Controversy surrounding the first suicide using the Sarco capsule

Assisted suicide

In the Netherlands, assisting suicide is a criminal offence. Only doctors can assist in suicide under specific circumstances. Buijsen explains: “A special exemption from criminal prosecution has been created for doctors under the Termination of Life on Request and Assisted Suicide (Review Procedures) Act (Euthanasia Act). If doctors provide such assistance, comply with the due care requirements of the Euthanasia Act, report the assisted suicide to the municipal coroner, and are found to have acted carefully by the Regional Review Committees for Euthanasia, the Public Prosecution Service will not pursue the matter. Prosecution will not take place.”

However, the Sarco was not used in the Netherlands but in Switzerland. Why might the device have been used there for the first time? Is assisted suicide not punishable in Switzerland? Buijsen explains: “Assisted suicide is not punishable in Switzerland, provided the assistance is offered altruistically, the individual is terminally ill but fully mentally competent. The assistance does not have to be provided by doctors, but they are always involved in practice. Access to medical records is required to verify the terminal illness, and psychiatrists assess the mental competence.”

When is it considered assistance?

The Swiss police have since arrested several individuals who were involved in some way with the suicide of the American woman. The suicide capsule was designed by an Australian doctor in the Netherlands. This raises the question: Can designing the Sarco also be seen as assisting suicide? Buijsen explains this is not the case: “Devices can be manufactured. However, if this device is supplied to someone who intends to commit suicide, and the suicide does indeed take place in this manner, it qualifies as assisted suicide. The design and production of the device itself is not considered assistance in suicide.” He continues: “What is punishable is intentionally helping with the suicide or providing the means to do so. Simply pointing someone to a book or website where suicide methods are described is not considered assistance under criminal law. That is merely providing information. Suicide counsellors generally limit themselves to this. Building a setup with a helium or nitrogen tank, an air hose, and a mask or bag for someone or supplying those materials with instructions is no longer just providing information but offering assistance within the meaning of the criminal code. Providing a paper instruction manual or a link to a webpage with detailed instructions for making such a capsule entirely by the individual would again be considered providing information, not assistance under the law.”

The Sarco in the Netherlands

In the Netherlands, the Sarco is illegal. Buijsen notes that it is unlikely that the Sarco could be made legal in the country. He explains: “As mentioned, only doctors are allowed to provide assisted suicide in the Netherlands. How and with which means doctors and pharmacists offer this assistance is thoroughly described in an evidence-based KNMG/KNMP guideline. Following this guideline is expected to ensure a careful end-of-life procedure.”

Buijsen stated on RTL Nieuws that if someone offers assistance in suicide using the Sarco in the Netherlands, they can expect to be prosecuted. He points to a 2022 ruling in which a person supplied a gas cylinder, nitrogen, and a plastic bag and was sentenced to a six-month suspended prison sentence with a two-year probation period. He said to RTL Nieuws: “If you offer assisted suicide in the form of such a capsule in the Netherlands, you can expect a similar penalty.”