Emotions ranged from anger to dismay when the friends and family of Lila Ammouri, 54, and Susan Frazier, 49, learned that the Arizona sisters had died by expensive assisted suicide in Switzerland in early February.
How was it that two healthy, wealthy health professionals – Ammouri a doctor, Frazier a registered nurse – could go so far? Many wondered if they had secret diseases or had been tricked or even lured into the dark organ trade in Europe. And if they were suicidal, why were they paying tens of thousands of dollars for it in Switzerland?
A source close to the family found the suicides so unfathomable that they believed the sisters may have faked them and instead disappeared from the scene, telling The Daily Beast they “bought new luggage, expensive clothes and had their eyelashes done ‘ and ‘celebrating with champagne in the airport lounge’ before the trip, which unfortunately was to be their last. “Who gets their eyelashes done and then flies to Switzerland to kill themselves?” asked the source.
As it turned out, the sisters did not suffer from a terminal illness, and each paid more than $11,000 to the Pegosos Clinic for Voluntary Assisted Suicide – VAD – in Basel, Switzerland. Pegosos is one of three clinics in Switzerland – where assisted suicide is legal – that caters to foreign clients who can afford its services. It is one of two such clinics where patients do not have to suffer from an incurable disease.
Pegosos says they need a psychological evaluation before beginning a lengthy process that includes obtaining documents from spouses or children, notarizing birth certificates and arranging international money transfers. When asked if the sisters might have faked suicide to disappear, Ruedi Habegger, President of the Pegasos Clinic, said they didn’t. “I was there when she died,” he told The Daily Beast.
When asked if they hesitated in the end, he also said no. “They were very happy with their decision. There were no last minute regrets.”
The story of the Arizona sisters has sparked a worldwide conversation about the ethics of high-dollar assisted suicide for those who are not terminally ill. Harry Nelson, a health advocate in the United States and author of The United States of Opioids: A Recipe for Liberation of a Suffering Nationtold The Daily Beast he hopes media attention to the Arizona sisters will shame Switzerland into changing its lax rules allowing foreigners to engage in what he calls “suicide tourism.”
Nelson says the trend is predictable. “We live in this age of growing medical tourism, with people traveling to Thailand, Costa Rica and Vietnam for everything from cosmetic to knee surgeries,” he said. “Medical tourism has increased enormously. It was only a matter of time before we would see suicide tourism.”
From a legal standpoint, there is very little families can do when their loved ones have gone abroad to pay a company to take care of the details, which generally include cremation and the “payment” of ashes and personal belongings. “Once in another country, the rules of that nation apply,” says Nelson. “The Swiss have very different attitudes towards a whole range of psychological and social issues and this edition of Suicide Clinics really shows a disturbing side of that.”
If you or a loved one is struggling with suicidal thoughts, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.
The Arizona sisters had initially told friends they were going to Dubai for the holidays, but they flew to Basel instead. They left the US on February 5 and the clinic says they died on February 11, but a source close to the family told The Daily Beast that she texted Ammouri on the 9th and received no immediate response, which was unusual. When she got a reply, Ammouri sent her a photo of the Rhine, saying it was her “morning walk”, but when the friend saved the picture it dated back two days, raising suspicions.
When they didn’t board their return flight on February 13 or show up at Aetna Health, where they both work, on February 15, the difficult questions began. They were reported missing on February 16 and the FBI opened an investigation into their disappearance. But it soon transpired that the deaths of the sisters had been reported to the US consulate in Zurich by the Basel clinic. Local prosecutors said the deaths fell “within the legal framework” for voluntary suicide assistance in Switzerland, which is why no criminal proceedings were opened.
Curious, Ammouri had brought her work computer with her on the deadly journey – a detail friends find unsettling, as it suggests, at least to them, that she wasn’t quite sure she wasn’t coming back. She logged on on February 9th and sent a slightly strange message to a manager saying she would be back soon. Aetna was able to trace the computer’s IP address back to Basel. When they didn’t return to Arizona, no one knew they paid a company to end their lives, so friends started a Facebook search page, assuming the sisters were having trouble or being taken advantage of. The US consulate then confirmed the sisters’ deaths in Basel.
The person listed as next of kin at the consulate was a man in Arizona whom The Daily Beast could not reach. He will finally receive their death certificates when Switzerland releases them.
Pegosos says the sisters died on the 11th.
The sisters have one brother, a high-functioning autistic man from New York who friends say they have financially supported. In interviews with various US-based media outlets, he doesn’t seem to fully understand what happened to his sisters, telling one that he hasn’t spoken to them in 30 years and another that he was a few weeks ago spoke to them.
The sisters first inquired about euthanasia in 2019, according to Philip Nitschke, the director of Exit International, which acts as a kind of broker for wealthy people who want assurances that their last wish will be granted. “Switzerland is unique because you don’t have to be sick to have a VAD,” Nitschke told The Daily Beast. “In Switzerland, it is not a crime to help someone die – if this help is for a non-malicious purpose.”
The COVD-19 pandemic made it impossible to travel to Switzerland in 2020, but the sisters stayed in touch with Nitschke, who says he recommended the Pegosos center mainly because the sisters were not ill. Nitschke says the sisters underwent psychological and physical evaluations before a doctor working with the clinic prescribed the deadly drug on their behalf. The clinic then arranged the room, filled the lethal IV and videotaped them being asked three questions including who they were, where they were and if they understood what would happen if they opened the IV tap what patients would have to do themselves.
Pegosos is currently embroiled in a legal battle with family members of another client, Krista Atkins, an American who Nitschke confirms rented the clinic in June 2020. Her sister-in-law Priscilla Lo told The Daily Beast that her bank records show that between November 2019 and May 2020 she paid $15,000 to Pegosos and an additional $2,500 to Flemming Schollaart, the founder of the society Right to Die in Denmark, who allegedly drove from Denmark to Zurich airport to meet her and served as a witness – a requirement of Pegosos. The Daily Beast emailed and left messages with the Right to Die Society, but received no response.
Atkins’ planned death came as COVID restricted international travel, raising questions about how she was able to get permission to travel to Switzerland. As part of the legal action Atkins’ brother is filing against the company, they allege Pegosos advised her to use a Red Cross loophole to enter the country due to ill health. Lo said Atkins, who was 40, was also physically healthy but suffered from alcoholism and severe mental illness with suicidal thoughts, which she did not share with Pegosos’ Ruedi Habegger.
Shortly before her death, the family claim to have reached out to Pegosos and informed her of Atkin’s history of mental illness – complete with medical records of her hospitalizations in the US. Nitschke, who also facilitated Atkin’s death, confirmed that the family was furious. “She has an unfortunate brother who is a medical professor and he didn’t take it well,” Nitschke told The Daily Beast, adding that he regretted the legal entanglement the parties found themselves in.
Atkins family members are furious after they claim their mental health warnings have been ignored. “While I understand that Pegasos’ service may seem altruistic, what I later found in the correspondence between Ruedi and Krista proved otherwise. While Krista may have mentioned her depression to Ruedi in her application, she has not fully disclosed the seriousness of her mental illness diagnosis to Pegasos, which led to her committal to a psychiatric hospital in early 2020,” Lo told The Daily Beast. Pegasus and Exit International don’t deny Atkins paid for her services, but say she met all of her requirements – and confirm she paid her fee in full.
The Pegosos Clinic performs three to four “procedures” for foreigners every week. The other two clinics in Basel did not respond to The Daily Beast’s requests for clarification on their activities. Regarding Pegosos, Nitschke says that the majority of his clients are foreigners (Swiss people go to different clinics covered by the national healthcare system) and the vast majority are not terminally ill.
Nitschke dismisses criticism that Switzerland is becoming a “suicide tourism” destination. “The Swiss are unique, they have never restricted access to their legislation to Swiss nationals. This has been challenged, even subject to a Swiss referendum, but the open-door policy remains in place,” he told The Daily Beast. “Internationally, opponents of euthanasia describe Switzerland as a center of suicide tourism. In general, the Swiss seem comfortable with this international slur.”
Nelson hopes the spotlight on the Arizona sisters’ case will prompt governments to question Switzerland’s allegedly lax screening of their customers. For those close to the Arizona sisters, this will do nothing to bring them back. “How can they take sane US citizens and just kill them like that?” the angry and grieving family source told The Daily Beast. “It may be Swiss law, but these are Americans.”