Suicide Tourism: People, largely from Germans and Britons, travel to Switzerland to die. How putative non-profit organizations such as Dignitas are profiting from physician-assisted suicide?

Switzerland has long been a global hub for “suicide tourism”—a practice where individuals from countries with restrictive euthanasia laws travel to end their lives legally. At the center of this phenomenon is Dignitas, a Swiss non-profit organization that has assisted over 3,248 deaths since its founding in 1998. While framed as a humanitarian service, Dignitas operates in a legal and financial gray zone, charging thousands of euros for physician-assisted suicides while claiming non-profit status. While Dignitas founder Ludwig Minelli believes in death on demand its rival organization in the UK Campaign for Dignity in Dying lashes out at him ‘’ Dignified death on one’s own terms should not be behind a paywall.’’

Advertisement

Robert Booth, a Guardian correspondent, covered the poignant story of 23-year-old ex-England rugby player, who was paralysed from the chest down in a training accident. James was a highly skilled rugby player with a promising future in the sport. He represented England at the under-16 level and later played for Loughborough University, where he was also pursuing a degree in engineering.

During a training session for forwards, he was practicing a scrum when the pack collapsed on top of him. The impact caused severe neck injuries, dislocating bones and compressing his spinal cord. Despite undergoing multiple surgeries in the following weeks and spending eight months in rehabilitation, including time at Stoke Mandeville Hospital, he only regained limited movement in his fingers.

In early October 2008, James traveled to Switzerland. He passed away shortly after, and his funeral was held in the UK on October 1, 2008.

UK’s Spinal Injuries Association expressed shock. “When someone has an injury like this, you think its the end of the world as life is going to change for ever,” said Daniel Burden, head of public affairs. “But our mantra is that life need not end if you are paralysed. We know of people with similar or worse injuries than Dan who have lived fulfilling lives.”

Mick Murray, from Derbyshire, traveled to Dignitas in 2014 alongside his friend Ann, who was battling progressive supranuclear palsy (PSP). A year later, he made the same journey with his best friend, Ann’s husband Bob, who was suffering from mesothelioma—a disease he developed due to asbestos exposure during his years as a carpenter’s apprentice. Mick said: “Ann and Bob were both determined to take control over their deaths.”

Ann faced increasing difficulty with eating and standing, fully aware that her condition was terminal. Determined to avoid a painful and prolonged decline, she made the choice to end her life on her own terms. When Bob neared the end of his battle with mesothelioma, he experienced excruciating pain despite receiving quality care. He would sit on the sofa, rocking back and forth, describing the sensation of his chest being on fire. Having witnessed his wife’s suffering—and the peaceful death she was able to achieve—he knew he wanted the same for himself when his time came.

In some ways, they were fortunate to have the option of assisted dying, but they shouldn’t have had to travel hundreds of miles from home or spend thousands of pounds to exercise that choice. For most people, the cost of assisted dying makes it an unattainable privilege, leaving them to endure immense suffering or resort to desperate measures on their own.

Ann and Bob were just two of the dozens of people making this journey every year. ‘’How much longer can we leave it to another country to fix the mess of our broken law?,’’ asks says Sarah Wootton, Chief Executive of Dignity in Dying, a rival organization of Dignitas in Britain.  ‘’The Government must give time for this crucial debate.”

“It’s immoral that we are outsourcing compassion to Switzerland for the few that can afford it,” Wootoon despairs. ”The increase in Dignitas’ latest figures is concrete evidence that Britons are desperate for choice and control over their deaths. Assisted dying is an option for millions across the world, but still we do not have a British law for British people.”

A peaceful, dignified death on one’s own terms should not be behind a paywall.

Sir Edward Downes, who conducted the BBC Philharmonic and the Royal Opera, held hands of his wife Joan, 74, a former ballerina, leading to a death staged for them. Joan had a diagnosis of terminal liver and pancreatic cancer, as they chose to die together eating barbiturate. When Sir Edward conducted music at Royal Albert Hall in London, his wife Joan was in the audience for every performance and every rehearsal. Colleagues and friends said they were “completely devoted to each other.”

The problem is that Sir Edward, while in failing health at age 85, was not dying. His vision had nearly faded, his hearing had weakened, and he was confronted with the daunting reality of life without his soulmate. “They drank a small quantity of clear liquid and then lay down on the beds next to each other,” their son Caractacus said. They fell asleep and died within minutes, he reported, calling it a “very civilized” final act.

‘’Civilized, in this case, is a relative term,’’ writes Time magazine’s journalist Nancy Gibbs who covered the story in August 2009, reflecting on this: ”The deaths are typically videotaped, to protect Dignitas’ doctors and nurses from prosecution for in any way coercing the patient. While Dignitas claims to be nonprofit — under Swiss laws, the most liberal in the world, you may assist in a suicide but not profit from it — its finances are less than transparent. The “clinic” over the years has moved between apartments, hotel rooms, a camper van. But none of that is what made the story so confounding, at a time when the tensions between private rights, public costs and first principles have never seemed so fierce.’’

London’s Metropolitan Police force said it had been notified of the deaths, and was investigating. News of the couple’s suicide came in a statement from their two children: “After 54 years together, our parents died peacefully and under circumstances of their own choosing,” said the statement from the couple’s son and daughter.

Sir Edward may have explored other avenues to end his life alongside his wife. The Netherlands allows euthanasia for individuals enduring unbearable suffering, while Oregon mandates that two doctors confirm a patient has less than six months to live. However, these options may not have been viable for him.

Some euthanasia activists, including Dignitas founder Ludwig Minelli, believe in death on demand. “If you accept the idea of personal autonomy,” he argues, “you can’t make conditions that only terminally ill people should have this right.”

Autonomy and dignity are invaluable principles, and the phrase “sanctity of life” can feel abstract and detached when confronted with immense pain and suffering. However, Minelli advocates for something far greater: the absolute primacy of personal autonomy. His perspective dismisses the notion that society could ever place a higher value on an individual’s life than they do themselves or that it might benefit from upholding the intrinsic worth of every life, even to the extent of preventing self-harm.

‘’This matters because we are about to have a fateful conversation about the end of life’’ says Nancy Gibbs. We can talk about reform and prevention and digital medical records, but it will remain true, as former American President Barrack Obama observed, that “those toward the end of their lives are accounting for potentially 80% of the total health-care bill.” ‘’If we really are going to change how we spend money on health, it means we must change how we spend money on death,’’ says Gibbs.

British music journalist and Right-to-die campaigner Debbie Purdy, who won a landmark ruling to clarify the law on assisted suicide in the UK, turned the Suicide Act 1961 on its head. The 51-year-old from Bradford had lived with primary progressive multiple sclerosis (MS) for almost 20 years. “In her own words she said if she was allowed to die it would help her live.” In her final interview with BBC Look North, Ms Purdy said the painful realities of her condition meant her life was “unacceptable”. She said: “It’s painful and it’s uncomfortable and it’s frightening and it’s not how I want to live. “It’s not a matter of wanting to end my life, it’s a matter of not wanting my life to be this.” Debbie had sought assurance over whether her husband would be prosecuted if he assisted her terminate her life.

Nick Triggle, BBC health correspondent, wrote in BBC Online, ”Debbie Purdy’s landmark legal victory did not result in a change in the law but it forced the authorities to clarify what the legislation meant in practice.”

Debbie’s condition deteriorated significantly and she was unable to go through with her plan to travel to Dignitas, the Swiss assisted-suicide organisation.

We accept the removal of feeding tubes, the withdrawal of respirators, and the replacement of aggressive treatment with palliative care—decisions that can be both wise and compassionate. Yet, with each step forward, the ethical terrain grows more precarious. ‘’Is there some point, visible in the cloudy moral distance, where the right to die becomes a duty to die?’’ reflects Nancy Gibbs.

‘’We don’t need to set Grandma adrift on her ice floe; the pressures would be subtle, wrapped in the language of reason and romance — the bereaved widower who sees no reason to try to start over, the quadriplegic rugby player whose memories paralyze his hopes, the chronically ill mother who wants to set her children free.’’

Already in Oregon in the USA, a third of those who opted for assisted suicide last year cited concern over burdening their families and caregivers as a reason. Meanwhile, a Dutch study revealed that one in four doctors admitted to ending patients’ lives without an explicit request—including a physician who euthanized a dying nun, convinced that her religious beliefs had restrained her from asking for it herself. In his view, the just and merciful course of action was to make the decision for her.

While Switzerland has earned a reputation as a haven for those wishing to die on their own terms, it has also drawn scrutiny for its commercialized approach to euthanasia. Among the organizations facilitating these deaths, Dignitas stands out—not just as a provider of assisted dying services, but also as a business profiting from despair. Though it presents itself as a humanitarian nonprofit, the high costs, lack of transparency, and ethical concerns surrounding its operations suggest a different reality. The organization was established in 1998, and takes advantage of the country’s liberal laws on assisted suicide, which suggest that a person can be prosecuted only if they are acting out of self interest.

Several countries, including the Netherlands and Belgium, as well as the U.S. states of Oregon and Washington, allow the incurably ill to seek medical assistance in ending their lives. However, only Switzerland, under a law dating back to 1942, permits foreigners to travel there for the sole purpose of assisted suicide. While other organizations cater to Swiss residents, Dignitas remains the primary option for those coming from abroad.

While British law explicitly prohibits assisted suicide, its enforcement has been relatively lenient.

In recent years, British courts have shown reluctance to convict individuals who assist loved ones in traveling abroad for assisted dying. No family member or friend of any Briton who has died at a Dignitas clinic has faced prosecution.

Despite this, repeated attempts to amend the law have failed. Just last week, the House of Lords rejected an amendment that would have eased restrictions on assisted dying.

Sarah Wootton, CEO of Dignity in Dying, argued that the deaths of Edward and Joan Downes highlight the urgent need for regulated assisted suicide.

Edward Downes remains one of the most well-known Britons to have sought an end to his life in Switzerland, a country uniquely open to foreigners seeking assisted death.

Touch Points:

• The mechanics of suicide tourism—How Dignitas facilitates deaths for foreigners.
• The financial contradictions—Is Dignitas truly non-profit, or profiting from death?
• Ethical and legal dilemmas—Who benefits, and who is exploited?
• The future of assisted dying—Will regulation curb commercialization?

The Mechanics of Suicide Tourism

How Dignitas Operates?

Dignitas claims to follow a strict protocol, though transparency remains limited, and the process comes at a significant financial cost. Applicants must first become members, paying a CHF 80 annual fee. They then undergo medical and psychological evaluations, requiring two consultations with Swiss doctors, which cost approximately £1,860. If deemed eligible, they receive a provisional green light, allowing a doctor to prescribe the lethal dose of pentobarbital. The assisted death takes place in either a rented apartment or Dignitas’ discreet facility, with two staff members present. The entire process, including cremation, costs between £6,500 and £15,000.

Who Uses Dignitas?

The majority of Dignitas’ clients—60%—are German, followed by British nationals, with over 300 Britons recorded as of 2015. Interestingly, 21% of those who seek assisted dying are not terminally ill but instead cite “weariness of life” as their primary reason. Cases like Daniel James, a 23-year-old paralyzed rugby player, and Sir Edward Downes, an 85-year-old who was not terminally ill, have ignited controversy and debate over the ethics of assisted suicide.

The main demographics of Dignitas clients include:

Foreign Nationals – The majority of Dignitas clients come from countries where assisted suicide remains prohibited. Germans make up the largest proportion, followed by Britons, as well as individuals from France, Italy, and the United States.

Terminally Ill Patients – Many individuals seeking Dignitas’ services suffer from incurable diseases such as late-stage cancer, ALS (Lou Gehrig’s disease), multiple sclerosis, or other degenerative conditions that severely impact their quality of life.

Non-Terminal Patients with Chronic Suffering – Some clients are not terminally ill but suffer from severe, debilitating conditions such as paralysis, chronic pain disorders, or neurodegenerative diseases like Parkinson’s or Alzheimer’s.

Elderly Individuals with ‘Weariness of Life’ – A controversial aspect of Dignitas is its acceptance of older individuals who are not suffering from a specific terminal illness but express a general desire to end their lives due to declining physical and mental health or perceived loss of autonomy.

People with Mental Illness – While Swiss law discourages assisted suicide for psychiatric patients, Dignitas has been criticized for assisting individuals with severe depression or other mental health conditions in ending their lives. This has raised ethical concerns about whether such individuals are in a position to make rational end-of-life decisions.

Couples Seeking Joint Euthanasia – Some cases involve elderly couples who choose to die together, even if only one partner is ill. The case of Sir Edward Downes and his wife Joan is a notable example.

Dignitas remains at the center of ethical and legal debates worldwide, particularly regarding its broad criteria for assisted suicide, which extends beyond terminal illness.

Death as a Luxury Good: Who Can Afford a “Dignified” Dignitas’ Death?

Dignitas sits at the intersection of ethics, law, and commerce. While it provides a dignified exit for many, its financial opacity and exploitation allegations tarnish its humanitarian image. As more countries debate assisted dying laws, Switzerland’s unregulated market serves as both a warning and a case study.

The exclusivity of assisted suicide through Dignitas reflects a broader issue: death, like healthcare and housing, is increasingly stratified by socioeconomic status. Wealthier individuals have the financial means to travel to Switzerland, pay the necessary fees, and secure a peaceful, medically supervised death. Meanwhile, those without financial resources are left to suffer in countries where assisted dying remains illegal, forcing many into prolonged agony or resorting to desperate, unsafe methods.

Even within Switzerland, the disparity is evident. Swiss residents have access to cheaper alternatives, such as EXIT, which charges significantly less for its services. But for foreigners, Dignitas remains one of the only options, making assisted suicide not just a right but a commodity—one that comes with a hefty price tag.

Logistical Challenges

For families, navigating the bureaucratic process can be exhausting, often requiring months to secure medical records, legal affidavits, and official translations. Additionally, the emotional toll is immense—many individuals must leave loved ones behind in Switzerland, as UK coroners often conduct investigations into their deaths, making it difficult for families to bring remains home immediately.

The Financial Contradictions of Dignitas: The Non-Profit Facade and Hidden Profits

Dignitas presents itself as a non-profit, yet there are persistent allegations that it operates with a keen eye on financial gain. Despite its status, the fees remain exorbitant, with costs reaching CHF 10,500 (~£7,770) for “family duties” such as funerals. Additionally, the organization maintains a lack of financial transparency, as it does not publicly disclose its financial records.

 Critics argue that the organization lacks transparency in its financial dealings. While other Swiss right-to-die organizations, like EXIT, charge only CHF 40 per year and focus on Swiss residents, Dignitas has built an international business model that relies on foreigners desperate for a legal alternative.

Founder Ludwig Minelli has been accused of profiteering from assisted suicide. In one case, a terminally ill 80-year-old woman reportedly donated CHF 100,000 (~£86,000) to Dignitas before her assisted death. Swiss prosecutors later accused Minelli of exploiting vulnerable individuals for financial gain, though he denied any wrongdoing. In another case, a mother and daughter were allegedly charged double the standard fees, leading to further scrutiny of Dignitas’ pricing model.

Adding to the controversy, financial records indicate that Dignitas holds assets far exceeding those of its Swiss competitors. While EXIT, the largest Swiss assisted suicide organization, holds a capital of CHF 200,000, Dignitas boasts nearly CHF 1.8 million in reserves. This disparity raises questions about whether the organization is truly operating as a non-profit or if assisted dying has become a lucrative industry for those in charge.

Let us put this in more precise terms:

Membership Fees: To even be considered for assisted suicide at Dignitas, individuals must first pay an annual membership fee of CHF 80 (approximately £70).

Medical & Psychological Evaluations: Before approval, applicants must undergo two medical consultations in Switzerland, costing around £1,860.

Final Approval & Lethal Medication: If approved, patients receive a “provisional green light” and are prescribed pentobarbital, the lethal drug used in their assisted death.

The Procedure: The assisted suicide takes place in a rented apartment or Dignitas’ private facility, under the supervision of two staff members. The entire process, including cremation and administrative fees, can range from £6,500 to £15,000.

Despite branding itself as a non-profit, the sheer costs associated with dying at Dignitas raise serious ethical and financial concerns.

Profiteering Allegations

Founder Ludwig Minelli has faced accusations of profiteering, including reports that he solicited excessive fees from vulnerable individuals. ISwiss prosecutors have argued that Minelli exploited terminally ill individuals, though he has consistently denied any wrongdoing.

On May 18, 2018, Ludwig Minelli stood trial at the Uster District Court in Zurich, facing accusations of financial exploitation in assisted suicide cases. Prosecutors alleged that in 2003, he accepted a 100,000 Swiss franc donation from an 80-year-old German woman, despite the actual cost of assistance amounting to only a few thousand francs. Another case from 2010 involved a mother and daughter who were allegedly charged double the usual fee—approximately 10,000 Swiss francs—for Dignitas’ services. Notably, the trial took place just a day after Dignitas marked its 20th anniversary.

Swiss law permits assisted suicide as long as it is not conducted for “self-serving motives,” such as financial gain—violating this principle carries a potential prison sentence of up to five years. This offense is prosecuted automatically (“ex officio”). In his closing arguments, the prosecutor accused Minelli of employing “unauthorized commercial tactics,” pointing to exorbitant fees that far exceeded actual costs. He further highlighted the financial disparity between Dignitas, which holds assets of 1.8 million Swiss francs, and Exit—Switzerland’s largest assisted suicide organization with a significantly larger membership but only 200,000 Swiss francs in capital.

The prosecution is seeking a fine of 7,500 Swiss francs, along with a suspended financial penalty of approximately 65,000 Swiss francs, calculated as 360 daily installments of CHF 180.

Ludwig Minelli, the founder of Dignitas, receives an annual salary of 150,000 Swiss francs (approximately 129,400 euros), a figure he deems justified. Defending his earnings, he argues that “all work deserves payment.”

In November 2017, the court sent the indictment back to the public prosecutor’s office for amendments, citing missing data that needed to be completed. The final judgment is expected at a later date. As the first trial of its kind, this case presents an opportunity to address fundamental questions regarding assisted suicide, including the legitimacy of associated costs and what constitutes fair compensation for such services.

The Business of Death

Dignitas heavily relies on foreign clients, as many Swiss residents opt for more affordable local organizations such as EXIT, which charges a membership fee of just CHF 40 per year. The organization has also been embroiled in cremation scandals—most notably in 2010, when over 60 urns containing human ashes were discovered dumped in Lake Zürich, allegedly by Dignitas staff. These revelations have only fueled further criticism regarding the organization’s ethics and financial motivations.

Dignitas’s assisted suicide services come at a significant financial cost. To begin the process, prospective clients must pay a membership fee of CHF 80 per year. If they wish to proceed with an assisted death, the cost escalates rapidly. Medical and psychological evaluations alone can cost around CHF 2,200.

These costs do not account for additional expenses, such as travel to Switzerland, accommodation for family members, and legal documentation. For those already suffering from terminal illnesses or debilitating conditions, these financial burdens can be overwhelming. The reality is that assisted dying at Dignitas is not a right; it is a service available to those who can afford it. For the wealthy, it is a pathway to what they perceive as a dignified exit. For the poor, it is an unattainable privilege.

The Ethics of Commercialized Euthanasia

Dignitas has faced ongoing criticism for potentially exploiting vulnerable individuals, particularly in cases involving mental health disorders. Despite Swiss medical guidelines discouraging assisted suicide for depression, the organization has facilitated such cases. Additionally, the broad criterion of “weariness of life” has raised concerns that it could be misused to allow euthanasia for non-terminal conditions.

Switzerland’s legal framework contains significant loopholes. Under Article 115 of Swiss law, assisted suicide is only prohibited if conducted for “selfish motives”, leaving room for interpretation. Unlike countries such as Canada or Oregon, Switzerland has no residency requirement, allowing foreign nationals to seek assisted death within its borders.

The UK’s legal stance on assisted suicide remains ambiguous. Although aiding a suicide is illegal, British authorities rarely prosecute families who accompany loved ones to Switzerland for euthanasia. A landmark case in 2009, involving Debbie Purdy, forced the UK government to clarify guidelines on assisted suicide, yet many families still fear legal repercussions for participating in so-called suicide tourism.

The idea that a person must pay thousands of pounds or francs to end their life raises profound ethical questions. Should the right to die be contingent on one’s financial status? Does placing a price on death create an incentive for profit-driven exploitation of vulnerable individuals?

Dignitas argues that its fees cover necessary medical evaluations, legal costs, and administrative expenses. However, critics argue that the exorbitant pricing and hidden financial dealings suggest that assisted suicide is being treated as a business rather than a fundamental human right.

There is also the question of psychological vulnerability. Many who seek assisted suicide are not terminally ill but suffer from chronic pain, depression, or simply “weariness of life.” In such cases, does Dignitas provide adequate safeguards to ensure that these individuals are making fully informed, autonomous decisions? Or is it possible that some may be encouraged to pursue assisted suicide due to financial or social pressures?

The Future of Assisted Dying and Cost of Autonomy

The demand for assisted suicide continues to grow, with 250 cases recorded in 2023, marking a steady increase. However, this rise has also sparked political and public debate in Switzerland. While some politicians have proposed stricter regulations, voters in Zürich firmly rejected a ban on assisted dying in 2011, signaling strong public support for the practice.

Despite Dignitas’ prominence, alternatives exist. EXIT Suisse, a cheaper, Swiss-only organization, provides assisted dying services for residents, reducing reliance on Dignitas’ high-cost model. Meanwhile, Canada’s MAiD (Medical Assistance in Dying) program has adopted a more restrictive approach, limiting assisted dying to Canadian residents to prevent “suicide tourism.”

At the heart of the debate lies a profound moral question: Should death be a paid service? Critics argue that Dignitas’ model risks commodifying euthanasia, turning assisted suicide into a transaction rather than a human right. Others question whether increased regulation is the solution—or whether it might drive desperate individuals toward riskier, unregulated methods.

Dignitas positions itself as a defender of personal choice and dignity in death. Yet, its pricing structure and financial opacity suggest that assisted suicide is, in many ways, a privilege of the affluent. In a world where access to healthcare, housing, and even a humane death is increasingly dictated by wealth, the very idea of “dying with dignity” becomes a luxury rather than a right.

If the global community truly believes in the autonomy of individuals to choose their own end, then assisted dying should not be a service available only to those with deep pockets. The case of Dignitas serves as a stark reminder that even in death, economic inequality persists, and the right to a dignified end remains, for many, an unaffordable dream.

Key Takeaways from the Industry of Suicide Tourism

The assisted dying industry, particularly Dignitas, operates in a legal and ethical gray area, raising concerns about financial transparency and exploitation. Despite presenting itself as a non-profit, Dignitas charges high fees while avoiding financial scrutiny. Families navigating suicide tourism face not only significant logistical hurdles but also emotional strain, as they must manage legal paperwork, medical records, and the distress of losing a loved one far from home. Additionally, the lack of strict legal oversight has led to concerns about exploitation, particularly in cases involving non-terminal conditions like depression or general “weariness of life.”

While global demand for assisted dying services continues to rise, pressure for stricter regulations is also growing. Countries may soon reassess legal frameworks to prevent abuses while balancing the right to die with dignity.

The increasing phenomenon of “death tourism” is a stark condemnation of a healthcare system that appears to prioritize everything except granting individuals the dignified and peaceful end they seek. ‘’But I’m not sure the solution is to invite Dignitas to open a clinic down the street from every hospital,’’ says Nancy Gibbs. Advancements in palliative care ensure that the final years of life no longer have to be a moral, medical, or financial ordeal.

‘’I respect Sir Edward’s right to make what his manager called a “typically brave and courageous” choice. I just wish he’d had better choices,’’ adds Gibbs.

The Campaign for Dignity in Dying in the UK recounted 2023 data from the Office for National Statistics (ONS) in the UK stating that individuals with serious or terminal illnesses are more than twice as likely to take their own lives compared to those without such conditions. Research from Dignity in Dying estimates that up to 650 terminally ill people in the UK end their own lives each year. This is in addition to the estimated 6,400 people annually who would die in pain even with universal access to hospice care, according to the Office of Health Economics.

‘’Public support for a change in the law is overwhelming, with 84% of Britons in favor of allowing assisted dying as an option for terminally ill individuals,’’ according to Campaign for Dignity in Dying. Support for reform is consistent across demographics, including age, gender, socioeconomic background, political affiliation, religious beliefs, and disability status.

Globally, more than 200 million people have access to some form of assisted dying legislation. In the US, 11 states permit it, while all Australian states and New Zealand have legalized the practice for mentally competent, terminally ill adults under strict safeguards. Meanwhile, assisted dying bills are progressing in Scotland, Jersey, and the Isle of Man. In France, President Emmanuel Macron has initiated a national debate with the goal of legalizing assisted dying by the end of 2023, while a special Dáil committee in Ireland is set to examine the issue later this year.