Assisted suicide: One last helping hand

When Rosemary asked her son-in-law James Ross to look at the logistics of an assisted suicide at a Dignitas clinic he wasn't sure if he could do it. Here he tells how he joined her daughters on their mother's final journey

Dying with dignity: James Ross's mother-in-law, Rosemary, aged 20 and at 81

This is a story about my late mother-in-law, Rosemary, her struggle with bereavement and Parkinson's disease, and her absolute determination to visit Dignitas in Switzerland for an accompanied suicide. Before retiring, Rosemary worked at a busy GP surgery in west London. She was a stylish lady, liked modern design and was of the Habitat era. She and her husband, Eric, retired to Sussex but, devastatingly, he contracted pancreatic cancer and died in 1998. He was only 73.

Rosemary was of the "stiff-upper-lip" generation and put on a brave face. Despite attentive local friends and family, Rosemary found life as a widow depressingly tough going and missed Eric dreadfully. She had always been a believer in euthanasia and, soon after Eric's death, heard about Dignitas in Switzerland.

Over the next 10 years, Rosemary soldiered on. But in 2010, her balance deteriorated and, after a bad fall, she broke her collarbone. Eventually, she was diagnosed with Parkinson's disease. Rosemary detested being dependent on other people and, to the distress of her family, became increasingly preoccupied with the concept of an accompanied suicide at Dignitas.

The process for arranging an assisted suicide at Dignitas is tortuous and Rosemary knew she'd need help with the logistics. My career had been in project management and I'd been dreading the inevitable summons to be her project manager. I was very fond of Rosemary, uncomfortable with the Dignitas concept, and didn't want to break the law.

Rosemary commanded that I at least investigate the options and we rummaged unenthusiastically on Google. We established that Dignitas applicants must be suffering from a "medically diagnosed hopeless or incurable illness, unbearable pain or unendurable disabilities". Rosemary reckoned she qualified on all three counts. Armed with a full set of medical reports and an independent psychiatric assessment, Rosemary submitted her application.

Meanwhile, Rosemary was distressed at her deteriorating memory. She resorted to carrying an appointment diary around at all times. The physical symptoms associated with Parkinson's were advancing at a worrying rate. Rosemary was now wheelchair-bound and increasingly incontinent. The realisation of her advancing incapacity appalled and terrified her.

In early 2010, and to her delight, Dignitas confirmed its "green light" for Rosemary to proceed. Its letter explained that she would be interviewed by a Dignitas-appointed physician on her first full day in Switzerland. The Swiss authorities require that a second day be a "cooling-off" day, to be followed by a further interview on the third day.

Providing the physician was satisfied that Rosemary was making an informed decision, of her own free will, she would then be permitted to visit the Dignitas apartment in Pfäffikon, near Zurich, on Day 4. There, Rosemary would be able to take the dose of sodium pentobarbital to end her life.

There were more forms to complete and a further payment to Dignitas, whose fees now totalled around £7,000. It's a continuing struggle for Dignitas to find local Swiss doctors, and the physician assigned to Rosemary's case was based in Basel, not Zurich. It was agreed that Day 1 of the process would commence in Basel, on Monday 29 March 2010.

Rosemary wanted to be accompanied by her daughters, Liz and Sarah, and by their partners. On arrival in Basel, we were exhausted but Rosemary was ebullient. She had at last achieved her ambition of getting to Switzerland.

Dignitas had appointed a delightful and empathetic Swiss physician, Dr Erika Preisig, to oversee Rosemary's case. Erika asked why Rosemary wanted to end her life. Rosemary shared a detailed, compelling and unruffled account, coming across more as an elderly lady discussing the merits of a new recipe than of an impending suicide.

Rosemary wanted to spend her last few days exploring. We drove into Germany heading for the Black Forest, where we had lunch of Wiener schnitzel but passed on the famous local gateau. It all felt rather surreal.

Day 2 was the "cooling-off" day and Rosemary opted for more sightseeing. The week was beginning to feel more like a whistle-stop tour of Europe than an accompanied suicide.

On the morning of Day 3, Erika ran through the same questions she'd asked on Day 1. She wanted to ensure that, after two days' reflection, Rosemary hadn't changed her mind. She hadn't.

Erika explained the process for Day 4, which would take place at the Dignitas apartment near Zurich. Taking the fatal dose of sodium pentobarbital is not straightforward. The drug tastes bitter and is easily regurgitated. Vomiting can cause some of the barbiturate to be rejected, resulting in coma but not death. To settle the stomach, and prevent the dose being regurgitated, a potion is taken 30 minutes before the fatal dose of barbiturate.

Erika endorsed the barbiturate prescription and gave the final Dignitas "green light". She bade Rosemary farewell, wishing her luck for the following day. And that was it. It was now down to Rosemary alone.

Leaving Basel, we drove east on country roads to our hotel in Zurich. Our conversation at dinner that evening felt awkward. Although Rosemary remained in eerily good form, for everyone else the meal was an uncomfortable affair.

The next morning, after a subdued breakfast, we set off for the Dignitas apartment. We were met by Arthur and Gabrielle. Arthur was rotund, wore wide braces and sported a magnificent moustache. Gabrielle was thin, tall and not very talkative. But it soon became clear they were gentle, patient people; strong on empathy and good listeners.

For the benefit of the Swiss authorities, Rosemary had to confirm, in front of Dignitas's video camera, that she fully understood the process.

"What will happen when you drink the barbiturate?" Arthur asked. "I will fall asleep," Rosemary answered. "And then what?" "Well, I will then die," Rosemary replied, calmly.

After a final round of form-filling, Arthur passed Rosemary the potion to settle her stomach. This didn't taste too bad. Rosemary now had 30 minutes before being able to take the lethal barbiturate.

We'd brought with us a CD featuring Rosemary's favourite music. This comprised Frank Sinatra, Barry White, Edith Piaf and Tom Jones. The mellow CD helped to lighten our mood. Not surprisingly, our conversation felt rather forced, with feeble attempts at humour. The 30 minutes ticked by slowly. After the allotted half-hour, Rosemary changed the subject abruptly. "I think it's time," she said.

"Would you like to sit or lie down on the bed?" Arthur asked, to the accompaniment of Tom Jones's "Sex Bomb". Rosemary opted to sit in a wide leather chair.

Arthur brought in the glass of barbiturate and placed it in front of Rosemary. He again pressed the "record" button on the video camera. With wonderful timing, Piaf's "Non, je ne regrette rien" played mournfully in the background.

Rosemary gulped the barbiturate in one swig. "It's very bitter," she grimaced. But she was soon drowsy and asleep within two or three minutes. After a further 15 minutes, Rosemary, still fast asleep, started coughing as her metabolism sought to reject the lethal barbiturate. This was painful to hear, although, as we were told later, not unusual. After another 25 minutes, it was all over. Rosemary was dead. She'd been the only one of us who'd remained unfazed by the whole process. She'd been calm and composed throughout the morning. No tears. No emotion. Just an unwavering resolve.

I can't put into words how the next hour felt. In stark contrast with Rosemary, we were all upset and in tears. For Liz and Sarah it was dreadful. On the one hand, Rosemary had achieved her Dignitas ambition. But Liz and Sarah had lost their mother.

We waited in a back room for an hour until the Swiss doctor arrived to certify Rosemary's death. The police, also, were obliged to attend. Although they were unfailingly polite, it was uncomfortable being interviewed by two uniformed and armed German-speaking police officers.

Meanwhile, the undertakers arrived and laid out Rosemary's body. We were then invited back to pay our last respects. It was less than two hours since all five of us had been chatting. In death, Rosemary looked calm, dignified and at ease. No one else did.

We went out for a meal that evening. After a few bottles of wine, we started to relax. It had been a hugely draining day but we could celebrate the fact that Rosemary had finally achieved what she'd wanted. The whole process had been dignified and well managed by Dignitas. There'd been nothing cheap or tacky about it. Suicides normally come across as sad, lonely and deeply tragic events. The Dignitas experience didn't feel like that at all.

We struggled to find words for describing the experience and our emotions. We all used the word "surreal". What had happened that day, however uncomfortable, somehow seemed to have been the right solution. It was what Rosemary had wanted.