My sister Anne ended her life at DIGNITAS – To live with dignity – To die with dignity, in Switzerland in July 2015. I was there with her.
Anne was a bright child and worked hard. After university she entered the probation service and her first training was in Armley Prison in Leeds. The prison is near to the old Turner and Newall asbestos factory where 300 workers went on to die from the asbestos-related disease mesothelioma. Fifty years later Anne began to show the symptoms of this incurable cancer.
Anne moved from the probation service to the Home Office and while there she met her future husband Alf. They were very happy together but he died ten years later.
Anne adjusted to widowhood and retirement with her usual no-nonsense energy and drive. She took an MA in law and became a magistrate, a prison visitor and active member of the Parole Board. She also volunteered for the Coram Foundation. She wrote two children’s books and published two novels.
In early 2014 she began to sound breathless after any physical effort and her doctor sent her for a chest X-ray. The results showed a large volume of fluid building in the pleura, her lung linings. An exploratory operation was performed at Harefield hospital and three litres of fluid were drained from her chest. She felt much better. I went with her to meet her consultant at Stoke Mandeville. The surgeon said that Anne had the unmistakable symptoms of mesothelioma, the condition was already advanced. The prognosis was poor, she was unlikely to live more than 15 months. After a brief period of complete shock, Anne set about planning the most effective use of her remaining time.
Quality of life is more important than its duration
Since childhood our family has always debated ethical issues over dinners and at various get-togethers. Anne and I always thought that quality of life was more important than its duration but many in the family disagreed with us. Our mother died aged 97, after a long deterioration into confusion and weakness. Anne completely accepted that our mother had no notion of assisted dying, nor would she have wanted it.
Regular trips with Anne to Stoke Mandeville showed progressive and rapid growth of the tumour mass in her right lung. She had already joined Dignitas and arranged to fly to Zurich to meet a consultant, who would assess whether she was sure of her wishes, and was of ‘sound mind’. Anne was told that her condition was so serious she would be given the ‘green light’ of approval when she felt it was time to go. A year later the CT scan showed that a huge solid mass had taken over her entire right lung. Its weight was pressing down on her abdomen and it was displacing her heart. Her remaining left lung airspaces were becoming compressed. She told her NHS consultant that she had decided to go to Dignitas to end her life, rather than endure the final phase of weakness and complete dependency. The consultant was kind and very open. While making it clear that he could not endorse her decision, he understood her position. We saw him once more and that meeting, with another staff member from the Cancer Unit, was very moving.
Anne told Dignitas that she now believed that her condition was rapidly worsening, and asked if she could make an appointment to go there to end her life. Having confirmed a date there was much paperwork for her to collate. Copies of X-rays, proof of residence, dental records and medical diagnoses were required, together with the Dignitas fee. Knowing her wish, I offered to accompany her. I also knew that my sister wanted a memorial service in her local parish church and I thought that she should tell her vicar about her plans. This she did.
Anne needed to be carried on to the aircraft to Switzerland but once aboard was calm and comfortable. We stayed in a central Zurich hotel where she met the same consultant she had seen a year earlier. He asked about her decision and made the assessment that she was still rational and sure that she thought it was time to die. He made it clear his presence there did not mean she was obliged to end her life. He said that he would write a prescription for a lethal dose of a drug which would be made available the next morning, if she still wanted it.
Our last evening together was a long supper during which she told me about the music and literature which had most enriched her life. By 11.00 pm we both decided to go to our rooms. We met for breakfast next morning before taking a taxi to Dignitas. The man and woman in the little bungalow were kind ordinary people who went through some paperwork to confirm Anne’s identity and to ask her once again if it was her sincere wish to go ahead with her suicide. She confirmed that it was her wish. They explained the process. A dose of anti-emetic must be swallowed at least 30 minutes before the lethal drug. We went for a stroll around their little garden and sat by the pond. A little later Anne said she was ready to go in. She drank the anti-emetic and we played music and talked about our time at home together and our school days. We laughed about the eccentricities of some of the teachers we had known. Anne went to the bed and asked for the drug, a liquid she swallowed in two sips. I sat beside the bed and we held hands tightly with some music by Tallis playing on the CD. Within a minute and a half her grip slackened and she was unconscious soon after. She went into a deep coma and died peacefully. Now it was the turn of the helpers to support me. They were very kind. I made my farewell to my dead sister and set off for the airport and the flight to London.
It was right for her
Her memorial service was held six weeks later. It was very well attended, the vicar spoke at length about my sister’s request to him and people shared memories of their time with her. Most people have been supportive of Anne’s decision, the most common remark is: “It was right for her”. But not everyone takes that view. Some people, even those who knew she was terminally ill, feel cheated of a ‘final goodbye’. Others feel that life has a natural end and a natural death is somehow better for both the dying person and the bereaved relatives. Others believe that God gives life and no one has the right to end it. I understand all those positions but I believe we should have the choice to decide on the basis of our own informed values.