If we permit assisted dying, doctors may become people to fear when we are at our most vulnerable

It is January 2019 and, in a hideous Edinburgh hospital, Donald, 78, awakes sore and groggy after emergency surgery. The heron-faced consultant is soon by his bedside. The news is grave. Donald, he pronounces, has late-stage, inoperable bowel cancer. He has but weeks to live. Might never even get home.

And, in certain lands, Doctor would then have suggested euthanasia.

Donald was my father; and thereby hangs a tale. But in recent years euthanasia – or, as it is absurdly called, ‘assisted dying’ – refuses to go away. Sometimes it even has a face.

Fifteen years ago it was Margo MacDonald, terrified lest she die in Parkinson’s paralysis. Then there was Tony Nicklinson, with locked-in syndrome. He could communicate only by blinking, but also fought for the right to have his life ended.

In fact, Margo MacDonald did not die of Parkinson’s. Nicklinson eventually succumbed to natural causes.

And then, shortly before Christmas, we had Esther Rantzen discussing her stage-4 lung cancer on the BBC.

‘I have joined Dignitas. I have thought, well, if the next scan says nothing’s working, I might buzz off to Zurich – but it puts my family and friends in a difficult position because they would want to go

with me. And that means that the police might prosecute them. So we’ve got to do something. At the moment, it’s not really working, is it?’

Sir Keir Starmer hailed this news by declaring: ‘I personally do feel there are grounds for changing the law.’

Now Orkney MSP Liam McArthur, with his Assisted Dying for Terminally Ill Adults (Scotland) Bill, is making what will be the fourth bid to legalise euthanasia at Holyrood, following tilts by Margo MacDonald, in 2010, and Patrick Harvie of the Scottish Greens in 2015.

Another proposed Bill, in 2005, did not win enough support to earn the right to be introduced in parliament.

And polls often show substantial public support for such a change. But, as Aesop sagely put it, it is one thing to call for Death: quite another to see him coming.

Behind all this is a huge, recent cultural shift. Until well after the Second World War, we largely died at home.

Most of us knew what dying looked like, were familiar with its successive stages, and were not afraid of it.

I am in my generation unusual because, given my traditional Hebridean background, I have seen about 16 dead bodies. Been in the room when several relatives died. Screwed shut several coffins. Even dug the odd grave.

But most have never seen a corpse and – given that bereavement only hits within immediate family about once every 11 years – know little about the end of life process, and imagine the worst.

‘People need to be reassured what dying looks like,’ murmurs Dr Christopher Kerr, of New York state and America’s leading expert in palliative care.

‘It’s actually quite hard to die in a sufferable state. Because, to die, you need to sleep, and to sleep you need to be comfortable, not only physically but psychologically. So, grad­ually, that comes over you.

‘Physical pain is overstated as an issue. Far and away, I’d say it’s confusional states, psychogenic distress, the consequences of impaired sleep, or changing sleep architecture – those become more prominent.’

About 10 per cent of deaths, Dr Kerr says, are acute. ‘The rest are essentially forecast­able. I ask, “Well, what were they like six months ago, four months ago, two months ago, today?” It’s seldom a falling-off-the-cliff phenomenon.

‘It’s a slow slide. That slope, that trajectory’s the same one that’s going to take them to the end.’

As for the final moment? ‘It’s remarkable how atraumatic it is – how anticlimactic. It’s quieter, it’s gentler, it’s more peaceful.’ Indeed, doctors often find family still tenderly around the bed, unaware their loved one is no longer breathing.

Because popular culture conditions us for some intense Hollywood ending. Even as we are encouraged to draft living wills, end-of-life directives, whether or not to permit resuscitation... or sign petitions for assisted dying.

And misinformation is rampant. In one American study of 97 episodes of such hospital dramas as ER – and, specifically, 67 scenes of cardio-pulmonary resuscitation – 75 per cent of these CPR struggles were successful.

Wider polling? The public think it succeeds about 50 per cent of the time. In the real world? It’s about 18 per cent. The vast majority then spend a prolonged period in intensive care.

‘Many are left with permanent brain damage,’ writes Irish specialist Seamus O’Mahoney. ‘I recall the case of the father of a school friend... The ambulance crew managed to resuscitate him and he was admitted to the Intensive Care Unit. When he woke up, he was raving. And he stayed raving for the remaining two years of his life.’

Still more irresponsible have been soap-opera portrayals of DIY euthanasia, in the likes of EastEnders, Casualty or Holby City – yet again fuelling terrors that the natural process of dying is pretty awful.

‘Assisted dying’ is, frankly, offensive – for we have been assisting the dying since we were painting the walls of our caves.

We tend, we nurse and we comfort. And when someone like Esther Rantzen raises the prospect of travelling to Dignitas, it is extraordinarily difficult to have a sober public discussion.

Given her vulnerability, after all, no journalist is going to go at Dame Esther like a studs-up Emily Maitlis. Nor – because of medical confidentiality – can we be sure we know the whole truth about a given famous patient’s condition, symptoms and medication.

Assuming they themself understand: Dr Kerr refers to research demonstrating that, the more doctors are involved in someone’s care, the less the patient actually knows. ‘Because you’ve got a bunch of spot-welders...’

A cardinal reporters’ rule is thereby broken: we are not sharing both sides of the story.

But we can weigh the overseas evidence. In 2016, Canada passed ‘Medical Assistance In Dying (MAID)’ legislation that granted, on supposedly strict terms, euthanasia.

It was only, declared the government, for people with terminal illness. Then, in 2021, the law was broadened by Bill C-7. MAID would now be available to people with non-terminal conditions. Yves Giroux, the Parliamentary Budget Officer, even crowed of the economics. Whereas the old MAID regime saved $86.9million per year – a ‘net cost reduction’, in his sterile words – Bill C-7 would create additional net savings of $62million per year.

Healthcare, particularly for those suffering from chronic conditions, is expensive; but assisted suicide only costs the taxpayer $2,327 ‘per case,’ ­Giroux enthused.

And we might ask ourselves who is really funding those slick social media campaigns in Britain for assisted suicide. Can we be confident it is not, for instance, private health insurers keen to save a bob?

MAID will change again this year. The mentally ill will now be eligible for euthanasia. Canada already contemplates making it available to minors.

‘Once the taboo is broken,’ one London journalist observes, ‘regulations are often later relaxed further to allow patients with mental health issues, autism, and even children, to choose to die...

‘Euthanasia deaths in Europe and Canada have leapt by almost a quarter in just 12 months, raising fears legalising assisted dying in the UK will become a slippery slope leading to more and more people choosing to die.’

Applicants for euthanasia have, incredibly, quadrupled in Canada since 2017 – many of them simply poor, homeless and unhappy.

Worse, in 2022, a veteran of Canadian armed forces, long racked with PTSD, sought support from Veterans Affairs Canada. A member of staff – unprompted – asked if he had considered taking advantage of the new euthanasia options.

Dr Kathryn Mannix recalls the case of Ujjal, brought up in England and subsequently a rising star in a Rotterdam oil company.

Then he was struck by a ghastly cancer. Surgery did not help and, after some days, the gentle professor came to

Ujjal, detailed grim symptoms likely to come and declared: ‘Of course, you have a choice. If you would not like to live like that, we have the euthanasia.’

The next day, Ujjal needed further unpleasant treatment. Afterwards, another Dutch doctor approached. A young one. ‘If you prefer not to endure the progress of the illness, we have colleagues who will help you with euthanasia. We will be able to sign the forms... you have only to ask.’

And, every day, doctor after doctor kindly observed that, you know, euthanasia was an option – until the terrified Sikh discharged himself and fled the Netherlands for England. Though Ujjal had fewer than three months to live, he won some quality of life. No longer beset by soft-spoken physicians poised to kill him.

The moment you fold on euthanasia, you send powerful social messages. You devalue the elderly, the sick, the disabled. The old and the ill will start to wonder if they are a burden. Some will undoubtedly be encouraged in that belief by particularly avaricious children.

We all know some decidedly dodgy families: Harold Shipman reminded us there are some decidedly dodgy doctors. The very idea we have of a physician will be changed irrevocably.

At our most vulnerable, they will be people to fear.

Dr O’Mahony considers such cases as Tony Nicklinson or, in Ireland – a decade ago – the vocal Mary Fleming. Both failed in their protracted bids for assisted suicide; a fixated determination to die by their own script. It was, he concludes, all about control.

He said: ‘Mary Fleming became famous. An Irish heroine. The media coverage was almost unanimously supportive and she was described as brave, courageous, clear-minded and an inspiration.

‘But, as I suspect the various judges who ruled on her case surmised, the law is also there to protect the cowardly, the stupid, the unloved and the uninspiring.’

And we can readily think of others, in bleak prognoses, who did not hit the courts or book a one-way flight to Switzerland.

Felled by locked-in syndrome, Jean-Dominique Bauby – who could move but one eyelid – wrote that sublime memoir, The Diving Bell and the Butterfly.

And, when the widely loved Gordon Aikman learned he had motor neurone disease during the independence referendum, the director of research for Better Together shook no fist at the heavens.

Aikman went out there, tender husband Joe Pike by his side, raising more than £500,000 for MND research in Gordon’s Fightback, knowing he would never see his 32nd birthday.

Professor David Galloway, past president of the Royal College of Physicians and Surgeons of Glasgow, deplores assisted suicide.

Any ‘safeguards’, he says, are plans for an ideal world. Not the real-time stresses of clinical practice, practical realities – it can be surprisingly hard, in many patients, to find a vein to inject – or judgment clouded by terminal illness.

And there is always plain cock-up. Not three weeks after my father’s death-sentence was pronounced, the histology tests came back. No terminal bowel cancer after all. Just a rare, unhurried cancer of the appendix.

He got home, shortly recovered, and enjoyed nearly four of the best years of his life – writing several books; gardening exuberantly – and, when he began to slip away, from October 2022, it was not by any malignancy, but simply the weight of years.

He stopped preaching and lecturing. Ate less and less. Slept more and more. Grew loath to leave the house. It was a lessening; a dwindle. And, in the end, that is all that dying is. It’s a dwindle.

Daddy especially felt the loss of his strength. Was cross about the garden: he had just ordered sacks and sacks of compost. Resented certain indignities.

He did need a little subcutaneous morphine, in the last ten days – he was by then ‘on hospice’ – to ease his breathing.

There are many myths about hospice, Christopher Kerr points out. ‘Patients live longer with hospice; not shorter. You don’t stop all their meds – we stop the absurdities, like cholesterol-lowering drugs. You don’t deny care. If you have heart failure, we manage the heart failure.

‘So it’s not a lesser care model. In fact, it’s a richer care model. You manage diabetes – it doesn’t feel good to have a high blood-sugar.

‘All the things that make you feel more comfortable need to be kept in place. It’s actually aggressive medicine, not passive medicine.’

More than 90 per cent of those on hospice are supported at home, and my father did not in any meaningful sense ‘suffer’.

And when Daddy finally died, on May 21 last, in his bedroom of 40 years and with all of us around him – one breath out, not followed by another back in – it was with the faintest smile on his lips. Mission accomplished: his journey done.