Appendix 4 – Supplement for US Citizens

by Laura Carroll

Why Switzerland for United States Citizens? 

Like the UK, the US does not make it easy for its citizens to have end-of-life choices. While suicide is not considered a crime in the US, in some states attempted suicide is a crime. Similar to what John Watson elaborates for the UK, the various ways to attempt it oneself in the US come with legal and medical risks if it fails. 

Helping someone commit suicide is a crime in all US states, with the exception of laws permitting physician-assisted suicide, which vary by state. This is also often called medical aid in dying (MaiD). Many prefer the use of MaiD to emphasize that people are not actively choosing suicide, but rather to end their suffering and have control over the end of their lives. As of this writing, according to Compassion and Choices, eleven states and Washington D.C. have authorized MaiD in their jurisdictions. They all have the requirement of a terminal illness and six or fewer months to live. Except for Oregon and Vermont who allow qualified non-residents to access MaiD in their state, most states with MaiD laws have historically required residency. Canada also has assisted dying laws, but they are not available to non-residents.

Those who do not meet the terminal illness requirements in any of the US jurisdictions can pursue a self-determined end-of-life in other ways. One is Voluntary Stop Eating and Drinking, or VSED. If people do not qualify for a hospice which allows for pain killing medications to keep them comfortable as their bodies shut down, VSED can be a particularly challenging way to go. However, in recent years, there have been more organizations that provide consultation and services to assist with this option, (as well as other end-of-life services), such as Empowered Endings. A second option is voluntary assisted death at an end-of-life center in Switzerland. Its voluntary assisted death services do not have the terminal illness and six month or less restrictions that US MaiD laws do. Also, unlike most US states with MaiD and Canada, Switzerland allows non-Swiss citizens to receive medical support for voluntary assistance in dying. In the US, there has been a growing interest in this option.

Services Expected in the United States

Final-stage-of-life services in the US include in-home care, assisted living facilities, nursing homes, memory care facilities, palliative care and hospice care that all provide care when people are in their final months or weeks of life. However, they are not designed to support a self-determined death. With the exception of hospice care when curative treatments are no longer pursued, these services focus on keeping people alive as comfortably as possible. 

US Law

If you are a US citizen, here are things to know regarding US criminal law and civil law and any potential implications when considering the Switzerland alternative.

First, when in Switzerland to pursue medical aid in dying, US citizens are subject to Swiss law, not US law. So once in Switzerland, the US Medical Aid in Dying (MaiD) laws do not apply. 

While assisted suicide is considered a crime in every US state, there is not a US law that specifically states it is illegal to accompany someone out of the country for voluntary assisted death. However, according to Thaddeus Pope, a leading attorney for the right-to-die movement in the US, there is “not a systematic or comprehensive answer to the legality of accompanying a US citizen to one of the Swiss medical aid in dying clinics.” 

Pope indicates that “state prosecutors (especially in Minnesota and Massachusetts) have regularly enforced [assisted suicide] statutes over the past few years,” though not for accompanying someone to Switzerland. For the Switzerland alternative, a physical action made in the US by the accompanying person, such as buying the person’s ticket, going to the airport, getting on the plane “probably constitutes ‘assistance’ within the meaning of assisted suicide statutes.” According to Pope, accompanying someone to Switzerland “might technically violate assisted suicide statutes.” 

Over the past 20 years however, Pope can’t identify a single US case where the accompanying person was investigated or prosecuted. An investigation or prosecution is conceivable, but as of this writing, it has never happened. 

Even so, when US citizens go to Switzerland to a medical aid in dying clinic, it can be a good idea to consider taking steps beforehand to ensure it’s very clear that their end-of-life decision has clearly been made of their own free will, and the accompanying person is doing just that – simply going with them as the clinics require or strongly encourage. 

Here are two suggestions in this regard. 

Establish a pattern of desire 

If possible, the person who has chosen to go to Switzerland documents the timeline of desire from the first date of consideration to the day the decision is made, including reason(s) for the accompanying person, and that person’s specific actions prior to leaving the country. The accompanying person can do the same. Have as much evidence as possible beforehand that the person’s desire is his/her own and was not made in haste.

Inform a selection of others

Tangibly tell loved ones and anyone the person feels should know. This can be done through a letter or video by recorded by the person embarking on travel to Switzerland. 

If the accompanying person will receive an inheritance, through letter or video do the same for beneficiaries in the person’s Will.

The laws in the right-to-die area are evolving, so it is best to follow any changes in one’s state and in the US that may legally impact the Switzerland alternative.

Planning Your Visit

Swiss entry requirements for US Citizens:

Currently, a valid US passport with at least 6 months validity is required. No visa is required for 90 days or less.

As of this writing, it is expected that in the last quarter of 2026, US citizens traveling to 

Switzerland will additionally need a European Travel Information and Authorization System (ETIAS) authorization. EITAS is a travel authorization system for visa-exempt countries and is linked to a valid passport. 

See the EITAS site for updates and details on when it will be fully operational and the application process. There will be a 7 Euro fee, for ages 18-70; above age 70 there is no fee. The site indicates most applications will be processed within minutes, but in some cases up to three days. 

Air travel:

If using the Lifecircle, Pegasos or Athanasios centers, the closest airport is the Basel/Mulhouse.   From the US, it will likely require a European connecting flight. Flying into Zurich can also be an option, as this can often provide more direct flights from the US and each center is no more than an hour to an hour and a half from Zurich by car.

If using the Dignitas center, fly into the Zurich airport.

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Laura Carroll lives in California and is a former trial consultant, industrial psychology professional and nonfiction author. She is a member of the Hemlock Society and Final Exit Network. She is not linked to any Assisted Dying Center in Switzerland. Laura offers this Supplement as a result of research for her own purposes of being informed of end-of-life options, so when the time comes, she can make the best decision for her. 

Disclaimer:

This Supplement reflects information gathered from right-to-die organizations and legal professionals in the United States, and online sources deemed reliable, the reality of which is not guaranteed.

It is believed to be correct at the time of publication and is for information purposes only and not intended to provide guidance or advice in any way. No liability will be accepted for any information that proves to be incorrect or legally interpreted differently than what is presented here. No part of this Supplement shall be regarded as advocacy of this action in any form. It is up to readers to seek their own professional consult and advice related to their situation.