‘To be honest, whether or not I have a terminal illness, there are days, irrespective of health, where I would quite happily have said, “It’s time to check out and move on now.”’
‘But then there are days when you don’t feel that way.’
‘Yeah, of course.’
‘If you had all this kit at home, would you think for a very long time before using it, or have you already done your thinking?’
‘I couldn’t do it right now, because it’s not cleared with the kids,’ he says. ‘Somehow, I need to have that conversation.’
David needs to have many more conversations, with the people who love him and the doctors who treat him, rather than with Exit and with me. The answers that he is looking for are much more likely to be found in his friends and family than inside a plastic bag. But that’s the only solution being offered to him at the moment.
* * *
I meet up with Lesley a couple of weeks later in Exit’s UK office – a room on an industrial estate near her home in Kent, among corrugated iron warehouses on the River Medway. This is where Lesley runs her cake business, but it’s not the bright, sugary world I was expecting. We sit at a table where decorating tools lie beside suicide manuals.
She talks me through a typical day. ‘First thing in the morning, when I’m still in my jim-jams, I open my computer, because Australia will have been around for a few hours by then. Then I’ll check the phone messages. We might get six or eight in a day. It doesn’t sound a lot, but the return calls can be quite tricky and long.’
There are two categories of caller that are the most difficult, she says. ‘There are young, depressed people. You can tell they’re depressed, and you can tell they’re not fifty, sixty, seventy years old. That’s an absolute no. We can’t.’ She shuts her eyes. ‘You say all the stupid things: “Have you spoken to your GP? Have you had counselling?” They don’t want to hear that, yet I’ve got to say it. Their line is usually, “They can’t help me. Help me to get Nembutal.” And I can’t.’ She winces. ‘I can’t. So they get off the phone and they do something worse.’
Then there are the people calling on behalf of someone else: people who want to assist a suicide. ‘We have to say, “We cannot encourage you to do this,”’ Lesley says mournfully. ‘It’s very tough. Some of the stories of situations people are in are similar ones to my story, and I could tell them things that would help. I wish I could. But I can’t.’
Her story begins in 1994, before she was in the cake business, when she worked in financial services for a woman called Sylvia Alper. Five years younger than Lesley, Sylvia was already her boss’s boss, ‘quite an elevated career woman, quite bossy’. Lesley had split up with her long-term partner. ‘I’d got over the misery of it and started to think, This isn’t half bad – you can do a lot when you’re on your own. She was having a horrid time with her husband and could see that there was a different life to be had.’
When Sylvia got divorced they became best friends, going to the cinema and theatre, travelling together. ‘We walked our legs off around Europe. You’re looking around and then you look at each other and think, How lucky are we that we’re here? Just enjoying things.’ She shows me a photograph from the late nineties of the two of them on a gondola in Venice. Sylvia has a thick cascade of auburn curls, Lesley has the same cropped hair that she does now. Broad smiles illuminate their faces. ‘It shouldn’t have worked, because we were such different people, but it just did,’ she says, with glossy eyes. ‘We complemented each other.’
From the beginning of their friendship, Lesley knew Sylvia had multiple sclerosis. Sylvia didn’t want the rest of the office to know in case it jeopardized her chances of getting promoted, so Lesley kept it quiet. ‘When she’d lose the use of a leg or go blind in one eye or whatever and had a bit of time off I knew what it was and would go and see her. But you get over that, in the early stages of MS: you get your sight back and you get your leg back.’ They both found new partners, and Sylvia moved away to Eastbourne, so they saw less of each other but kept in touch over the phone. Then Sylvia stopped getting better. Lesley’s fiercely independent best friend became confined to a wheelchair, dependent on round-the-clock care.
Sylvia had always said, when the time came, she wanted to go to Dignitas. ‘She phoned me to say that she wanted me to come to lunch, that she had something important to talk about. I kind of knew what it would be. That’s when she said that she wanted me to do the research. It was like we were back at work and she was giving me a project to do, and I was taking notes and saying, “Right, OK.” I went off and kind of did it as an assignment.’
But they quickly ruled Dignitas out. ‘By now she had to be winched from chair to bed to wheelchair. She was doubly incontinent. There was no earthly way I could get her to Switzerland.’ Even if they had found a way, it was too much money. ‘It was going to cost about twelve or thirteen thousand pounds,’ Lesley says.
‘Why so much?’
She gives me a wry smile. ‘There’s no reason for it to cost that much, apart from that’s what they charge.’ The current Dignitas brochure puts the cost at around £8,300, including doctors’ fees, administration, funeral and registry office expenses, but not transport, accommodation, the compulsory Dignitas membership fees or VAT. Sylvia didn’t want to spend money she could leave to her husband. Plus, he refused to take her to Dignitas anyway. ‘He couldn’t be the instrument of her death. So whatever we did next had to be behind his back.’
‘That’s quite a lot of pressure to put on you. Did you ever have any doubts?’
‘Sylvia was very single-minded about everything in life. So no, there was no question when she asked that she meant it.’
My question was about whether Lesley had ever doubted that she wanted to be involved in assisting a suicide, but it doesn’t even occur to her to take it this way.
Lesley found the Exit website, and learned that Philip was due to give a practical workshop in London in a few months. ‘Reading about his reputation as Dr Death, it might seem grim to some, but it was perfect for me.’ She went along, never letting on that she was there for someone else. She ‘earwigged’ on conversations around her, noting down names of possible suppliers, how much the drugs cost, how long they took to arrive. She read up on assisted suicide and what the possible consequences might be for her. She deliberately left a paper trail, so she had nothing to hide when she turned herself in (she always intended to go straight to the police; she wanted to take responsibility for her part in Sylvia’s death, she felt no shame in it). She emailed a supplier and sent £400 into the unknown. Then she waited.
‘In those weeks, I could barely breathe,’ she says, staring at the untouched coffee in front of her. ‘This is the single most important thing anyone had ever asked me to do.’
To her surprise, the package arrived. Sylvia wanted to use it immediately, begging Lesley to come down to Eastbourne as soon as possible. Sylvia’s husband left them alone together. ‘We talked a little about what great things we did, and wasn’t it great that we did them when we could, and what a life.’ She breaks off and catches her breath. ‘Then I can’t remember who said, “Shall we do this?” but I went into the kitchen and opened the bottle.’
Lesley held Sylvia’s hand as she drank the fatal dose. From what she describes, Nembutal was far from a quick and dignified death, and Sylvia’s last moments were anything but peaceful. She was retching, and her eyes, nose and mouth were streaming so much Lesley didn’t know if she had taken enough to kill her. ‘I have no idea how long I held her,’ she says quietly. ‘I don’t know when she died. I tried to feel pulses, but my heart was going so much I had no idea whose pulse I was feeling.’
When she was sure Sylvia was dead, she phoned Sylvia’s husband and told him to come home, and then she turned herself in to the police. Lesley describes how the ambulance and police came, how she was arrested under suspicion of assisting suicide and importing a controlled substance, how she was taken into custody for
the night and made to put on a jumpsuit, and she talks in the second person. ‘You’re searched. They take all your clothes. If you needed to go to the loo you had to be watched by a policewoman and you couldn’t wash your hands because you might wash off some evidence… Half of you has shut down anyway, you just go into a different place, but a little bit is thinking, Blimey, this is quite an experience.’
It took ten months for the CPS to decide not to charge Lesley. During that time, her life began to disintegrate. She says she was ‘emotionally broken’ and her business was ‘in ruins’. Her partner was angry that she’d put them both at risk: while she was in custody the police searched their home, seized all his computers and held on to them until the charges against her were dropped; he works in IT, so his business was devastated too. ‘He has gone completely to pieces,’ Lesley says. It’s the only time I hear a hint of regret in her voice.
When Philip came back to the UK for his next workshop Lesley went along too, even though she was still facing charges at that time. She wanted to thank him, and share her story in case it was any use to him. That’s when she learned they were looking for a UK coordinator to man the phones for a couple of hours a week. She started working for Exit only a month after her case was dropped.
Lesley clearly had a lot on her plate when she decided to become the British face of rational suicide. How could she know what she was letting herself in for? Was it fair to ask her?
‘Why put yourself through all of this again,’ I ask, ‘when you know so well what the consequences could be for you, and how devastating it has been already?’
‘Because it’s wrong!’ she almost howls. ‘It’s just fucking wrong.’ There’s a long pause. ‘It’s the right thing to do, that’s all I can say. It’s right to help people who are stuffed. They are stuck and they’re worried. In later years you shouldn’t be that fearful about what’s going to happen to you. It’s everybody’s individual right to have a say in it.’
‘So you do want the law to be changed, so that people have the right to die?’
‘Fuck, of course I do!’
‘But you’d be out of a job.’
‘Don’t care. Job done. I’d retire, I’d read a book – I’m absolutely fine with that. There shouldn’t be this job, and the sooner there isn’t, great.’
Lesley is no tub-thumper for rational suicide. She just wanted to help her friend, and wants to prevent anyone else having to go through what she had to. She has become Philip’s representative in the UK because there is nothing else to offer British people.
‘There are hundreds and thousands of people who are going through this now, not years down the line when the law changes. They’re worrying about it today,’ she says. ‘People like that need somewhere to turn.’
* * *
On the second day of Philip’s medical tribunal hearing, I finally get him on the phone. It’s a little intimidating to finally have an audience with Dr Death himself. It’s eleven p.m. in Darwin, but he is energized, and defiant in the face of the charges against him, even though he accepts that his actions may have led to a serial killer escaping justice.
‘This is a case of rational suicide,’ he says deliberately. ‘Brayley wasn’t sick, he was forty-five, but he certainly had fairly cogent reasons, I would argue, for ending his own life. The thought that he would spend the next twenty-five years in prison led to that decision.’
‘So even if he was being investigated for murder it would have been rational and you would have been comfortable with the idea of him killing himself?’
‘I suppose comfortable is the right word,’ he replies.
Philip tells me how he arrived at this radical libertarian view of the right to die. He discovered the world of euthanasia in 1996, when there was a nine-month window during which the Northern Territory allowed people close to death to get help from a doctor to die under the Rights of the Terminally Ill Act, which was repealed by the federal government of Australia a year later. He was in his late forties and had just qualified as a doctor then; he came to medicine late in life, after a short spell in the air force, a stint as an Aboriginal land rights activist and a few years as a Northern Territory parks and wildlife ranger.
‘I heard about it on the radio and thought it was a good idea and went back to sleep again,’ he says. He only got involved after there was a high-profile campaign against the new right to die, spearheaded by both doctors and the Church. ‘I was annoyed, very annoyed, by the medical profession’s attempt to subvert what was clearly the wish of the people. They were saying everything that I can’t stand about medicine – that is, in the most patronizing way, that the doctors know what’s best for you, even if you think as a member of the general public that this is a good idea. I just found that so offensive.’ He made his feelings known, and people who wanted to die came knocking on his door.
‘I was very much of the opinion in those early days, 1996, that it made sense that a doctor could come and see you and, if you were sick enough, provide you with the drugs to end your life. Four of my patients ended their lives. I was the only doctor to use the law, and in fact for a while I was the only doctor in the world to use legislation to effectively administer a lethal injection.’ I can hear the pride swelling in his voice as he tells me this.
‘Exit grew out of that, because after the overturning of that law people kept coming to see me. But then I started to see some shifts: they weren’t all terminally ill; in fact, there were some people who had non-medical reasons for wanting to die, and I was challenged pretty strongly by some of these people, who said, “Why is it up to you to decide?” It’s really the person who’s dying’s decision. That became our focus: giving people practical options, rather than sitting at the feet of politicians, begging them to change laws.’
‘Are you proud of being Dr Death?’
‘If you got too troubled by name calling you wouldn’t do much,’ he sniffs. ‘It’s a rare day when you don’t walk down the street and someone comes up and says very nice things to you. That didn’t used to happen when I was writing out prescriptions for penicillin. It’s nice to be involved in an important, cutting-edge social debate. It’s exciting.’
‘I’ve been looking at how much the things you sell cost,’ I say. ‘The handbook is not cheap. If you want to get the nitrogen cylinder and all the other stuff through Exit, the way you recommend, it’s not cheap. Are you making a profit out of all this?’
‘It’s not cheap, but it’s not cheap to travel around the world running workshops either,’ he snaps back. ‘The idea that one could run the organization without that sort of financial basis is not possible. It’s a not-for-profit organization. Sometimes people feel that you should never earn anything if you’re associated with the issue of helping people have a peaceful death. It’s almost as if the issue itself doesn’t allow you to break even, let alone make a living.’
He’s annoyed now that I’ve tainted things by questioning his motives. But when he talks about his role in helping people die, he speaks in the language of business. ‘Having a local presence on the ground in the UK will make a big difference. I would expect quite significant growth. Europe, in particular the UK, is a big area of interest.’
I don’t know it yet, but Philip has plans to expand the market for his work in ways no one can imagine. He has an ambitious idea that transcends the legal boundaries of any state. Something far smarter than drugs or bags. Something that doesn’t require anyone’s help or permission. A vehicle that will drive people to the perfect death.
CHAPTER FOURTEEN ‘The Elon Musk of suicide’
At least thirteen other doctors have earned the epithet Dr Death, including Harold Shipman and Joseph Mengele. Philip isn’t even the original Dr Death of euthanasia, nor the most famous. That honour goes to Jack Kervorkian, the Michigan pathologist who campaigned for the organs of death row inmates to be harvested, who pioneered the use of blood transfusions from deceased corpses, and who personally assisted the deaths of 130 America
ns during the 1990s.
Kervorkian invited his patients into the back of his 1968 Volkswagen Vanagon, a campervan with some of the seats removed, where he hooked them up to one of his purpose-built death machines. His first device was called the Thanatron (after Thanatos, the embodiment of death in Greek mythology), and was made of whatever he had to hand: car parts, magnets, pulley chains, coils and toy parts. It was little more than three bottles hanging on a crude metal frame, connected to a single IV line, with a large, red button on the boxed base of the device – the kind you might find on an old arcade machine. You could easily mistake the entire thing for a macabre school science project.
When Kervorkian connected his patients to the machine they initially received a harmless intravenous saline solution, but when they pushed that red button the saline would stop, and a fast-acting barbiturate anaesthetic would be dispensed, putting them into a deep coma. After sixty seconds, a lethal dose of potassium chloride would be administered, which stopped their heart. They would die of a heart attack while they slept.
The Thanatron was used for the first time in 1990. The patient was Janet Adkins, a fifty-four-year-old schoolteacher from Portland, Oregon, living with the early stages of Alzheimer’s. She met Kervorkian for the first time only the weekend before her death; he decided she had the mental capacity to understand what she was doing, and he drove her to a local park the following Monday afternoon, where she died in the back of his van. Kevorkian told the New York Times two days later that, just before she died, ‘she looked at me with grateful eyes and said, “Thank you, thank you, thank you.”’
The Thanatron was a pretty basic way for Kervorkian to try to absolve himself of accountability: his patients were the instigators of their own death, because if they didn’t push the button they would remain alive on the saline drip he had hooked them up to. But the Michigan Medical Board didn’t see it that way, and revoked Kervorkian’s medical licence after he used the Thanatron a second time. This meant he no longer had legal access to the substances he needed for it to work. His death machine of choice then became the Mercitron – effectively a gas mask connected to a tank of nitrogen and carbon monoxide, with a clothes peg stopping the flow of gas into the mask. The patient removed the peg, and precipitated his or her own death, with Kervorkian standing by.
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