'My patient shot himself when I wouldn't help him die – he deserved better'

As a GP with over 30 years of experience in end-of-life care, I have seen dozens of patients who wished to end their own lives through an assisted death. Denying them this choice is cruel and obscene, writes Dr Julian Neal

"My patient had the most obscene, cruel, violent death imaginable because he didn’t want to have the indignity of suffering in the last few months of his life"
“My patient had the most obscene, cruel, violent death imaginable because he didn’t want to have the indignity of suffering in the last few months of his life”

Some years ago, a terminally ill patient of mine came to me and asked how he could take his own life.

He’d been diagnosed with metastatic melanoma, which had spread throughout his body, 20 years after getting his primary melanoma removed. With a grossly swollen leg and the cancer having spread to his bones, liver and brain, he faced months of decline, inexorable loss of independence, mental anguish and intolerable physical symptoms before an inevitable death.

Palliative care had been discussed and offered by the local palliative care team.

He initially presented a few weeks earlier when he came to see me with a hugely swollen leg, which was immediately a red flag. When I examined him I found huge cancerous lymph nodes in his groin, causing his leg to swell to three times the size of the other.

Three weeks after his diagnosis was confirmed by the local hospital, he came to me and asked what was going to happen to him. He wanted the facts, and he didn’t want them sugarcoated.

I told him, honestly, that I did not know for certain, but that his leg was likely to continue swelling and start weeping; that the cancer would continue to grow in his liver; that pain was highly likely.

I painted what I thought was a realistic prospect of a gradual demise over the next four to six months. He thanked me for being honest and left.

A few weeks later he returned, asking me: “Look, I’ve been thinking, can you tell me how to take my own life?”

Fears of someone overhearing, worries about telling him what to do and losing my job or getting arrested and sent to prison stopped me from giving this man what he wanted.

I told him: “I’m terribly sorry, I want to be able to help you, but I can’t.” He shook my hand and left – I never saw him again.

Dr Julian Neal has had to live with the violent suicide of his patient because he couldn’t assist him with dying


Dignity In Dying)

His wife turned up at the GP surgery unannounced where I worked a few weeks later. She was almost hysterical – her husband, my patient, had shot himself and she had discovered his remains.

She had to live with that ghastly memory for the rest of her life. And because of my inability, my cowardliness, to help him, I had to live with that shockingly violent death for the rest of my own life. And I have lived with the thought that I let this patient down for the rest of my life.

Under the 1961 Suicide Act, ending one’s own life is not a crime, but helping someone end their life carries the risk of prosecution with a maximum jail turn of 14 years – no matter if the person is dying or if it is their deeply held wish, no matter how compassionate the ‘assister’.

My patient had the most obscene, cruel, violent death imaginable because he didn’t want to have the indignity of suffering in the last few months of his life. I couldn’t help him.

Doctors who help people like this man risk a jail sentence. Their families, who will already be facing the heartache of losing a loved one, also risk a police investigation if they try to help.

The other option is Dignitas, which can cost up to £15,000 and isn’t viable for people who are already too sick to travel. The families of those who do manage to go also risk getting in trouble with the law when they return home.

On Friday October 22 2021, the Assisted Dying Bill will have its second reading in the House of Lords.

The Bill would legalise assisted dying as a choice for terminally ill, mentally competent adults with six months or less to live, alongside existing end-of-life care options, enabling them to die in a manner and at a time of their choosing.

Dr Neal is campaigning for the right of terminally ill people to take their lives with dignity


Dignity In Dying)

New polling finds that seven in 10 Brits want Parliament to back the Bill.

Research by Dignity in Dying found that up to 650 terminally ill people are taking their lives every year, with up to ten times as many trying.

Under the current law, doctors are seeing patients suffering every day, and palliative care and painkillers can only do so much.

Many doctors and medical professionals – myself included – are prepared to advise them on how to end their suffering, or help them do so.

It’s time the law changed so that terminally ill people don’t have to spend the last months of their life in agony, so that their loved ones don’t have to watch them die in extreme pain and so doctors don’t have to live with the trauma of being unable to help their patients, some of whom go on to die in violent, extreme and painful ways.

We should not allow any other terminally ill people to die the way my patient did. He deserved better – we all do when our time comes.

For more information about assisted dying, visit Dignity In Dying.

If you’re struggling and need to talk, the Samaritans operate a free no-judgement helpline open 24/7 on 116 123. Alternatively you can email jo@samaritans.org if you’d prefer to write down how you feel

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