DAVID PATRIKARAKOS: The day my aunt Rosie died at Dignitas

On Wednesday September 11 at 10.30am local time, my aunt Rosie killed herself in Zurich. She had planned it for a while – over months in fact, as she was obliged to do.

Death, when it came, was a release. It was quick, it was painless and – the most important thing here – it was entirely voluntary.

Rosie had muscular dystrophy: a genetic disorder characterised by the progressive weakening of the body’s skeletal muscles. It’s a tortuous process of degeneration. Over time, your muscles break down, and it becomes harder to walk, breathe, swallow – to do anything really.

It was late last year when Rosie told me she had decided to do it. I was upset, but I understood her decision. It now took her 20 minutes to go to the loo; 30 minutes to get dressed.

‘Do you really want to see me at the point where I have to be winched out of bed, David?’ she asked. I did not.

And so Rosie made the decision to take her own life (though she never referred to it as killing herself). But there was a problem.

In the UK, assisted dying is illegal. The 1961 Suicide Act makes assisting or encouraging someone to take their own life a criminal offence punishable by up to 14 years in prison.

This meant Rosie had to look further afield, so she did – and found Dignitas, a non-profit organisation based in Zurich, Switzerland, that operates under Article 115 of the Swiss Penal Code making assisted suicide legal provided there are no ‘selfish motives’.

What makes Dignitas unique is that it offers its services not just to Swiss residents but also to foreigners. Between 1998 and 2023, 571 British nationals died at Dignitas. And it’s getting more popular; in 2023 alone, 40 people died there – the highest number since 2019.

Critics call it ‘suicide tourism’ but Dignitas operates under, to my mind, an unimpeachable moral principle: everyone has the right to a dignified death. More specifically, in the face of intolerable suffering, anyone should have – under strict safeguards of course – the right to control how and when they die.

It seems that the British people largely agree with me. A 2021 YouGov poll found that 73 per cent of respondents supported some form of assisted dying for terminally ill adults.

A 2015 Commons vote to legalise assisted dying was defeated by 330 votes to 118, while in 2021 a bill introduced in the House of Lords proposed allowing terminally ill patients to choose assisted dying. But it never progressed to a vote.

Now Parliament is set to debate the issue for the first time in almost a decade, with a new bill to be put forward this month. Though Keir Starmer has previously stated he is in favour of changing the law, MPs will be allowed a free vote as it is a matter of conscience.

As it stands, the cabinet is split on the issue. Justice Secretary Shabana Mahmood has said she won’t support it; Health Secretary Wes Streeting says he’s conflicted.

It’s high time we had a vote. Rosie’s great fear was that she would degenerate so much she would be unable to make the trip to Switzerland, so in the end she probably went sooner than she had to. If it were available here she probably would have lived for at least another few months.

There are undoubtedly problems with assisted dying. In the Netherlands, people with psychiatric – so not necessarily terminal – conditions are eligible for it. In 2017, 83 people died with psychiatric complaints that may well have been curable or at least treatable.

Doctors must never be too permissive. Death should be an option only for those who are in incurable pain or terminally ill. It’s not for adolescents who think they want to die because they are hormonal, depressed, bored or all three. Nor should hospital staff be brandishing euthanasia papers at the elderly to free up hospital beds.

Things don’t get any more serious than death – and Dignitas is a serious business. Rosie decided that she wanted to go at the end of last year.

For the first step, she was required to give evidence of her condition and, being Rosie, could provide everything including her first ever diagnosis from when she was in her 20s. She applied for a provisional green light in November 2023, for which she had to write a letter outlining her reasons for wanting to die: an increasing lack of independence, pain and tiredness.

She also had to provide an up-to-date medical report, but because assisted dying is illegal in the UK, she couldn’t tell her doctors why she needed it. She then also had to send her birth certificate, dental records and passport. It was a comprehensive process.

She got the provisional green light in December. It would cost 7,000 Swiss francs, slightly over £6,000. Dignitas says that often when people get a green light, they feel a sense of relief that buys them a few months – and so it did for Rosie. In the next few months a succession of people – friends and family she had told – came to visit her and say goodbye.

Every so often I, too, would come to the UK and spend a few days with her. It could get tense. “Daaaaviiiiid” would reverberate through the flat whenever she needed something.

I knew Rosie my entire life; she is in fact my mother’s first cousin but given she’s 20-odd years older than me I called her my aunt. My first Rosie memory is seeing her struggle up the long winding path that ran through the front garden of our house in Highgate.

I would stand at the door and watch her negotiate up each step; it took so much effort she would have to bend almost double on every step. But she did it every time – without help.

I sometimes wondered how I would respond if faced with a diagnosis of muscular dystrophy. Not with her strength and good humour I always suspected. She was a presence for me and my younger brother Phillip throughout our lives. Indeed, she devoted her personal life generally to her family and friends.

In late August, Phillip, who lives in the United States, came to London to see her for the last time. We ate in the Greek restaurant Lemonia in Primrose Hill and after walked down to Camden Town – Rosie whizzing along in her electric wheelchair – where she could get her bus home (she refused our offer of a taxi).

As she boarded, I couldn’t help but think: this is a human life – it first approaches you up some stairs in Highgate and 40-odd years later drives out on a bus in Camden Town.

As she got on, she waved to us through the window. We waved back. The bus went to move off then stalled, hissing as it sank several inches. We continued waving at each other. ‘Well, this is awkward,’ said my brother.

When we were together, Rosie and I talked about almost everything, but there were three subjects she would return to without fail.

One, how I needed to return to the UK and get a flat here; two, my utter failure to commit to any of the ‘lovely girls’ I introduced her to over the years (inevitably accompanied by her amazement that they ‘put up with me’); and three – and this really got to her – the amount of money I spent on Ubers.

These monologues used to drive me up the wall, but of course I knew that behind each of them was the same impulse: she wanted the best for me.

And I listened. I am changing. I am trying to settle down; and I even took the Tube several times last week.

And I keep thinking – about life and death. Last year, I reported from the Battle of Bakhmut in eastern Ukraine, perhaps the bloodiest urban battle of the 21st century, while using a crutch and wearing a brace after fracturing my ankle shortly before I was due to go.

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I remember speaking to a friend after I returned: ‘You’ve got a death wish, David,’ he said with a performative whistle. I don’t.

In fact, every trip I take, every word I write, every country I visit is, in one way or another, an attempt to squeeze every drop that I can from what is ultimately a short existence. It’s not a wish for death, but a lust for life that I have.

But Rosie did have a death wish – literally. And paradoxically she only had this because she was one of the most alive people I ever met.

You cannot adequately consider death without also contemplating the only corollary that gives it meaning: life. Rosie’s death was, in the end, like her life, a lesson not just in courage but what creates courage: agency.

If anything should remove your agency it’s muscular dystrophy; a disease that almost literally disembodies you, that slowly renders your physical form useless and you a prisoner within it.

But Rosie had more agency than almost anyone I knew. She refused even to let muscular dystrophy take its normal course. She should have degenerated far earlier, but discovered Meir Schneider, an alternative therapist who was certified blind but, using alternative exercise techniques, was able to see again.

I was never sure of the science behind it, but every day Rosie spent hours doing her exercises and it did help. And Schneider really could see; he even had a driving licence. That said, I wouldn’t have got in a car with him, certainly not after I saw him eat an apple.

About ten days after my brother returned to the United States, I went to see Rosie for the last time. As we said goodbye in her living room, I began to cry.

‘You were like my mother,’ I told her.

‘I know,’ she said, and started to cry, too.

I walked outside. I thought I would turn back to look at her a final time, but I couldn’t. I opened the car door and got in.

‘David is it?’ said the Uber driver.

It’s late morning on September 10, the day before Rosie is going to die, and my WhatsApp is ringing. It’s her. I pick up. ‘I’m ringing you for the last time,’ she says cheerfully.

She is now at a hotel in Zurich. She had some problems with the journey over. Her wheelchair was too big for the Swiss Air flight, so she had to book with another airline.

She’s been moaning about it ever since, specifically how she wants a refund. Why do you care? I keep wanting to ask.

Instead, I ask what she’ll do today. A Dutch friend who has accompanied her chips in. ‘There is a lovely lake here,’ he says. ‘We might take a stroll around it.’

‘What are you talking about?’ she responds. ‘It’s a total s***hole.’

I ask her how she feels. ‘I’m ready to go,’ she replies. ‘Are you scared?’ I ask. ‘Why should I be scared?’ she replies.

The next day she went. I got the full story from someone who was with her.

On Tuesday at 5pm local time a doctor from Dignitas visited to check that Rosie was of sound mind and knew what she was doing. He also explained what would happen the next day. Only once, in his career, had someone decided then that they wanted to back out.

That evening the group had a final dinner. ‘This is the last supper’, a relative of ours said. ‘The difference is Jesus returned,’ someone else retorted, ‘Rosie won’t!’

The following morning the doctor arrived at 8.30am, and Rosie confirmed that she would be going through with it. It was scheduled for 10am so Rosie and those with her took a cab from the hotel to Dignitas – a corrugated prefab house on an industrial estate, which is, I was told, ‘nicer than it sounds, because it’s Switzerland’.

There was a room with a table where she signed some forms, before being lifted on to the bed. First, she was given an anti-sickness drink to line her stomach. Then the barbiturates that would kill her.

She couldn’t lift the glass, so the nurses gave her a straw, and she drank the liquid down in one go. There was no hesitation or final words.

‘It doesn’t taste very nice,’ she said.

The nurses had already explained what was going to happen. After two or three minutes you go into a coma, and then your breathing slowly stops. And so everyone waited. ‘It hasn’t worked yet,’ Rosie mumbled. And then, her last words. ‘I can still hear.’

Assisted dying is a fraught subject that is ill-served by lazy sloganeering. But it is clear to me that the time has come for the law in the UK to change. Switzerland gave Rosie something that her own country could not: the chance to die as she lived, with dignity and on her own terms.

Rosemarie Lawy, 30 July 1956 – 11 September 2024. Baruch Dayan HaEmet. May her memory be a blessing.