Dr Phil Hammond, broadcaster and sessional GP in Bristol

Is assisted death preferable to palliative care?
 

I tuned into A short stay in Switzerland, a dramatised documentary about the assisted death of GP Dr Anne Turner, with expectations of a BAFTA-winning performance from Julie Walters, but no real expectation of a change in my opinion. If I had progressive supranuclear palsy, I’d certainly want the option of an early exit even if I didn’t choose to exercise it. But, as this excellent drama portrayed, it’s hard to say what effect this could have on those people left behind.

It wasn’t easy to watch Walters dying, not just because she is a hero of mine, but also because it isn’t always easy to differentiate her serious acting roles from her humorous ones. Comedy and tragedy are never far apart, but my first and most lasting impression of Walters is as Mrs Overall, the deliciously mad cleaner in Victoria Wood’s Acorn Antiques. My defence mechanism as a doctor has always been to satirise my emotions, and the sadder and more emotionally draining A short stay in Switzerland became, the more Mrs Overall popped out from my subconscious. ‘Why aren’t you crying?’ my tear-stained wife asked, as she dug into her tenth tissue.

The programme was made with the consent and approval of Dr Turner’s children. They had already witnessed their father die of a degenerative illness, and had to deal with the shock not just of their mother’s diagnosis, but also her attempted suicide, before agreeing to a covert visit to Switzerland, where assisted death in some circumstances is legal.

Dr Turner’s journey had already been filmed in real life and she had made her own impassioned plea for the right to die, but it was the relentless physical decline as portrayed by Walters that was most harrowing, from falls and emotional lability, to choking, incontinence, and progressive paralysis. Would you want to hang on until the bitter end?

Walters’ version of Dr Turner was a spiky character who dismissed palliative care in one bitter line. But one danger of legalising assisted death is that palliative care will receive even less attention and funding, and there will be less research on it. In the UK, we rely on the wisdom of healthcare professionals to up the dose of drugs to ease suffering and sometimes speed up death under the guise of the double effect. The fact that far too many people are still denied a good death is largely because of a lack of good palliative care, and it’s hard to see what incentive there would be to provide care if a quicker, cheaper option were available. Then, of course, there are the coercive, thin-end-of-the-wedge arguments. ‘You don’t want to be a burden, do you?’

Dr Turner clearly knew her own mind, but even though this was a ‘pro-choice’ film, the effects her decision had on her children were subtly and cleverly portrayed. Their mother had to be fit enough to travel to Geneva and swallow a large dose of barbiturates unassisted, and this inevitably meant that a precious chunk of her remaining reasonable quality of life was sacrificed. The night before her death, she enjoyed a meal out with her family; a few minutes before her death she was laughing and sharing Swiss chocolates. She even ate a few to take away the bitterness of the barbiturate. And then, too quickly, she was no more, leaving her poor children looking like rabbits caught in the headlamps, as the body-removal men turned up.

Under British law, her children were all accomplices to her unlawful killing, and had to keep her death plan a secret from her close friends who weren’t able to say goodbye. But it was Walter’s last-minute confession—‘I have broken their hearts by dying’—that got me thinking. She may have ended her suffering, but she left a lot of guilt, regret, and confusion behind. Is there a better way? G