inhaling the pure nitrogen, patients lose consciousness immediately (in approximately 12 seconds)^[8] and die a few minutes later.

Nitschke said: "So it's extremely quick and there are no drugs. Importantly this doesn't fail – it's reliable, peaceful, available and with the additional benefit of undetectability." However, Nitschke commented in 2010 that if helium is used, new autopsy tests can detect it.^[9]

The principle behind the effectiveness of the device is oxygen deprivation that leads to hypoxia, asphyxia and death within minutes. Deprivation of oxygen in the presence of carbon dioxide creates panic and a sense of suffocation (the hypercapnic alarm response), and struggling even when unconscious, whereas anoxia in the presence of an inert gas, like nitrogen, helium or argon, does not. Nitrogen (N₂) weighs 28 g/mol, the same as air, whereas carbon dioxide (CO₂) weighs 44 g/mol, and will tend to fall out of the bag.

The basic principle of autoeuthanasia by anoxia was first described in the book Final Exit by Derek Humphry in 1991, although the newer technique that uses inert gases to reduce time taken to die to about five minutes was first discussed in the third edition of Humphry's book.^[10] The original methodology was devised, using helium, by the NuTech group — engineers, physicians, divers and others, a small number of people first assembled in 1998 under the leadership of John Hofsess, Philip Nitschke, and Derek Humphry.^[11] Nitschke's innovation is the use of a hardware store barbecue gas canister, although in his book The Peaceful Pill eHandbook, he mentions the use of disposable helium canisters, used for inflating party balloons.^[5]

Close contact with an enclosed inert gas is lethal because it flushes oxygen from the body, but released into the open air, it quickly disperses, and is safe for others. It is neither flammable nor explosive.^[10] Close contact with the gas is achieved in Humphry's book by enclosing the head in a suicide bag — a strong, clear plastic bag of dimensions 22 inches (560 mm) by 36 inches (910 mm), secured around the neck by a strap,^[12] or by using a product available from the Canadian Right to Die Society called the "EXIT bag", which has a sewn-in Velcro collar and fastened-in, flexible plastic tubing. In all cases, the inert gas is fed into the bag by plastic tubing.

Suicides using this method are well documented in the literature. In the study Asphyxial suicide with helium and a plastic bag (Ogden et al.),^[13] the authors describe the following case history:

CASE REPORT
This death occurred in September 2000, in South Carolina. The deceased was a 60-year-old white woman with a diagnosis of adenoid cystic carcinoma that had spread to the eye, causing double vision. ... Her husband discovered her on the living room floor approximately 2 hours after she was last seen alive. She wore a surgical mask over her face, and a clear plastic bag was secured over her head. ... Next to her body was an industrial refillable tank labeled “helium.” A clear plastic hose was attached to the tank valve and led to the plastic bag. Also at the scene were the book Final Exit, Final Exit: The Video, and the Spring 2000 Hemlock Society Newsletter, which included an article on helium and plastic bag suicide. The decedent appeared to have diligently followed the instructions in these materials. ... The deceased’s skin color was unremarkable, and there were no external signs of poisoning. Toxicologic examination of blood and urine for therapeutic and abused substances did not reveal data of significance .... When a person breathes inside a plastic bag filled with helium, unconsciousness will occur almost immediately, and death will ensue in minutes.

Dr Nitschke said the suicide device will prolong the lives of the terminally ill by making them feel in control of their future. "That idea of giving people access to a means of feeling that they're back in control of this issue is actually a way of prolonging life. It may seem paradoxical, but what we find is when people feel that they're back in control, they're less likely to do desperate things in desperate ways and people are always doing desperate things in desperate ways and ending their lives."^[14]

See also

• Euthanasia
• Suicide booth

References

1. ^ Risser, D; B�nsch, A; Schneider, B (1995). "Should coroners be able to recognize unintentional carbon monoxide-related deaths immediately at the death scene?". Journal of forensic sciences 40 (4): 596–8. PMID 7595295. 
2. ^ "Death by Computer - WSJ.com". online.wsj.com. http://online.wsj.com/article/SB835824113352032000.html?mod=googlewsj. Retrieved 2009-01-06. 
3. ^ http://www.nationalreview.com/interrogatory/interrogatory060501.shtml Euthanasia Sets Sail An interview with Philip Nitschke, the other “Dr. Death.” By Kathryn Jean Lopez, NR associate editor June 5, 2001
4. ^ Wheatley, Kim (2008-12-16). "AdelaideNow... New death device to be launched in Adelaide". www.news.com.au. http://www.news.com.au/adelaidenow/story/0,22606,24813754-2682,00.html. Retrieved 2008-12-19. 
5. ^ ^{a b} Nitschke (MD), Philip; Fiona Stewart (MD) (2007). The Peaceful Pill eHandbook. USA: Exit International. pp. 51. ISBN 0978878825. 
6. ^ "Euthanasia group Dignitas films gas and plastic bag deaths". www.dailymail.co.uk. http://www.dailymail.co.uk/news/article-539929/Euthanasia-group-Dignitas-films-gas-plastic-bag-deaths.html. Retrieved 2009-05-15. 
7. ^ Wheatley, Kim. "AdelaideNow... Dr Philip Nitschke launches 'flawless' euthanasia device". www.news.com.au. http://www.news.com.au/adelaidenow/story/0,22606,24816520-5006301,00.html. Retrieved 2008-12-18. ^{[dead link]}
8. ^ Goldfrank, Lewis; Neal Flomenbaum, Robert S. Hoffman, Mary Ann Howland, Neal A. Lewin, Lewis S. Nelson (2006). Goldfrank's Toxicologic Emergencies. McGraw-Hill Professional. pp. 1675. ISBN 0071360018. 
9. ^ "Test detects suicides from natural deaths - ABC News (Australian Broadcasting Corporation)". www.abc.net.au. http://www.abc.net.au/news/stories/2010/01/14/2792176.htm?section=australia. Retrieved 2010-01-15. 
10. ^ ^{a b} Humphry, Derek (1991). Final Exit: the Practicalities of Self-Deliverance and Assisted Suicide for the Dying. New York: Delta Trade Paperback. ISBN 0385336535 
11. ^ "The many ways to hasten death". www.worldrtd.net. http://www.worldrtd.net/node/613. Retrieved 2008-12-26. 
12. ^ Humphry, D. 1991: "...a small strap, which reaches around the neck and can be fastened with Velcro at either end, or strong ribbon, which goes around the neck with Velcro sewn into the ends, or even ties easily into a knot. Large rubber bands or panty hose firmly but not harshly around the neck will do. It does not have to be completely airtight"
13. ^ Ogden, Russel D.; Wooten, Rae H. (September 2002). "Asphyxial Suicide with Helium and a Plastic Bag". American Journal of Forensic Medicine & Pathology 23 (3): 234–7. doi:10.1097/01.PAF.0000022963.33157.9B. PMID 12198347. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0195-7910&volume=23&issue=3&spage=234. 
14. ^ "Nitschke's suicide machine slammed - ABC News (Australian Broadcasting Corporation)". www.abc.net.au. http://www.abc.net.au/news/stories/2008/12/18/2449786.htm. Retrieved 2008-12-19. 

External links

• DIY euthanasia - Death with Dignity for the Terminally Ill (archive, 7z-version)
• PBS Frontline: The Thanatron