Sisters who died at Swiss suicide clinic said they weren’t ‘100% well’ and had health problems
The two Arizona sisters who killed themselves at a Swiss suicide clinic last month suffered from collapsed discs and chronic back pain and hinted at a ‘troubled’ period of their lives, according to the doctor they consulted before their death.
Dr. Phillip Nitschke says that Dr. Lila Ammouri, 54, and nurse Susan Frazier, 49, were not ‘100 percent well’ when they sought to end their lives.
‘They were complaining about what you might call frustrations. Collapsed dics, chronic back pain, chronic insomnia, vertigo,’ Dr. Nitshke told The Independent.
‘They had both decided they were tired of life and it was time to go. What was very clear was that dying together was non-negotiable, it was very important to them,’ he said, adding that they also told him about a ‘troubled’ period in their lives.
‘They didn’t give us much detail, but they said they had helped each other through what had been a difficult time and saw themselves as being each other’s best friend.’
The sisters first reached out to Dr. Nitschke – the founder of assisted suicide advocacy group Exit International – in October 2020.
After he warned them about the legal concerns of killing themselves in the U.S., they chose the Pegasos clinic in Basel, Switzerland, where they died on February 11.
Their grieving brother, meanwhile, wants answers about what drove the sisters to make such a decision. He says his sisters appeared happy and were doing well at work.
Dr. Lila Ammouri (left) and nurse Susan Frazier complained of ‘collapsed dics, chronic back pain, chronic insomnia, vertigo’ before ending their lives at a Swiss suicide clinic last month
Dr. Philip Nitschke, director and founder of Exit International, one of Switzerland’s largest assisted suicide advocacy nonprofits, says the sisters also hinted at a ‘troubled’ period in their lives – though they didn’t give much detail about it
The sisters’ trip to the Pegasos clinic , pictured, had been postponed in August 2021 due to flight restrictions caused by the pandemic. They finally got there on February 3, 2022
Dr. Nitschke told DailyMail.com that the sisters reached out to his organization in October 2020 to become members and learn about how they could end their lives.
He says he warned them about the dangers and legal concerns of killing themselves in the US. Ammouri and Frazier then opted to travel to Switzerland to die in the Pegasos clinic, since it does not require patients to be terminally ill or suffering from a life-limiting illness.
He said the sisters had originally scheduled their trip in August 2021, but the plan was delayed due to COVID travel restrictions during the Delta variant surge.
Nitschke added that while the process was not cheap – costing about $11,000 per person without accounting for travel costs – the sisters were adamant about dying in peace together.
‘The idea of two people dying together is not possible in the U.S.,’ Nitschke told DailyMail.com, ‘but the sisters made it very clear to us that they wanted to end their lives together.’
Nitschke said the sisters had completed a psychiatric evaluation when they arrived at Basel to ensure they were in the right mental capacity to make such a decision.
In a joint statement filed with Exit, Pegasos Director Reudi Habegger said: ‘Pegaso’s Swiss Association is committed to ensuring that adults capable of judgement can exercise their right to a self-determined, humane death.
‘After careful clarifications and within the framework of the official rules, we respectfully accompany people with unbearable suffering on their last journey.’
HOW ARIZONA SISTERS WENT ABOUT ENDING THEIR LIVES TOGETHER
Dr. Lila Ammouri, 54, and Susan Frazier, 49, sisters from Arizona, contact Exit International, one of Switzerland’s largest assisted suicide advocacy nonprofits.
They speak with director and founder Philip Nitschke and his staff on how they can end their lives.
The sisters were told how they could get drugs that could kill them humanely, but were advised that killing themselves in the U.S. carries dangerous and legal issues as assisted suicide is only legal in 11 states and only if the patient is suffering a terminal illness with only six months to live.
The sisters then begin inquiring about traveling to Switzerland to die.
The Sisters join the Pegasos Swiss Association, which does not requite patients to be terminally-ill or suffering from a life-limiting illness to die.
The sisters are slated to travel to Pegasos’ office, in Basel, Switzerland, but the trip is called off due to pandemic travel restrictions amid the Delta surge.
February 3, 2022:
The sisters depart from Phoenix, Arizona to Basel.
February 10, 2022:
Ammouri calls her brother, Cal, who does not know what the sisters intend to do.
A colleague receives a misspelled text from one of the sisters, worrying them.
February 11, 2022:
The sisters go the Pegasos clinic and end their lives together.
February 15, 2022:
Frazier fails to show up for work, triggering friends and colleagues to look for her and her sister, filing a missing persons report
February 18, 2022:
Swiss authorities and the US Consulate confirm that the sisters died within the legal framework of the country.
March 22, 2022:
Cal learns that his sisters are dead after being called by reporters.
Nitschke added that while he sees many couples wishing to die together when one of them has a terminal illness, Ammouri and Frazier’s case is extremely rare.
‘Exit has only seen one previous occasion when in 2017 in Gold Coast, Australia, mother Margaret Cummins, 78, and her daughters Wynette and Heather, aged 53 and 54 all decided to end their lives together,’ he said.
Nitschke noted that the sisters, who triggered a hunt from friends and family seeking answers when they never returned to Arizona on February 15, most likely traveled in secret out of fear of being stopped.
‘We’ve seen extreme cases in the past where people go to the airport to stop patients from coming over here or event get them certified as mentally incompetent to stop them.’
It comes as the sisters’ only known relative – their brother Cal Ammouri, 60, of New York – demanded answers over their deaths, which he did not learn about until reporters reached out to him earlier this week.
‘They were so secretive, especially with me,’ Cal told the New York Post. ‘Can someone tell me what happened? Do people snap just like that?
‘It could be. You wake up one day and you don’t feel like life is precious.’
Although Cal admitted he has not seen his sisters in 30 years, he said he spoke to them regularly over the phone and called them shortly before their trip to Switzerland.
He told the Post that he got a call from Ammouri on February 10, the day before her death, but that she sounded normal.
Frazier’s employer, Aetna Health, in Phoenix, raised the alarm after she failed to return to work on February 15, with many friends and colleagues speculating that they had been kidnapped after they received odd messages from them.
Dr. David Biglari, a longtime friend of sisters, said he and others were worried when they had not heard from the duo for a week after they arrived in Basel, Switzerland, on February 3.
Then on February 10, just a day before the sisters took their own lives at what is most likely Basel’s Pegasos assisted suicide clinic, Biglari said one of the sisters’ co-workers had gotten an odd message.
It read: ‘Hey! Sorry you needed surgery. I hope you’re [sic] pain is controlled. I’m currently in Europe on a little vacation.’
Biglari, an associate program director of cardiology at the University of Arizona, told Fox 10 that the misspelled ‘you’re’ was one of several messages that had he and his colleagues believe that the person on the other side of the phone was not actually one of the sisters.
‘Some of the text communications they had, we are certain they were not from them,’ Biglari said, as he and others initially believed that the sisters were kidnapped when they failed to show up for work on February 15.
‘They were most likely fabricated with someone else.’
After learning of their suicides, Biglari said he still wanted answers.
Selinda Staggers, a medical assistant who worked remotely with Ammouri, said her jaw dropped about the doctor’s death.
‘She was the nicest, sweetest person,’ Staggers told the Post. ‘Always asked me about myself. She was very normal, very kind, very professional.’
Like Cal, Staggers said she saw no indication that Ammouri was depressed.
The sisters traveled to Basel on February 3, staying a week in the city and completing a psychiatric evaluation before dying together on February 11
The sisters opted to use Pegasos, a nonprofit in the field, which has a facility in Basel (pictured). Pegasos allowed the non-terminally ill sisters to die together
The grieving brother said that both sisters appeared happy, with Lila owning a home in Phoenix and enjoying her job helping patients with serious illnesses and pain, and Susan recently getting a promotion.
‘Why would you leave your jobs, your home, your loved ones, just abandon everything,’ Cal asked. ‘I just want some answers.’
Cal told the Post that he kept in touch with his sister after they were separated during their parents’ divorce years ago. Cal and their father, Andrew, moved to New York where he currently resides in Washington Heights, while they went to Arizona with their mother, Faye.
‘I begged them to call me every week but they hardly ever did,’ Cal said. ‘I had to be very careful how I talked to them. One slip and it was, ”Oh, boy.”’
Dr. David Biglari, a long time friend of sisters, had believed that the sisters were kidnapped after colleagues said they received odd messages from the sisters that they believed were sent by someone else just hours before their deaths
A misspelled text message from sisters Dr. Lila Ammouri and nurse Susan Frazier tipped off friends and co-workers that something was wrong
Dr. Biglari has not shared any of the other texts. DailyMail.com has contacted the medic for more information.
Meanwhile, DailyMail.com has also discovered an unusual property maneuver made by Ammouri in the weeks leading up to her death.
She placed million dollar Cave Creek home in an intrafamily trust on January 25, 17 days before she and her sister killed themselves.
The arrangement, also known as a living trust, allows family members, friends or even business partners to receive the property after her death without having to go through the legal process of probate to prove they’re the rightful heirs to an estate.
The trust would have allowed Ammouri to specify who would receive the home, free of estate taxes, or split up the value of the property to multiple people. It remains unclear who was named as a recipient in the trust.
According to public records, Ammouri purchased the home in 2014 for $549,000. The single-family home features three bathrooms, 2.5 bathrooms and a pool in a spacious backyard. It has doubled in value since she purchased it.
Ammouri had put her $1 million Cave Creek home in an intrafamily trust on January 25, less than two weeks before the sisters trip to Switzerland
The trust allows the home to be transferred to family without the conventional legal process of proving they’re the heirs to the property
According to public records, Ammouri purchased the home in 2014 for $549,000. The single-family home features three bathrooms, 2.5 bathrooms
The home also has a large pool in a spacious backyard
A spokesman for the Basel-Landschaft Public Prosecutor’s Office confirmed to The Independent that the sisters had died by suicide ‘within the legal framework’.
Pegasos says it accepts applications from patients the world over, but insists it refers anyone who is suffering from depression to counselling services.
Its website states: ‘Pegasos 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 a VAD. But this does not mean the person is ‘well’. (Assisted suicide patient) Professor David Goodall was one of these people.
‘He was not sick but his eye sight was failing him, as was his mobility. Old age is rarely kind. The decision to end one’s life is an intensely personal one. Pegasos makes every effort to understand fully the unique circumstances of everyone who makes contact with us.’
Basel is home to an assisted suicide service called Pegasos, whose website is pictured. Unlike the more famous Dignitas clinic, patients do not have to be terminally-ill or severely disabled to end their lives there
The company says it accepts application for people all over the world and has no required waiting period for assisted suicide
Dignitas is the most famous suicide clinic, but is based in a different Canton (county) to where the sisters took their lives. It only offers an $8,000 assisted suicide to people who are terminally-ill, or who live with a disability that severely limits their quality of life.
Other clinics across Switzerland also offer similar services, with patients given a solution of barbiturates dissolved in water, which guarantees a painless death after being consumed.
Visitors to the clinics must undergo stringent checks before being allowed to avail of their services.
Pegasos, in particular, which has English speakers on staff, requires looking for assisted suicides to be members of the organizations and pay fees that exceed $11,000.
Michael Lutz, a spokesperson for the Basel-Landschaft Public Prosecutor’s Office, told The Independent that the sisters death did not immediately result in a criminal investigation since it was strictly performed through legal means.
The Phoenix Police Department, who were contacted by friends and family to investigate the incident, said they could not open a case since it was outside their jurisdiction.
Assisted suicide is legal in Switzerland, but in the US, only 11 states allow it if the patient is terminally-ill with six months to live
In Switzerland, it is legal to provide an individual the means to commit suicide as long as the reason is not ‘based on self-interest.’
According to Swissinfo.ch, around 1,300 people died by assisted suicide in Switzerland in 2020. Prior to the pandemic, about half those were from oversees, the majority came from Germany and the UK.
The process is primarily carried out with the assistance of Dignitas, the largest assisted suicide organization in the country.
Dignitas was founded in 1998 and requires those wishing to end their life perform two consultations with the group and an independent doctor, with rival services enforcing similar safeguards.
Dignitas only accepts patients who are terminally-ill or suffer from severe disabilities, but Pegasos, another assisted suicide provider, says it accepts applications from people who are not dying.
According to Dignitas, the individual is reminded multiple times throughout the process that they can stop, including up to the moment they are provided with a lethal drug cocktail to take their own lives.
A signed affidavit is also produced as a show of proof that the suicide was conducted without malice, coercion or any other outside force, as per the country’s law.
The primary form of death through Dignitas is by an oral dose of a sedative drug, followed by a dose of another sedative which would kill the patient already dulled to sleep by the first drug.
After consultations, legal paper work and registry expenses, Dignitas services can cost around $8,000.
The services for Pegasos, on the other hand, costs more than $11,000 and has no required waiting period for assisted suicide but does require consultations and paperwork to be completed first.
Patients are given the option of intravenous infusion or a small drink that provide a lethal overdose that will lull them to sleep and result in death.
Per Pegasos’ regulations, a patient must come in with a third party in order to identify them after death, but the rule can be waived if the patient is also a member of Exit International, one of Switzerland’s largest assisted suicide advocacy nonprofits.
Exit International was founded by Dr. Philip Nitschke in 1997 to advocate for legalizing voluntary euthanasia and assisted suicide and provides information and guidance on those seeking to end their lives.
The nonprofit has more than 30,000 members worldwide, who are on average 75 years old.
The company provides workshops, webinars and literature to help members understand the options they have when choosing to end their lives.
Nitschke said that while Exit International advices people on possible Do-It-Yourself methods to commit suicide humanely, many opt to travel to Switzerland to die in the assisted suicide clinics.
In its website, Exit states: ‘Our philosophy… is that every adult of sound mind has the right to implement plans for the end of their life so that their death is reliable, peaceful and at a time of their choosing.’
In the U.S. assisted suicide is only legal in California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii, Washington and Washington D.C. if an individual has a terminal illness with a prognosis of six months or less to live.
The Supreme Court ruled in 1997 that states laws banning physician-assisted suicides do not violate the constitution and left it up to each state to decide if they would allow assisted suicides and under what capacity.
In 2020, Colorado reported 188 prescriptions for aid-in-dying medications, with Oregon reporting that of the 2,895 prescriptions given out in the state that year, 1,905 were taken.
Vermont indicated that between July 1, 2017 and June 30, 2019, 34 patients had requested assisted suicide, with all 34 given the option.
Washington state reported in 2019 that the state had written 1,668 prescriptions for assisted suicide in the last decade, of which 1,622 people went through with the process.
There were about 4,249 prescriptions for assisted suicide given out to patients in the U.S. between 1998 to 2017, according to ProCon.org. Only about 66.3 percent of patients ended up using their prescriptions in that time.
In the UK, under the Suicide Act 1961, anyone helping or encouraging someone to take their own life in England or Wales can be prosecuted and jailed for up to 14 years if found guilty of an offence.
Section two of the act states that a person commits an offence if they carry out an act capable of encouraging or assisting the suicide or attempted suicide of another person, and the act was intended to encourage or assist suicide or an attempt at suicide.
In 2015 MPs including former prime minister David Cameron rejected a Bill to legalize assisted dying.
Opposition to changing the law has come from faith groups, campaigners who say disabled people may feel pressured to end their lives and campaigners who fear assisted dying would become a business.
The Campaign for Dignity in Dying, an anti-Dignitas group, estimates that nearly 350 Britons have died through Dignitas.