So, Jake thought, no AD if you lose your mind but if your ‘serious’ physical condition causes unbearable mental suffering, that would be enough.
In so far as Jake had ever thought about the issue before, it had always seemed eminently sensible. After all, it was more than seventy years since suicide itself had ceased to be a crime. It was surely necessary that assisted suicide, or assisted dying as it was now called, should also cease to be a crime. Looking back to social commentators, writing before the law had been changed, Jake noted with approval the prescience of the fantasy writer Terry Pratchett, who had written in 2011: ‘The truth is that assisted dying in the UK will happen sooner or later, because it is how the world works: eventually the unthinkable is the everyday, quite often for the best.’
The low hum of conversation around the open-plan office reverberated in Jake’s head that Monday morning as he tried to finish a short piece on homing pigeons. Wakefield Council had ordered a Mr Ted Burrows to get rid of his pigeons. He had tried to get rid of them, Mr Burrows explained to the magistrates, but they had merely done what they were trained to do, which was always to return to the same place. Pressing the send button and rubbing his eyes, Jake got up to stretch his legs. What a load of crap, he thought, as he walked slowly to the coffee machine and pushed espresso twice. Passing a colleague on his way back to his desk he said, ‘Hi, George – do you know if we’ve ever done anything on AD?’
George looked up, surprised. ‘What have you heard?’
‘Heard? Nothing – what do you mean?’
George looked around. ‘I need a coffee.’
Jake followed him back to the coffee machine.
‘So what’s your interest in AD?’ George asked.
‘One of my rellies. Rumoured to be contemplating an assisted death – that’s all.’
‘OK, I thought you might have picked up some gossip somewhere – Charlie is terrified we may be scooped but he’s got some deep throat at one of these AD clinics. Thinks it all smells a bit. We’re planning an exposé – but I don’t know too much about it. If you’re interested, you should talk to Mills.’
Bringing his coffee back to his desk, Jake put his head into a small glass office where Mills was working. ‘George tells me that you’re doing an investigation into AD?’
‘Correct – but keep it to yourself.’
‘What’s the story?’
Mills shrugged. ‘As you probably know, the NHS won’t touch AD, nor will private sector hospitals, so it’s all in the hands of the specialist AD clinics. What we’ve found is stuff like heavy commercial pressure from management to maximise “throughput”; staff bonuses linked to secret targets; evidence from one clinic that has never turned away a single applicant; and aggressive marketing to NHS trusts. There’s also this,’ she said, handing him a sheet of paper with a passage highlighted.
Jake began to read. ‘Shit, I see what you mean. The clinics are paying commission back to the NHS hospitals and GPs. That’s shocking.’
‘Is it?’
Jake turned and saw that Charlie had come into the room. ‘More interested in our research than your own,’ Charlie added, ‘or are you flirting with Mills?’
‘No chance,’ said Mills. ‘He’s only got eyes for his young cousin…’
‘Hey, that’s not…’
‘Come over here,’ said Charlie as he walked to his own screen.
‘What is it?’
‘Just read,’ and he pointed to his screen. ‘DEATH PATHWAY. TRUSTS PAID MILLIONS.’ Jake read on: ‘The majority of hospitals in England are being given financial rewards for placing terminally ill patients on a “pathway” to death, it can be disclosed. Almost two thirds of NHS trusts using the Liverpool Care Pathway have received pay-outs totalling millions of pounds for reaching targets related to its use…’ Jake looked at the date – November 2012.
‘Twenty-one years ago,’ said Charlie. ‘You can find a lot of articles around that time on a similar theme.’
‘Yes, but surely that was completely different?’ said Jake. ‘I mean, the Liverpool Pathway… wasn’t that considered good clinical practice for those who were shortly about to die in any event? It wasn’t medically assisted suicide.’
‘Theoretically that’s true, but if you read the contemporary material you will see that there was an element of hastening the end, denial of water and so on, and this was linked to specific financial incentives to NHS hospital trusts.’
‘So, you don’t think there is a problem?’ asked Jake.
‘Oh yes, there are abuses in the way that AD operates today and we are going to expose them. But there are also deficiencies in the present law – it doesn’t work for dementia sufferers – which is why some patients are rushing to the clinics at the first hint of Alzheimer’s. All I’m saying is that managing death has never been easy. Now I suggest you get on with your own work. I’m expecting that investigation of yours to be wrapped up in the next week.’
23
Marianne heard a door close and she knew it must be Dorrie using the front-door key she had given her. Dorrie greeted her warmly but with a quizzical look.
‘Well? Tell me how it went,’ she said, sitting across the kitchen table and measuring a small amount of milk into her tea.
‘It was entirely predictable,’ Marianne replied.
‘Well, what you may have been able to predict is not within the range of my more limited powers, so you’re just going to have to tell me.’
Marianne shrugged. ‘OK, I’ll tell you – but after that I don’t want to talk about it anymore today.’
‘OK, fine.’
So Marianne told Dorrie how it had gone at the clinic. Rather to her surprise, she found it a relief to have someone she could share the experience with and to have a laugh about the absurdities of the process. She tried to inject a little irony into the description and she thought she might have succeeded because Dorrie acknowledged the humorous side.
‘Hard to know whether to laugh or cry; but seriously, Marianne, you’re not going to go on with this, are you?’
‘Yes, I am.’
‘But why now? That’s what I don’t understand.’
Marianne sighed. ‘I don’t know whether you remember how things were in England before the law was changed, when people went off to that awful blue chalet in Switzerland?’
‘I remember.’
‘Well, what was most tragic about those cases was the fact that the patients were going off far too early, but they didn’t dare leave it any longer in case they found it was too late and were no longer able to travel.’
‘And so…?’
‘AD is still only possible if you are deemed to be of sound mind. If I had a stroke tomorrow which left me mentally disabled, then even if I still had the wit to ask for an assisted death the chances are that it would be refused.’
‘Maybe, but I had the impression they were fairly flexible on that now. I’ve known some friends who were pretty gaga but they were still accepted for AD.’
‘If they were, then the law was being broken; it’s not a risk I am prepared to take.’
Dorrie got up from the kitchen table and went over to the window. It was almost dark and the East Anglian wind was blowing small streaks of rain onto the glass panes. She pulled down the blind and turned back towards Marianne. ‘Morally – doesn’t it trouble you…?’