April 3, 2022

Deaths of Arizona Sisters Spark War Over Assisted Suicide

The Daily Beast, Barbie Latza Nadeau

When the friends and family of Lila Ammouri, 54, and Susan Frazier, 49, found out that the Arizona sisters had died by high-priced assisted suicide in Switzerland in early February, emotions ranged from rage to dismay.

How could it be that two healthy, affluent health-care professionals—Ammouri a doctor, Frazier a registered nurse—could go to such extremes?

Many wondered if they had secret illnesses, or had been tricked, or even lured into the dark organ trade in Europe. And if they were suicidal, why did they pay tens of thousands of dollars to do 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 gone off the grid, telling The Daily Beast they “bought new luggage, expensive clothes and had their eyelashes done” and were “celebrating with champagne in the airport lounge” before the trip that would sadly be their last.

“Who gets their eyelashes done and then flies to Switzerland to kill themselves?” the source asked.

The sisters, as it turns out, did not suffer from terminal illness, and each paid more than $11,000 to the Pegasos voluntary assisted dying (VAD) clinic in Basel, Switzerland.

Pegasos is one of three clinics in Switzerland—where assisted suicide is legal—that cater to foreign clients who can afford their services. It is one of two such clinics that do not require clients to suffer from terminal illness.

Pegasos says it does require a psychological evaluation before starting a lengthy process that includes obtaining documents from any spouses or children, certifying birth certificates, and arranging international money wires.

When asked if the sisters could have faked the suicide to vanish, Ruedi Habegger, president of Pegasos clinic, said that did not happen. “I was present at their death,” he told The Daily Beast.

When asked if they had any hesitation at the end, he also said no. “They were very comfortable with their decision. There were no last-minute regrets.”

The story of the Arizona sisters has started a global conversation about the ethics of high-dollar assisted suicide for those who are not terminally ill.

Harry Nelson, a health lawyer in the United States, and author of The United States of Opioids: A Prescription for Liberating A Nation in Pain, told The Daily Beast that he hopes media attention given to the Arizona sisters will shame Switzerland into changing its rules, which allow foreigners to engage in what he calls “suicide tourism.”

Nelson says the trend was predictable. “We have been living in this age of rising medical tourism, people go to Thailand, Costa Rica, Vietnam for everything from cosmetic to knee surgeries,” he said.

“Medical tourism has gone up tremendously. It was only a matter of time before we would see suicide tourism.”

From a legal standpoint, there is very little families can do if their loved one has gone overseas to pay a firm to handle the details, which generally include cremation and “disbursement” of ashes and personal belongings.

“Once in another country, the rules of that nation apply,” Nelson says.

“The Swiss have very different attitudes towards a whole range of mental health and social questions and this issue of the suicide clinics really highlights a disturbing side of that.”

The Arizona sisters had told friends they were going to Dubai on holiday, but instead flew to Basel. They left the U.S. on Feb. 5 and the clinic says they died on Feb. 11, but the source close to the family told The Daily Beast that she texted Ammouri on Feb. 9 and did not get an immediate response, which was unusual.

When she did get a response, Ammouri sent her a photo of the Rhine river, saying it was her “morning walk,” but when the friend saved the picture it backdated to two days earlier, which raised suspicion.

When they didn’t board their return flight on Feb. 13, or show up at Aetna Health, where they both worked, on Feb. 15, the hard questions started. They were reported as missing persons on Feb. 16 and the FBI launched an investigation into their disappearance.

But it was soon determined that deaths of the sisters had been registered with the U.S. Consulate in Zurich by the clinic in Basel.

The local prosecutor said that the deaths had fallen “within the legal framework” of voluntary suicide assistance in Switzerland, so no criminal proceedings will be opened.

Curiously, Ammouri had taken her work computer with her on the fatal journey—a detail friends find troubling since it suggests, at least to them, that she wasn’t entirely sure she wouldn’t be back.

She logged in on Feb. 9 and sent a somewhat peculiar message to a manager saying she would be back soon. Aetna was able to trace the computer I.P. address to Basel.

When they didn’t come back to Arizona, no one knew that they had paid a company to end their lives, so friends launched a Facebook search page, assuming the sisters had met trouble or were taken advantage of.

The U.S. Consulate then confirmed the sisters’ deaths in Basel.

The person listed with the consulate as their next of kin was a man in Arizona whom The Daily Beast has not been able to reach. He will eventually receive their death certificates when Switzerland releases them.

Pegasos says the sisters died on Feb. 11.

The sisters have one brother, a high-functioning autistic man in New York for whom, friends say, they have made financial provisions. In interviews with various U.S. media outlets, he seems not to fully understand what happened to his sisters, telling one outlet he has not spoken to them for 30 years, and telling another he spoke to them a few weeks before.

The sisters first inquired about volunteer assisted death in 2019, according to Philip Nitschke, the director of Exit International, which acts as a broker of sorts for affluent people who want assurances that their last wishes will be carried out.

“Switzerland is unique because you do not have to be sick to have a VAD,” Nitschke told The Daily Beast. “In Switzerland, it is not a crime to help a person die—if that assistance is given for a non-malicious purpose.”

The COVD-19 pandemic made it impossible to travel to Switzerland in 2020, but the sisters kept in touch with Nitschke who says he recommended the Pegasos center, primarily because the sisters were not sick.

Nitschke says the sisters underwent psychological and physical exams before a doctor who works with the clinic prescribed the lethal drug in their names.

The clinic then arranged the room, filled the fatal IV, and videotaped them being asked three questions including who they were, where they were, and if they understood what would happen when they opened the IV tap, which clients have to do themselves.

Pegasos is currently embroiled in a legal suit with family members of another client, Krista Atkins, an American who Nitschke confirms hired the clinic in June of 2020.

Her sister-in-law, Priscilla Lo, told The Daily Beast her bank records show that she paid $15,000 to Pegasos between November 2019 and May 2020, and an additional $2,500 to Flemming Schollaart, founder of the Right to Die Society in Denmark, who they say drove from Denmark to Zurich airport to meet her and served as the witness—a requirement by Pegasos.

Philip & Flemming in Denmark, February 2020

The Daily Beast sent emails and left messages with the Right to Die Society but did not receive a response.

Atkins’ scheduled death happened at a time when international travel was restricted by COVID-19, which raises questions about how she was able to get permission to travel to Switzerland.

In the legal action Atkins’ brother is filing against the company, it is claimed that Pegasos advised her to use a Red Cross loophole to enter the country for health reasons.

Lo said that Atkins, who was 40, was physically healthy but suffered from alcoholism and severe mental illness with suicidal ideation, which she did not disclose to Ruedi Habegger of Pegasos.

Shortly before her death, the family claims to have reached out to Pegasos and informed them of Atkins’ history with mental illness—complete with medical records of her hospitalizations in the U.S.

Nitschke, who also helped facilitate Atkins’ death, confirmed that the family was angry. “She has an unhappy brother who is a professor of medicine, and he did not take it well,” Nitschke told The Daily Beast, adding that he regretted the legal entanglement the parties were in.

Atkins’ family members are livid after alleging that their mental health warnings were ignored. “While I understand Pegasos’ service may seem altruistic, what I subsequently found in the correspondences between Ruedi and Krista proved otherwise.

While Krista may have mentioned her depression to Ruedi in her application, she did not fully disclose to Pegasos the severity of her mental illness diagnosis which resulted in her hospitalization in a psychiatric hospital in early 2020,” Lo told The Daily Beast.

Pegasus and Exit International do not dispute that Atkins paid for their services, but say she passed all their requirements–and confirm that she paid her fee in full.

The Pegasos clinic carries out three or four “procedures” for foreigners every week. The other two clinics in Basel did not respond to The Daily Beast’s requests for clarification of their activities.

With regard to Pegasos, Nitschke says the majority of its clients are foreigners (Swiss residents go to different clinics covered by national health care) and the vast majority are not terminally ill.

Nitschke dismisses criticism over Switzerland 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 put to Swiss referendum, but the open-door policy remains,” he told The Daily Beast. “Internationally, the opponents to people being able to get help to die label Switzerland as the center of suicide tourism.

Generally the Swiss seem comfortable with this international vilification.”

Nelson hopes the spotlight on the Arizona sisters case will cause governments to question Switzerland’s allegedly lax vetting of its clients. For those close to the Arizona sisters, that will do nothing to bring them back.

“How can they take healthy U.S. citizens and just kill them like this?” the exasperated and grieving family source told The Daily Beast.

“It might be Swiss law, but these are Americans.”