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Dr David Goodall (104) travels from Australia for a Good Death in Switzerland

There has been much reporting of the death of 104 year old Dr David Goodall, who ended his life at Lifecircle in Switzerland on 10th May 2018. The BBC include a video extract from his last press conference in an article on their website.

Dr Goodall was a British ecologist and botanist who was not terminally ill, but had a deteriorating quality of life due to poor health. He lived and worked in Australia but had to fly to Switzerland in order to have the medically assisted death he wished for. The Daily Mail article describes how Dr Goodall, an honorary research associate at Perth’s Edith Cowan University, made international headlines in 2016 when he was declared unfit to be on campus over concerns about his safety, including his ability to commute. Scientists around the world supported him to get the decision reversed. In another article the BBC quoted a friend, Carole O’Neill, who explained how these events had affected Dr Goodall. He was forced to work in a location closer to home, apart from his colleagues and friends. At a similar time his deteriorating health also meant he had to give up driving and performing in theatre. He was, of course, most fortunate still to be able to enjoy doing these things up until the age of 102! Mrs O’Neill went on to explain that the events of 2016 marked the beginning of him not being happy anymore. “He’s an independent man. He doesn’t want people around him all the time, a stranger acting as a carer. He doesn’t want that. He wants to have intelligent conversation and still be able to do the same things like catching the bus into town.”

The Guardian reports that he had attempted suicide about two months ago after suffering a fall. This shows the difficulties even the best educated people can face when trying to end their lives without medical assistance. Those who argue that the assisted dying law doesn’t need to be changed, as suicide is no longer a crime and people can end their lives if they wish, totally miss the point about how difficult it is for people to achieve this peacefully and unaided, at the time when they rationally decide that it is the best option. Dr Goodall’s doctors in Australia are reported as saying “he’s talking about ending his life, there’s nothing much wrong with him, so therefore he’s a risk to himself.” This apparently led them to consider keeping him in hospital against his will, and attempting to prevent him from travelling abroad. Not exactly the kind of patient-centred care he would have hoped for. Wouldn’t it have been better for his doctors to be able to accept and assist in what appears to be a very rational and well thought out end-of-life decision?

Cases such as this present a real dilemma for those who believe that medically assisted dying should be restricted to those who are deemed “terminally ill” in the sense of having a life expectancy of six months or less. What do they propose should be done for someone like Dr Goodall? Deny him the good death he quite rationally seeks? Why?

Dr Goodall was very clear about what a good death meant to him. The Daily Mail article reports him saying:

“I am 104 years old so I haven’t got much time left anyway. I might as well not have [my health] getting worse and worse, making me unhappy as it goes.”

From the information available it seems that Dr Goodall’s decision is a classic case of someone who has decided that their life is complete, and who finds their incurably deteriorating health has made their quality of life unacceptable. He rationally decided that a medically assisted death was his best option. MDMD support his decision and thank him, and his family and friends, for publicising his situation so widely. They have done much to stimulate the debate on future end-of-life care and how we should support people in their choices.

From MDMD’s standpoint, it seems totally unacceptable that someone should need to embark on such a long journey in order to have what for them is a good death. Not only that, if he, and others who share his end of life wishes, knew that their good death option was available in their home country, without the need for an arduous journey, they might delay their life ending decision for a little longer; until they decide to go to their nearest Good Death Centre perhaps?

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Scottish Parliament’s Cross-Party Group on End of Life Choices meeting

MDMD Associate Coordinator Colin Brewer represented MDMD at the Scottish Parliament’s Cross-Party Group on End of Life Choices. Here is his report…

We heard a good presentation by Dignity in Dying’s Scottish organiser on their excellent recent survey of people from Britain who approached Dignitas for assistance and the financial, legal and bureaucratic obstacles that some of them encountered in the process. (I presented my own, more modest, research in the same field at Euthanasia2016 – the international conference organised by the World Federation of Right to Die Societies in Amsterdam two years ago.) When I mentioned the importance of including early dementia among other slowly progressive conditions that should at least be discussed in any legislative proposals, the reaction was interesting. Several people applauded or nodded vigorous approval and some later spoke in favour of the idea. Others, while apparently not unsympathetic, were worried that even mentioning dementia would make legislation even more difficult to pass. I noted that in Oregon and Canada, dementia is now up for discussion as an approved addition to the present categories. MDMD looks forward to contributing to Westminster’s equivalent group in the near future.

MDMD believe discussion of dementia is particularly important now that it is the largest cause of death in England and Wales, and many more people die with it, rather than of it.

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Should we be able to choose our own death?

The BBC Ideas website has recently added a short video titled ‘Should we be able to choose our own death?’. Although MDMD had no part in its making, it demonstrates one really good way of achieving our goal.

It is a personal opinion piece by philosopher Nigel Warburton. He starts by asking us to imagine a world where we get what we all deserve: a good death. He then continues to describe his utopian vision of “Good Death Centres”.

The safeguards he proposes are well aligned with those of MDMD. To receive medical assistance to die at one of Warburton’s proposed “Good Death Centres” the applicant must satisfy the following conditions:

  • Undergo thorough psychological examination and counselling by trained experts with experience in end of life situations.
  • Have sufficient mental capacity to make a life-ending decision
  • Demonstrate a genuine desire for a medically assisted death
  • There must be a good reason, such as a painful terminal illness or the first signs of dementia
  • The person must have a well informed understanding of their situation and the alternative options available

As the video says at the end… “Its a comforting thought”.

Another comforting thought is provided by palliative care doctor Kathryn Mannix in her video ‘Dying is not as bad as you think’ in the same BBC Ideas series. MDMD agree with her that death needs to be talked about more and no longer be treated as a taboo subject. Mannix describes a peaceful, natural death. For those where this sort of death comes quickly, without a large amount of trauma, distress and loss of dignity leading up to it, Warburton’s Good Death Centres are not necessary. However, Mannix doesn’t give information about the likelihood of various causes of death, and of having the sort of good death she describes. We know, for example that in England and Wales dementia is now the leading cause of death, and that many more people die with it than of it. People who have witnessed people dying with or of dementia, often say that they would not wish to die that way themselves. Other causes of death are discussed here.

MDMD suggest that the truly comforting thought is to have both options well funded and available: excellent palliative care, with the safeguarded option of a medically assisted death, if this is necessary for the patient to have what they consider to be a good death, in their particular circumstances.

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Dignitas hit out at UK politicians

Dignitas issued a hard-hitting press release this week “Ignorance, irresponsibility and hypocrisy – How a majority of UK politicians violate human rights and create suffering and costs“. Here’s an extract:

Just over a week ago, once again an individual from the UK has travelled to DIGNITAS – To live with dignity – To die with dignity, for having access to the human freedom and right to decide on time and manner of his own end of suffering and life, as it has been basically acknowledged by the European Court of Human Rights in 2011. This freedom and right has been violated by the UK once again – for the 394th (!) time now.

A majority of UK politicians ignore that these journeys cause a lot of suffering for the individual and his family and friends. Not only is it very hard for someone already in a deplorable health situation to travel abroad. It all has to take place in secret and with fear, as it is shadowed by an absurd law that threatens to criminalise loved ones who give their compassion and care – something which every suffering individual deserves.

The press release was picked up by the Daily Mirror in an article titled ‘Dignitas blasts “ignorant and irresponsible” MPs for refusing to back change to assisted death laws in UK‘. The Mirror article refers to the case of James Howley who accompanied his partner to Dignitas. On return he was investigated by the police for six  months before charges were dropped. MDMD are aware of other similar cases.

MDMD fully agree with Dignitas that the UK law on assisted suicide is not working and needs to be changed to allow medically assisted dying in the UK, with similar safeguards to those which apply at Dignitas. In Switzerland medically assisted suicide is possible for a person who requests it provided that they are mentally competent and have a medical condition which is incurable and which causes unacceptable suffering. It is not restricted to those who are “terminally ill” in the sense of having a life expectancy of six months or less, which means that it is available to those with the early stages of dementia provided that they still retain mental capacity. MDMD feel this is particularly important now that dementia is recognised as the leading cause of death in England and Wales, and many more people die with it rather than of it.

I’m not frightened of dying, but I am frightened about the way I die

The current law causes far too much suffering, both for the dying person and their family. Many people would agree with Helen Johnson, (James Howley’s partner who ended her life in Switzerland), when she said ‘I’m not frightened of dying, but I am frightened about the way I die’. The option of a medically assisted death in the UK, for those that want it, would greatly reduce that understandable fear, which even the best palliative care cannot allay. This would enable far more people to have a “good death” whether or not they actually choose medical assistance to die as their end-of-life situation unfolds.

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