This article originally appeared on Tonic Netherlands.

In the Netherlands, euthanasia was written into the law in 2001. The law went into effect in 2002, which makes the country one of the most progressive when it comes to euthanasia. In 1996, Philip Nitschke became the first doctor to legally administer a deadly injection to one of his patients. In the international debate surrounding the topic of euthanasia, he is one of its most well-known and controversial proponents.

It wouldn't be a stretch to call Nitschke, who has been nicknamed "Dr. Death," a "euthanasia guru." He's the founder of Exit International, an organization that promotes voluntary euthanasia. He also wrote the suicide handbook The Peaceful Pill. Initially, he only spoke out about euthanasia for the terminally ill, but he's since changed his mind: He now believes that euthanasia shouldn't be confined by conditions and criteria, but instead is something that each person has the right to choose. In recent years, he's spent a lot of time designing Sarco, a 3D-printable suicide machine, which—according to him—will allow people to die peacefully. Due to this new invention, the past few weeks both Nitschke and his ideas have once again received a lot of attention. We talked to Philip about euthanasia as a human right, his own death, and his latest invention: The Sarco.

Photo: Frederieke van der Molen

Tonic: Let's dive right in: How do you feel about the nickname 'Dr. Death'?

Philip Nitschke: Well, you get used to it. Of course I'd much rather have a nicer nickname, though then I probably should involve myself with a more cheerful topic.

Yes, you're quite controversial. How did you become so interested in this particular topic?

It's actually a political thing. When I was working to legalize euthanasia in Australia, I met more and more people who wanted to die but didn't have a medical reason. One of them was a French woman, a scholar, who had planned to die at age 80. Not because she was sick, but simply because she thought that was a beautiful age to pass away. When I responded with initial skepticism, she answered—and she was right—that it wasn't my place to judge her. She said it was her decision, one that isn't bound by the rules I follow as a doctor. Partially due to her, I changed my mind. I became convinced that death should be a right for any sane human.

That turns out to be a controversial opinion. What is the biggest counter argument you come up against?

The most common argument is that there is no such thing as rational suicide, and that a death wish is, per definition, the result of a psychiatric illness. I reject that idea. Someone's death wish isn't something that needs to be treated, per se. Another objection is that life is a gift, one you should be thankful for. My counter argument for that is: If life is indeed a gift, you are also allowed to give it away. Otherwise, isn't it a burden instead of a gift?

"The most common argument is that there is no such thing as rational suicide, and that a death wish is, per definition, the result of a psychiatric illness. I reject that idea."

Photo: Frederieke van der Molen

Aren't you responsible to a degree, because you are facilitating the option [to commit] suicide?

I don't think that's fair. Look, I believe that choosing death is a right. If you would tell me right now that you are going outside to kill yourself, should I stop you? I don't think so. I believe that you, being an autonomous entity, are free to make that decision for yourself. It doesn't make me happy, but it's your decision. In that case, I only offer the option of a peaceful passing.

But you don't think you are lowering the threshold for people who otherwise might choose an alternate route like psychotherapy, for instance?

You don't know that. Wouldn't people who want to die jump in front of trains more often, then? Or hang themselves? People who truly want to die might otherwise choose a violent death. In the UK, hanging is by far the most commonly used suicide method. People don't know the alternatives, they know how this method works, and rope is always available—that doesn't take away from the fact that it's a horrible way to die. I'm only saying that you should be able to die peacefully, either aided by drugs or the Sarco.

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There might be people who abuse the Sacro or particular drugs, but there are also a lot of people who will benefit. It is, for instance, a type of safety net for old people when they become very ill. Knowing that they can die peacefully gives them an increased sense of happiness. They know they won't have to do anything desperate, like jumping in front of a train or riding their wheelchair off the pier, boom, into the ocean.

You believe that death is a human right. Then why is there a minimal age limit of 50 years old in The Peaceful Pill?

The age limit has been talked about a lot. My personal point of view is, that someone needs to be an adult and of sane mind to be able to make the decision. In the United States however, this was met with a lot of criticism in 2011. I was accused of being happy when young people commit suicide. That's why we have added the condition of a reasonable amount of life experience and the quite random age limit of 50. This was the only way to prove that we don't contribute to suicide amongst young people, but it doesn't change my philosophical point of view.

The Sarco takes away the preliminary stages of euthanasia, with a doctor as a gatekeeper. Isn't that necessary to ensure a certain accuracy? It's like me walking into a pharmacy and being able to pick up any kind of medication without a prescription.

So you're still stuck in the medical field. In my opinion—and when it comes to the Sarco—a doctor is not necessary. There are still certain conditions that people need to meet before they are considered, like being of sane mind. This is determined by an online questionnaire. In the future, artificial intelligence will be able to determine this faster and more accurately than a doctor.

You are in favor of a scenario in which depressed people can also use the Sarco. Are they able to make such a decision?

Depressed people will also have to pass the test that determines mental capability. Many depressed people still have the mental capacity to realize that death is permanent. Depression is not an excluding factor when it comes to use of the Sarco. But if you're depressed or physically ill to the point that you don't know what you're doing, you won't pass the test and Sarco is not an option for you. It may be a gray area, but it's not more or less gray than the tests that psychologists use right now.

Can you explain how the Sarco works?

The coffin can be printed with a 3D-printer and uses liquid nitrogen, which can be bought legally. After you have taken your seat inside the machine, nitrogen starts flowing. After a minute and a half you start to feel disoriented—a feeling comparable to that of having a few too many drinks—and a few minutes later you lose consciousness. In about five minutes, you're gone. The only way to control the coffin is from the inside, so it's not possible to kill someone with it. You can also choose either a dark or transparent view, so you can take the machine somewhere if you prefer a certain view.

I hope the blueprints will be available online in early 2018. The first Sarco will most likely be built in Switzerland, because someone there has taken an interest in the machine. Dutch lawyers have told us that using the machine isn't illegal, because over here, it's not a crime to end your own life. I'm only providing the blueprints and instructions online, but don't give personal instructions and there is no assistance required to operate the machine. The user is in complete control.

Coming back to that view you mentioned, what view would you choose for yourself?

I'd go back to the northern part of Australia and put my Sarco in the desert. During the sunset, that sounds nice. Though, on second thought, it'd be hard to take the nitrogen, because of the distance and the fact that nitrogen doesn't keep very well.

Photo: Frederieke van der Molen

"I recently received my first actual death threat. I don't know if it’s from a fundamentalist, or from someone who sells illegal euthanasia drugs."

If you're already in the Sarco and you change your mind, is there a panic button?

Yes, there is an emergency window that opens right away when you click against it, which allows for oxygen to flow into the machine at once. Additionally, you can press the stop button up until the moment you lose consciousness.

What does your family think about your beliefs?

My mother was a big supporter of my ideas. She was in a nursing home the last few years of her life, because she wasn't able to live at home any longer. She hated it there, and wanted to die. But she wasn't sick, so she didn’t qualify for anything. I couldn't give her anything either, because everyone would have known I was behind it. Knowing that she had a choice would have been a tremendous consolation for her.

Have you gotten death threats from opponents?

In the past twenty years I've luckily received only a few. I recently got my first actual threat. I don't know if it's from a fundamentalist, or from someone who sells illegal euthanasia drugs. In the book I mention several fake websites that sell pills for 700 Euros a pop. So it could also be a swindler. As for public events, we always make sure the security measures are very tight.

If you are struggling with a mental health issue in the USA, call the National Suicide Prevention Lifeline at 1-800-273-8255. In Canada, visit suicideprevention.ca for more information on how to get help.