Assisted dying: the law must be changed

Last week a former much loved colleague of my partner’s killed herself. She chose a violent and shocking way to do so. Her death came a few days after she’d been told that treatment for secondary liver cancer was not working. Still virtually symptomless from the cancer, but following a gruelling time on chemotherapy it seems she simply could not face what was to come. We can only speculate about the desperate state of mind which drove her to plan and carry out her death. We can only guess about how her GP, her hospital consultants, her palliative care team, may each have failed her.

Her death has sparked the deepest anger in me that in the UK we do not have the option of choosing a dignified way to die, through voluntary euthanasia or assisted suicide. I have advanced breast cancer which I know is not curable though right now it is just about being managed: I have pain in my shoulder, and a hoarse voice from neck tumours pressing on nerves. It’s inevitable that sooner or later cancer will be uncontrollable and sooner or later I will die...probably after the cancer has spread to my liver, lungs or bones or brain..perhaps to all of them. Tomorrow I’ll start chemotherapy again. I’ve already been on six different chemotherapy drugs over 75 weeks of the past five years. I’m doing more chemotherapy for the chance of a bit more good quality time.

As I get on with the hard business of living with terminal cancer one issue overshadows everything right now and that is my fear and desperation at the thought of the end stages of my cancer. Palliative care nurses reassure me that pain and nausea can be managed, that a peaceful ‘good death’ is possible. These reassurances are less than compelling. I think they are telling half truths. I have known too many people who have died of cancer who have undergone months and months of deteriorating heath, who have tolerated dreadful painful and distressing ‘procedures’ for perhaps a few more weeks of horrible ill health. Yes, many, though by no means all, in their final 24 or 48 hours, enjoyed a morphine rich unconsciousness which their families choose to call peacefulness.

It is less the final days than the final weeks and months which scare me. Cancer treatment is like that old story about what happens when you boil a frog. Put a frog straight in boiling water and it will die, but put the frog in cooler water and heat it up to boiling point and it takes much longer to die...but die it will. Yes I have amazed myself at my resilience this far, about how well I have coped with my 25 cycles of debilitating chemotherapy. But unlike the frog which is boiled alive I want to put limits on my torture and know that at some point I will say no to more treatments and want only to seek a death with dignity at a time of my own choosing. It seems to me that the Christian cultural tradition which celebrates suffering, coupled with the loud contemporary applause for brave battling cancer patients combine to sanitise the unpleasantness of a cancer death.

A friend told me recently about someone she knew in Holland with terminal cancer who had a celebratory goodbye party the night before she used the recent change in the law there to have a gentle ‘easeful death’. There is enough evidence now from the law in Oregon USA on assisted dying, to know that palliative care services have improved since the law was changed, and that the negative predictions of opponents to the law have not occurred. There have actually been relatively few assisted deaths but evidence that many many people have taken deep comfort from knowing that assisted dying is available if wanted.

I don’t know how much suffering I will feel I can bear as my cancer progresses. Like anyone in my situation of course I want to live as long as I can as well as I can. I am 59; I am an atheist; I have no children, close family or dependents, simply good friends and a loving partner. I don’t want them to see my final dreadful suffering, but mainly I don’t want it for myself. I have accepted the reality of my premature death from cancer, but I rage at the injustice which will make my last weeks or months intolerable for me. It feels an intense dilemma that I know I probably won’t want to travel to Switzerland, the only legal option available to me in Europe, because I suspect that if I’m well enough to travel I won’t be ill enough to want to die quite yet. But everything I know about myself: my intolerance of sickness and ill health, my wish for privacy, dignity and intellectual integrity as my body fails, leads me to feel pretty sure in my knowing that with the UK law on my side I would choose an assisted death. I know for others with cancer this option would be out of the question, but for them too any change in the law which leads to an improvement in end of life care has to be a bonus.

In the assisted dying debate I think the voices of those with degenerative illnesses are more often heard than those of us living with advanced cancer who fear the physical and mental anguish which will accompany our last weeks and months. We can never entirely know the loneliness and terror of another but I can imagine some of what that woman who smashed her car into a wall might have felt. I wish so much for a change in the law which would make such a desperate death less likely.

Thanks to Daphne for the frog metaphor

JaneRA 09/08