‘Yes, I understand. So, on a scale of one to ten, with ten being the most severe, how would you evaluate the pain you suffer from your hips?’
How to answer this question? How can anyone know what level ten pain could amount to? Have I had my fingernails ripped out? Have I been broken on the rack in a medieval torture chamber? I haven’t even come anywhere near the pain suffered by my poor father at the end of his life. I suspect that my pain would barely register against the full capacity for human beings to suffer.
‘Maybe five?’ The nurse noted it down. Marianne knew that it didn’t really matter what she said. Her case for AD was mental – I have a reasonably held belief, based on my physical condition, that it is no longer tolerable to go on living. Once it became settled practice that the interpretation of a serious physiological condition meant any condition which wasn’t trivial then it all turned on of the reasonableness of your belief. When you were into your eighties or nineties there was seldom any argument about it.
‘Yes, and your hands?’ said the nurse. ‘You mentioned about the pain in your hands?’
‘Yes. You see, although my hips and hands are both troubling on their own, the combination is particularly difficult. I need two sticks to walk now and it’s very difficult trying to hold the sticks, especially first thing in the morning, or using the commode at night.’
‘So how would you score that?’ Marianne opted for a four then said perhaps four and a half. Were halves allowed? It seemed they were. The nurse noted it down.
Gradually they worked through Marianne’s bodily ailments. Her headaches, her sometimes painful eyes, constipation, haemorrhoids and occasional incontinence. By now Marianne was feeling acutely uncomfortable at having to talk up such common ailments of old age.
They had been going for over an hour and the nurse saw that Marianne was beginning to flag. She offered her a cup of tea or coffee and a short break. Marianne opted for tea. The nurse suggested she might like to go back and have her tea in the reception with her daughter-in-law. Marianne declined and spent a few minutes leafing through a brochure describing the legal implications of AD: the law did not permit discrimination against those who opted for an assisted death, the de Zeeou Group was pleased to inform readers, and life insurers were obliged to pay provided the policy was taken out at least three years before death.
Another article explained that euthanasia was still illegal in Britain; hence no doctor could administer a fatal dose. Patients had to self-administer the necessary drugs, but the de Zeeou clinics provided for that process to be easy, pain free and to take place in a secure environment under medical supervision.
When they resumed, Marianne realised that the topic had changed. So far it seemed that they had been concentrating on the reasonableness or otherwise of her view that life was no longer tolerable. Now they had to concentrate on ensuring that she was not being swayed by ‘inappropriate’ criteria. This could range from domestic circumstances, financial considerations, all the way to undue influence.
‘So I take it, Mrs Davenport, from our previous discussion, that you live alone but have a carer who comes in every day.’
‘Yes.’
‘Can you describe the arrangement for me?’
Marianne described how Anna looked after her.
‘She seems very helpful, your Anna. Would you describe it as a good relationship?’ How to describe her relationship with Anna? Good wouldn’t even get close. She loved Anna. She knew that she loved her too much. Too much for her own good and possibly Anna’s as well.
‘Yes,’ she replied. ‘Yes, it’s a good relationship.’
The questions moved on to money. Shortage of money, as Marianne knew, is a big no-no as far as the clinics are concerned. There had been a lot of bad publicity a few years earlier when some researchers suggested that anxiety about money was the second biggest factor involved in people’s decisions to go for AD. That didn’t seem a particularly strange conclusion to Marianne, since health and money are the two overriding concerns of old age. Nevertheless, the research spawned a big political debate about pension levels and the cost of care with articles in the press suggesting that AD clinics were profiteering from the financial anxieties of the elderly. As a result, the clinics tried hard to show that shortage of money was not a factor in choosing AD.
Marianne disliked this part of the enquiry even more than the discussion about her health and domestic circumstances. She had always guarded the privacy of her financial affairs. ‘I own my own house. I have a pension from the university and my state pension. No particular money problems,’ she lied. The nurse seemed pleased with her answers.
The final section dealt with the attitude of her relations. To some extent this had already been dealt with at stage one. Callum had come with her on that occasion. He had told them that he certainly would not encourage it but he would respect his mother’s decision to choose AD if the situation ever arose. Similar questions were now asked of Marianne.
‘Mrs Davenport, please tell me which one of the following statements most accurately describes the attitude of your son to your decision to seek AD: strongly supports, supports, is neutral, opposes or strongly opposes?’
For the first time Marianne gave an answer which seemed to trouble the nurse: ‘I would say the second.’
The nurse frowned. ‘Your son is supportive of your decision?’
‘Yes, I think so,’ Marianne said, but she hadn’t quite realised that this answer would set off an alarm bell; except in cases of extreme suffering or a severe degenerative disease, the AD clinics preferred relations to be neutral or mildly opposed. This suggested that the decision was that of the patient alone, entered into without persuasion or interference.
‘So has your son played any part in persuading you to choose AD?’ the nurse asked anxiously.
‘No, no, not at all. He regards it as my decision and supports whatever decision I wish to make.’
‘I wonder, therefore, if neutral isn’t really the correct answer?’ she asked.
Neutral? Marianne wondered how a son could be neutral about his mother’s death. He may support the decision because he respects and loves his mother or even because he doesn’t. Or he may oppose it for the same reasons. But to be neutral as to whether his mother lives or dies? And with one of those sudden flashes of memory which are a feature of old age, Marianne remembered a discussion in her literature class seventy or more years ago when they were reading Sons and Lovers. Paul grinds up the morphine and puts it in his mother’s milk to hasten her death ‘yet he loved her more than his own life’. She had never forgotten those words. Neutral? That would hardly be possible.
‘So on reflection, what shall I put down?’ asked the nurse. Marianne looked down at the form and tried to focus on the question – oh, what the hell.
‘Yes, you’re right, neutral is better,’ she said; the nurse smiled and ringed three on her form.
‘And your daughter-in-law? Would the answer be the same for her?’ Marianne was startled by the question. Helen? Why is she asking me about Helen? And for half a second a little devil inside her suggested, ‘strongly supports’. She suppressed it immediately. Totally unfair. Helen had never expressed any view and had deliberately kept out of any conversation on the subject.
‘I am sure her attitude is the same as my son’s,’ she said.
‘Excellent,’ said the nurse. ‘Now we are all done.’
When she returned to reception, Marianne noticed Helen was looking both bored and anxious. ‘Is everything alright?’ she asked.