Personal Views: I dread not death but dying
Authors: Brian Allt
Journal: BMJ (2003)

I have long held the view that we must change our attitudes to prolonging life longer than is wished for or economically sensible, a view reinforced by an article in the Independent last November by Jane Feinmann describing how a leading cancer specialist with a tumour refused treatment that he routinely referred his patients for.​for.




Figure 1



Thomas Braithwaite of Ambleside (d 1607) making his will, English School, 17th century

Credit: ABBOT HALL ART GALLERY, KENDAL/BAL




It is ridiculous that such a huge part of the NHS budget is spent on elderly people in their last year of life. I am 75. I chain smoke and drink a bit too much. I have atrial fibrillation, a much reduced vital capacity, and asthma. Forty years of spondylosis means that I have long needed anti-inflammatory drugs and chiropractic treatment. Add touchy gut and irritable bowel syndrome and the result is that I take 14 different drugs at five different times each day.


A few days in one local hospital were far worse than anything Dante could have dreamt up


Widowed 20 years ago, I have lived alone for the past 17. I have many interests and find little time when I don't know what to do with myself. I have always disliked the early morning, so I go to bed at 2 am or 3 am and get up at any time between 9 30 am and 11 am. I cook a wide range of the foods that I like, play music very loud (I am not deaf), and generally please myself. I manage alone, save for a gardener. But I have never found more than a small percentage of the human race interesting or bearable to spend time with. Most of my close friends have died during the past 15 years (including several doctors younger than myself), and none of my interests involve socialising, so I see other people socially only two or three times a week. I am perfectly happy with this.

Like any other thinking elderly person, I dread not death but dying. But it is not the likely pain and suffering that I most dread. No, it is the probability that, unless I take relevant action, I will have to endure a possibly long period having to see unappealing (however well intentioned) people every day, and many times a day. I will have no choice of food, daily routine, or surroundings. This last aspect is probably the most serious, as I am like a prematurely exposed chick when I am kept away from my shell (much of which I have designed or made myself).

Until a couple of years ago I had spent no time in hospital, apart from a minor operation in 1965. A few days in one local hospital and two pairs of days in another were, to me, far worse than anything Dante could have dreamt up, and I am not just talking about squalor and inedible food. A year or so ago, when I experienced what I assumed was a terminal heart attack, I did not ring for help but sat down and wrote a farewell letter. Amusingly, after about four hours the pain's relocation made me realise that it must have been heartburn.

I was sickened a few years ago to see a television programme by Baroness Finlay about hospices. The state of what looked like live bait at an angling shop—which she insisted still had “quality of life”—made clear the extent of power that others can exert on the helpless and mindless. If Feinmann is correct, many doctors do not tell patients of their impending death and let them suffer invasive procedures, away from home and at huge expense. We should, when we feel the time is right, and perhaps with some hinting from our GP, be able to get an annual assessment of the probability of our being able to live the next year independently. (It might be necessary to explain “probability” to some people.) When the probability falls to a level that we personally—and hence without pressure—deem unacceptable, we should be able to be prescribed a drug to end our life comfortably and efficiently.

As things are, elderly people who wish to end their lives are put in the position of gambling on inadequate knowledge and means, which can result in more suffering and expense if their steps are unsuccessful. Only the knowledge that I have paid a fair amount in direct and indirect taxation assuages my guilt at my NHS drugs bill. Having been exposed to religion only through my observation of social phenomena (I am a psychologist by training), I resent my life being governed by the “spiritual” (a word I have never understood) beliefs of others.