Terminally ill people shouldn’t have to travel abroad for assisted dyingBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6201 (Published 14 September 2012) Cite this as: BMJ 2012;345:e6201
- Laura McClelland, specialty registrar in anaesthetics, Prince Charles Hospital, Merthyr Tydfil, UK
My aunt, Geraldine McClelland (Mo), died at Dignitas in 2011. She had been diagnosed with breast cancer in 2009, aged 58, and had radical surgery, chemotherapy, and radiotherapy. Some months later Mo developed a bad cough. The formal diagnosis of metastatic disease took four months. She was breathless after walking from her sofa to her fridge and wasn’t eating. She started palliative chemotherapy and was advised that she could live for up to 18 months. She went into rapid decline and so stopped treatment.
Mo was always clear about her decision to choose a medical death in the event of a terminal diagnosis if she felt her suffering was too great and if she became dependent on others. This was simply her wish.
Mo and her friends worked tirelessly to arrange everything. She had been unaware of how stringent the process was. Dignitas doesn’t promote its services; it just provides them for the small percentage who need them. It’s expensive and involves interminable paperwork. I thought of others like Mo who do not have the money, skill, or support to achieve what they want.
When Mo should have been surrounded by her special people, she was conference calling with the strangers who were going to help her to die. To my sense of anticipatory loss was added a visceral frustration that Mo couldn’t have the death she wanted in her homeland.
The date for the trip was brought forward because of Mo’s decline. She received wonderful palliative care yet was uncomfortable unless she was heavily sedated. One nurse told her, “But that is what it is like when you are dying, Mo.” This was precisely what she wanted to avoid, the deplorable “dyingness” of it all. By now she was receiving oxygen continuously and needed to be carried up and down stairs. She awoke at night, hypoxic, confused, and petrified. “This is no life,” she said.
I expressed my sadness to Mo once, in a letter. After that, we spoke positively about the process and how she was looking forward to D Day—dying day. One Thursday Mo called. She sounded bright. She had good news: a slot had become available for the next Thursday so she would be leaving for Zurich on Sunday. I’d not banked on this, having only just accepted the inevitable. Now she wanted to leave us even earlier. I have never felt so sad in my life. I tried to sound pleased, taking it all in, trying to gain comfort from her genuine happiness. I became oddly thankful for this bittersweet news because it had become her reason to live. “I just want to go now,” she told me.
A Channel crossing was booked and the car packed with cushions and oxygen. For the individuals who accompanied Mo to Zurich it was incomprehensibly painful. Although they fully supported Mo’s choice, accompanying her to a foreign country to her chosen end was unfathomable.
For weeks before and months after she left, I had recurring thoughts about the moment during which Mo would look round her flat for the last time, taking in what she saw: her home, her possessions, the photo of her great niece. That minute when the door shut finally behind her. She left her street, her London, and all of its familiar sights, sounds, and smells.
The exact details of what followed are intensely private, but during our last conversation, Mo was in a hotel in France, telling me the breathlessness had worsened. “Not for long!” I said. We laughed. She because of the sad honesty, and I because I just didn’t know what to say. I told her I loved her and would speak to her later. I knew I’d never hear her voice again.
Two days later, my sister and I took D Day off work. What is the right thing to do on the day when you know the exact time, place, and mode of death of a loved one? For us, it transpired to be an aimless amble round the supermarket, phone in hand, waiting. My sister took the call. Mo had gone.
I am told that just before Mo embarked on the last leg of her journey, once settled in the clinic, she smiled, and told those with her that she was finally happy. People have told me that they think that those who choose an assisted death are cowards. I disagree.
During my lifetime I hope to see a change in the law enabling people like Mo to have an assisted death in their own country should they choose to. Palliative care services, although of the highest quality, cannot guarantee everyone a comfortable, dignified death. It is not an either/or situation. Palliative care can coexist with assisted dying for those who choose it. Although it is relevant to ascertain what medical professionals and organisations think on the subject of assisted dying, and we must engage fully with the debate, ultimately, society must decide.
Cite this as: BMJ 2012;345:e6201
Competing interests: I am a member of Healthcare Professionals for Assisted Dying.
Provenance and peer review: Not commissioned; not externally peer reviewed.