'They were tired of life and it was time to go': Arizona sisters who died at Swiss suicide clinic told doctors they weren't '100% well' and had been complaining about collapsed discs, chronic back pain, insomnia and vertigo

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The two Arizona sisters who killed themselves at a Swiss suicide clinic last month suffered from collapsed discs and chronic back pain and hinted at a 'troubled' period of their lives, according to the doctor they consulted before their death.

Dr. Phillip Nitschke says that Dr. Lila Ammouri, 54, and nurse Susan Frazier, 49, were not '100 percent well' when they sought to end their lives.

'They were complaining about what you might call frustrations. Collapsed dics, chronic back pain, chronic insomnia, vertigo,' Dr. Nitshke told The Independent.   

'They had both decided they were tired of life and it was time to go. What was very clear was that dying together was non-negotiable, it was very important to them,' he said, adding that they also told him about a 'troubled' period in their lives. 

'They didn’t give us much detail, but they said they had helped each other through what had been a difficult time and saw themselves as being each other's best friend.'

The sisters first reached out to Dr. Nitschke - the founder of assisted suicide advocacy group Exit International - in October 2020. 

After he warned them about the legal concerns of killing themselves in the U.S., they chose the Pegasos clinic in Basel, Switzerland, where they died on February 11. 

Their grieving brother, meanwhile, wants answers about what drove the sisters to make such a decision. He says his sisters appeared happy and were doing well at work.

Dr. Lila Ammouri (left) and nurse Susan Frazier complained of  'collapsed dics, chronic back pain, chronic insomnia, vertigo' before ending their lives at a Swiss suicide clinic last month

Dr. Philip Nitschke, director and founder of Exit International, one of Switzerland's largest  assisted suicide advocacy nonprofits, says the sisters also hinted at a 'troubled' period in their lives - though they didn't give much detail about it

The sisters' trip to the Pegasos clinic , pictured, had been postponed in August 2021 due to flight restrictions caused by the pandemic. They finally got there on February 3, 2022

Dr. Nitschke told DailyMail.com that the sisters reached out to his organization in October 2020 to become members and learn about how they could end their lives.

He says he warned them about the dangers and legal concerns of killing themselves in the US. Ammouri and Frazier then opted to travel to Switzerland to die in the Pegasos clinic, since it does not require patients to be terminally ill or suffering from a life-limiting illness. 

He said the sisters had originally scheduled their trip in August 2021, but the plan was delayed due to COVID travel restrictions during the Delta variant surge. 

Nitschke added that while the process was not cheap - costing about $11,000 per person without accounting for travel costs - the sisters were adamant about dying in peace together. 

'The idea of two people dying together is not possible in the U.S.,' Nitschke told DailyMail.com, 'but the sisters made it very clear to us that they wanted to end their lives together.' 

Nitschke said the sisters had completed a psychiatric evaluation when they arrived at Basel to ensure they were in the right mental capacity to make such a decision. 

In a joint statement filed with Exit, Pegasos Director Reudi Habegger said: 'Pegaso's Swiss Association is committed to ensuring that adults capable of judgement can exercise their right to a self-determined, humane death. 

'After careful clarifications and within the framework of the official rules, we respectfully accompany people with unbearable suffering on their last journey.'

Nitschke added that while he sees many couples wishing to die together when one of them has a terminal illness, Ammouri and Frazier's case is extremely rare.

'Exit has only seen one previous occasion when in 2017 in Gold Coast, Australia, mother Margaret Cummins, 78, and her daughters Wynette and Heather, aged 53 and 54 all decided to end their lives together,' he said. 

Nitschke noted that the sisters, who triggered a hunt from friends and family seeking answers when they never returned to Arizona on February 15, most likely traveled in secret out of fear of being stopped. 

'We've seen extreme cases in the past where people go to the airport to stop patients from coming over here or event get them certified as mentally incompetent to stop them.'  

It comes as the sisters' only known relative - their brother Cal Ammouri, 60, of New York - demanded answers over their deaths, which he did not learn about until reporters reached out to him earlier this week. 

'They were so secretive, especially with me,' Cal told the New York Post. 'Can someone tell me what happened? Do people snap just like that?  

'It could be. You wake up one day and you don't feel like life is precious.' 

Although Cal admitted he has not seen his sisters in 30 years, he said he spoke to them regularly over the phone and called them shortly before their trip to Switzerland. 

He told the Post that he got a call from Ammouri on February 10, the day before her death, but that she sounded normal.  

Frazier's employer, Aetna Health, in Phoenix, raised the alarm after she failed to return to work on February 15, with many friends and colleagues speculating that they had been kidnapped after they received odd messages from them. 

Dr. David Biglari, a longtime friend of sisters, said he and others were worried when they had not heard from the duo for a week after they arrived in Basel, Switzerland, on February 3.

Then on February 10, just a day before the sisters took their own lives at what is most likely Basel's Pegasos assisted suicide clinic, Biglari said one of the sisters' co-workers had gotten an odd message. 

It read: 'Hey! Sorry you needed surgery. I hope you're [sic] pain is controlled. I'm currently in Europe on a little vacation.'  

Biglari, an associate program director of cardiology at the University of Arizona, told Fox 10 that the misspelled 'you're' was one of several messages that had he and his colleagues believe that the person on the other side of the phone was not actually one of the sisters.  

'Some of the text communications they had, we are certain they were not from them,' Biglari said, as he and others initially believed that the sisters were kidnapped when they failed to show up for work on February 15. 

'They were most likely fabricated with someone else.' 

After learning of their suicides, Biglari said he still wanted answers. 

Selinda Staggers, a medical assistant who worked remotely with Ammouri, said her jaw dropped about the doctor's death.

'She was the nicest, sweetest person,' Staggers told the Post. 'Always asked me about myself. She was very normal, very kind, very professional.'

Like Cal, Staggers said she saw no indication that Ammouri was depressed.

The sisters traveled to Basel on February 3, staying a week in the city and completing a psychiatric evaluation before dying together on February 11 

The sisters opted to use Pegasos, a nonprofit in the field, which has a facility in Basel (pictured). Pegasos allowed the non-terminally ill sisters to die together 

The grieving brother said that both sisters appeared happy, with Lila owning a home in Phoenix and enjoying her job helping patients with serious illnesses and pain, and Susan recently getting a promotion. 

'Why would you leave your jobs, your home, your loved ones, just abandon everything,' Cal asked. 'I just want some answers.' 

Cal told the Post that he kept in touch with his sister after they were separated during their parents' divorce years ago. Cal and their father, Andrew, moved to New York where he currently resides in Washington Heights, while they went to Arizona with their mother, Faye.   

'I begged them to call me every week but they hardly ever did,' Cal said. 'I had to be very careful how I talked to them. One slip and it was, ''Oh, boy.'''

Dr. David Biglari, a long time friend of sisters, had believed that the sisters were kidnapped after colleagues said they received odd messages from the sisters that they believed were sent by someone else just hours before their deaths 

A misspelled text message from sisters Dr. Lila Ammouri and nurse Susan Frazier tipped off friends and co-workers that something was wrong

Dr. Biglari has not shared any of the other texts. DailyMail.com has contacted the medic for more information. 

Meanwhile, DailyMail.com has also discovered an unusual property maneuver made by Ammouri in the weeks leading up to her death.   

She placed million dollar Cave Creek home in an intrafamily trust on January 25, 17 days before she and her sister killed themselves. 

The arrangement, also known as a living trust, allows family members, friends or even business partners to receive the property after her death without having to go through the legal process of probate to prove they're the rightful heirs to an estate. 

The trust would have allowed Ammouri to specify who would receive the home, free of estate taxes, or split up the value of the property to multiple people. It remains unclear who was named as a recipient in the trust.   

According to public records, Ammouri purchased the home in 2014 for $549,000. The single-family home features three bathrooms, 2.5 bathrooms and a pool in a spacious backyard. It has doubled in value since she purchased it.   

Ammouri had put her $1 million Cave Creek home in an intrafamily trust on January 25, less than two weeks before the sisters trip to Switzerland

 The trust allows the home to be transferred to family without the conventional legal process of proving they're the heirs to the property

 According to public records, Ammouri purchased the home in 2014 for $549,000. The single-family home features three bathrooms, 2.5 bathrooms 

The home also has a large pool in a spacious backyard

A spokesman for the Basel-Landschaft Public Prosecutor's Office confirmed to  The Independent that the sisters had died by suicide 'within the legal framework'.   

Pegasos says it accepts applications from patients the world over, but insists it refers anyone who is suffering from depression to counselling services. 

Its website states: 'Pegasos believes that for a person to be in the headspace of considering ending their lives, their quality of life must be qualitatively poor. 

'Pegasos accepts that some people who are not technically 'sick' may want to apply for a VAD. But this does not mean the person is 'well'. (Assisted suicide patient) Professor David Goodall was one of these people.

'He was not sick but his eye sight was failing him, as was his mobility. Old age is rarely kind. The decision to end one's life is an intensely personal one. Pegasos makes every effort to understand fully the unique circumstances of everyone who makes contact with us.' 

Basel is home to an assisted suicide service called Pegasos, whose website is pictured.  Unlike the more famous Dignitas clinic, patients do not have to be terminally-ill or severely disabled to end their lives there 

The company says it accepts application for people all over the world and has no required waiting period for assisted suicide

Dignitas is the most famous suicide clinic, but is based in a different Canton (county) to where the sisters took their lives. It only offers an $8,000 assisted suicide to people who are terminally-ill, or who live with a disability that severely limits their quality of life.  

Other clinics across Switzerland also offer similar services, with patients given a solution of barbiturates dissolved in water, which guarantees a painless death after being consumed. 

Visitors to the clinics must undergo stringent checks before being allowed to avail of their services. 

Pegasos, in particular, which has English speakers on staff, requires looking for assisted suicides to be members of the organizations and pay fees that exceed $11,000.   

Michael Lutz, a spokesperson for the Basel-Landschaft Public Prosecutor's Office, told The Independent that the sisters death did not immediately result in a criminal investigation since it was strictly performed through legal means.   

The Phoenix Police Department, who were contacted by friends and family to investigate the incident, said they could not open a case since it was outside their jurisdiction.