Jenny (not her real name) was a week or so short of her sixtieth birthday when she came into the hospice. She had advanced cancer and she, and her family, knew the end was close. And her family were devoted. Not a day went by without one or more of them at her bedside.
We stabilised Jenny's condition; she was comfortable, more independent and able to have quality time with her family. And, as often happens with good palliative care, the prospect of her imminent death receded. Then came her birthday. It was a muted affair, but understandably so as it was clearly her last.
But then the family visits gradually fell away. "It's a pity your family can't come so often these days," one of the nurses said to Jenny. "Oh," she replied. "They won't be in so much now. You see, my fixed-term life insurance expired on my birthday."
This isn't the only time I've been fooled. Most patients' families are loving and caring. But sadly some are not, and they are not the rare exception.
Laws on 'assisted dying', like the one tabled by Lord Falconer and debated last year in Britain's House of Lords, are written as if everyone is a strong-minded, no-nonsense individual and never susceptible to depression or influence or doubt. But I must tell you, most patients facing an approaching death just aren't like that. They are struggling to come to terms with their mortality, veering between hope and despair and back again, worried about the impact of their illness on those around them and trying to make sense of what is happening to them. In a word, they become vulnerable.
Yet many who want to legalise what they call "assisted dying", and are passionate about concepts such as autonomy and control, seem unable to grasp real-world vulnerabilities. There is a problem of self-projection. Thoroughly decent people who wouldn't dream of coercing others and couldn't be coerced themselves sometimes find it hard to imagine that others are not so scrupulous. When we are fit and well, it's all too easy to look at someone who is seriously ill or disabled and tell ourselves that we "wouldn't want to live like that" and we would want to make our exit.
Real compassion means recognising and relieving suffering; you have to be alongside it. That is what doctors who specialise in caring for the dying do day after day. End-of-life care has made huge advances in recent years; yet it's about far more than good medicine. It's about recognising vulnerabilities, which patients, like everyone, often try to hide, and then working to support them to live well in whatever time they have left. It's about accompanying people along what may well be the most difficult journey they have ever made and assuring them, not just with words but with actions, that, as Cicely Saunders (the founder of the hospice movement) put it: "You matter because you are you."
Oh, don't worry, we are told, all this will be dealt with through safeguards. No, it won't. These "tick-boxes" may sound plausible in theory, but they fall to pieces under the stresses of real-life terminal illness.
Matt (again, not his real name) was referred for pain control. He was clear-minded and determined to travel to Switzerland for assisted suicide. He'd been given three months to live, he said, and he wanted to get it over with. When I tentatively asked: "Is there anything you've always wanted to do before you die?" he wistfully outlined his dream holiday. He then let me help plan his travel on this holiday, and enjoyed it in a way he never thought possible. He never went to Switzerland, but had some surprisingly wonderful times before dying peacefully at home of his cancer.
Matt certainly had what Lord Falconer's Assisted Dying Bill calls a "settled intent" to die. It would have been all too easy for a willing doctor to sign off his assisted suicide. But only a small minority of doctors (just under a fifth, according to a recent poll) say they would be willing to process such requests. Most want to work to help patients live well and die well despite illness, not to be a gatekeeper for assisted suicide.
Laws are more than just regulatory instruments. They send social messages. As a society we are clear that suicide is not something to be encouraged or assisted. Legalising assisted suicide flies in the face of that. It sends the message that, if you are terminally ill, ending your life is something that society endorses and that you might want to consider. Is that really the kind of society we want?