‘I think something like this will be well accepted.’
‘It’s better than a bag,’ Alex adds gently.
‘Technology is changing the face of the world, and death is no exception. We’re going to see a lot more of people taking control of the final aspects of their life. People are saying, “Enough is enough,” in terms of the ability of modern medicine to keep people alive.’
‘But then, is the answer a machine to kill them, or a change in our attitude to death?’
‘They go hand in hand,’ Philip says.
Alex is a relative newcomer to the business of death. ‘Have you thought about how you’ll feel the first time someone uses your design to kill themselves?’
‘Philip will have made the decision to give them access to it, and I trust in Philip to make those decisions,’ he replies with a shrug. ‘Our responsibility stops with the design.’
Alex suggests I get myself a glass of Prosecco – it’s made locally, he says, particularly good here. I head back down to the reception, where the pyramid of fruit has been eaten but the drinks continue to flow. I have a glass on the decking, beside the Grand Canal. While the live band takes a break, Ella Fitzgerald and Louis Armstrong sing ‘Cheek to Cheek’ on the sound system. ‘Heaven. I’m in Heaven.’ Everything is balmy, rose tinted, beautiful, unserious, fun.
Except that it’s not. It’s grotesque. The people who funded Philip’s trip and the invention that brought him here aren’t thinking about flying joyfully off to the next world in style; they are living with despair, fear, sorrow, pain and panic in this one, and are searching for anyone who can help them out if it. Sarco’s launch feels so much like an indulgence, another milestone to flatter Philip’s ego, rather than a viable way of helping those people.
Even if the prototype I saw upstairs was in perfect working order and ready to go, it would not be the answer for people who are desperate for a death they completely control. Philip controls this technology, and the access to it. He owns the IP, and if you want it you will have to be accepted into his organization, and pay him.
But then I think about one of the last things Philip said to me upstairs. ‘We’re planning to make it open source,’ he told me. ‘We’ll make it available to people who have The Peaceful Pill Handbook, and that will mean you have to be over a certain age, you’ll have to sign something.’ He shrugged. ‘Look, we know it will bleed. And that doesn’t really matter.’
He knows he will never be able to fully control who gets access to the technology he has invented. So long as everyone knows he’s the man who created it, he doesn’t really care.
CHAPTER FIFTEEN ‘The means to an end’
What is it with men and car analogies? RealDolls are the Rolls Royce of adult toys. DS Dolls are the Bugatti Veyron. Clean meat is the automobile that makes the horse and cart of animal meat obsolete. Sarco is the Tesla of death machines.
But Philip wants everyone to know that the true inspiration behind Sarco isn’t actually a vehicle at all, but a cult movie released in 1973 starring Charlton Heston.
‘I must say that some of my original ideas came from watching the death scene in Soylent Green,’ he’d told me as he sipped his beer in Venice. ‘This futuristic idea that there will be people – and we have them contacting us right now – who say, “I’ve got to this stage where my life is complete, and I want to do the right thing by the planet.”’
The reference was lost on me that day, but in the weeks after the launch I keep hearing Soylent Green mentioned whenever Philip talks about Sarco. He gushes about the ‘ground-breaking’ film in a piece he’s written to promote Sarco in the Huffington Post, and in a brief interview with Vice, where he repeats that strange idea of a ‘death that does what’s right for the planet.’ So I buy a second-hand DVD to try to work out what he means.
Set in a stinking and violent New York of 2022, where the city’s population is forty million and the temperatures are sweltering, Soylent Green is the well-worn story of a hard-bitten cop (called Thorn, Heston’s character) trying to solve a murder and inadvertently uncovering a global conspiracy along the way. Soylent Green is the name of the lab-engineered superfood humans are forced to eat now that overpopulation and global warming have made conventional agriculture almost impossible. Billed as ‘the miracle food of high-energy plankton’, it could be any number of the comestibles being cooked up in Silicon Valley today.
The ‘death scene’ that inspired Philip comes in the final act of the film. Thorn’s best friend and flatmate, Sol, who is old enough to remember the good old days, goes to a creepy building where people with benevolent smiles ask him what his favourite colour is (‘orange’) and his favourite kind of music (‘classical’). Then staff in white robes with orange fringing link arms with Sol and guide him to a raised, tomb-like bed – a sarcophagus – where he is propped on a pillow and tucked under some sheets. Bathed in orange light, Sol drinks a cup of something. A button is pressed. Images appear on giant screens around him – orange tulips, orange sunsets, a babbling brook, tropical fish, mountains and a glade carpeted with daffodils – as Beethoven’s Symphony No. 6 is piped into the room.
Sol dies with his eyes wide open. The screens and orange lights are switched off. Then the people in the robes wheel his corpse into a chute, which sends his body to the Soylent Green factory, where it is turned into food. Because it turns out that the secret ingredient of Soylent Green is not plankton, but human flesh. ‘They’re making our food out of people!’ Heston shouts in the closing shots of the film. ‘Soylent Green is people!’
I blink as the credits roll. Out of all the euthanizing scenarios dreamed up in the canon of science fiction, from Star Trek to Futurama, this is what has inspired Philip? The calm, controlled death Soylent Green depicts is the compliance of an old, depressed and desperate person relieving the burden on an overpopulated planet; death engineered so that humans can eat other humans. It is total madness. Can Philip really have seen this cautionary tale and concluded that the death scene is ‘doing the right thing by the planet’? Yes, Sol felt no pain, chose when to die, and had his favourite colour shone into his face. But his death was hellish.
When Philip talks about reclining in the Sarco for the sake of the planet, he’s describing something eerily similar to the ethical suicide parlours in Kurt Vonnegut’s short story, ‘Welcome to the Monkey House’. In Vonnegut’s fictional world of seventeen billion, the government strategy to address overpopulation included ‘the encouragement of ethical suicide, which consisted of going to the nearest Suicide Parlour and asking a Hostess to kill you painlessly while you lay on a Barcalounger.’ Perhaps this is what rational suicide is, at its most brutally rational: as soon as you feel you have fulfilled your purpose on earth, the logical thing is to check out as soon as possible and stop taking up precious resources.
We are closer than ever to having to make choices like this. Defying death has become a key objective in Silicon Valley: venture capitalists funding anti-ageing research see a future when death is something that we actively choose when we are tired of living, instead of the scary, unpredictable shadow hanging over us that it is now. Even if escaping death may be beyond us, it’s likely that our lifespans, in wealthy countries at least, will stretch out over hitherto unimaginable horizons. Sarco looks like it has been designed not for the terminally ill, but for those who are fit enough to manage to contort themselves into its seat: people who are tired of life and make the choice to die. And because the parameters of illness and disability will no longer be relevant in the decision to give people access to this kind of death, because this will be a death with no gatekeepers, being sure that the choice to die is a rational one, entered into freely, becomes more important than ever.
Which bring us to the mental-capacity assessment required to get the code to enter Sarco, the test that Philip blithely waved away as something that will be carried out by AI as soon as the intransigent medical establishment gives way to the inevitable march of progress. On t
he face of it, you could easily develop a program that could test whether someone understands what they are about to do when they use Sarco. The Deliverance software already did that part quite effectively: its first question was, ‘Are you aware that if you go ahead to the last screen and press the Yes button you will be given a lethal dose of medications and die?’ and the second was, ‘Are you certain you understand that if you proceed and press the Yes button on the next screen you will die?’ Pretty unambiguous.
But for a person to truly have rational capacity to make a decision, they need to be able to weigh it up and put it in the appropriate context. When doctors evaluate whether someone is fit to choose for themselves they make a value judgement: they look at how the person behaves as much as what they say, not only while taking the test, but in the days and years preceding it. They don’t have to agree with the decision their patient makes; they just have to be confident that it was rationally made, based on their answers, behaviour and medical history. It is an art, as much as a science. This value judgement might epitomize the ‘doctors know what’s best for you’ attitude that Philip abhors, but it is the only thing we can rely on for the foreseeable future. In a case where there is any complexity, it’s unlikely that computers will be able to get it right, and certainly not by 2030, the time that Philip expects 3D printers to be able to pump out Sarcos quickly and affordably. Getting this right every time really matters, because it’s always a life-or-death decision.
Software is not neutral; AI always contains the biases of the people who programmed it, and anything that gets Philip’s blessing will be as value-loaded as any doctor’s assessment could be. The view that everyone should have the means to have a peaceful death at a time that only they choose is a libertarian position, a political belief, not a fact. With his technology, Philip is able to impose his worldview without any state or doctor getting in the way, and he is imposing it on bereaved families as well as the people dying in his machines. You could say he is as paternalistic as any of the patronizing doctors he despises.
The most revealing insight into how extreme Philip’s views are on the right to die comes from his reaction to news of the death of Noa Pothoven. Noa was a Dutch teenager with a history of self-harm, anorexia, depression and post-traumatic stress disorder after being sexually abused at eleven and raped at age fourteen. On 4 June 2019, Daily Mail Online reported that Noa had been legally ‘euthanized at home by “end-of-life” clinic’ at only seventeen because ‘she felt her life was unbearable due to depression’. It was the top story on the site, and went on to make headlines from Australia to India, Italy and the US.
A gleeful press release from Philip popped into my inbox the following day. ‘Netherlands Shows Nuance of Euthanasia Debate as Psychiatrically Ill Dutch Teenager Dies’, read the headline. ‘The global news today that Arnhem teenager, Noa Pothoven, has been helped to die with euthanasia shows the sophistication of the Dutch euthanasia debate as it has developed over the past two decades. Today, I live in a country that is the world leader in open-mindedness when it comes to end of life decision-making for all,’ Philip gushed. ‘There are no hysterics about whether she was sick enough. She was not sick at all. At least not physically. There is little controversy over the fact that she had a mental illness […] her opinion of her suffering [has] been respected.’
But the story wasn’t true. Hours after Philip issued his statement, it emerged that Noa had died at home after refusing food and fluids, and no one assisted her death. Noa had approached a euthanasia clinic without her parents’ knowledge in 2017 that refused to help her die. ‘They consider that I am too young,’ she told the Gelderlander newspaper, six months before her death. ‘They think I should finish my trauma treatment and that my brain must first be fully grown. That lasts until your twenty-first birthday. It’s broken me, because I can’t wait that long.’
Amid the flood of international interest, Dutch Health Minister Hugo de Jonge announced an investigation into Noa’s death. ‘We are in touch with her family, who have told us that there is no question of euthanasia in this case. Questions about her death and the care she has received are understandable, but can only be answered once the facts have been established,’ he said.
Philip later wrote a corrective blog post saying he got the story wrong but it didn’t matter. ‘There is something about the Netherlands that makes the fake news of how Noa died not that relevant […] [T]he fact that her parents allowed her to go through with her wishes, and that the medical profession (in hero role) did not rush in demanding she be saved from herself, says something about this place. The type of respect shown to Noa, if not by not helping her, then at least by not interfering, is a good lesson to those countries who insist on “nanny-stating” the rest of us to death… so to speak. Rational suicide is a fundamental human right.’
I believe in the right to die. I believe that future generations will look back in horror when they see how we allow desperate people to suffer – and how people like Lesley, moved by nothing more than love and compassion, are put under immense pressure to break the law to help them – when all they desire is a peaceful and dignified end. But I do not see how there can ever be any ‘good lesson’ to draw from the starvation of a traumatized, anorexic, self-harming child.
Philip believes anyone should have the right to die painlessly, at a time and place of their choosing, even if they are still in the middle of trauma treatment, as Noa was, even if their brain is still developing, even if there’s good reason to think they might one day feel differently. Any psychiatric test that is a barrier to the information and technology he provides is meaningless if Philip thinks people who are profoundly mentally ill are rational enough to choose to die. Sarco’s keypad is a fig leaf, the disclaimer that allows Philip to promote his machine while accepting no responsibility for whoever uses it. It doesn’t really matter if an AI sophisticated enough to replace psychiatrists is far down the road; Philip wants everyone to have access to his machine anyway, even if there is hope that they might one day want to live.
* * *
I find Lesley in her new home in rural Norfolk, a cottage surrounded by fields. She’s doing bits and pieces of creative writing and is very involved with the local RSPB. Her days of teaching people how to kill themselves are well behind her. Her time with Exit is now little more than a bewildering memory.
‘It was looking great,’ she tells me in her sun-drenched living room. ‘When you go to an Exit meeting it’s very obvious that the people there are finding a great relief in being able to talk to people. They can’t acknowledge to anyone else that they’re thinking of euthanasia at all, so the freedom to be able to speak freely in a safe environment seemed such a great thing.’
She says she had the idea of organizing roadshows, so members around the country could connect with each other, and Exit HQ in Australia seemed keen, but what they really wanted was more members. ‘I was told to sign up as many people as we could, encourage people to subscribe to the handbook, sell books and other merchandise, and generally keep the income coming in.’ A sad smile crosses her face. ‘When I took the job, I didn’t think that I would be taking on a sales role.’
Lesley began to question what Exit members in the UK were getting for their money. After the Brayley business Philip had come under scrutiny from the Met Police, which meant Lesley couldn’t promise there would ever be any practical workshops from him. ‘I was concerned that Exit had actually courted the publicity that had caused this to happen. They were always very pleased when there was anything in the newspapers or the news over here that seemed to make Dr Nitschke into an even more infamous figure. But I was dismayed by the impact that had on what we could then do for members.’
As well as answering the phones to suicidal people, Lesley says she began to field complaints from customers who had ordered equipment through Exit that never arrived, people who had in some cases waited a year or more. She lobbied on their behalf and got them all refunds. But they didn’t really
want their money back. They desperately wanted someone to deliver on the promise of the peaceful death Philip had sold them. There was nowhere else for them to go.
The main problem was the distribution of Max Dog nitrogen: Exit couldn’t find a courier prepared to ship canisters of compressed gas from Australia to the UK affordably. But then a UK nitrogen supplier was found, a company in Margate, which sold canisters to Exit for £43 a pop. Exit then sold them on to British members for £465.
‘That did include freight costs,’ Lesley adds, apologetically.
‘It’s an enormous markup,’ I say.
‘Yes it is. Yes.’
‘And people thought they were getting an Exit product, because it was branded as Max Dog nitrogen?’
‘They had stickers put on them to say they were Max Dog cylinders, but people knew that they were sourced in the UK, so I don’t think that was any kind of deception.’ She shifts in her seat. ‘It does seem like a huge markup, but Exit does need consistent income, and they’d spent a lot developing the Max Dog range of products. So I was happy, initially, that this was the case.’
‘How do you feel about it now?’
Lesley frowns. ‘I do accept that they have to cover their costs or they will go under. But I think that the markup was taking advantage of people’s need and desperation, in some cases: they knew that individuals wouldn’t be able to get hold of these cylinders themselves – because of their age, their infirmity, or for whatever reason it wasn’t that simple – and that people would have to buy them through Exit, with a bit of loyalty thrown in to support the cause. They paid a really very high price.’
Even with the new supplier in place, Exit could not find a sustainable way of distributing the cheap nitrogen around the UK. While Lesley was in charge, she says they only managed to ship three canisters. She has no idea if the people who bought them have used them to end their lives.
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