Half Life - 24 - Dignitas?

Half Life – 24 – Dignitas?

April 9th, 2021

Along with jokes and discussions about hair loss and the perfect morphine-enriched sundowner cocktail, references to buying one-way tickets to Switzerland (first class, please) are central to chat forums frequented by gallows humour sharing members of the terminal cancer brigade. Understandably, not everyone thinks there is a funny side, but for others it’s a way of lightening the load, sharing experiences, and dealing with otherwise near impossible subjects. Inside every smile and quip sits a real question, decision, or dilemma.  All of those dreaming up witty suggestions on what to talk about with the person sitting next to you on that last flight to Zurich had hoped the subjects would stay as dinner table debates, pub pontifications, or vaguely interesting episodes of Radio Four’s Moral Maze. Dashing hopes more efficiently than a pilotless plane into the side of Mont Blanc, cancer’s laugh turned the theoretical into the personal. 

The assisted suicide debate was brought, momentarily, back into the public eye by the latest famous surgeon to join the noble ranks of the advanced prostate cancer club. His chilling statement that ‘the law insists I must suffer’ stripped the UK’s approach to its bare bones as he wrestled anew with one of the decisions terminal sufferers know well. Consistent with the views he advocated through a lifetime treating and operating on cancer patients, watching in close proximity both their lives and their deaths, his horror at the unnecessary cruelty inflicted sends shivers down the backs of even the most flippant pun maker and joke creator. More than most, he knows what is coming his way should he stay in the UK to the very end. His decision about where and how to die has shifted, he is now at the centre of it and no longer commenting on it. 

The razor-sharp reality of such a problem, when it puts you in its spotlight, doesn’t make it any easier or simpler. Unencumbered by religious issues, my humanist views add to the complexity rather than detract from it. As an equal opportunity atheist, who disbelieves in all deities, the trip to Switzerland would be a complete end with nothing coming afterwards except a flight back in a large box in the hold or as ashes in hand-luggage. The solid certainty which religious convictions can provide are valuable and clear - no on-going internal debate required. However, for those with no fundamental moral objections about assisted suicide, at the right moment for the terminally ill, such clarity often proves elusive and the practicalities as to when, and if, to take such a decision impossibly difficult. 

The desire to keep living is deep-rooted, incredibly strong and, when not in pain, makes the idea of carting yourself off to Switzerland, or any other place which allows you to kill yourself, alien from the outset. Fondue or raclette are, surely, not on anyone’s last meal list and, although Swiss wine is at least drinkable, the only safe final gastronomic experience would be coffee and chocolate, which is nice, but dull. Life’s grip, however deep, starts to loosen, and self-destruction becomes more attractive, as extreme agony kicks in. Memories of struggling to open a bottle of liquid morphine, tears pouring down due to the torture of a cancer gripped spinal cord flood back. It would have been easy in those moments to pick up a gun and squeeze the trigger, if one had been available. Not having loaded handguns nearby, other than a sensible general principle, is a good way of avoiding snap decisions. Tragically, in countries where guns are available many have, simply, blown their brains out in a desperate move to do anything to make the pain stop. Months after the morphine bottle wrestling match, treatments completed, pain reduced and life improved, that decision to end the pain and everything else in one quick action would have been the wrong one and, if in a position to have regretted it, I would have. Life was not over, the desperation passed, but the lingering memory of the unbearable pain remains. Trips abroad are, at least, not snap decisions with quick and irreversible endings. 

Time sits at the heart of most cancer choices. The measurements used to show how much is left subtly changes, inching critical points closer. Early meetings with the oncologist, getting a first idea into the what the future looked like, had involved years. Not high numbers, but years or parts of years. More than one more birthday, more than one more Christmas.  Survival rates, impacts of treatments, times to recover and be treatment free, all had that twelve-month ring to them. The shift to months went unnoticed at first, creeping in as they mixed with the years before eventually replacing them. Weeks will be the next regime to take over, followed by whispered conversations about days. Each change closing the window for any travel and pill swallowing arrangements.

Death is not frightening, dying is. It doesn’t have to be that way, as the new surgical member of the prostate cancer club has pointed out. The ability to choose to avoid the prolonged, final, morphine-dripping, mind numbing, stages of existence by bringing it all to an end earlier is wrapped up in how much time there is, or isn’t, left. Choosing to die legally abroad, with no option either closer to home or closer to the ending, inevitably cuts short the time left for life. Leave it too long and you risk being unable to get there and becoming forced into the torturous, slow, death process which otherwise awaits. So, mostly healthy and low pain patients make the trip and die by their own hand months before they need to. It’s not the most attractive of alternatives or easiest of trade-offs - less pain and less life, or more life and an ending in suffering. 

Dogs, loved and cared for all their lives, are allowed to slip away with an injection when the pain is seen to be too great and keeping them alive excessively cruel. Humans, even with the ability to say it’s what they want and devise ways of preventing it being abused, remain denied that simple grace in the UK. The suffering the law demands in the UK sits like a medical trap set at the end of a long battle, with few believing the claims of palliative care. The living, breathing, nightmare of this situation continues to fill chat forums, but with no conclusions. Sufferers wonder what decision to take, if they will be able to take it in time, and fear what their end will involve if they don’t cut their existence short with a final flight to a lonely clinic in a foreign country.