On a sun-bleached afternoon in May, Rebecca Drury and Louise Sweeney, friends since their teenage years, strolled along a pebbled beach near Brighton, talking about death.

Rebecca, a blonde, stylish 53-year-old dance instructor, was dying. After fighting cancer on-and-off since 2016, she’d been told by oncologists in 2020 that her illness – which despite chemo and immunotherapy had spread to her pleura and bones – was incurable. Rebecca was not afraid of death itself. But she’d heard that palliative medicine cannot prevent painful deaths for some people. Already in immense pain, she was afraid of a bad death, and was making plans to avoid it.

Louise, also 53, recalls visiting Rebecca’s flat that day: a plant-decorated sanctuary perched at the top of a Regency townhouse. Rebecca, a creative cook, had prepared a salad of avocado, couscous and beetroot. Out of the window, the sun scorched down on the sea. After lunch, Rebecca took Louise on a walk, to her favourite spot, quiet Ovingdean beach. On the way, they talked. It was now clear that Rebecca wasn’t well enough to fly to Dignitas in Switzerland, which allows people of sound judgement to apply for assisted suicide by drinking tonics of antiemetic and pentobarbital drugs. (Nearly 350 Brits have taken the trip, falling asleep within five minutes and then drifting away within half an hour.) Besides, Dignitas paperwork takes three or four months. Rebecca wasn’t sure she had that long.

Instead, Rebecca said she was meeting with an end-of-life doula, a trained healthcare companion who supports people during dying. The doula, Li Mills, would help to set her affairs in order, manage end-of-life care and sit with her as she died. The cancer had taken away Rebecca’s old life – dancing, cycling, socialising, hosting – and the pain was becoming unmanageable. “I wish that I had a heart attack tonight, because I don’t want to be in this pain all the time,” Rebecca said. Louise understood. She’d watched her sister die of cancer and knew how horrible life’s final chapters can be. “Well, you know I’ll be there to hold your hand too,” Louise said.

Conversations about death tear through dozens of families every month. Even if every dying person had access to the best palliative care, an average of 17 people a day would still die in severe pain in the UK, according to a 2019 study commissioned by campaign group Dignity In Dying and conducted by the Office of Health Economics. For some cancers, like those shredding through the lungs, end-of-life sedatives sometimes don’t work; it’s hard to fall asleep if you can’t breathe, leading to the horrific sensation of being awake during your own death.

What Rebecca and Louise did not talk about was the prospect of assisted dying at home in Brighton, surrounded by loved ones. When the UK parliament decriminalised suicide in the 1961, it created a criminal offence for “assisting, aiding or abetting” suicide punishable by up to 14 years in prison. Doctors administering a lethal dose of painkillers or people helping dying friends travel to Switzerland both fall under the Suicide Act’s crosshairs. For decades, assisted dying campaigners have pushed to change this law – which they say would stop thousands of painful deaths a year, and finally grant people agency to choose how and when they die.

For a long time, it appeared the tide would never turn. In 2007 the Daily Mail blasted a Liberal Democrat MP as “Dr Death” for supporting assisted suicide. As recently as 2015, MPs voted overwhelmingly to uphold the blanket ban. But after years of campaigning, and a pandemic that has forced everyone to confront their own mortality, momentum is building. After Covid, “We’re just more aware that people can die badly,” Sarah Wootton, chief executive of Dignity in Dying, told me. New bills are being debated by lawmakers in Westminster, Holyrood and Jersey. “Now, there’s a real sense that the campaign is winning the argument. We’re in the strongest strategic position that we’ve ever been in,” Wootton said.

When they returned from the beach, Rebecca insisted on gifting Louise a pair of silver Mexican earrings studded with turquoise and blue opal. “I want to give you something to remind you of me,” she said. Louise was reluctant at first, but accepted. They embraced. “It’s really nice that you’re giving it to me now, before you’re gone,” she told her.

Rebecca was raised in a theatrical family in Nottinghamshire, with a drama teacher mum and music teacher stepdad. In her early 20s she moved to Brighton for university, fell in love with the city’s creative streak and never left. She became famous for hosting cocktail parties. “Becca’s the linchpin of the social circle,” Janice Britz, an NHS worker who’s been close to her for 15 years, told me. Friends say she made each guest feel as if the whole night had been planned for them. “Rebecca makes you feel your best self,” Janice said. “She makes people glow.”

Dignity in death

At age 48 she was active, teaching dance classes and cycling across Brighton to see friends. Rebecca’s 2016 stage-two lung cancer diagnosis screeched the brakes on her life. She immediately cut out meat, ate organic, reduced drinking and quit smoking. Within two months, she’d had an operation and was two-thirds of a lung down. Those close to her during this first phase recall a relentless optimism. When she visited the hospital, Janice remembered being asked by Rebecca, “How are you? What’s going on for you?”

Rebecca vowed to rebound and run 8k within the year. She did. Two years later, she got the all-clear. Life in her flat, nicknamed the Pink Palace, returned to normal again.

But cancer, as the physician and author Siddhartha Mukherjee wrote in his 2010 book The Emperor of All Maladies: A Biography of Cancer, “is an expansionist disease; it invades through tissues, sets up colonies in hostile landscapes, seeking ‘sanctuary’ in one organ and then immigrating to another.” In 2018, Rebecca began to suffer a pain doctors couldn’t explain. After a series of painful tests, they spotted a tumour in Rebecca’s pleura, the cavity between the lungs and chest. Again, it was removed. Eight months later, however, with the pain still present, oncologists discovered the cancer had spread to her bones, entering through the ribs.

Rebecca was told in late 2019 her disease was incurable. She opted for chemo to beat it back. But she also started planning to end her life, in the hope of avoiding a bad death. With her energy dulled by heavy medication, Rebecca began researching Dignitas.

In 1998, Dignitas was launched in Zurich. The assisted suicide non-profit allows people to die in a domestic apartment, rather than a sterile hospital environment. Since its launch, it has aided 3,248 people’s deaths. During the application process, those who wish to take their own life meet twice with Dignitas consultants, plus independent doctors, for an evaluation to determine informed consent. The catch for British members is that the months-long process and necessity of travelling to Switzerland means people have to put a premature stop to their lives. But it is still popular with those who can afford it; someone from the UK travels to Switzerland to die on average every eight days. The typical cost is £10,000. So after her incurable diagnosis, Rebecca started saving.

Rebecca wanted dignity at the end. “I live life in agonising pain, and my pain is only going to get worse,” she said. “It just seems an obvious choice to me, if I could have a lovely little party – that’s what I was famous for, throwing parties – a nice little gathering of people around me the day before, and then someone to hold my hand.” Rebecca also began campaigning for a change to UK law with Dignity In Dying. She didn’t want other people to face her dilemma: a painful death, a potential botched home suicide, or ending life early (and friends facing prosecution) via Switzerland. “The UK’s law is inhumane,” she wrote to then health secretary Matt Hancock in June. “I want a beautiful death, on my own terms.”

The 1961 Suicide Act created the legal paradox that assisting someone to do something legal was itself illegal. This is even if suicide is someone’s explicit wish and assistance is motivated by compassion. Some doctors and nurses talk of the “old days” when, if a terminally ill patient was suffering extreme pain, a doctor would prescribe or administer a high dose of painkillers to “make them more comfortable”, speeding up their death and letting them drift away painlessly. But things changed. After the conviction in 2000 of GP serial killer Harold Shipman for murdering patients via lethal doses of diamorphine, palliative care was radically altered. Doctors spoke of the “Shipman effect”.

Medical professionals are now much more conservative with painkiller dosage. Some people die in immense pain, drawn out for days. “We treat dogs better,” one bereaved husband told me. His wife had cancer, and asphyxiated in August last year, four painful days after asking nurses to end her life. This is the death Rebecca feared the most.

In 2010, the Department of Public Prosecutions (DPP), then led by Keir Starmer, clarified guidance on who would be punished over trips to Switzerland. In a years-long lawsuit, Debbie Purdy, who had multiple sclerosis and planned to fly to Dignitas to die, demanded to know if her husband would face prison time for assisting her. Eventually forced by the court to clarify, the DPP said it was not likely to seek prosecutions as long as there was, among other things, a “voluntary, clear, settled and informed decision” to die and any assistance was “wholly motivated by compassion”. To campaigners, it felt like the edges of the jagged law had been sanded down. But the law was still in place. Now they wanted it replaced for good.

At the time, ministers saw nothing to be gained from decriminalising assisted dying. And with a trinity of opponents to provoke – religious leaders, newspapers and the medical establishment – it was a potential vote loser. Then in 2015, MPs got the chance to vote on assisted dying for the first time in 20 years. Labour backbencher Rob Marris’s assisted dying bill was pulled out the hat in the parliamentary private member’s bill ballot. It proposed stringent safeguards: not only two doctors were needed to approve a request but also the High Court, and only those with six months left to live were deemed eligible. (Humanists UK criticised the bill for being too narrow.)

MPs torpedoed the proposal 330-118. But since then energy has surged. Blanket bans seem to be waning globally. Nine US states, three Australian states and four European countries (most recently Spain) now have assisted dying laws. This May, Baroness Molly Meacher, a cross-bench peer and chair of Dignity In Dying, introduced a new bill to the House of Lords, modelled on the 2015 proposal. And this year The Sunday Times launched a campaign to legalise assisted dying. “That’s extremely powerful,” Meacher told me, “partly because Conservative MPs read The Sunday Times, every single one of them.”

Most significantly, the majority of UK medical professionals now support legalisation. Last October the British Medical Association published a poll of 150,000 doctors, finding 50 per cent personally supported a change in the law to enable assisted suicide, with 39 per cent personally opposed and 11 per cent undecided. Then, in September this year, the BMA dropped its opposition to assisted dying and adopted a neutral stance. Opponents have lost their nuclear argument.

Limits to palliative care

But opponents still remain, and they’re fighting hard. Many are people of faith who want to preserve the sanctity of life. In parliament they’re led by Danny Kruger, Conservative MP and chair of the all-party parliamentary group on Dying Well. (His office did not respond to an interview request.) The lobby to retain criminalisation centres around three arguments: first, government should properly fund disability benefit and palliative care, much of which is currently funded by charity. (Legalisation advocates say these goals are not mutually exclusive.) Secondly, they say people may feel like a burden on their carers and feel pressed to die early. Finally, they argue it is impossible to have adequate safeguards to protect people from malicious families.

“It can be quite a compelling idea, that greedy relatives want auntie Flo’s assets so they’re pushing her to go for an assisted death,” said Trevor Moore, chair of My Death, My Decision, which campaigns for a broader bill to include people suffering incurable pain. “Frankly, that’s specious.” There are much easier ways to grab assets that wouldn’t include a rigorous assisted dying procedure, Moore said.

In November 2020, when Hancock announced a fresh coronavirus lockdown, a strategic question at the dispatch box from the co-chair of the All-Party Parliamentary Group for Choice at the End of Life, Andrew Mitchell, forced him to clarify government guidance further. Amid travel restrictions, “It is legal to travel abroad for the purpose of assisted dying where it is allowed in that jurisdiction,” Hancock said. It was hailed as another step towards legalisation. The strategy, for Mitchell’s co-chair Karin Smyth, is to attack the existing law – “you have to chink away at some of the side bits” – while also battling for a new one.

The Meacher bill will have its second reading this autumn. As a private member’s bill, its chances of passing are slim, but campaigners are hoping the government buckles to public pressure: according to a 2019 Yonder poll, a total of 84 per cent are now in favour of assisted dying.

On Friday 25 June, Janice visited Rebecca at the Pink Palace. Some other friends also dropped by to dye Rebecca’s hair pink. Then they drank tea and chatted. Rebecca was heavily medicated, but the pain was controllable and she was overjoyed to play the host. “Becca was just glowing. She was saying, ‘This is like it was before!’” Janice said. “And you could just see her. She’s still Becca – we haven’t lost her yet.”

Three days later, Rebecca entered a hospice. The plan was a short stay of two weeks to experiment with drugs that would placate her pain and allow her to function. But she was deteriorating fast. Two weeks later, Janice was phoned by Li Mills, the doula, saying Rebecca was in bad shape. Janice rushed to the hospice. The doctors said they suspected Rebecca’s cancer had penetrated her brain. She was near the end. Rebecca’s body was resisting sedation, plunging her into an endless agony. Janice gripped her hand for hours and hours. Rebecca could only rally a whisper, but Janice recalled her leaning in and saying, “I want to go, can you help me?” Janice checked in with the doctor about the situation with her medication. With a look of kindness and empathy, a nurse said, “We’re upping her meds as much as we can.” Janice knew there was a line they could not cross. Rebecca was pushing up against it. After Janice left that evening, she pulsated with anger at the law which trapped Rebecca in this suffering. Rebecca wasn’t scared of exiting this world. “She was scared about the suffering,” Janice said. “I’m just holding her tortured face in my mind all the time.”

At last, the doctors found a balance of drugs that let Rebecca stay under and shelter from her aching body. She was tranquil, as if sleeping. Her room was flanked by pink roses, her favourite, that matched her pink hair. She stayed in this state for a few days, as if drawing one last deep breath before letting go. On the morning of 14 July, Rebecca died, her breathing ending almost imperceptibly.

Rebecca Drury did not have the death she wanted. She exercised as much agency as she could; her doula was with her right until the end. But now, in her memory, Rebecca’s friends are fighting to change the law – to stop others suffering a painful end.

The day before Rebecca died, I spoke to Louise over the phone. “I’m wearing her earrings today,” she said, “I really needed to feel her closer to me.”

This article is from the New Humanist autumn 2021 edition. Subscribe today.