Planning to travel? Your motivation is likely going to fall into one of these boxes:
1. Visits to friends and family
2. Vacation
3. Business
What is missing from the list? People who travel to commit suicide.
What is it?
Death tourism (a specific type of medical tourism) is a system whereby non-terminally ill individuals travel to another locale and enlist the services of death clinics to help them end their lives. Subsets of “death tourism” include “suicide” and “assisted suicide and euthanasia.” With basic suicide, the patient ultimately takes his/her own life.
Sterbe tourismus is a German term that means journey of a person from the country where euthanasia and/or assistance in suicide is prohibited to the locale in which one or both of the procedures are, under certain conditions, permitted by law, which allows administration of these medical treatments to the person.
The American Medical Association defines physician assisted suicide (PAS) as “a physician facilitating a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.” While a patient receives assistance from a physician – either in the form of medication, instruction, or advice – the key component is that the patient cannot do it alone.
Euthanasia, (from the Greek “ew” meaning good, and Thanatos meaning “death”) involves the physician acting to cause the patient’s death. This is frequently accomplished by administering a lethal injection or removing the patient from some form of life-support. The defining characteristic of euthanasia is that it is the physician, not the patient, who carries out the ultimate life-ending action.
Passive euthanasia is allowed in most countries as the practice is generally associated with a patient’s right to refuse medical treatment, rather than a request that the physician kills him/her. The underlying premise of this argument is the belief that the right to choose how to live one’s life necessarily encompasses the right to choose how to end it; however, it is illegal in most of the United States.
While some people decide to commit suicide at home, many others are selecting other nearby or foreign destinations to end their lives, enabling a few states and countries to become a breeding ground for “death tourists.”
Market segment
Suicide is the tenth leading cause of death in the US for all ages (CDC). It may be difficult to accept the fact that globally 800,000 – 1 million (WHO) people commit suicide each year (approximately one person every 40 seconds); twice the number of people who die from homicide.
Older adults make up 12 percent of the US population, but account for 18 percent of all suicide deaths. Of the more than 47, 000 suicides that took place in the US in 2017, those 65 and older accounted for more than 8,500 of them (Centers for Disease Control and Prevention). Due to the stigma associated with suicide, and the reality that it is illegal in some states and countries, the numbers could be an underestimate as suicides are frequently classified as unintentional injuries.
One in 4 seniors who attempts to kill themselves will die, compared to 1 in 200 youths. Men who are 65 and older face the highest risk of suicide, while adults 85 and older, regardless of gender, are the second most likely age group to die from suicide. Not counted are silent suicides such as deaths from overdoses, self-starvation, dehydration, and “accidents.”
States for suicide
Suicide/assisted suicide/euthanasia death is legal in:
o California (2016)
o Colorado (2016)
o Hawaii (2018/2019)
o Maine (2020)
o New Jersey (2019)
o New Mexico (2021)
o Oregon (1994)
o Texas (1999)
o Vermont (2013, only permitted for terminal illness)
o Washington (2009)
o Washington, DC (2016/2017)
In Montana, a district court judge declared (December 2008) that the state’s constitution recognizes the right of terminally ill patients to “die with dignity,” by obtaining a prescription for lethal medication from their physicians. The decision was challenged, and the court held that a physician’s aid in a patient’s death does not violate the state’s public policy exception. Montana legally recognizes PAS although the right has not been codified by statute.
In the US, there are no federal laws directly permitting or prohibiting PAS or euthanasia. The right to legislate end-of-life procedures lies within the purview of the individual states.
Time to fly; time to die
In 2017, 1.4 percent of global deaths were from suicide, and in some countries, this share is as high as 5 percent. In 2017, the highest rate of suicide (5 percent) occurred in South Korea, 3.9 percent in Qatar, and 3.6 percent in Sri Lanka. The countries with the lowest suicide rates are Greece (0.4 percent) and Indonesia (0.5 percent). Switzerland has been a popular destination for suicides since 1942.
Germans represent 44 percent of foreign-nationals paying others to get help them commit suicide. In addition, a large number of UK suicide seekers (21 percent) register at a Zurich-based “suicide clinic” earning it the “death tourism” tag. “To live with dignity – to die with dignity,” is the slogan of the famous Swiss organization, Dignitas (started in 1988) whose goal is to help patients commit suicide; however, it is an offence to assist a suicide if it is done with selfish motives.
The promotion for the organization highlights the fact that help can be obtained by any person who suffers from an incurable illness or permanent disability and wants to voluntarily end their life. The main reasons for deciding to die were neurological diseases (47 percent), cancer (37 percent), and rheumatic and cardiovascular diseases (Institute of Legal Medicine, University of Zurich). The organization had participated in 3,248 cases of assisted suicides by the end of 2020 (fluxtrends.com). The cost of an assisted death in Zurich, Switzerland, runs between US$9,040 – $21,000 and includes air, accommodations, food, and organizational fees.
In the Netherlands, euthanasia and assisted suicide are legal if the patient is enduring unbearable suffering, and there is no prospect of improvement. Anyone from the age of 12 can request this, but parental consent is required if a child is under 16. In addition, the doctors must consult with at least one other independent doctor on whether the patient meets the necessary criteria.
In Belgium, prospective candidates for suicide must meet with a doctor several times over a period of months to ensure that the application is voluntary, well-considered, and without outside pressure. The applicant must also be experiencing unbearable and unrelieved physical or psychological suffering. It is estimated that the cost is approximately $3,500 (The Guardian). There were 2,357 cases of euthanasia in 2018 which equates to about 6 per day.
Belgium, Luxembourg, Canada, and Colombia allow euthanasia and assisted suicide; however, there are differences. Only terminal patients can request assistance in Colombia, and in Belgium there are no age restrictions for children with a terminal illness.
In Spain (2019), parliament legalized euthanasia and physician assisted suicide. Since 2019, the Australian state of Victoria permits assisted suicide for terminally-ill adult patients with fewer than 6 months to live, or one-year in the case of motor neuron disease and multiple sclerosis. Residency requirements and medical assessments from multiple doctors are mandatory and patients are barred from traveling from overseas or other states to access the euthanasia laws in Victoria.
International suicide landmarks
o In San Diego, California, the Coronado Bridge (200 feet) is a popular suicide spot. From 1972 – 2000, over 200 people jumped to their deaths from this structure.
o The Humber Bridge, UK, (near East Yorkshire and North Lincolnshire) registers an average of 7 suicide jumps per year. Between 1981 (when the bridge opened) and 2007, approximately 200 people fatally hurled themselves into the waters below. The 98-foot drop makes death almost certain.
o The Sunshine Skyway Bridge (opened in 1987) in Tampa Bay, Florida, has chronicled 207 suicides (through 2009) where jumpers fall into the Tampa Bay. The bridge has averaged 9 suicides a year from 1999 to 2009.
o The West Gate Bridge in Melbourne, Australia, (opened in 1978). Police reports find that one person every 3 weeks leaps to their death from the 190-foot-high bridge.
o Beachy Head in East Sussex, England, is the destination for approximately 20 people who kill themselves here every year.
o Niagara Falls, on the border of Ontario and New York, finds that approximately 20-25 people leap into the waters each year. From 1956-1995, this was the site of 2,780 known suicides.
o The South Head peninsula in Australia is the focus of the continent’s top suicide spots. The Gap is a steep cliff overlooking the Tasman Sea and each year approximately 50 people select to end their days in the water below.
o The Nanjing Yangtze River Bridge in China is one of the most notorious suicide hotspots in the world. Between construction in 1968 and 2006, 2,000 people took their own lives at the bridge. It is estimated that around once each week someone make the 130-foot leap to death. The number is only approximated since the Chinese authorities do not count those who missed the river, the ones who leaped but landed in trees along the riverbank or on the concrete apron beneath the bridge or were found emerged in the earth – two feet from the rushing water.
o Another nearby popular suicide Chinese spot that also crosses the Yangtze River is the Wuhan Yangtze River Bridge which is the site of an estimated 25 suicides each year.
o San Francisco, California’s Golden Gate Bridge is described as the most popular suicide spot in the world. The 75-year-old structure has witnessed more than 1,500 (known) suicides since it opened in 1937 with an average of one suicide every 2 weeks.
o The Aokigahara forest (Sea of Trees), Japan, has a death toll that is so great that local police have blanketed the forest with signs urging people to reconsider. By 2003, the suicide rate was reported as high as 100 per year. In 2010, it was reported that 247 people tried to kill themselves (54 successfully).
o The Aurora Bridge (aka the George Washington Memorial Bridge), Seattle, Washington, opened in 1932 and over the years it has become a popular place from which to jump. Since 1932, it is estimated that more than 230 people have committed suicide from the bridge averaging 5 each year between 1997 and 2007.
Countries with highest suicide rates
In 2019, the 10 countries with the highest suicide rates (number of suicides per 100K) were:
1. Lesotho – 72.4
2. Guyana – 40.3
3. Eswatini – 29.4
4. South Korea – 28.6
5. Kiribati – 28.3
6. Federated States of Micronesia – 28.2
7. Lithuania – 26.1
8. Suriname – 25.4
9. Russia – 25.1
10. South Africa – 23.5
11. Belgium – 18.3
(worldpopulationreview.com)
Tourism suicide go/no go
Destinations, in an effort to remain competitive, are continuously developing novel and sophisticated attractions as their marketing strategy resulting in new tourism products. As medical attractions are emerging in response to the growing need to travel to medical services not available locally or too expensive in the home locale, some question whether medical treatment (in general) and assisted suicide/euthanasia (specifically) qualify as “new tourism” product(s).
In the past, tourism has been associated with optimistic incentives and outcomes. Some academics and experts question whether medical tourism, suicide, and assisted suicide travel/tourism actually fit into the “hospitality, travel, and tourism” paradigm. As the population ages and people live longer with severe illnesses, each locale and industry segment should review its policy on medical tourism, suicide, and assisted suicide tourism to determine whether these products are appropriate for its culture, customs, and industry.
When someone suffers from a severe illness and contemplates death, the laws and policies impacting on end-of-life decisions take center stage. Death, in reality, frequently involves family and friends. It is a fact that death tourism (including suicide, assisted suicide, and euthanasia) exists, and will continue. At the very least, there should be recognition of whether or not death tourism falls within the parameters of the local laws and the ethical/legal parameters of the hotel/travel and tourism industry toward this market segment.
In addition, each locale and the hospitality industry should publicly acknowledge its position on the issue(s) and the permitted legal parameters as it would provide clarity and greater certainty. In addition, it would enable individuals to regulate their lives in a way that minimizes the prospect of being prosecuted or otherwise injured or harmed as they make plans for death tourism. The guidelines, developed in consultation with academics, health providers, politicians, religious groups, and suicide/assisted suicide advocates, should jointly participate in the decision-making process and be totally transparent in the position(s) taken.
End-of-life decisions are not made frivolously and all parties/markets (willing or unwilling) participating in the process should understand the motivations, as well as the risks and rewards, of the traveler/consumer, locale, and industry in this tourism product, as death tourism proliferates around the globe.
© Dr. Elinor Garely. This copyright article, including photos, may not be reproduced without written permission from the author.
