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Opinion

Assisted dying framed as true love

ݮƵ 2024; 384 doi: (Published 06 February 2024) Cite this as: ݮƵ 2024;384:q297

Linked Opinion

A television drama examines illegal assisted suicide and raises questions about legalisation

  1. Tessa Richards, patient advocate, associate editor12
  1. 1Patient author
  2. 2The ݮƵ

Pressure to make assisted dying legal in the UK is mounting, writes Tessa Richards

The TV series Mr Bates v The Post Office’s outstanding depiction of “one of the greatest miscarriages of justice in the UK’s history,” where hundreds of postmasters were falsely accused of criminal action, outraged the public and galvanised action.1

The new series Truelove may or may not sway public opinion on whether the UK should legalise assisted dying—but kudos to the producers for tackling a contentious and now very timely matter. Following Esther Rantzen’s decision to go public about signing up with Dignitas,2 a petition is circulating calling on the government to hold a parliamentary debate on assisted dying and allow MPs a free vote on the matter.3

In the first episode of Truelove old school friends, now in their 70s, meet at the funeral of one of their group. Reference is made to his suffering and death from “cancer and cancer drugs.” The series lead, a cool former detective, says, “If I get near that point, take me out and shoot me.” My feisty 96 year old mother said the same to us. She too valued her autonomy and had seen close friends suffer prolonged, painful, undignified deaths. This fate is experienced by too many,4 including, sadly, my mother.

The Truelove friends promise to help each other die, if, and when, they decide that they want to end their life. Their pact is called “true love,” after the Cole Porter song immortalised by Bing Crosby, and in this context is a manifestation of their love for each other. Helping loved ones die risks a prison sentence in the UK, even if it’s been motivated by compassion and a desire to end suffering.5

Loyalty to the pledge is soon put to the test when one of the group shares the news that he has advanced incurable metastatic cancer with a short life expectancy. He asks for help to end his life after he fails in a suicide attempt. This is not a far fetched scenario. The suicide rate of patients with severe cancer is over double that of matched controls.6

After much soul searching, two of the friends fall in with his elaborate plan to end his life, devised to convince the police and coroner that he has died at sea by his own hand. After the event, the friends’ anguish is palpable. So is their worry that the police may suspect them. When another friend with dementia turns to them for help they refuse. But after she too fails in a suicide attempt they support her as she takes the lethal drugs she has stockpiled. Her end is peaceful but the drama hinges on the events that precede her decision.

In 2015 a bill to legalise assisted dying under strict controls was defeated in parliament, but since then public support has been growing.7 A House of Commons health and social care committee is to report back soon on the options for changing the law based on the experiences of countries where assisted dying is legal.8

These countries include Australia, Austria, Belgium, Canada, Colombia, Luxembourg, The Netherlands, New Zealand, Spain, Switzerland, and several US states. The nature of the laws enacted and conditions for eligibility vary from country to country, although being terminally ill, mentally competent, and able to make a voluntary and repeated request are key criteria. In a few countries it’s possible to seek medically assisted dying if you live with a chronic incurable physical condition that causes unbearable pain or makes a dignified life impossible.

Belgium enacted its euthanasia law in 2002. Since then there have been around 2500 cases of euthanasia a year. A small proportion requests come from France and the UK.9 Over time, medically assisted dying has become an integral part of the work of some general practitioners and anaesthetists who work closely with palliative care teams. There is no requirement—as there is with Dignitas—for self-administration of life ending drugs. There has, however, been controversy over its use in patients with intractable mental suffering caused by psychiatric disorders, who make up 1.4% of the total number of euthanasia cases.10

Unsurprisingly, discussions on assisted dying are often polarised, emotional, and laced with warnings about “slippery slopes” where the bar for who is eligible is set lower and lower. A recent BBC Radio 4 Moral Maze debate was no exception. But both the presenter and Mona Siddiqui, an ethicist and expert public speaker, steered the discussion well. The most compelling contribution came from a woman who described the gruelling and traumatic events preceding the deaths of two close family members.11

The UK is not the only country where a rethink of the law on assisted dying is being contemplated. France has been soliciting wide public opinion through 500 debates in 132 French towns. The process has culminated in a call to strengthen end-of-life care and legislative change that would decriminalise voluntary assisted dying.12

Interestingly, the option to access good quality end-of-life care is not even alluded to in Truelove. No doubt because it would have sabotaged the storyline—but also, perhaps, because it’s known that access to palliative care in England is inadequate and not enough doctors have the skill and confidence to talk about death and help patients and families make advance care plans.13

Polls suggest that up to two thirds of people in the UK support legislative change to allow people the option of assisted dying.14 I’m one of them. The view that “it is not about ending life, it’s about shortening death” resonates with me.15 And it can be argued that the ability to make an informed choice about how and where you die is as important as having a choice on how you live.

Mr Bates v The Post Office illuminates how being prosecuted for a crime you did not commit casts a long shadow. So does a bad death. Truelove sheds light on the fear many have, and I share, about losing control and experiencing prolonged suffering at the end of life and the impact of this on the people we love.

Footnotes

  • Not commissioned, not externally peer reviewed.

  • Competing interests: TR lives with multiple long term conditions including metastatic adrenal cancer.

References