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January 27, 2024

The Facts about Nitrogen Hypoxia 101

The Facts about Nitrogen Hypoxia 101 by Dr Philip Nitschke

This week the State of Alabama executed Kenny Smith using an off-the-shelf, one-size-fits-all face mask that they purchased for $308 (exc shipping).

In using the face mask in this way Alabama Corrections went against the manufacturer’s instructions and warranty.

And they ignored advice provided to them by the assisted suicide movement: the only group in society with any experience in the use of nitrogen to bring about death.

Indeed, Alabama used the face mask in a way that it was not intended. They also failed to undertake a negative pressure test before its use, as mandated in the face mask manual.

How do I know this?

Because I purchased this same face mask when I was in Montgomery AL in December.

I was in the US to appear as an expert witness for Kenny Smith’s defence as we tried to bring a halt to this macabre killing by the State.

I am under court order not to disclose the make of the face mask used to kill Kenny.

This does not mean I cannot discuss the science of what happened in his execution.

Fact Checking the Media Reporting – The Facts about Nitrogen Hypoxia 101

Over the past few weeks there has been much said about death by nitrogen hypoxia.

Some reports have been more accurate than others. Some have been outright wrong. Some comments have been skewed to suit the political argument of the author or journalist.

In this blog we examine some of facts, myths and half-truths that have been peddled about death from nitrogen hypoxia.

Myth No 1 – Nitrogen = Grim & Tortuous Death

Nitrogen is an inert gas and makes up around 80% of the air we breathe.

A hypoxic death is not suffocation; there is no physical blocking of the airways. There is no analogy to holding a pillow over one’s face to cause death.

Mechanically blocking the airway is a terrifying death, but allowing the free flow of a gas into the lungs, but with no oxygen causes a gentle ‘hypoxic’ (low oxygen) death.

Furthermore, nitrogen gas does not cause suffocation.

When done in the way that has been tried and tested or over 20 years within the assisted suicide movement, nitrogen hypoxia can provide a most peaceful and reliable elective death.

Myth No 2 – Nitrogen Gas bears No Telation to Zyclon B (cyanide) Gas that was used in the Holocaust

It is disingenuous for Jewish anti-death penalty lobby groups (eg. L’Chaim and Mike Zoosman as quoted in The Guardian, 26 January 2024) to draw parallels between the ‘Nazi legacy of experimentation’ and the use of nitrogen in the process of hypoxic death.

Nitrogen is an inert gas. It is not a poisonous gas.

I can understand why, from a political point of view, such statements are made but they are factually incorrect and they cloud debate.

These statements also spread fear amongst people who may be seriously ill or elderly and who are considering using nitrogen gas with a plastic Exit bag to end their lives.

This fear-mongering is damaging and unnecessary.

Myth No 3 – It’s Not the Nitrogen it’s the Mask Dummy

For close to 20 years, those active in the assisted suicide movement have argued against the use of a face mask when planning for a hypoxic death.

Repeated failures when using masks caused them to being abandoned long ago.

Face masks introduce an unacceptable level of risk for a peaceful and reliable hypoxic death.


As we explain in the Peaceful Pill eHandbook Essentials, face masks require an airtight seal between face and mask to be maintained until death has occurred.

This means there can be no air leakage between the mask and the skin of the face.

Yet an airtight fit is difficult to achieve and even more difficult to maintain once consciousness is lost.

Other factors that can also affect an airtight fit. For example, facial hair.

No matter how clever the design of the complex strapping that holds the mask to the face, a one-size-fits-all mask can never guarantee a leak-free fit. This makes its use inherently risky.

An airtight fit is also difficult to maintain because of the changes in facial muscle tone once consciousness is lost.

Unless an assistant were to hold and dynamically reposition the mask so that a seal is maintained as consciousness is lost, the airtight fit until death remains a problem.

Myth No 4 – Nitrogen is a Dangerous, Poisonous Gas

There is nothing poisonous or dangerous about nitrogen. This applies to other inert gases also, such as helium and argon. These gases are not poisonous.

The State of Alabama could just as easily have killed Kenny using one of these other inert gases. (At the current time, nitrogen gas is both cheaper and more freely available than helium gas.)

Kenny’s death was not caused by nitrogen per se, it was caused by the lack of oxygen in the air that he could breath.

The horror show that was Kenny Smith’s death is not associated with any particular property of nitrogen.

The spetacle is all due to him having a face mask non-voluntarily strapped on his head and him fighting against his execution in every way possible.

Myth No 5 – Involuntary Convulsions are a part of all Hypoxic Deaths

It has been widely reported in the media, that Kenny Smith experienced convulsions prior to death.

The convulsions that Kenny experienced were almost certainly accentuated by his obvious (and understandable) non-cooperation with the execution process.

The longer Kenny tried to preserve the air in his lungs (eg. by holding his breath and then finally taking tiny breaths), the slower the dying process was going to be.

In addition, breath-holding would have increased the level of carbon dioxide in his body, acidifying his blood and increasing discomfort and distress.

With the resulting increase in time to loss of consciousness and death, his brain spent more time trying to function on limited oxygen.

The body’s reaction from rising carbon dioxide is to convulse. By the time of the convulsions, Kenny would not have been aware of what was happening to him.

Had Kenny cooperated (but then, why would he, he was being killed against his will), and taken deep breaths of the air (and then the nitrogen) that was being pumped into the mask, he would, almost certainly, have lost consciousness and died much sooner.

There would have been no carbon dioxide rise, and the risk of convulsions would have been minimised.

Convulsions could also have been controlled had Kenny been given an anti-convulsant such as valium prior to his execution. But, again, why would Kenny willingly cooperate with his death.

Myth No 6 – Escaped Nitrogen Gas and/or Carbon Dioxide Presented a Risk to Others in the Execution Chamber

It has been widely reported that the leakage of nitrogen gas (and/or exhaled carbon dioxide) into the execution chamber would pose a danger to those present.

This argument is factually baseless.

Nitrogen comprises around 80% of the air we breath. Nitrogen gas is not poisonous.

The circumstance that brought about Ken Smith’s death is not the high level of nitrogen, it was the low oxygen level in the gas entering his lungs.

I visited Alabama’s execution chamber in December 2023. It is a large room and it is clear that there was never any possibility that the nitrogen released into this room from Kenny’s face-mask could ever affect others present.

Kenny’s spiritual advisor, Dr Hood, would have had to place his nose up against the exit port on Kenny’s death mask and hold it there for some time for any possibility of harm to come to him.

Now for the Facts

Fact No 1 – Death by nitrogen hypoxia is about practice & technique

Exit argues that if nitrogen hypoxia is to be selected as a method of choice for a peaceful death, then practice is required.

A death by nitrogen hypoxia is most effective and most peaceful when the person hyper-ventilates for a short time and then exhales completely before immersing themselves in 100 percent nitrogen. Immersion is done by pulling down a plastic Exit bag filled with nitrogen down over one’s head. The person then inhales completely with the deepest breath.

If the person has no underlying restrictive respiratory disease, they will lose consciousness almost immediately and die peacefully a few minutes later.

Fact No 2 – Don’t ever under-estimate the Psychological Trauma of Having an Octopus Mask Strapped over your Face

There is something deeply disturbing about the legal, non-voluntary taking of life.

Whether it is trying to find a vein to insert a needle for lethal drugs or strapping a grotesque face mask on a person’s head, these non-voluntary invasions of a person’s bodily integrity are extremely confronting. Most people would refuse participation.

But there are staff at Alabama Corrections (and other states that continue with the death penalty) that say it is ‘simply a job’.

The prisoner who is forced to undergo this bodily intrusion is, understandably, terrified.

They are entirely helpless, having no control over what is happening to their body.

When I had the face mask strapped on my head by the attorney for the State of Alabama my heart skipped a beat.

For those few moments I experienced something of the horror that awaited Kenny Smith.

The experience was chilling.

Fact No 3 – Had the State of Alabama opted for the building of a hypoxic Death Chamber, it is more likely that Kenny Smith would have experienced a peaceful death

In my deposition in the December 2023 court hearings in Montgomery Alabama, I stressed that if the State wanted a system that would reliably and peacefully kill, they should take the time and spend the money to build a designated execution room.

In this room, the level of oxygen could be rapidly lowered to quickly create the necessary hypoxic environment.
A prisoner would not be forced to wear the octopus face mask, and they would be able to see and speak freely. The death that would follow in this low oxygen room would be much faster.

But, this advice fell on deaf ears.

The State of Alabama deserves the criticism that is now coming their way, Kenny Smith should never have been forced to undergo this grotesque face mask execution.

Fact No 4 – the Sarco Device will provide the peaceful and dignified death that should have been the right of Kenny Smith

It is expected that the Sarco capsule will be used for an assisted suicide in the coming months.

The science behind the Sarco capsule relies on creating a small enclosure where the level of available oxygen in the air can be rapidly dropped, creating a lethal hypoxic environment.

Fact No 5 – the Difference in the Type of Death experienced by a Person who wants to die vs a Person who does not want to die should never be Under-estimated

The horror of the Kenny Smith execution is that Kenny did not want to die.

Because he was being executed (against his will), he used every bit of his strength to fight the mask and to fight the nitrogen that was being pumped into it.

But, by fighting, Kenny ensured that his death was slower and more distressing.

There are no clear winners here.

For Kenny to cooperate with his own unjust execution, he would have epitomised the lamb to the slaughter.

He would have played into the political hands of the State of Alabama who have long argued that a face mask is an effective means of delivering death by nitrogen hypoxia.

Kenny Smith had little choice. He had to fight.

What is most tragic that despite his fight and his suffering, is that it is now likely that other States will follow Alabama’s horrific example of how best to kill an unwilling human being.

Final Words

I am proud to have known Kenny Smith.

And I am pleased to have been able to play my small part in fighting back against this new system of State-sanctioned killing.

Vale – Kenneth Eugene Smith

Kenneth Eugene Smith with Philip Nitschke of Exit International

Kenny Smith & Philip Nitschke, 13 December 2023

© The Facts about Nitrogen Hypoxia 101 by Dr Philip Nitschke, 2024

Recent Media Reports

New York Times – Alabama Carries out First Nitrogen Execution (26 Jan)

Associated PressAlabama to Execute Inmate with Nitrogen Gas (25 Jan)

Washington PostAlabama Plans First Nitrogen Execution (25 Jan)

TMZ (video) – 26 Jan 24