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ASSISTED SUICIDE

How were two healthy American sisters able to take their own lives in Switzerland?

An unresolved mystery is surrounding the death of two healthcare workers from the US state of Arizona who reportedly came to Switzerland for a vacation but never returned home. This is what the authorities say happened to them.

Published: 23 March 2022 12:04 CET
How were two healthy American sisters able to take their own lives in Switzerland?
Assisted suicide in a Swiss clinic is legal under certain conditions. Photo by Bret Kavanaugh on Unsplash

As reported in the US media on Tuesday, the sisters, Lila Ammouri, 54, and Susan Frazier, 49, a doctor and nurse, took a trip to Switzerland on February 3rd, telling everyone they were going on vacation.

But when they didn’t return on their February 13th flight home, their family and friends began to worry.

After the US State Department got involved in the mystery disappearance, it turned out the two women, who were reportedly healthy and happy, died by assisted suicide in a Basel clinic — a plan they kept secret from everyone.

This information was confirmed by the Basel-Country’s public prosecutor’s office.

More questions than answers

The question of why the sisters chose to die and why they came all the way to Switzerland to do so when nine US states allow assisted suicide may remain unanswered.

While the women’s friends and family believe foul play was involved in their death, Basel’s prosecutor said no criminal investigation has been launched as the assisted suicide took place “within the legal framework” and no crime was committed.

That’s because Swiss legislation permits assisted suicide under certain conditions: if the patient is over the age of 18, mentally and physically capable of making the decision to die, and administers the drug him/herself  in a private residence.

Also, the person assisting in the suicide must not have any selfish motives.

If a third party administers the drug, the act is considered euthanasia, which remains illegal here.

READ MORE: What you need to know about assisted suicide in Switzerland

Membership and paperwork

A sign that the sisters had been planning their death in Switzerland for a while is that it is not possible for anyone to just walk into a clinic and ask to be put to death right there and then (as gruesome as it sounds).

The process includes making first contact (either directly or through a family member), personal interviews, counselling, and loads of paperwork. It can take three months or longer, as it involves becoming a member of a right-to-die organisation and paying all the administrative fees — amounting to several thousand francs — for cremation and other expenses, upfront. A prescription for lethal medication will then be ordered from a doctor.

There is even more paperwork involved when foreigners choose assisted suicide in Switzerland and this can be time-consuming as well.

To ensure that the process complies with the law, a video is shot of the patient stating their name, date of birth and that they understand what they are about to do. The camera keeps rolling as they open the valve that allows a barbiturate to begin flowing into their vein. This footage is used as evidence that they willingly took their own life.

That Basel authorities are not filing charges in the case of the two sisters implies that all processes leading to their death complied with the rules.

Can healthy people choose to die this way?

Neither Ammouri nor Frazier reportedly suffered from terminal or incurable medical conditions, so why were they allowed to commit suicide?

Only three conditions have to be fulfilled for assisted suicide in Switzerland: the person wishing to die has to have her/his decisional capacity; opens the valve him/herself, and the assisting person must have no selfish motive.

No specific restrictions relating to the ground of suffering are mentioned in the law.

While some organisations, like Exit, apply stricter criteria to the notion of illness and suffering — for instance, the patient has no chance of recovery, or lives with chronic and unbearable pain or disability — Swiss legislation in this matter doesn’t specifically apply to physical illness.

Mental distress, also defined as “existential suffering”, while decidedly a bit of a grey area that lacks definition, also falls under the “suffering” category.

According to a report co-authored by two Geneva medical ethicists, “suffering is surely not limited to disease status. If we consider relief from suffering to be one of the central considerations for assisted suicide, it is reasonable to think that the acceptability of a request should not exclusively depend on the diagnosis of an incurable or terminal disease”.

For instance, one of the Swiss right-to-die organisations, Pegasos — reportedly the clinic where the sisters died — says on its website it “believes that for a person to be in the headspace of considering ending their lives, their quality of life must be qualitatively poor. Pegasos accepts that some people who are not technically ‘sick’ may want to apply for assisted suicide”.

READ MORE: Switzerland: What is the difference between assisted suicide and euthanasia?

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For members

ASSISTED SUICIDE

Do Swiss cantons have different rules on assisted suicide?

Under Switzerland’s federalist structure, cantons have a far-reaching autonomy in deciding what happens on their territories. A few have their own rules on assisted suicide.

Published: 27 September 2023 15:54 CEST
Do Swiss cantons have different rules on assisted suicide?

Switzerland has had an assisted suicide law on the books since 1942 — a constitutional right of each person to determine the manner of his or her death.

This basic principle is the same throughout the country, and while some people and organisations are opposed to this practice, most are in favour of the legislation.

In a survey carried out by Swiss Medical Weekly publication, for instance, 81.7 percent of respondents supported the legality of assisted suicide, as is currently the case in Switzerland, and 60.9 percent stated that they would potentially consider asking for assisted suicide under certain circumstances. 

What does this law say?

The practice is heavily regulated in Switzerland on federal level.

Foremost among the rules is that people must commit suicide by their own hand, for example, by taking medication themselves. A doctor cannot administer a lethal injection without being liable for criminal prosecution (this would be euthanasia, which remains illegal in Switzerland).

People must also be aware of actions they are undertaking and have given due consideration to their situation. In addition, they be consistently sure they wish to die, and, of course, not be under the influence of another person, or group of persons.

READ ALSO: What you need to know about assisted suicide in Switzerland

Do these rules differ from one canton to another?

The rules described above are the same throughout Switzerland.

And while cantons have a lot of flexibility to modify existing legislation, cantonal laws cannot contravene federal ones.

In other words, cantons cannot repeal national legislation but, rather, build on it by adding their own rules. 

Relating specifically to assisted dying, “there can be differences in the practical process of assisted suicide — for instance, official investigations following an assisted suicide are not regulated in the same way in every canton,” Muriel Düby, spokesperson for Switzerland’s largest assisted suicide organisation, EXIT, told The Local.

She cited the example of canton of Bern, where “forensics and forensic medicine are always called in, whereas this is not the case in other cantons. This is because federal law, determines the substantive content of criminal procedures, while the implementation is left to the cantons.”

By the same token, there are also different regulations when it comes to assisted suicide in healthcare facilities.

As this is not comprised in the federal legislation, “some cantons have introduced special laws requiring all nursing homes to allow assisted suicide as a basic right,” Düby said.

This is the case in Geneva, Vaud, Neuchâtel, and Valais.

This means that anyone who lives in one of these cantons and is a resident in an elderly care facility, has the right to assisted dying, while this is not the case in the other 22 cantons.

The Geneva ‘exception’
 
While this right has not been challenged in Vaud, Neuchâtel, and Valais, it is currently under threat in Geneva.

At the beginning of September, the Geneva parliament voted to repeal the law passed in 2018 which allows the practice.

In response, EXIT has vowed to force a referendum to stop the canton from revoking the legislation. (Note that this move concerns only healthcare facilities, and is not intended to repeal the entire assisted suicide law).
 
READ ALSO: Can foreigners access Switzerland’s assisted suicide clinics?

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