According to Dutch media, the case of the first assisted suicide using the Sarco capsule has been raised as the 64-year-old American woman who was the first to use it last September was allegedly found to have signs of strangulation.

According to the head of the prosecutor’s office, Peter Sticher, the finding raises the question of “homicide with intent”, Dutch newspaper de Volkskrant reported.

A coroner who spoke with Stichter a few hours after the 64-year-old woman’s death reportedly told him that the woman had severe wounds to her neck that resembled strangulation.

However, so far there has been no official report from a coroner with the Volkskrant newspaper questioning why Stichter has not formally charged Last Resort company chairman Florian Villette, but has extended his pre-trial detention only on the basis of his suspicions.

It should be noted that of the four people arrested in late September after the 64-year-old woman’s death, only Villette, who was the only eyewitness to the woman’s final moments, remains in custody.

Swiss website NZZ reported, citing a person close to the Last Resort company, that the 64-year-old had been diagnosed with osteomyelitis at the base of her skull, a disease that could have caused these marks.

The US woman had reportedly declared her desire to end her life “because of the severe illness that was causing her acute pain” as there were days when she had headaches so severe that they prevented her from moving or even going to the toilet. According to Last Resort, the woman had an immune problem that prevented her from receiving treatment for osteomyelitis.

Last Resort’s lawyer, Fiona Stewart, had said the 64-year-old American woman was examined by a psychiatrist before giving her consent with a four-minute video.

The chamber had been placed in a wooded area in northern Switzerland so the American woman could see the trees and sky in her final moments with the capsule’s creator, Philip Nietzsche, who has been nicknamed “Dr Death”, describing that the woman entered the chamber and “almost immediately pressed the button” to end her life.

“Everything happened as we expected. I believe she lost consciousness two minutes after the procedure started and finally died after five minutes,” Nietzsche had told Dutch media according to whom “we saw small contractions and muscle movements in her arms but she was probably already unconscious.”