Leaving the Country to Die: When the U.S. System Won’t Let You Choose

Traci Arieli
Jan 15
4 min read

What happens when the law gives you a choice, just not the one you need? For Americans living with illnesses like dementia, ALS, or advanced heart failure, medical aid in dying is often out of reach. Even in states where it’s legal, strict rules limit access to those who are both terminal and fully capable of making and carrying out the request. Many never meet both requirements at the same time. As a result, some families turn to the only option left: leaving the country.

Switzerland is one of the few places where medically assisted death is legal for people facing incurable, unbearable suffering. There is no requirement that death must be imminent. But getting there is not simple. It takes months of planning, legal navigation, and the emotional strain of arranging a loved one’s final days in a foreign country.

Today, we are going to look at what that process involves, why people are choosing it, and what it reveals about the limits of end-of-life care in the United States.

Why Some People Are Forced to Look Abroad to Die with Dignity

The idea of traveling to another country to die sounds extreme. For many families, it is. But for people with progressive diseases, the U.S. system often offers no real choice. In most states with medical aid in dying laws, the requirements are strict: a terminal diagnosis with less than six months to live, the mental capacity to make the request, and the physical ability to take the medication on your own. These laws were designed with late-stage cancer in mind, where the body is failing, but the mind is often clear. That’s not the reality for everyone.

People with Alzheimer’s and other forms of dementia may have full cognitive awareness for years, but they are not considered terminal. By the time they meet that definition, they may no longer be mentally competent. Others, like those with ALS, may be sharp and clear-minded but physically unable to lift a cup or swallow medication. In both cases, the law shuts the door. Even families who plan and have everything in writing find that advance consent is not legally allowed. If the person cannot say “yes” in the moment and take the medication themselves, their wishes are not honored. That’s why some people start looking outside the country.

The Swiss Model: What Makes It Different

Switzerland allows medically assisted death for people who meet three criteria: they must be of sound mind, make the decision freely, and suffer from a condition that causes unbearable, irreversible decline. There is no requirement that death is imminent. That flexibility makes all the difference for people with long-term conditions that do not follow a predictable timeline.

Organizations like Dignitas, based in Zurich, support people from other countries who meet their criteria. Applicants must provide medical documentation and undergo a psychiatric evaluation to confirm they are acting voluntarily and are mentally competent. If approved, the person is allowed to travel to Switzerland and go through a two-step interview process in person before moving forward. The process is regulated, careful, and precise. But it still takes time.

The Reality of Going Abroad for MAiD

The decision to seek medically assisted death abroad should not be made lightly. It comes with logistical and emotional weight that most people are not prepared for. First, there’s the travel itself. The person must be physically well enough to fly, sit through interviews, and complete the process. That means acting early, often earlier than they would like.

Then there’s the cost. In addition to Dignitas fees, families pay for international flights, lodging, documentation, and legal support. It can take several months to collect and submit the required medical records, navigate immigration requirements, and coordinate the timing around the person’s health.

Legal issues are a major concern. Some states in the U.S. criminalize assisted suicide, even when it happens abroad. Families have to be careful about documentation, communication, and who participates. In one case, a family had to change the person’s power of attorney midway through the process because the original agent feared legal consequences.

The emotional burden is just as real. Family members often carry both grief and fear. They’re trying to support a loved one through a deeply personal decision while navigating unfamiliar legal and cultural systems far from home. Some describe it as “surreal.” Others call it exhausting.

What Families Need to Know

Despite the complexity, some families have found help through consulting groups. One such group, Axios Consulting, was founded after a family navigated the process on their own and realized how little guidance was available. Now, they help others understand what to expect and how to prepare.

The steps include:

Getting membership approval from Dignitas, which can take one to three months
Submitting medical records, personal statements, and a psychiatric evaluation
Preparing travel documents, lodging, and care plans
Completing two required in-person interviews in Switzerland
Navigating legal logistics, including power of attorney and documentation

For some, there is also a desire to make the trip meaningful. Axios helps families arrange visits to parks, restaurants, and museums, or to create legacy videos for loved ones before the final day. None of this is easy. But for those who feel the law has left them behind, it can offer peace.

The decision to pursue medical aid in dying is never impulsive. When accessing it requires international travel, the process becomes even more complex: legally, financially, and emotionally. Until U.S. law expands to recognize the full range of illnesses people face, many will be shut out. Some will be forced to act too early, afraid of losing capacity. Others will wait too long and lose the option altogether. And a few will leave the country. Not because they want to die somewhere else, but because they have no other way to do it on their own terms.