Description
This paper views the growing popularity of death tourism which directs the confrontation with
grief and mortality with the expressed purpose of orchestrating travel that culminates in assistance to
end one’s life. The specific aims of this paper are to describe the emerging phenomenon of death
tourism and situate it as a form of dark tourism, to present briefly the social and legal aspects of assisted
suicide in conjunction within the tourism industry, and to conclude with how the trend of death tourism is
potentially spreading to other countries beyond Europe.
International Journal of Culture, Tourism and Hospitality Research
When death is the destination: the business of death tourism – despite legal and social implications
DeMond Shondell Miller Christopher Gonzalez
Article information:
To cite this document:
DeMond Shondell Miller Christopher Gonzalez, (2013),"When death is the destination: the business of death tourism – despite legal and
social implications", International J ournal of Culture, Tourism and Hospitality Research, Vol. 7 Iss 3 pp. 293 - 306
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Philip Stone, (2013),"Dark tourism scholarship: a critical review", International J ournal of Culture, Tourism and Hospitality Research, Vol. 7
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Anna Farmaki, (2013),"Dark tourism revisited: a supply/demand conceptualisation", International J ournal of Culture, Tourism and Hospitality
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When death is the destination: the
business of death tourism – despite legal
and social implications
DeMond Shondell Miller and Christopher Gonzalez
Abstract
Purpose – This paper views the growing popularity of death tourismwhich directs the confrontation with
grief and mortality with the expressed purpose of orchestrating travel that culminates in assistance to
end one’s life. The speci?c aims of this paper are to describe the emerging phenomenon of death
tourismand situate it as a formof dark tourism, to present brie?y the social and legal aspects of assisted
suicide in conjunction within the tourism industry, and to conclude with how the trend of death tourism is
potentially spreading to other countries beyond Europe.
Design/methodology/approach – By employing a variety of primary and secondary resources, from
death tourismindustry documents, legal statutes, and news reports, this study explores the propositions
of this article.
Findings – Whereas much of the contemporary research in dark tourism focuses on sights,
experiences, and actual memorialization, death tourism tends to comprise a holistic view of the
emerging phenomenon by viewing supply and demand management (and promotion), political
interpretation and control. The ?nal component of the paper views societal interpretations of death
tourism and its potential for market expansion.
Research limitations/implications – There have been several social movements and legislative
attempts to curtail the spread of assisted suicide and death tourism; however, the demand for the
services has grown to the point where jurisdictions are considering measures to allowthis practice. Such
an expansion of legalized assisted suicide will allow those seeking the right to die more options for a
death within a diversi?ed tourism industry.
Originality/value – Death tourism, within dark tourism, represents an emerging ?eld with few academic
resources. This paper works to conceptualize and clarify the unique place death tourism holds within
tourism and dark tourism speci?cally.
Keywords Tourism, Death, Suicide, Dark tourism, Death tourism, Assisted suicide, Suicide tourism
Paper type Research paper
Introduction
An individual’s choice to die without the administration of arti?cial life support procedures
and devices is now becoming a more thoroughly entrenched idea in many countries.
However, some communities and nations maintain a ?rm position against assisted suicide.
Hastening death by assisted suicide has remained controversial and illegal in many places.
Some family members and friends who have accompanied loved ones to die beyond their
home country’s borders have been investigated by the of?cials on their return fromtravel as if
they were party to a crime. There are several documented cases of individuals, families and
couples traveling to Zurich, Switzerland to end their lives. Reginald Crew, in 2003, was the
?rst recorded British citizen to travel to end his life with the assistance of Dignitas in 2003.
The English conductor, Sir Edward Downes, and his wife Lady Joan ended their lives
together in Zurich on July 7, 2009 (see Safyan, 2011). Clients, willing to travel and seek a
tourism experience within the ?nal moments, are seeking such services. With reports of
death tourism on the rise[1] Safyan (2011, p. 288) notes that ‘‘the emergence of death
DOI 10.1108/IJCTHR-05-2012-0042 VOL. 7 NO. 3 2013, pp. 293-306, Q Emerald Group Publishing Limited, ISSN 1750-6182
j
INTERNATIONAL JOURNAL OF CULTURE, TOURISM AND HOSPITALITY RESEARCH
j
PAGE 293
DeMond Shondell Miller
and Christopher Gonzalez
are based at Rowan
University, Glassboro, New
Jersey, USA.
The authors wish to thank the
anonymous reviewers for their
insightful comments and Ms
Marianne McCulley for her
comments and editorial
assistance.
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tourism as a new ‘industry’ has revived international debate regarding the legislation of
physician-assisted suicide and euthanasia’’.
This paper describes the emerging phenomena of death tourismand classi?es it as a formof
dark tourism. In doing so, the paper will brie?y present an overview of dark tourism, the
social and legal aspects of assisted suicide in conjunction within the tourism industry and
conclude with how the trend of death tourism is potentially spreading to other countries
beyond Europe. We maintain that not only is death tourism a form of dark tourism, but we
make the argument that it is well-suited within the conceptual framework of dark tourism,
apart from medical tourism, and it is expanding in a more globalized tourism market place
despite the social and legal implications.
Situating death tourism in dark tourism
Dark tourism, sometimes referred to as grief tourism, involves travel to sites linked with death
and tragedy or sites where death and suffering has occurred or been memorialized. Also
known as thanatourism, it involves locations such as Holocaust sites, battle?elds, prisons,
slavery sites, graveyards and other places of great suffering. Philip Stone, founder of The
Institute for Dark Tourism Research (www.dark-tourism.org.uk/) at the University of Central
Lancashire in England, states that dark tourism, in its various shades, can potentially provide
individuals in contemporary secular societies a vehicle to get up close and personal to tragic
events that have perturbed our collective consciousness. The term ‘‘dark tourism’’ was
coined by Malcolm Foley and John Lennon in a 1996 editorial for International Journal of
Heritage Studies; in 2000, they published the book Dark Tourism: The Attraction of Death
and Disaster. Only recently has dark tourism been recognized as a subset of the tourism
industry and begun to be studied academically (Stone, 2006). There is no universal typology
of dark tourism, or even a universally accepted de?nition. However, scholars view dark
tourism with an academic lens in order to scrutinize broader socio-cultural considerations,
managerial and political consequences, or ethical dilemmas (Stone, 2012a). Augmenting
various typologies of dark tourism, alternative terminology has also been applied to the
phenomenon:
‘‘Dark Tourism’’ [is used] to signify a fundamental shift in the way which death, disaster and
atrocity are being handled by those who offer associated tourism ‘‘products’’. In particular, [. . .]
‘‘dark tourism’’ is both a product of the circumstances of the late modern world and a signi?cant
in?uence on these circumstances. Moreover, the politics, economics, sociologies and
technologies of the contemporary world are as much important factors in the events on which
this dark tourism is focused as they are central to the selection and interpretation of sites and
events which become tourist products’’ (Lennon and Foley, 2000, p. 3). For example, Seaton
(1996) refers to death-related tourist activity as thanatourism, while other labels include morbid
tourism (Blom, 2000), death-related tourist activity associated with natural disaster (Miller, 2008;
Hutter and Miller, 2011, 2013), black spot tourism (Rojek, 1993), grief tourism (see www.grief-
tourism.com) or as Dann (1994, p. 61) alliterates, ‘‘milking the macabre’’. More speci?cally,
Bristow and Newman (2004) introduce the term ‘‘fright tourism’’, a variation of dark tourism
whereby individuals may seek a thrill or shock fromthe experience. Meanwhile, Dann (1998, p. 15)
suggests that ‘‘dicing with death’’ – that is, seeking experiences that heighten tourists’ own sense
of mortality – may be considered a particular consequence of dark tourism.
The tourism literature is frequently confronted with new forms of tourism or ‘‘new tourism’’
(Poon, 1994) as examples of how products and services, not originally linked to tourism, are
nowbeing commodi?ed into key tourismattractions. Over the last 15 years, dark tourismhas
been popularized through media as well as the internet. In the infancy of dark tourism, travel
that was associated with death, atrocity or disaster had not been previously featured in the
academic literature as a speci?c element of consumption in periodic typologies of tourism
(Stone, 2011a). Pilgrimages to places associated with death have occurred as long as
people have been able to travel. In other words, it has always been an identi?able form of
tourism, though socio-cultural contexts in which death-related travel transpired have
obviously changed throughout the ages (Stone, 2012a):
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Several commentators view pilgrimage as one of the earliest forms of tourism (Vellas and
Becherel, 1995; Lickorish and Jenkins, 1997). This pilgrimage is often (but not only) associated
with the death of individuals or groups, mainly in circumstances which are associated with the
violent and the untimely (Lennon and Foley, 2000, p. 3).
Seaton (2010) states that dark tourism was originally traditional travel that has evolved
through profound shifts in the history of European culture and been in?uenced by
Christianity, Antiquarianism, and Romanticism. However, the demand for dark tourism
experiences and the supply has grown in both scale and scope due to the growth in
participation of tourism since the mid-twentieth century (Sharpley and Stone, 2009a). Up
until now, it has often been assumed that ‘‘generally, visitors are seen to be driven by
different intensities of interest or fascination in death’’ (Stone and Sharpley, 2008) to see and
experience various places. Stone (2006, p. 145) contends that ‘‘society’s fascination with
death, real or ?ctional, media inspired or otherwise, that is seemingly driving the dark tourism
phenomenon’’ as a key factor in the demand of dark tourism.
Pagliari (2004) argues that contemporary society is now entering a death-deriding age,
where death is mocked, commercialized and sold for the sake of art and entertainment.
Businesses are using death as an opportunity to commodify, package and repackage it in
order to pro?t from death and death-related subjects. The curiosity among tourists makes
the need for such a site a necessity. There are a number of motives for dark tourism that
attempt to explain tourists’ behavior and location selection for travel to speci?c areas that are
associated with death. Dann (1998) identi?es eight in?uences. These motives include the
fear of phantoms (i.e. overcoming childlike fears), the search for novelty, nostalgia, the
celebration of crime or deviance, basic bloodlust, and, at a more practical level, ‘‘dicing with
death’’ – that is, undertaking journeys, or ‘‘holidays in hell’’ (O’Rourke, 1988; Pelton, 2003)
that challenge tourists or heighten their sense of mortality.
For Dale and Robinson (2011, p. 212; see also Pidd, 2009), ‘‘dark tourism is taken to a
different stage when physical travel is driven by the act of observing or participating in death
itself [. . .] This is further symbolized in suicide or euthanasia tourism, where people travel to
clinics to end their lives’’. Also called ‘‘suicide tourism’’ or ‘‘euthanasia tourism’’, death
tourism involves the commodi?cation of a solution to suffering and human misery fashioned
together by the tourismindustry in such ways that make it appealing to the individual seeking
to travel abroad for the expressed purpose of seeking death. This commodi?cation involves
the de-medicalization of assisted death. Where the de-medicalization can be viewed as
‘‘stripping away medicine as a dominant frame of reference to reveal the ‘‘true’’’’ nature of the
tourism experience (Lupton, 2005, pp. 245, 256; Ost, n.d., pp. 4-5). By doing so, the ?nal
days of life are not consumed with the life-extending medical equipment or the next medical
appointment, but rather the tour event is a way to embrace life’s ?nality and enhance the
quality of life during the last days.
We identify four characteristics that set death tourism within the larger context of dark
tourism. Death tourism is unique in that it has four fundamental characteristics that set it
apart from other forms of dark tourism which memorialize events, people or places such as
battleground tourism, genocide/holocaust tourism or cemetery tourism (Miller and Rivera,
2006). People are motivated to seek the services of companies to arrange travel plans to a
destination because:
1. the procedures may be illegal in their home countries;
2. the person/client/traveler seeks to take care of un?nished business either in their personal
life or the business of ending their lives;
3. the person/client/traveler seeks a ?nal solution – not a medical ?x[2] or to prolong or
improve the quality of life; or
4. they seek the Romantic idealism of the ‘‘death with dignity’’, where the deathbed is a
Romantic notion of a death free of pain and suffering.
Tercier (2005, p. 15; see Stone, 2011a, p. 23) notes, ‘‘the business of the [Romantic]
deathbed became just that: the tidying and tying up of un?nished business’’. Thus, the
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Romantic reconstruction of the deathbed was nothing more than a ?nal, peaceful sleep. With
a darkened room, family and loved ones at the bedside, affairs in order, peace made with
both survivors and God, and with a few gentle and quiet farewells, the decedent would drift
off into an eternal slumber.
The topic of death tourismcan be de?ned as assisting a suicidal individual to travel fromone
location to another in which that individual may be assisted in their suicide by another person
(Huxtable, 2009, p. 328). Dark tourism has a centuries-long tradition in cultures around the
world as people traveled to sacred sites to visit places where martyrs once stood before they
expired in the coliseums in Rome, catacombs, graveyards, battle?elds, places of trauma
and even modern disaster sites. However, modern death tourism can trace its roots back to
the nineteenth century idea of a Romantic death. Termed by Aries (2008; Stone, 2011a, p. 23)
‘‘as ‘Thy death’ (or ‘The death of another’) the Romantic death evolved through a waning of
external damnation messages prescribed by priests with advancements in medicines
prescribed by doctors’’. Stone (2011a: 23) goes on to assert:
The Romantic death became a death-with-dignity, a good death where calmness prevailed in
readiness for a digni?ed departure from the mortal world. The good death was an illustration of
howman paid respectful deference to the laws of nature, and howthe time of passing became an
opportunity to ‘‘put things in order’’.
It is important to note that we maintain that the place for death tourism is not within the niche
sector of medical tourism. Medical tourism, where patients travel overseas for operations,
has grown rapidly in the past decade (Connel, 2006). The rise of medical tourism
emphasizes the privatization of health care, the growing dependence on technology, uneven
access to health resources and the accelerated globalization of both health care and
tourism. Carrera and Bridges (2006) de?ne medical tourismas ‘‘the organized travel outside
of one’s natural healthcare jurisdiction for the enhancement or restoration of the individual’s
health through medical intervention’’. Countries in Southeast Asia[3] are capitalizing on their
popularity as tourist destinations by combining high-quality medical services with tourist
packages (Pocock and Phua, 2011). However, assisted suicide tourism does not occupy a
place in the overall conceptual framework of medical tourism revised by Tikkanen (2005)
and Tourism Research and Marketing (2006). This process has been widely criticized due to
the fact that it may provide a loss of the authenticity of a site or experience; it also calls into
question the ethics of operating such a service in order to create personal gain out of the
death and misery of others (Lennon and Foley, 2000; Miles, 2002; Muzaini et al., 2007).
Huxtable (2009) notes that death tourism presents distinctive ethical, legal and practical
challenges. Because people are not legally allowed to pursue their wish to die in their own
country, they are motivated to travel to other countries where they have the option, under
strict guidelines, to obtain the services of professionals who are not legally responsible for
the death of the individual. The person wishing to die engages in a series of steps that
involves traveling, visiting, seeking medical consultations, but ultimately death; a
well-planned, speci?cally choreographed end of a visit to another country is the goal of
the person traveling to this destination. Hence, the person wishing to die becomes a client.
The client then enlists the help of others, often agencies that specialize in choreographing
everything from travel, hotel stays, doctor visits, to the actual speci?cations of the place of
death; the assisting person, typically supplied as volunteers and specialized physicians,
clearly plays a causal role in their death but it is the client themselves who performs the ?nal,
fatal act (Kamisar, 1997, pp. 228-9). Death tourists are highly motivated to travel to go to
destinations in which they will have more freedom in their search of death via assisted
suicide. The individual can select when, where, and how-place of death, time of death, and
do so within their own speci?c timeframe and based on their own needs – as a ‘‘right’’ to die.
Ost (n.d., p. 12) cites three primary reasons persons are motivated to seek commoditized
death travel that are psycho-emotional factors typically linked to the legality of assisted
suicide in speci?c places and the need to have a more natural family-oriented death. Ost
(n.d., p. 12) contends: ?rst, this may make the assisted death feel less medicalized and less
clinical, and thus a less tense affair. Secondly, it might reassure the person concerned that
their relatives approve of their decision, or at least that they are at peace with their decision to
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die. Thirdly, they may need the emotional support that their relatives provide. Their
experience of assisted death is therefore a better death because they are accompanied
throughout the process by their loved ones. Those who travel as a part of the ?nal
experience, especially family members and friends, they are brought close to the
experience of death, the room become a mediating place where ‘‘dark tourism is a modern
mediating institution, which not only provides a physical place to link the living with the dead,
but also allows a cognitive space for the self to construct contemporary ontological
meanings of mortality’’ (Stone, 2012b, p. 1566), in much the same way the tombstone or
cemetery involves a socially constructed reality dark tourism.
While few systematic studies motivation for death tourism have been conducted, persons
seeking their option and their realities such as ‘‘Lesley Close, who accompanied her brother
to Switzerland for an assisted suicide through Dignitas, emphasized the signi?cance of his
‘chance to say goodbye, to interact with us at that last moment’’’ (BBC News, 2009).
According to Dr Turner’s son, the family ‘‘chatted, sang some songs and joked’’ in the ?nal
hours before her death (BBC News, 2009). For relatives, being present at their loved one’s
death may be equally important so that they can see their wish for an assisted death being
ful?lled, share their ?nal moments of life with them and ensure that they do not have an
isolated death (Chabot and Goedhart, 2009). They may reaf?rm their support for their loved
one’s decision through their attendance. Mr Cutkelvin’s partner stated: ‘‘I wanted to be with
him because this was what he wanted, to die in a digni?ed and peaceful manner, which is
what happened’’ (BBC News, 2009) (see Ost, n.d., pp. 12-13). Moreover, Stone’s (2010; see
also Stone, 2011b) work notes that dark tourism, for some people for some of the time at
some sites, is not about consuming narratives about disaster and tragedy death, but, rather,
of contemplating life in the face of one’s mortality.
Traveling and death (assisted suicide) tourism
Euthanasia, derived from the Greek euthanatos, which means a gentle and easy death, is
the practice of intentionally ending a life in order to relieve pain and suffering; it remains
controversial. Killing in the name of compassion, or mercy killing, are other terms given to
euthanasia (Jenkins, 2011). In The Netherlands, euthanasia de?nes the termination of life by
a doctor at the request of a patient. The Dutch government understands that there are issues
concerning this subject matter. As Jenkins (2011) states, the question of whether and how
criminal liability for euthanasia should be restricted has been the subject of broad political
and public debate for the past three decades. The debates delve into both sides of the
argument. Those against the practice make reference to the fact that the patient may, in
some cases, not really want to die; the patient may be in a situation where they are being
taken advantage of for ?nancial reasons or other gains. Proponents of euthanasia believe
that a patient has a reserved right to end their life rather than face the suffering brought on by
a terminal disease. They simply believe that instead of going through pain and suffering,
they can take action by bringing forward the inevitable (their death).
Though similar, assisted suicide is the term used to describe actions by which an individual
(professional medical assistant) helps another person voluntarily bring about their own
death. The ‘‘assistance’’ refers to the act of providing one with the means (drugs or
equipment) to end one’s own life. It differs from euthanasia in that another person ends the
life of the patient seeking death. Views of assisted suicide vary around the world. While some
countries[4] have de?ned laws prohibiting the act, others[5] have no speci?c law deterring
the practice but a charge of ‘‘manslaughter’’ may be brought against anyone assisting
suicide. Countries have long debated the question of whether or not doctors and other
health-care professionals, in certain circumstances, should participate in intentionally
causing the death of a patient, and whether society as a whole should ethically accept this
practice (Vilela and Caramelli, 2009).
Currently, Switzerland, Belgium, The Netherlands, Mexico and Oregon (USA) have laws
allowing certain methods of assisted suicide, under well-de?ned circumstances. Swiss law
requires that assisted suicides be conducted for altruistic reasons (Humphry, 2002). These
circumstances vary with the illness, condition, mental state and speci?c requests of the
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person seeking help. In 2001, The Swiss National Council con?rmed the assisted suicide
law, although voluntary euthanasia is still prohibited. There are four groups involved in
assisted suicide in Switzerland, but only one, Dignitas, will accept non-Swiss citizens as
clients who travel fromaround the world. The decision, by Dignitas, to accept themis closely
monitored within the organization (Jenkins, 2011). Switzerland’s main non-medical
right-to-die organization Exit Deutsche Schweiz and its subgroups Exit International,
Dignitas, and Exit ADMD have been prescribing lethal doses of sodium pentobarbital drugs
for self-administration since 1982 (Bosshard et al., 2003). Other organizations located in
Belgium, The Netherlands, Mexico and Oregon have also been providing individuals with
legal ways of terminating their lives.
Dignitas
‘‘Live with dignity, die with dignity,’’ is the slogan for Dignitas, a Swiss assisted suicide
organization. Located in Zurich, this organization has received notoriety and international
headlines as people with chronic diseases from around the world traveled to Switzerland
seeking help in committing suicide. Founded in 1998 by Swiss lawyer Ludwig Minelli,
Dignitas legally provides its ‘‘visiting’’ clients with the means to ends one’s life. Switzerland’s
law maintains that a person can only be prosecuted if they are acting out of self-interest. Due
to their liberal regulations on assisted suicide, Dignitas is able to operate without much legal
trouble. According to the article ‘‘Dignitas: Swiss suicide helpers’’ (BBC News, 2003), the
law on suicide actually states that: ‘‘Whoever lures someone into suicide or provides
assistance to commit suicide out of a self-interested motivation will, on completion of the
suicide, be punished with up to ?ve years’ imprisonment.’’ Dignitas’ leadership interprets
this to mean that anyone who assists suicide altruistically cannot be punished. Moreover,
their staff members are declared as volunteers to ensure there can be no con?ict of interest.
Another way Dignitas attempts to avoid legal issues is by providing a text for patients, which
states their wish for assisted suicide in terms which cannot be misconstrued and which
allows them to carry out their wishes even in the face of opposition, if necessary (BBC News,
2003). The overall process assures that the individual seeking death is completely satis?ed
with the choice that they alone will ultimately make.
Once contacted, Dignitas provides background information to their potential patient
(brochure) while examining further ways of treating the client. Minelli (2007) states that
information pertaining to appropriate analgesics and further support may sometimes
eliminate the feeling of wanting to die as the client may develop a better understand of their
life. If the feeling of wanting to die remains, the patient is given the option of joining the
Dignitas organization where they can continue the process of assisted suicide. In order to
apply, the patient must submit a letter of request and their medical ?le which must include all
up-to-date information (diagnosis, treatment, prognosis of their condition). The next step in
the process involves Dignitas locating a Swiss doctor capable and willing to provide the
patient with a prescription of the lethal barbiturate drug. This is followed by a meeting
between the patient and the doctor that takes place once the patient has secured all needed
medical and legal documents. The doctor performs a psychological evaluation of the patient
and once the doctor is certain that the desire of wanting to die remains within the patient, the
prescription is issued. At this point, ‘‘. . .the person must be able to understand what shall be
done and must also have the capacity to express himself (or herself), at least to answer
questions by signs indicating ‘yes’ or ‘no’’’ (Minelli, 2007, p. 6). Dignitas also suggests to the
patients that they communicate their wishes with loved ones; this creates an opportunity for
the people closest to the patient to voice their opinion on the matter at hand. Also,
relatives/loved ones can choose to be present when the death occurs. After the patient signs
a ‘‘Declaration of Suicide’’ and takes the ?nal act[6], Dignitas contacts various authorities in
order to have them investigate and ensure that no offense has been committed (Minelli,
2007). The body of the patient is then released to the family. The process secures that
patients of Dignitas, both natives and tourists, are able to receive their ?nal wishes without
complications.
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It is estimated that nearly 85 percent of all Dignitas clients travel to Switzerland with speci?c
intentions of dying; since operations began in 1998, Dignitas has provided services to over
1,000 individuals. Out of these, approximately 935 were foreigners traveling to Switzerland
(Schweye, 2011). In Switzerland, between 1990 and 2000, the organization EXITassisted in
748 deaths among Swiss residents (this accounted for approximately 0.1 percent of total
deaths, 4.8 percent of total suicides) (Bosshard et al., 2003). Compared to EXIT, Dignitas
provided more assistance to non-residents (91 percent of Dignitas patients were
non-residents, while 3 percent of Exit clients were non-residents). Additionally, in Oregon,
there were 114 documented cases where doctors prescribed lethal medications to patients
in 2011. Out of these 114, 71 were ultimately used. In 1998, only 24 lethal doses were
prescribed, 16 of which were used[7].
Although there is a demand for the services provided by Dignitas and other assisted suicide
organizations, the organization has, and continues to face opposition within Switzerland.
Beatrice Wertli, from the Swiss Christian democrats, has voiced concerns about the legal
basis of an organized group promoting and carrying out assisted suicide. She stated that
‘‘We do not want Switzerland to be a destination for tourism for suicide,’’ (BBC News, 2003)
which is the feeling of many in reference to assisted suicide. There are moral, ethical,
political and social issues that stem from the practice of assisted suicide.
Political and social issues with death tourism
As noted, there are a number of legal implications within the practice of assisted suicide.
Even in the areas where a form of it is legal (Switzerland, Belgium, The Netherlands, Mexico
and Oregon), assisted suicide is subject to both legal and ethical scrutiny. Speci?cally, in
Switzerland, the debate has and continues to grow. The Swiss law that allows anyone to help
patients die, as long as there are no ulterior motives, dates back to 1942. The Swiss position
regarding the legality of assisted suicide is summarized by Guillod and Schmidt who
conclude that ‘‘assisted suicide is a crime only when four elements can be shown: a suicide
was committed or attempted; a third party encouraged or helped in the suicide; the third
party acted on sel?sh grounds; the third party acted deliberately (intent)’’ (Guillod and
Schmidt, 2005, p. 29). However, Article 115 of the Swiss penal code considers
assisted-suicide a crime if and only if the motive is sel?sh; it further prohibits assisted
suicide for altruistic reasons. Article 115 does not require the involvement of a physician nor
that the patient be terminally ill. It only requires that the motive be unsel?sh (Mishra, 2007).
Furthermore, Article 115 only criminalizes any assistance in suicide that is motivated by
‘‘sel?sh[8]’’ reasons, for example, for ?nancial bene?t (Huxtable, 2009). Assisted suicide is a
controversial topic in Switzerland, but data on public attitudes towards assisted suicide and
euthanasia are scarce. Moreover, Guillod and Schmidt (2005, p. 31) state that ‘‘Article 115 of
the Penal code is a criminal provision and, therefore, cannot create a right to assisted
suicide. It merely recognizes the liberty to request assisted suicide and leaves it to each third
party (whether a health-care professional or not) to accept such a request.’’
According to one survey (Mishra, 2007), half of the respondents were willing to ‘‘shorten the
life of a family member who suffered too much and who asked for euthanasia.’’ Moreover, in a
1999 survey of the Swiss public, 82 percent of the 1,000 respondents agreed that ‘‘a person
suffering froman incurable disease and who endures intolerable physical and psychological
suffering has the right to ask for death and to obtain help for this purpose.’’ Of these, 68
percent considered that physicians should provide this help; 37 percent considered that the
family, 22 percent that right to die societies, 9 percent that nurses, and 7 percent that
religious representatives should be able to ful?ll such requests. Legislation to allow
euthanasia was favored by 71 percent of all respondents (Mishra, 2007). These statistics
illustrate the feelings of the public in reference to assisted suicide. Nevertheless, there is a
constant demand for the services provided by Dignitas and other assisted suicide
organizations.
Though The Netherlands was not the ?rst country to bring forth the debate of euthanasia, it
was the ?rst country to reform its law. This debate started in England, Germany and the USA
in the middle of the nineteenth century when drugs became available to physicians that
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allowed them to in?uence the way people die. Interestingly, the ?rst known proposal to
decriminalize voluntary euthanasia was made in 1906 in the US state of Ohio (Vanderpool,
1997). The views on euthanasia and assisted suicide within these locations have changed
over the past 100 years due to the political and social issues concerning the legality of the
practice. For example, the Dutch position on euthanasia and assisted suicide is the result of
a long discussion both in society and in parliament on the acceptability of voluntary
euthanasia and assisted suicide and the mechanisms for social control of these practices. In
Belgium, the legal conditions for the lawful practice of voluntary euthanasia can be found in
the Belgian Act on Euthanasia of May 28, 2002 that came into effect on September 23,
2002[9]. Both the Dutch and the Belgian Acts regulate the practice of voluntary euthanasia,
de?ned as the intentional termination of one person’s life, at their request, by another person.
Whereas the Dutch Act treats voluntary euthanasia and assisted suicide in the same way
and regulates both practices, the Belgian Act does not consider assisted suicide at all. While
the Dutch Criminal Code criminalizes assisted-suicide (section 294), the Belgian Criminal
Code does not. Also, in March 2009, Luxembourg decriminalized both voluntary euthanasia
and assisted suicide[10].
The marketing and selling of ‘‘your right to die’’
Sundow (1967) and more recently Walter (1996) have pointed to the increasing
‘‘industrialization’’ of death in the late twentieth century in some cultures where business
associated with all aspects of a process that includes hardware, real estate and funeral or,
even, cryogenic services have arisen, some global in their scope (Lennon and Foley, 2000,
p. 4). It is dif?cult to understand how one attempts to sell death to an individual. Those who
choose to end their own lives have the choice of committing suicide whenever and wherever
they please. Unless the suicidal feelings subside, this individual is more than likely to ?nd a
way to end their life. What Dignitas and other assisted-suicide organizations are selling is the
right for an individual to die with dignity while also having the bene?t of being surrounded by
loved ones during their ?nal breaths. Along with this, Dignitas, for example, offers their
clients attractive packages which provide a day (or more) of enjoyment and relaxation
before the assisted suicide takes place. Additionally, the assisted suicide packages are
offered for the purpose of giving potential clients options while stressing the ‘‘rights’’ and
‘‘freedom’’ that they deserve as human beings. According to the Dignitas web site, ‘‘Many
people are afraid of ?nding themselves in a hopeless condition or unconscious and
connected to machines in a hospital and being kept alive arti?cially for a long period of time.
They are afraid of pointless operations and ineffective pharmaceutical therapies’’
(www.dignitas.ch/). When selling death, or essentially anything, a business must ensure
that they are providing value for the customer; in this case Dignitas is aware that freedom is
the value that many clients are seeking.
Baumeister (1990) ?nds a number of studies have discovered that most individuals pursuing
physician-assisted suicide possess a common desire for freedom or escape. By applying
the framework of tourism and leisure motivation conceived by Iso-Ahola (1982), assisted
suicide may provide an outlet for simultaneously escaping something (i.e. physical and
psychological effects of a chronic or terminal illness) and seeking something (i.e. the fantasy
and illusion of oblivion). Assisted suicide organizations emphasize freedom of choice and
the right to die with dignity to their clients, by packaging the assisted suicide services.
Travel for assisted suicide offers an alternative world of physical and psychological escape
for patients (World Health Organization, 2009). Today, dignity is frequently understood as
some kind of intrinsic, morally relevant value that places a moral obligation on the individual
(and on others) to respect someone by virtue of their dignity (Seifert, 1997). Dignitas, Exit
and other assisted suicide organizations pride themselves in giving their clients a choice.
They associate the opportunity of dying with ultimate freedom and dignity. The intentional
marketing to tourists as having ‘‘rights’’ and dying with ‘‘dignity’’ may very well sway the
decision of vulnerable patients who believe that exercising one’s rights to death with dignity
as part of a whole tourism package that culminates in the death is an option. The topic of
assisted suicide patients being taken advantage of has been ongoing for years.
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Nonetheless, assisted suicide organizations are continuing to do business; some are even
growing. Jones (2012) states that the number of assisted deaths administered by Dignitas in
2011 increased by 35 percent when compared to the previous year’s total of the 144 people
who ended their lives in 2011 with the help of the clinic, and all but ?ve patients were of
foreign nationality. Additionally, Exit also saw an increase of about 17 percent from the
previous year; from 257 to more than 300, according to the article (Jones, 2012). The
sustainability and growth of the death tourism industry among the assisted suicide
organizations is clear and compellingly meeting the needs of its clients. The fact that they
have continuously been pro?table is itself not so clear. Because they are supposed to be
non-pro?t organizations, the ?nances of Dignitas have raised several concerns.
An investigation carried on by The Telegraph newspaper in the UK has raised questions
about Dignitas and whether Ludwig Minelli, its founder and director, makes a pro?t from his
‘‘mercy killings.’’ Before setting up Dignitas in 1998, Minelli, previously a human rights lawyer
and attorney in Zurich, had no taxable personal fortune registered. A little over a decade
later, the investigation found that Minelli had an annual taxable income of £98,000 and a
personal fortune of over £1.2 million. Along with his wealth, he is said to possess a luxury
villa. Minelli, who said he would take no salary from Dignitas when opening the clinic years
ago, has insisted that his wealth came from an inheritance left by his mother. However, the
cost of a simple suicide at Dignitas has risen from £1,800 in 2005 to £4,500, which adds to
the suspicion that the clinic may not be in compliance with Swiss laws that are supposed to
prevent people from ‘‘sel?shly’’ pro?ting from assisted suicide (The Telegraph, 2010).
In a rare 2008 interview with Der Tagesspiegel, a German daily newspaper (www.
tagesspiegel.de/weltspiegel/dignitas-chef-minelli-im-interview-wenn-sie-das-trinken-gibt-
es-kein-zurueck/1198414.html), Minelli revealed a great deal about the practices of
Dignitas; he speci?cally described the business aspect of his assisted suicide organization.
The cost of ‘‘preparation and monitoring’’ a suicide costs the patients approximately 4000 e
or just a little over $US 5,100. If Dignitas assumes the responsibility for tasks that a family (or
family members) would typically do (i.e. the funeral proceedings, the doctor, and of?ce
fees), the price would total approximately 7000 e or about $US 8,900. Minelli stated that
running the business itself was expensive (www.tagesspiegel.de/weltspiegel/dignitas-chef-
minelli-im-interview-wenn-sie-das-trinken-gibt-es-kein-zurueck/1198414.html). This was
due to the 15 employees, the of?ce, telephone and rental costs, and also legal fees that
are brought forth by considerable harassment. Minelli did not elaborate on that issue in the
interview; however, it can be assumed that citizens, government regulators and others,
speci?cally families of Dignitas patients, take legal action against the organization due to the
fact that they feel that Dignitas took advantage of patients while seeking monetary gains.
Fischer et al. (2008) state that 21 percent of Dignitas members who received an assisted
death did not have a terminal or progressive illness, but rather ‘‘weariness of life.’’ This
statistic provides insight regarding the negative views of family members and other
opponents of assisted suicide. Essentially, one out of every ?ve clients that is serviced by
Dignitas dies without any form of terminal illness or unbearable pain and suffering. When
questioned about persuading clients to commit suicide in order to increase pro?ts, Minelli
refuted the accusation claiming that he does not practice that way. He also described a case
where a young man wanted to die but after spending several days swimming, talking, and
drinking wine, the client decided to go home. Minelli stated that he was happy that the young
man changed his position on death.
To contain or spread death tourism and its future implication
Over the years, fascination with death and suffering has turned dark tourism into a pro?table
sector within tourism. Death tourismhas itself become popular since its emergence; due to a
great deal of media attention, with respect to the negative attention via newspaper
headlines, video and news attention and government action, which inadvertedly served to
market death tourism as a product. Even though the practices of Dignitas, Exit, and other
assisted suicide organizations are protested by many groups and individuals, the growth of
this aspect of dark tourism indicates that there is indeed a market for assisted suicide
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tourism-related services. New ?gures published in Britain show that the number of
assisted-suicide deaths in Switzerland have jumped 700 percent in just 11 years (Ertelt,
2012). Ertelt (2012) also states that of?cial ?gures published for the ?rst time reveal almost
300 Swiss residents died by way of assisted suicide in 2009, compared to just 43 in 1998.
Also, Dignitas now reports approximately 75,000 registered members. These membership
numbers illustrate that while the number of Swiss and non-Swiss residents opting for
assisted suicide is growing, the number of death tourists that seek the full range of
services[11] offered by Dignitas, is also on the rise.
Despite the attention sand growth abroad, death tourism has only recently been discussed in
the USA and other countries (Srinivas, 2009). Issues such as morality, human dignity, medical
ethics, and religion play a role in the heated debate. While in general, tourism presents a
variety of ethical challenges and dark tourism presents some unique challenges with respect
to site meaning, who is able to tell the story, how can site ‘‘Disney?cation’’ he avoided, what is
historically accurate, what political issues frame the site and what is the balance between
voyeurism and educational enlightenment. However, death tourism’s ethical dilemmas tend to
lie beyond the person seeking the services and the service provider. The client seeks to end
life in a controlled manner, oftentimes with their family’s knowledge and accompaniment. The
site of death is not a commercialized reconstructed village or complex of macabre spectacles,
but neither a place of calm where the last moments of life are related calm and connected to
the world where few mediations between death (such as hospital machines, rules about
visitors and social taboos) exist and the client and his or her family are able to directly be a part
of the experience, a part of the moments that many consider a natural part of the life process.
Legal and ethical concerns regarding the right to die and physical assisted suicide arise from
the medical profession, within legislatures, and society. However, for those who are suffering,
the ethical, humane and legal response is to allow death tourism. Death tourism repackages
the death experience in such a way that grief and suffering is transformed into a relaxed and
more natural ‘‘romantic-styled’’ death with and experience for the consumers and those they
invite to share in their ?nal moments of life. If done correctly, companies such as Dignitas can
provide the consumers with an experience that meets the need of its clients and their families.
While the question of whether or not the other countries are willing to adopt assisted suicide
practices still exists, there is no doubt that doing so will lead to pro?ts. This is true due to the
fact that death tourism is becoming a trend. The growth of assisted suicide provides a viable
segment within the tourism industry. For instance Srinivas (2009) asserts that there are only
two avenues for Americans searching for life ending procedures; the ?rst route is to travel to
Switzerland, and the second involves traveling to a state where assisted suicide is legal[12]
(Montana, Oregon, and Washington). However, death tourism in the USA is in its infancy.
Moreover, with advancing technologies and medical breakthroughs people are living longer
with more chronic debilitating diseases. This, paired with what many believe is their right to die
with dignity, will lead to more people opting for assisted suicide via death tourism if the option
is available. This, in turn, creates a market for assisted-suicide organizations and the tourism
industry.
With the shifting of death from a more-medically institutionalized form, where doctors and
state of the art medical technologies are used to keep patients alive, to one that is more
Romantic death, more research is needed to address the more complex ethical challenges
this social transformation has and its impact on the tourismindustry. More systematic studies
regarding the motivations to seek such services, role of family members throughout the
process and the volunteers who assist the person throughout the process are needed to
comprehend this complex phenomena. Death tourism not only provides a death free of
suffering, it allows for the patient, or death tourist, the opportunity to experience those ?nal
days surrounded by loved ones in a well-orchestrated, peaceful environment. The peace,
serenity, ability to construct an end of life death tour, ‘‘modeled as a vacation’’ experience all
become crucial marketing foci to providers of assisted-suicide as a way of commodifying
and presenting death tourism to future clients. The Romantic nature of this death differs
greatly from the death that many face and serves as a powerful motivator for the death
tourist. Legal and social arguments toward a more humane death or a death with dignity will
continue to shape death tourism.
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Notes
1. See Sayfran (2011, p. 289), e.g. Ertelt, S. (July 14, 2008), Switzerland government of?cial wants
assisted suicide death tourism to stop,http://archive.lifenews.com/bio2510.html (accessed 9
February 2013). The article describes how a Swiss of?cial wanted to stop the practice of "death
tourism" or, at least, slow the process.)
2. As with medical tourism
3. Southeast Asia, speci?cally Thailand, Singapore and Malaysia comprise the main regional hubs for
medical tourism (Smith et al., 2009)
4. Canada, Italy, Russia, Hungary and Ireland
5. Sweden and Germany
6. The patients are responsible for triggering the lethal dosage of medicine prescribed by the doctor
which will ultimately end their lives.
7. Oregon Public Health Division- Oregon’s Death With Dignity Act-2011
8. In evidence to the UK House of Lords Select Committee on the Assisted Dying for the Terminally Ill
Bill, the Swiss Ministry of Justice explained that – self-serving ends – would cover assisting a death
– to satisfy his own material or emotional needs . . . the possibility of eliminating some major problem
for the family, or other motives such as gaining an inheritance, relieving himself of the burden of
supporting the individual – or eliminating a person he hated.
9. Wet betreffende de euthanasie, see www.ejustice.just.fgov.be
10. Loi du 16 Mars 2009 sur l’euthanasie et l’assistance au suicide, online at:http://admdl.wollt.net/data/
16309euthanasie.pdf
11. These services include a Dignitas group membership and access to on-going death education and
counseling (death education, suicide and suicide-attempt prevention), client instructions (living wills
and advanced directives), preparation for an accompanied suicide (including ?ights/travel to
Switzerland, ground transport, and accommodation costs in Switzerland), doctor’s visits while in
Switzerland, a volunteer to assist with an accompanied suicide, funeral services/cremation/return of
remains to family/burial (at the directive of the client); completing of?cial procedures and paperwork.
(seehttp://www.dignitas.ch/index.php?option ¼ com_content&view ¼ article&id ¼ 6&Itemid ¼ 47&
lang ¼ en andhttp://exiteuthanasia.wordpress.com/2011/03/13/a-quick-guide-to-dignitas/)
12. Though only residents of Oregon are permitted to commit assisted-suicide, this may change in the
future which will allow non-residents to do so as well.
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Corresponding author
DeMond Shondell Miller can be contacted at: [email protected]
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This article has been cited by:
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deliberative forums on euthanasia. Policy Sciences 48, 339-361. [CrossRef]
2. Richard C. Franklin, Peter A. LeggatBasic epidemiology of non-infectious diseases 9-22. [CrossRef]
3. Craig Sinclair, Jessica Smith, Yann Toussaint, Kirsten Auret. 2014. Discussing dying in the diaspora: Attitudes towards
advance care planning among first generation Dutch and Italian migrants in rural Australia. Social Science & Medicine 101,
86-93. [CrossRef]
4. Avital Biran, Kenneth F. Hyde. 2013. New perspectives on dark tourism. International Journal of Culture, Tourism and
Hospitality Research 7:3, 191-198. [Abstract] [Full Text] [PDF]
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doc_536852875.pdf
This paper views the growing popularity of death tourism which directs the confrontation with
grief and mortality with the expressed purpose of orchestrating travel that culminates in assistance to
end one’s life. The specific aims of this paper are to describe the emerging phenomenon of death
tourism and situate it as a form of dark tourism, to present briefly the social and legal aspects of assisted
suicide in conjunction within the tourism industry, and to conclude with how the trend of death tourism is
potentially spreading to other countries beyond Europe.
International Journal of Culture, Tourism and Hospitality Research
When death is the destination: the business of death tourism – despite legal and social implications
DeMond Shondell Miller Christopher Gonzalez
Article information:
To cite this document:
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When death is the destination: the
business of death tourism – despite legal
and social implications
DeMond Shondell Miller and Christopher Gonzalez
Abstract
Purpose – This paper views the growing popularity of death tourismwhich directs the confrontation with
grief and mortality with the expressed purpose of orchestrating travel that culminates in assistance to
end one’s life. The speci?c aims of this paper are to describe the emerging phenomenon of death
tourismand situate it as a formof dark tourism, to present brie?y the social and legal aspects of assisted
suicide in conjunction within the tourism industry, and to conclude with how the trend of death tourism is
potentially spreading to other countries beyond Europe.
Design/methodology/approach – By employing a variety of primary and secondary resources, from
death tourismindustry documents, legal statutes, and news reports, this study explores the propositions
of this article.
Findings – Whereas much of the contemporary research in dark tourism focuses on sights,
experiences, and actual memorialization, death tourism tends to comprise a holistic view of the
emerging phenomenon by viewing supply and demand management (and promotion), political
interpretation and control. The ?nal component of the paper views societal interpretations of death
tourism and its potential for market expansion.
Research limitations/implications – There have been several social movements and legislative
attempts to curtail the spread of assisted suicide and death tourism; however, the demand for the
services has grown to the point where jurisdictions are considering measures to allowthis practice. Such
an expansion of legalized assisted suicide will allow those seeking the right to die more options for a
death within a diversi?ed tourism industry.
Originality/value – Death tourism, within dark tourism, represents an emerging ?eld with few academic
resources. This paper works to conceptualize and clarify the unique place death tourism holds within
tourism and dark tourism speci?cally.
Keywords Tourism, Death, Suicide, Dark tourism, Death tourism, Assisted suicide, Suicide tourism
Paper type Research paper
Introduction
An individual’s choice to die without the administration of arti?cial life support procedures
and devices is now becoming a more thoroughly entrenched idea in many countries.
However, some communities and nations maintain a ?rm position against assisted suicide.
Hastening death by assisted suicide has remained controversial and illegal in many places.
Some family members and friends who have accompanied loved ones to die beyond their
home country’s borders have been investigated by the of?cials on their return fromtravel as if
they were party to a crime. There are several documented cases of individuals, families and
couples traveling to Zurich, Switzerland to end their lives. Reginald Crew, in 2003, was the
?rst recorded British citizen to travel to end his life with the assistance of Dignitas in 2003.
The English conductor, Sir Edward Downes, and his wife Lady Joan ended their lives
together in Zurich on July 7, 2009 (see Safyan, 2011). Clients, willing to travel and seek a
tourism experience within the ?nal moments, are seeking such services. With reports of
death tourism on the rise[1] Safyan (2011, p. 288) notes that ‘‘the emergence of death
DOI 10.1108/IJCTHR-05-2012-0042 VOL. 7 NO. 3 2013, pp. 293-306, Q Emerald Group Publishing Limited, ISSN 1750-6182
j
INTERNATIONAL JOURNAL OF CULTURE, TOURISM AND HOSPITALITY RESEARCH
j
PAGE 293
DeMond Shondell Miller
and Christopher Gonzalez
are based at Rowan
University, Glassboro, New
Jersey, USA.
The authors wish to thank the
anonymous reviewers for their
insightful comments and Ms
Marianne McCulley for her
comments and editorial
assistance.
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tourism as a new ‘industry’ has revived international debate regarding the legislation of
physician-assisted suicide and euthanasia’’.
This paper describes the emerging phenomena of death tourismand classi?es it as a formof
dark tourism. In doing so, the paper will brie?y present an overview of dark tourism, the
social and legal aspects of assisted suicide in conjunction within the tourism industry and
conclude with how the trend of death tourism is potentially spreading to other countries
beyond Europe. We maintain that not only is death tourism a form of dark tourism, but we
make the argument that it is well-suited within the conceptual framework of dark tourism,
apart from medical tourism, and it is expanding in a more globalized tourism market place
despite the social and legal implications.
Situating death tourism in dark tourism
Dark tourism, sometimes referred to as grief tourism, involves travel to sites linked with death
and tragedy or sites where death and suffering has occurred or been memorialized. Also
known as thanatourism, it involves locations such as Holocaust sites, battle?elds, prisons,
slavery sites, graveyards and other places of great suffering. Philip Stone, founder of The
Institute for Dark Tourism Research (www.dark-tourism.org.uk/) at the University of Central
Lancashire in England, states that dark tourism, in its various shades, can potentially provide
individuals in contemporary secular societies a vehicle to get up close and personal to tragic
events that have perturbed our collective consciousness. The term ‘‘dark tourism’’ was
coined by Malcolm Foley and John Lennon in a 1996 editorial for International Journal of
Heritage Studies; in 2000, they published the book Dark Tourism: The Attraction of Death
and Disaster. Only recently has dark tourism been recognized as a subset of the tourism
industry and begun to be studied academically (Stone, 2006). There is no universal typology
of dark tourism, or even a universally accepted de?nition. However, scholars view dark
tourism with an academic lens in order to scrutinize broader socio-cultural considerations,
managerial and political consequences, or ethical dilemmas (Stone, 2012a). Augmenting
various typologies of dark tourism, alternative terminology has also been applied to the
phenomenon:
‘‘Dark Tourism’’ [is used] to signify a fundamental shift in the way which death, disaster and
atrocity are being handled by those who offer associated tourism ‘‘products’’. In particular, [. . .]
‘‘dark tourism’’ is both a product of the circumstances of the late modern world and a signi?cant
in?uence on these circumstances. Moreover, the politics, economics, sociologies and
technologies of the contemporary world are as much important factors in the events on which
this dark tourism is focused as they are central to the selection and interpretation of sites and
events which become tourist products’’ (Lennon and Foley, 2000, p. 3). For example, Seaton
(1996) refers to death-related tourist activity as thanatourism, while other labels include morbid
tourism (Blom, 2000), death-related tourist activity associated with natural disaster (Miller, 2008;
Hutter and Miller, 2011, 2013), black spot tourism (Rojek, 1993), grief tourism (see www.grief-
tourism.com) or as Dann (1994, p. 61) alliterates, ‘‘milking the macabre’’. More speci?cally,
Bristow and Newman (2004) introduce the term ‘‘fright tourism’’, a variation of dark tourism
whereby individuals may seek a thrill or shock fromthe experience. Meanwhile, Dann (1998, p. 15)
suggests that ‘‘dicing with death’’ – that is, seeking experiences that heighten tourists’ own sense
of mortality – may be considered a particular consequence of dark tourism.
The tourism literature is frequently confronted with new forms of tourism or ‘‘new tourism’’
(Poon, 1994) as examples of how products and services, not originally linked to tourism, are
nowbeing commodi?ed into key tourismattractions. Over the last 15 years, dark tourismhas
been popularized through media as well as the internet. In the infancy of dark tourism, travel
that was associated with death, atrocity or disaster had not been previously featured in the
academic literature as a speci?c element of consumption in periodic typologies of tourism
(Stone, 2011a). Pilgrimages to places associated with death have occurred as long as
people have been able to travel. In other words, it has always been an identi?able form of
tourism, though socio-cultural contexts in which death-related travel transpired have
obviously changed throughout the ages (Stone, 2012a):
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Several commentators view pilgrimage as one of the earliest forms of tourism (Vellas and
Becherel, 1995; Lickorish and Jenkins, 1997). This pilgrimage is often (but not only) associated
with the death of individuals or groups, mainly in circumstances which are associated with the
violent and the untimely (Lennon and Foley, 2000, p. 3).
Seaton (2010) states that dark tourism was originally traditional travel that has evolved
through profound shifts in the history of European culture and been in?uenced by
Christianity, Antiquarianism, and Romanticism. However, the demand for dark tourism
experiences and the supply has grown in both scale and scope due to the growth in
participation of tourism since the mid-twentieth century (Sharpley and Stone, 2009a). Up
until now, it has often been assumed that ‘‘generally, visitors are seen to be driven by
different intensities of interest or fascination in death’’ (Stone and Sharpley, 2008) to see and
experience various places. Stone (2006, p. 145) contends that ‘‘society’s fascination with
death, real or ?ctional, media inspired or otherwise, that is seemingly driving the dark tourism
phenomenon’’ as a key factor in the demand of dark tourism.
Pagliari (2004) argues that contemporary society is now entering a death-deriding age,
where death is mocked, commercialized and sold for the sake of art and entertainment.
Businesses are using death as an opportunity to commodify, package and repackage it in
order to pro?t from death and death-related subjects. The curiosity among tourists makes
the need for such a site a necessity. There are a number of motives for dark tourism that
attempt to explain tourists’ behavior and location selection for travel to speci?c areas that are
associated with death. Dann (1998) identi?es eight in?uences. These motives include the
fear of phantoms (i.e. overcoming childlike fears), the search for novelty, nostalgia, the
celebration of crime or deviance, basic bloodlust, and, at a more practical level, ‘‘dicing with
death’’ – that is, undertaking journeys, or ‘‘holidays in hell’’ (O’Rourke, 1988; Pelton, 2003)
that challenge tourists or heighten their sense of mortality.
For Dale and Robinson (2011, p. 212; see also Pidd, 2009), ‘‘dark tourism is taken to a
different stage when physical travel is driven by the act of observing or participating in death
itself [. . .] This is further symbolized in suicide or euthanasia tourism, where people travel to
clinics to end their lives’’. Also called ‘‘suicide tourism’’ or ‘‘euthanasia tourism’’, death
tourism involves the commodi?cation of a solution to suffering and human misery fashioned
together by the tourismindustry in such ways that make it appealing to the individual seeking
to travel abroad for the expressed purpose of seeking death. This commodi?cation involves
the de-medicalization of assisted death. Where the de-medicalization can be viewed as
‘‘stripping away medicine as a dominant frame of reference to reveal the ‘‘true’’’’ nature of the
tourism experience (Lupton, 2005, pp. 245, 256; Ost, n.d., pp. 4-5). By doing so, the ?nal
days of life are not consumed with the life-extending medical equipment or the next medical
appointment, but rather the tour event is a way to embrace life’s ?nality and enhance the
quality of life during the last days.
We identify four characteristics that set death tourism within the larger context of dark
tourism. Death tourism is unique in that it has four fundamental characteristics that set it
apart from other forms of dark tourism which memorialize events, people or places such as
battleground tourism, genocide/holocaust tourism or cemetery tourism (Miller and Rivera,
2006). People are motivated to seek the services of companies to arrange travel plans to a
destination because:
1. the procedures may be illegal in their home countries;
2. the person/client/traveler seeks to take care of un?nished business either in their personal
life or the business of ending their lives;
3. the person/client/traveler seeks a ?nal solution – not a medical ?x[2] or to prolong or
improve the quality of life; or
4. they seek the Romantic idealism of the ‘‘death with dignity’’, where the deathbed is a
Romantic notion of a death free of pain and suffering.
Tercier (2005, p. 15; see Stone, 2011a, p. 23) notes, ‘‘the business of the [Romantic]
deathbed became just that: the tidying and tying up of un?nished business’’. Thus, the
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Romantic reconstruction of the deathbed was nothing more than a ?nal, peaceful sleep. With
a darkened room, family and loved ones at the bedside, affairs in order, peace made with
both survivors and God, and with a few gentle and quiet farewells, the decedent would drift
off into an eternal slumber.
The topic of death tourismcan be de?ned as assisting a suicidal individual to travel fromone
location to another in which that individual may be assisted in their suicide by another person
(Huxtable, 2009, p. 328). Dark tourism has a centuries-long tradition in cultures around the
world as people traveled to sacred sites to visit places where martyrs once stood before they
expired in the coliseums in Rome, catacombs, graveyards, battle?elds, places of trauma
and even modern disaster sites. However, modern death tourism can trace its roots back to
the nineteenth century idea of a Romantic death. Termed by Aries (2008; Stone, 2011a, p. 23)
‘‘as ‘Thy death’ (or ‘The death of another’) the Romantic death evolved through a waning of
external damnation messages prescribed by priests with advancements in medicines
prescribed by doctors’’. Stone (2011a: 23) goes on to assert:
The Romantic death became a death-with-dignity, a good death where calmness prevailed in
readiness for a digni?ed departure from the mortal world. The good death was an illustration of
howman paid respectful deference to the laws of nature, and howthe time of passing became an
opportunity to ‘‘put things in order’’.
It is important to note that we maintain that the place for death tourism is not within the niche
sector of medical tourism. Medical tourism, where patients travel overseas for operations,
has grown rapidly in the past decade (Connel, 2006). The rise of medical tourism
emphasizes the privatization of health care, the growing dependence on technology, uneven
access to health resources and the accelerated globalization of both health care and
tourism. Carrera and Bridges (2006) de?ne medical tourismas ‘‘the organized travel outside
of one’s natural healthcare jurisdiction for the enhancement or restoration of the individual’s
health through medical intervention’’. Countries in Southeast Asia[3] are capitalizing on their
popularity as tourist destinations by combining high-quality medical services with tourist
packages (Pocock and Phua, 2011). However, assisted suicide tourism does not occupy a
place in the overall conceptual framework of medical tourism revised by Tikkanen (2005)
and Tourism Research and Marketing (2006). This process has been widely criticized due to
the fact that it may provide a loss of the authenticity of a site or experience; it also calls into
question the ethics of operating such a service in order to create personal gain out of the
death and misery of others (Lennon and Foley, 2000; Miles, 2002; Muzaini et al., 2007).
Huxtable (2009) notes that death tourism presents distinctive ethical, legal and practical
challenges. Because people are not legally allowed to pursue their wish to die in their own
country, they are motivated to travel to other countries where they have the option, under
strict guidelines, to obtain the services of professionals who are not legally responsible for
the death of the individual. The person wishing to die engages in a series of steps that
involves traveling, visiting, seeking medical consultations, but ultimately death; a
well-planned, speci?cally choreographed end of a visit to another country is the goal of
the person traveling to this destination. Hence, the person wishing to die becomes a client.
The client then enlists the help of others, often agencies that specialize in choreographing
everything from travel, hotel stays, doctor visits, to the actual speci?cations of the place of
death; the assisting person, typically supplied as volunteers and specialized physicians,
clearly plays a causal role in their death but it is the client themselves who performs the ?nal,
fatal act (Kamisar, 1997, pp. 228-9). Death tourists are highly motivated to travel to go to
destinations in which they will have more freedom in their search of death via assisted
suicide. The individual can select when, where, and how-place of death, time of death, and
do so within their own speci?c timeframe and based on their own needs – as a ‘‘right’’ to die.
Ost (n.d., p. 12) cites three primary reasons persons are motivated to seek commoditized
death travel that are psycho-emotional factors typically linked to the legality of assisted
suicide in speci?c places and the need to have a more natural family-oriented death. Ost
(n.d., p. 12) contends: ?rst, this may make the assisted death feel less medicalized and less
clinical, and thus a less tense affair. Secondly, it might reassure the person concerned that
their relatives approve of their decision, or at least that they are at peace with their decision to
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die. Thirdly, they may need the emotional support that their relatives provide. Their
experience of assisted death is therefore a better death because they are accompanied
throughout the process by their loved ones. Those who travel as a part of the ?nal
experience, especially family members and friends, they are brought close to the
experience of death, the room become a mediating place where ‘‘dark tourism is a modern
mediating institution, which not only provides a physical place to link the living with the dead,
but also allows a cognitive space for the self to construct contemporary ontological
meanings of mortality’’ (Stone, 2012b, p. 1566), in much the same way the tombstone or
cemetery involves a socially constructed reality dark tourism.
While few systematic studies motivation for death tourism have been conducted, persons
seeking their option and their realities such as ‘‘Lesley Close, who accompanied her brother
to Switzerland for an assisted suicide through Dignitas, emphasized the signi?cance of his
‘chance to say goodbye, to interact with us at that last moment’’’ (BBC News, 2009).
According to Dr Turner’s son, the family ‘‘chatted, sang some songs and joked’’ in the ?nal
hours before her death (BBC News, 2009). For relatives, being present at their loved one’s
death may be equally important so that they can see their wish for an assisted death being
ful?lled, share their ?nal moments of life with them and ensure that they do not have an
isolated death (Chabot and Goedhart, 2009). They may reaf?rm their support for their loved
one’s decision through their attendance. Mr Cutkelvin’s partner stated: ‘‘I wanted to be with
him because this was what he wanted, to die in a digni?ed and peaceful manner, which is
what happened’’ (BBC News, 2009) (see Ost, n.d., pp. 12-13). Moreover, Stone’s (2010; see
also Stone, 2011b) work notes that dark tourism, for some people for some of the time at
some sites, is not about consuming narratives about disaster and tragedy death, but, rather,
of contemplating life in the face of one’s mortality.
Traveling and death (assisted suicide) tourism
Euthanasia, derived from the Greek euthanatos, which means a gentle and easy death, is
the practice of intentionally ending a life in order to relieve pain and suffering; it remains
controversial. Killing in the name of compassion, or mercy killing, are other terms given to
euthanasia (Jenkins, 2011). In The Netherlands, euthanasia de?nes the termination of life by
a doctor at the request of a patient. The Dutch government understands that there are issues
concerning this subject matter. As Jenkins (2011) states, the question of whether and how
criminal liability for euthanasia should be restricted has been the subject of broad political
and public debate for the past three decades. The debates delve into both sides of the
argument. Those against the practice make reference to the fact that the patient may, in
some cases, not really want to die; the patient may be in a situation where they are being
taken advantage of for ?nancial reasons or other gains. Proponents of euthanasia believe
that a patient has a reserved right to end their life rather than face the suffering brought on by
a terminal disease. They simply believe that instead of going through pain and suffering,
they can take action by bringing forward the inevitable (their death).
Though similar, assisted suicide is the term used to describe actions by which an individual
(professional medical assistant) helps another person voluntarily bring about their own
death. The ‘‘assistance’’ refers to the act of providing one with the means (drugs or
equipment) to end one’s own life. It differs from euthanasia in that another person ends the
life of the patient seeking death. Views of assisted suicide vary around the world. While some
countries[4] have de?ned laws prohibiting the act, others[5] have no speci?c law deterring
the practice but a charge of ‘‘manslaughter’’ may be brought against anyone assisting
suicide. Countries have long debated the question of whether or not doctors and other
health-care professionals, in certain circumstances, should participate in intentionally
causing the death of a patient, and whether society as a whole should ethically accept this
practice (Vilela and Caramelli, 2009).
Currently, Switzerland, Belgium, The Netherlands, Mexico and Oregon (USA) have laws
allowing certain methods of assisted suicide, under well-de?ned circumstances. Swiss law
requires that assisted suicides be conducted for altruistic reasons (Humphry, 2002). These
circumstances vary with the illness, condition, mental state and speci?c requests of the
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person seeking help. In 2001, The Swiss National Council con?rmed the assisted suicide
law, although voluntary euthanasia is still prohibited. There are four groups involved in
assisted suicide in Switzerland, but only one, Dignitas, will accept non-Swiss citizens as
clients who travel fromaround the world. The decision, by Dignitas, to accept themis closely
monitored within the organization (Jenkins, 2011). Switzerland’s main non-medical
right-to-die organization Exit Deutsche Schweiz and its subgroups Exit International,
Dignitas, and Exit ADMD have been prescribing lethal doses of sodium pentobarbital drugs
for self-administration since 1982 (Bosshard et al., 2003). Other organizations located in
Belgium, The Netherlands, Mexico and Oregon have also been providing individuals with
legal ways of terminating their lives.
Dignitas
‘‘Live with dignity, die with dignity,’’ is the slogan for Dignitas, a Swiss assisted suicide
organization. Located in Zurich, this organization has received notoriety and international
headlines as people with chronic diseases from around the world traveled to Switzerland
seeking help in committing suicide. Founded in 1998 by Swiss lawyer Ludwig Minelli,
Dignitas legally provides its ‘‘visiting’’ clients with the means to ends one’s life. Switzerland’s
law maintains that a person can only be prosecuted if they are acting out of self-interest. Due
to their liberal regulations on assisted suicide, Dignitas is able to operate without much legal
trouble. According to the article ‘‘Dignitas: Swiss suicide helpers’’ (BBC News, 2003), the
law on suicide actually states that: ‘‘Whoever lures someone into suicide or provides
assistance to commit suicide out of a self-interested motivation will, on completion of the
suicide, be punished with up to ?ve years’ imprisonment.’’ Dignitas’ leadership interprets
this to mean that anyone who assists suicide altruistically cannot be punished. Moreover,
their staff members are declared as volunteers to ensure there can be no con?ict of interest.
Another way Dignitas attempts to avoid legal issues is by providing a text for patients, which
states their wish for assisted suicide in terms which cannot be misconstrued and which
allows them to carry out their wishes even in the face of opposition, if necessary (BBC News,
2003). The overall process assures that the individual seeking death is completely satis?ed
with the choice that they alone will ultimately make.
Once contacted, Dignitas provides background information to their potential patient
(brochure) while examining further ways of treating the client. Minelli (2007) states that
information pertaining to appropriate analgesics and further support may sometimes
eliminate the feeling of wanting to die as the client may develop a better understand of their
life. If the feeling of wanting to die remains, the patient is given the option of joining the
Dignitas organization where they can continue the process of assisted suicide. In order to
apply, the patient must submit a letter of request and their medical ?le which must include all
up-to-date information (diagnosis, treatment, prognosis of their condition). The next step in
the process involves Dignitas locating a Swiss doctor capable and willing to provide the
patient with a prescription of the lethal barbiturate drug. This is followed by a meeting
between the patient and the doctor that takes place once the patient has secured all needed
medical and legal documents. The doctor performs a psychological evaluation of the patient
and once the doctor is certain that the desire of wanting to die remains within the patient, the
prescription is issued. At this point, ‘‘. . .the person must be able to understand what shall be
done and must also have the capacity to express himself (or herself), at least to answer
questions by signs indicating ‘yes’ or ‘no’’’ (Minelli, 2007, p. 6). Dignitas also suggests to the
patients that they communicate their wishes with loved ones; this creates an opportunity for
the people closest to the patient to voice their opinion on the matter at hand. Also,
relatives/loved ones can choose to be present when the death occurs. After the patient signs
a ‘‘Declaration of Suicide’’ and takes the ?nal act[6], Dignitas contacts various authorities in
order to have them investigate and ensure that no offense has been committed (Minelli,
2007). The body of the patient is then released to the family. The process secures that
patients of Dignitas, both natives and tourists, are able to receive their ?nal wishes without
complications.
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It is estimated that nearly 85 percent of all Dignitas clients travel to Switzerland with speci?c
intentions of dying; since operations began in 1998, Dignitas has provided services to over
1,000 individuals. Out of these, approximately 935 were foreigners traveling to Switzerland
(Schweye, 2011). In Switzerland, between 1990 and 2000, the organization EXITassisted in
748 deaths among Swiss residents (this accounted for approximately 0.1 percent of total
deaths, 4.8 percent of total suicides) (Bosshard et al., 2003). Compared to EXIT, Dignitas
provided more assistance to non-residents (91 percent of Dignitas patients were
non-residents, while 3 percent of Exit clients were non-residents). Additionally, in Oregon,
there were 114 documented cases where doctors prescribed lethal medications to patients
in 2011. Out of these 114, 71 were ultimately used. In 1998, only 24 lethal doses were
prescribed, 16 of which were used[7].
Although there is a demand for the services provided by Dignitas and other assisted suicide
organizations, the organization has, and continues to face opposition within Switzerland.
Beatrice Wertli, from the Swiss Christian democrats, has voiced concerns about the legal
basis of an organized group promoting and carrying out assisted suicide. She stated that
‘‘We do not want Switzerland to be a destination for tourism for suicide,’’ (BBC News, 2003)
which is the feeling of many in reference to assisted suicide. There are moral, ethical,
political and social issues that stem from the practice of assisted suicide.
Political and social issues with death tourism
As noted, there are a number of legal implications within the practice of assisted suicide.
Even in the areas where a form of it is legal (Switzerland, Belgium, The Netherlands, Mexico
and Oregon), assisted suicide is subject to both legal and ethical scrutiny. Speci?cally, in
Switzerland, the debate has and continues to grow. The Swiss law that allows anyone to help
patients die, as long as there are no ulterior motives, dates back to 1942. The Swiss position
regarding the legality of assisted suicide is summarized by Guillod and Schmidt who
conclude that ‘‘assisted suicide is a crime only when four elements can be shown: a suicide
was committed or attempted; a third party encouraged or helped in the suicide; the third
party acted on sel?sh grounds; the third party acted deliberately (intent)’’ (Guillod and
Schmidt, 2005, p. 29). However, Article 115 of the Swiss penal code considers
assisted-suicide a crime if and only if the motive is sel?sh; it further prohibits assisted
suicide for altruistic reasons. Article 115 does not require the involvement of a physician nor
that the patient be terminally ill. It only requires that the motive be unsel?sh (Mishra, 2007).
Furthermore, Article 115 only criminalizes any assistance in suicide that is motivated by
‘‘sel?sh[8]’’ reasons, for example, for ?nancial bene?t (Huxtable, 2009). Assisted suicide is a
controversial topic in Switzerland, but data on public attitudes towards assisted suicide and
euthanasia are scarce. Moreover, Guillod and Schmidt (2005, p. 31) state that ‘‘Article 115 of
the Penal code is a criminal provision and, therefore, cannot create a right to assisted
suicide. It merely recognizes the liberty to request assisted suicide and leaves it to each third
party (whether a health-care professional or not) to accept such a request.’’
According to one survey (Mishra, 2007), half of the respondents were willing to ‘‘shorten the
life of a family member who suffered too much and who asked for euthanasia.’’ Moreover, in a
1999 survey of the Swiss public, 82 percent of the 1,000 respondents agreed that ‘‘a person
suffering froman incurable disease and who endures intolerable physical and psychological
suffering has the right to ask for death and to obtain help for this purpose.’’ Of these, 68
percent considered that physicians should provide this help; 37 percent considered that the
family, 22 percent that right to die societies, 9 percent that nurses, and 7 percent that
religious representatives should be able to ful?ll such requests. Legislation to allow
euthanasia was favored by 71 percent of all respondents (Mishra, 2007). These statistics
illustrate the feelings of the public in reference to assisted suicide. Nevertheless, there is a
constant demand for the services provided by Dignitas and other assisted suicide
organizations.
Though The Netherlands was not the ?rst country to bring forth the debate of euthanasia, it
was the ?rst country to reform its law. This debate started in England, Germany and the USA
in the middle of the nineteenth century when drugs became available to physicians that
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allowed them to in?uence the way people die. Interestingly, the ?rst known proposal to
decriminalize voluntary euthanasia was made in 1906 in the US state of Ohio (Vanderpool,
1997). The views on euthanasia and assisted suicide within these locations have changed
over the past 100 years due to the political and social issues concerning the legality of the
practice. For example, the Dutch position on euthanasia and assisted suicide is the result of
a long discussion both in society and in parliament on the acceptability of voluntary
euthanasia and assisted suicide and the mechanisms for social control of these practices. In
Belgium, the legal conditions for the lawful practice of voluntary euthanasia can be found in
the Belgian Act on Euthanasia of May 28, 2002 that came into effect on September 23,
2002[9]. Both the Dutch and the Belgian Acts regulate the practice of voluntary euthanasia,
de?ned as the intentional termination of one person’s life, at their request, by another person.
Whereas the Dutch Act treats voluntary euthanasia and assisted suicide in the same way
and regulates both practices, the Belgian Act does not consider assisted suicide at all. While
the Dutch Criminal Code criminalizes assisted-suicide (section 294), the Belgian Criminal
Code does not. Also, in March 2009, Luxembourg decriminalized both voluntary euthanasia
and assisted suicide[10].
The marketing and selling of ‘‘your right to die’’
Sundow (1967) and more recently Walter (1996) have pointed to the increasing
‘‘industrialization’’ of death in the late twentieth century in some cultures where business
associated with all aspects of a process that includes hardware, real estate and funeral or,
even, cryogenic services have arisen, some global in their scope (Lennon and Foley, 2000,
p. 4). It is dif?cult to understand how one attempts to sell death to an individual. Those who
choose to end their own lives have the choice of committing suicide whenever and wherever
they please. Unless the suicidal feelings subside, this individual is more than likely to ?nd a
way to end their life. What Dignitas and other assisted-suicide organizations are selling is the
right for an individual to die with dignity while also having the bene?t of being surrounded by
loved ones during their ?nal breaths. Along with this, Dignitas, for example, offers their
clients attractive packages which provide a day (or more) of enjoyment and relaxation
before the assisted suicide takes place. Additionally, the assisted suicide packages are
offered for the purpose of giving potential clients options while stressing the ‘‘rights’’ and
‘‘freedom’’ that they deserve as human beings. According to the Dignitas web site, ‘‘Many
people are afraid of ?nding themselves in a hopeless condition or unconscious and
connected to machines in a hospital and being kept alive arti?cially for a long period of time.
They are afraid of pointless operations and ineffective pharmaceutical therapies’’
(www.dignitas.ch/). When selling death, or essentially anything, a business must ensure
that they are providing value for the customer; in this case Dignitas is aware that freedom is
the value that many clients are seeking.
Baumeister (1990) ?nds a number of studies have discovered that most individuals pursuing
physician-assisted suicide possess a common desire for freedom or escape. By applying
the framework of tourism and leisure motivation conceived by Iso-Ahola (1982), assisted
suicide may provide an outlet for simultaneously escaping something (i.e. physical and
psychological effects of a chronic or terminal illness) and seeking something (i.e. the fantasy
and illusion of oblivion). Assisted suicide organizations emphasize freedom of choice and
the right to die with dignity to their clients, by packaging the assisted suicide services.
Travel for assisted suicide offers an alternative world of physical and psychological escape
for patients (World Health Organization, 2009). Today, dignity is frequently understood as
some kind of intrinsic, morally relevant value that places a moral obligation on the individual
(and on others) to respect someone by virtue of their dignity (Seifert, 1997). Dignitas, Exit
and other assisted suicide organizations pride themselves in giving their clients a choice.
They associate the opportunity of dying with ultimate freedom and dignity. The intentional
marketing to tourists as having ‘‘rights’’ and dying with ‘‘dignity’’ may very well sway the
decision of vulnerable patients who believe that exercising one’s rights to death with dignity
as part of a whole tourism package that culminates in the death is an option. The topic of
assisted suicide patients being taken advantage of has been ongoing for years.
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Nonetheless, assisted suicide organizations are continuing to do business; some are even
growing. Jones (2012) states that the number of assisted deaths administered by Dignitas in
2011 increased by 35 percent when compared to the previous year’s total of the 144 people
who ended their lives in 2011 with the help of the clinic, and all but ?ve patients were of
foreign nationality. Additionally, Exit also saw an increase of about 17 percent from the
previous year; from 257 to more than 300, according to the article (Jones, 2012). The
sustainability and growth of the death tourism industry among the assisted suicide
organizations is clear and compellingly meeting the needs of its clients. The fact that they
have continuously been pro?table is itself not so clear. Because they are supposed to be
non-pro?t organizations, the ?nances of Dignitas have raised several concerns.
An investigation carried on by The Telegraph newspaper in the UK has raised questions
about Dignitas and whether Ludwig Minelli, its founder and director, makes a pro?t from his
‘‘mercy killings.’’ Before setting up Dignitas in 1998, Minelli, previously a human rights lawyer
and attorney in Zurich, had no taxable personal fortune registered. A little over a decade
later, the investigation found that Minelli had an annual taxable income of £98,000 and a
personal fortune of over £1.2 million. Along with his wealth, he is said to possess a luxury
villa. Minelli, who said he would take no salary from Dignitas when opening the clinic years
ago, has insisted that his wealth came from an inheritance left by his mother. However, the
cost of a simple suicide at Dignitas has risen from £1,800 in 2005 to £4,500, which adds to
the suspicion that the clinic may not be in compliance with Swiss laws that are supposed to
prevent people from ‘‘sel?shly’’ pro?ting from assisted suicide (The Telegraph, 2010).
In a rare 2008 interview with Der Tagesspiegel, a German daily newspaper (www.
tagesspiegel.de/weltspiegel/dignitas-chef-minelli-im-interview-wenn-sie-das-trinken-gibt-
es-kein-zurueck/1198414.html), Minelli revealed a great deal about the practices of
Dignitas; he speci?cally described the business aspect of his assisted suicide organization.
The cost of ‘‘preparation and monitoring’’ a suicide costs the patients approximately 4000 e
or just a little over $US 5,100. If Dignitas assumes the responsibility for tasks that a family (or
family members) would typically do (i.e. the funeral proceedings, the doctor, and of?ce
fees), the price would total approximately 7000 e or about $US 8,900. Minelli stated that
running the business itself was expensive (www.tagesspiegel.de/weltspiegel/dignitas-chef-
minelli-im-interview-wenn-sie-das-trinken-gibt-es-kein-zurueck/1198414.html). This was
due to the 15 employees, the of?ce, telephone and rental costs, and also legal fees that
are brought forth by considerable harassment. Minelli did not elaborate on that issue in the
interview; however, it can be assumed that citizens, government regulators and others,
speci?cally families of Dignitas patients, take legal action against the organization due to the
fact that they feel that Dignitas took advantage of patients while seeking monetary gains.
Fischer et al. (2008) state that 21 percent of Dignitas members who received an assisted
death did not have a terminal or progressive illness, but rather ‘‘weariness of life.’’ This
statistic provides insight regarding the negative views of family members and other
opponents of assisted suicide. Essentially, one out of every ?ve clients that is serviced by
Dignitas dies without any form of terminal illness or unbearable pain and suffering. When
questioned about persuading clients to commit suicide in order to increase pro?ts, Minelli
refuted the accusation claiming that he does not practice that way. He also described a case
where a young man wanted to die but after spending several days swimming, talking, and
drinking wine, the client decided to go home. Minelli stated that he was happy that the young
man changed his position on death.
To contain or spread death tourism and its future implication
Over the years, fascination with death and suffering has turned dark tourism into a pro?table
sector within tourism. Death tourismhas itself become popular since its emergence; due to a
great deal of media attention, with respect to the negative attention via newspaper
headlines, video and news attention and government action, which inadvertedly served to
market death tourism as a product. Even though the practices of Dignitas, Exit, and other
assisted suicide organizations are protested by many groups and individuals, the growth of
this aspect of dark tourism indicates that there is indeed a market for assisted suicide
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tourism-related services. New ?gures published in Britain show that the number of
assisted-suicide deaths in Switzerland have jumped 700 percent in just 11 years (Ertelt,
2012). Ertelt (2012) also states that of?cial ?gures published for the ?rst time reveal almost
300 Swiss residents died by way of assisted suicide in 2009, compared to just 43 in 1998.
Also, Dignitas now reports approximately 75,000 registered members. These membership
numbers illustrate that while the number of Swiss and non-Swiss residents opting for
assisted suicide is growing, the number of death tourists that seek the full range of
services[11] offered by Dignitas, is also on the rise.
Despite the attention sand growth abroad, death tourism has only recently been discussed in
the USA and other countries (Srinivas, 2009). Issues such as morality, human dignity, medical
ethics, and religion play a role in the heated debate. While in general, tourism presents a
variety of ethical challenges and dark tourism presents some unique challenges with respect
to site meaning, who is able to tell the story, how can site ‘‘Disney?cation’’ he avoided, what is
historically accurate, what political issues frame the site and what is the balance between
voyeurism and educational enlightenment. However, death tourism’s ethical dilemmas tend to
lie beyond the person seeking the services and the service provider. The client seeks to end
life in a controlled manner, oftentimes with their family’s knowledge and accompaniment. The
site of death is not a commercialized reconstructed village or complex of macabre spectacles,
but neither a place of calm where the last moments of life are related calm and connected to
the world where few mediations between death (such as hospital machines, rules about
visitors and social taboos) exist and the client and his or her family are able to directly be a part
of the experience, a part of the moments that many consider a natural part of the life process.
Legal and ethical concerns regarding the right to die and physical assisted suicide arise from
the medical profession, within legislatures, and society. However, for those who are suffering,
the ethical, humane and legal response is to allow death tourism. Death tourism repackages
the death experience in such a way that grief and suffering is transformed into a relaxed and
more natural ‘‘romantic-styled’’ death with and experience for the consumers and those they
invite to share in their ?nal moments of life. If done correctly, companies such as Dignitas can
provide the consumers with an experience that meets the need of its clients and their families.
While the question of whether or not the other countries are willing to adopt assisted suicide
practices still exists, there is no doubt that doing so will lead to pro?ts. This is true due to the
fact that death tourism is becoming a trend. The growth of assisted suicide provides a viable
segment within the tourism industry. For instance Srinivas (2009) asserts that there are only
two avenues for Americans searching for life ending procedures; the ?rst route is to travel to
Switzerland, and the second involves traveling to a state where assisted suicide is legal[12]
(Montana, Oregon, and Washington). However, death tourism in the USA is in its infancy.
Moreover, with advancing technologies and medical breakthroughs people are living longer
with more chronic debilitating diseases. This, paired with what many believe is their right to die
with dignity, will lead to more people opting for assisted suicide via death tourism if the option
is available. This, in turn, creates a market for assisted-suicide organizations and the tourism
industry.
With the shifting of death from a more-medically institutionalized form, where doctors and
state of the art medical technologies are used to keep patients alive, to one that is more
Romantic death, more research is needed to address the more complex ethical challenges
this social transformation has and its impact on the tourismindustry. More systematic studies
regarding the motivations to seek such services, role of family members throughout the
process and the volunteers who assist the person throughout the process are needed to
comprehend this complex phenomena. Death tourism not only provides a death free of
suffering, it allows for the patient, or death tourist, the opportunity to experience those ?nal
days surrounded by loved ones in a well-orchestrated, peaceful environment. The peace,
serenity, ability to construct an end of life death tour, ‘‘modeled as a vacation’’ experience all
become crucial marketing foci to providers of assisted-suicide as a way of commodifying
and presenting death tourism to future clients. The Romantic nature of this death differs
greatly from the death that many face and serves as a powerful motivator for the death
tourist. Legal and social arguments toward a more humane death or a death with dignity will
continue to shape death tourism.
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Notes
1. See Sayfran (2011, p. 289), e.g. Ertelt, S. (July 14, 2008), Switzerland government of?cial wants
assisted suicide death tourism to stop,http://archive.lifenews.com/bio2510.html (accessed 9
February 2013). The article describes how a Swiss of?cial wanted to stop the practice of "death
tourism" or, at least, slow the process.)
2. As with medical tourism
3. Southeast Asia, speci?cally Thailand, Singapore and Malaysia comprise the main regional hubs for
medical tourism (Smith et al., 2009)
4. Canada, Italy, Russia, Hungary and Ireland
5. Sweden and Germany
6. The patients are responsible for triggering the lethal dosage of medicine prescribed by the doctor
which will ultimately end their lives.
7. Oregon Public Health Division- Oregon’s Death With Dignity Act-2011
8. In evidence to the UK House of Lords Select Committee on the Assisted Dying for the Terminally Ill
Bill, the Swiss Ministry of Justice explained that – self-serving ends – would cover assisting a death
– to satisfy his own material or emotional needs . . . the possibility of eliminating some major problem
for the family, or other motives such as gaining an inheritance, relieving himself of the burden of
supporting the individual – or eliminating a person he hated.
9. Wet betreffende de euthanasie, see www.ejustice.just.fgov.be
10. Loi du 16 Mars 2009 sur l’euthanasie et l’assistance au suicide, online at:http://admdl.wollt.net/data/
16309euthanasie.pdf
11. These services include a Dignitas group membership and access to on-going death education and
counseling (death education, suicide and suicide-attempt prevention), client instructions (living wills
and advanced directives), preparation for an accompanied suicide (including ?ights/travel to
Switzerland, ground transport, and accommodation costs in Switzerland), doctor’s visits while in
Switzerland, a volunteer to assist with an accompanied suicide, funeral services/cremation/return of
remains to family/burial (at the directive of the client); completing of?cial procedures and paperwork.
(seehttp://www.dignitas.ch/index.php?option ¼ com_content&view ¼ article&id ¼ 6&Itemid ¼ 47&
lang ¼ en andhttp://exiteuthanasia.wordpress.com/2011/03/13/a-quick-guide-to-dignitas/)
12. Though only residents of Oregon are permitted to commit assisted-suicide, this may change in the
future which will allow non-residents to do so as well.
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Corresponding author
DeMond Shondell Miller can be contacted at: [email protected]
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