Written by the son of a strong-minded woman in her ninth decade who asked him to help her plan an assisted death, this book promises to explore a major taboo. Surprisingly, it is often flippant and comedic in tone, but the serious issue at its core – the limit of autonomy – makes a deep impression.
By the end of the book, Susie Kennaway has not died. What happened? In a Guardian interview with author Guy Kennaway, published January 2019, Lynn Barber states that Susie was recently hospitalised, ‘in exactly the helpless situation she wanted to avoid’. The pathos-filled concluding chapter that the reader (and maybe the author) expected was not written. My internet search today revealed no death date.
But back to the beginning. Susie tells Kennaway that she wants to choose the timing and manner of her own death. She asks him to source some heroin. He demurs. ‘The principle flaw,’ Kennaway writes, ‘is that she wasn’t ill or that infirm.’
Susie is used to getting her own way. After the accidental death of her first husband, the author’s father, when she was 38 (this is in the 1960’s), Susie had to forge her way through a chauvinistic world with four children. She became strong, opinionated and combative. She took people to court. She sued a boat club for making too much noise after buying a house in its vicinity. This precedent, we are told, has subsequently allowed established night clubs and venues to be closed down all over the county by incoming residents. Susie knows her own mind, and is effective.
She lives in France with Stanley, whom she married later in life. He is older than her. They make a pact, to die together. It is clear that Susie has driven this decision. She is tired of old age, of the ‘little explosions of pain’ that occur when she moves or bends. And she remembers the good old days, when a family friend wracked by cancer was allowed to die after ‘…the doctor rigged up a morphine drip on a stepladder and attached it to Beryl’s forearm’.
The author does not buy lethal drugs. He jokingly mentions the request to friends at dinner parties. Several confirm that they have been asked to do the same. There are many elderly and infirm people out there, Kennaway suggests, who are worrying about how they will die. The merits of cocaine, nitrogen asphyxiation (‘…the brain doesn’t panic’) and specially designed death machines are considered.
Kennaway explores the transition between autonomy and its reverse, complete dependence on the decisions of others. Also, the issue of money.
He recalls how another elderly relative, Nanna, made it clear to her children that she did not want to ‘be any more trouble than I already am… I don’t know if I want to go on…’. She was admitted to hospital, and her children, knowing her preference, tried to bring her home as soon as possible. ‘Where is this place? Why am I here? I want to go home and die…’ Nanna said. She was probably delirious. The ‘doctors weren’t having any of it…. they couldn’t let that happen.’ Kennaway goes on to explain how wrong it is that 40% of a British person’s medical costs are spent in the last six months of their life, money which ‘is wasted on Nanna.’ She was eventually ‘put into care’, where the cost was £2000 a month. ‘Nanna worked for 60 years to pay off a mortgage and save £10,000. In five months a life’s worth of thrift would be wiped out, and soon after that her modest home.’ Nanna’s children became resigned to losing their inheritance. They could no longer support her previously stated wish to die, as to do so would have appeared to be for ‘pecuniary rather than human reasons’. Money and death are entwined. Duty and guilt are mixed with hard financial projections. No wonder the issue is morally complex.
Kennaway, observing Susie and Stanley, decides that ‘it was way too early to contemplate suicide’. They are frail, but they are not dying.
Susie is admitted to a French hospital with E coli septicaemia. She does not tell Guy until she is home again. He recalls how she once rang him on a mobile and chatted for a full five minutes, asking him how he was, before revealing that she was hanging upside down in an overturned car. She is a stoic. Now, for the first time, she seems vulnerable, changed. ‘I am ill actually,’ she confides. The reader takes a breath. The crisis appears to be approaching.
Kennaway tries to discuss the ‘elephant in the room’ and takes Stanley to one side. ‘One the reasons I’m here is that I don’t think we should be talking about shortening your lives, but making them as good as possible for as long as they last. What I want to know from you is what to do before you die, so I cam make it happen, or at least try to. So you are actually doing what you want to do and enjoying life, rather than simply existing.’ He tries to clarify Stanley’s views about the ‘pact’.
‘I wanted to talk about the idea Mummy said you and she had discussed, of ending your lives together.’
‘But what if I am on the middle of a model aeroplane?’ (he spends his days making them) ‘My new Sopwith Camel has a thousand pieces. It could take a year.’
‘What are you saying?’
‘I can’t in all honesty see myself doing it now.’
He is not ready to go. The pact is dead.
Susie hears this. ‘That’s not what you said to me… you are saying something different.’
There is an aroma of coercion here. It is uncomfortable.
‘… I cannot see myself wanting to die.’
Susie looks ‘deflated, beaten’. But she maintains her point of view. She has ‘red lines’, beyond which she definitely does not want to go. ‘When I am bedbound and can’t look after myself. You know. Go to the lavatory on my own.’
Time To Go was an opportunity to dig into the history of failed attempts by various MPs and Lords to pass an assisted dying law, but this is a very personal account, and Kennaway only touches on the legislative aspects. He meets an ex-minister, who declares proudly that he opposed Rob Marris’ Private Member’s Bill in 2015.
‘Why?’ askes the author.
‘For the simple reason that is was an invitation to unscrupulous people to kill wealthy relatives.’
The ex-minister elevated potential risks to the vulnerable over the immediate and palpable wishes of the dying. Kennaway, so close to his mother’s point of view, cannot understand this attitude. It is ‘bizarre.’ He does not believe that there are legions of scheming relatives out there, eyeing up their parents’ estates. ‘It is a rubbish argument.’ But it keeps coming up.
Stanley deteriorates. He acquires a urinary catheter; the drainage bag sits in a blue bucket. He loses a great deal of weight. He enters a terminal phase at home. ‘He was going to die, and he was somewhere I’d put between the outskirts of that sprawling suburb Discomfort near the dual carriageway to the ancient city of Agony.’ There is a bewildering collection of drugs in his room. Nurses continue to attend and inject antibiotics despite their apparent futility. Susie witnesses the horrors of dying and tells her son; ‘…there were strings of a gluey mucus type substance coming from his open mouth… I pulled with my fingers, on and on until it broke… I had a big towel in my hand and I wanted to end the agony… I put away the towel and cried, for him and for me.’ By the time Stanley dies, grief has been all but consumed. ‘I had already priced death into his valuation.’ His death was ‘traumatising to us all.’ It occurred in his own home, though not in the UK, and I wondered if there were medical-cultural differences behind the ‘desperate last-ditch operation to keep him alive for another few hours.’ It was not a well-managed death, on paper. Although it left a deeply negative impression on the author, Stanley’s death is not a strong argument for assisted dying. It is an argument for sensible end of life care.
The strong arguments for assisted dying come from Susie, who contributes a chapter! It is the book’s playful coup de crayon. Kennaway allowed her to read the first four-fifths of the manuscript (the final fifth had not yet been lived). Her cry for autonomy articulates the frustrations of many.
‘I am simply wanting to go while the going is still good, when I can be responsible for my life and my death’.
‘Why the hell should anyone tell me I do not have the right to dispose of myself when and how I wish? … And here I am not just speaking of illness and pain. I am talking about the time to live and the time to die. I am asking on behalf of those of us who have lived fine lives and do not want to end up in a care home, no longer in charge of making decisions for ourselves.’
Later, knowing that her son will not be providing heroin, Susie discloses that she has set aside a large store of Tramadol. She identifies a section of the road to St Antonin; ‘It’s steep and there’s no barricade. And there’s a long drop to the river. I know a good spot. I know exactly the spot.’ It is sad to read this kind of suicidal ideation. But it is a reaction to the fear of loss of control.
The book ends gently. Susie does not die. She engages her impressive mind and spirit on various causes. Her son hopes that ‘…there was plenty of time to go, before it would be her time to go.’
Recent court cases and parliamentary debates have been concerned with making provision for those with clearly diagnosed terminal illness; old age is not regarded as such (though Susie would beg to differ, I’m sure). Nevertheless, the essential themes are common to both scenarios, and are well described in Time To Go; loss of agency on one hand, risk of coercion on the other. Anyone interested or involved in the assisting dying debate would benefit from reading this book. As would those who are likely to grow old. All of us, then.
Guardian interview with the author.