It took me a little while to figure it out. More than just a way to establish closeness, Dovie’s intellectual ribbing shattered the pitying mentality and saccharine tone — the false piety — that can sometimes characterize the way we relate to people with severe disabilities. It was as if to say: here I am, no different from you — unable to walk or to breathe unassisted, yes, but capable of disagreeing and being disagreed with. Have at me.

Dovie, who died last week while in a coma at age 35, spent his last conscious days railing against the assisted-suicide and euthanasia laws sweeping the democratic West. When New York state lawmakers took up an assisted-suicide bill last year, he published a viral essay in UnHerd urging Gov. Kathy Hochul to veto it. “As a young man with disabilities,” he wrote, “I fear what this state should become if suicide-by-doctor becomes law.” 

He worried that with doctors authorized to prescribe death, people like him would be nudged to choose suicide by health systems and public attitudes that view some lives as too difficult and too painful to be worth continuing. He saw this culture of death menacing his own existence. 

Dovie’s life was difficult and painful in many ways. He was born with a genetic disorder called nemaline myopathy. It basically meant that he had catastrophically low muscle tone, leaving him unable to walk. Speaking was only possible in between drags on an air tube, and then in a voice that barely rose above a thin rasp. Yet his life — his indefatigable, irrepressible drive to partake of all that it means to be human — bore witness against the culture of death.

I first met him through a mutual friend — Professor Robert George, the great Princeton ethicist — after an event on the rise of anti-Semitism, held at New York’s Center for Jewish History in 2017. As I would soon learn, he had very little patience for small talk and pleasantries. That first time, he cut to the chase. “We’ll never have a proper discussion about anything,” he began, “until we learn that rational people may have perfectly rational reasons for believing things we find horrible.” 

OK, but what are you talking about? 

“Gun control and abortion,” he shot back. “According to one side of these debates” — a deep drag on the air tube — “I have blood on my hands for supporting the Second Amendment” — another drag — “and I’m only motivated by the Bible to oppose abortion.”

Dovie debated vigorously, on first principles — rare among our cohort but natural for one reared on traditional Jewish learning. In those days, both of us still adhered to the tenets of traditional Reaganite conservatism. In the decade that followed, he stayed there, more or less, only becoming slightly more Trump-friendly. Whereas I gradually shifted to a more heterodox position that embraced labor unions and thicker welfare nets — conservative social democracy or blue Labour are probably the best labels for it. 

Dovie would have none of it. “Unions?” he scoffed. “That’ll just mean the people who care for me will cost more and work less!” And he wouldn’t relent in such discussions, no matter the social context. It’s what made his company equal parts maddening and enjoyable. Dovie offered no deference to social rank or politesse, and he expected none for his disability. He would have been disappointed in me if I backed away from my pro-labor position on account of his needs. And so we argued, by phone and in person, almost to the end.

Dovie befriended with no less vigor. Typical for a Millennial and one with his physical limitations, many of his friendships took shape online. But as much as possible, he tried to drag them into the real world: to force his e-friends see the man behind the tweets. He unburdened himself with relative ease — “Am I likable? Like, do you grit your teeth around me?” Yes, you are — and invited similar openness. He drank life fully, somehow, and strong bourbon, too.

Dovie fell in love. Attending conservative galas, he’d often come accompanied by young women who were all too happy to assist him. Sometimes, though, he wanted more than assistance. He wondered out loud to me if he had a shot with some of them. “I need to get married, dude,” he’d say. His romantic side attested to Aristotle’s observation that man’s domestic impulse is even stronger and more foundational than his political impulse. But in Dovie’s case, that impulse would remain frustrated, as far as I know. I could help him get published, but I couldn’t help him there. Here, I may have succumbed to that pity I knew he hated. 

And Dovie believed. Though born to an Orthodox rabbinic family, he began exhibiting a strong attraction to the Christian faith in the late 2010s. At first, it was merely a civilizational draw. “I do not know whether or not there is a God,” he wrote to me. “I am inclined to think so. Yet I think that atheism is an absolutely untenable philosophy for society even if it is the truth.”

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But as is often the case, his “I am inclined to think so” led him to “mere Christianity.” He had himself baptized as an Episcopalian, but I could sense he was heading Rome-ward. “I HAVE CATHOLIC QUESTIONS,” he texted me in 2018. Dovie, I think, was one of those people for whom the Catholic Church is its own proof: the sheer fact of an institution that has persisted for two millennia, teaching the same thing — not least when it comes to the value of life, all life.

When he was ready to be received in the Church, I served as his confirmation sponsor at a Mass celebrated in Latin at a church in Brooklyn on April 17, 2022 — Easter.

As the years wore on, it was hard to avoid the impression that his condition was worsening. When we’d go out to dinner, he could only manage soup, having once relished grilled chicken. Later, just the bourbon. Eventually, not even that. Then, in late May 2025, days after his UnHerd essay appeared and was adapted into a New York Post column, he had an apparent mishap with his breathing device. I visited him at the Brooklyn hospital where he was initially treated, said several decades of the Rosary, held his hands. 

Early on, there were little signs of movement under the eyelids, but these apparently proved illusory. Dovie stayed in a coma, lovingly cared for by his family at multiple facilities, for more than a year. My final text to him — “Hey, dude, still basking in the afterglow of publication?” — went unanswered. Then again, at his confirmation Mass, the words of the Introit reassured both of us: Resurréxi, et adhuc tecum sum, alleluia. 

Jane was fortunate: her parents successfully sued for guardianship, and a court ordered the medication to be destroyed. Jane “went on to recover from all of it, including her anorexia”, according to Matt Vallière, the executive director of the Institute for Patients’ Rights. Jane found work as an occupational therapist, went on vacation, and even purchased a home. Although she ultimately died two years later of complications from her history of eating disorders, she’d had an opportunity to “live her best life”, Vallière says. That any medical professional decided that Jane qualified for assisted suicide, he claims, was “absurd”. 

Jane’s case isn’t unusual. It’s a symptom of unprecedented behind-the-scenes chaos in the assisted-suicide bureaucracy. Violations of assisted-suicide laws are rampant in the states with the largest and oldest programs. Yet I have found no suspensions or revocations of clinician licenses, even when patients were endangered.  

Much of the issue is oversight. In each of the 11 states that have implemented suicide-by-doctor, regulations require clinicians to submit compliance forms, typically within days of a patient’s death. These forms document that the patient expressly consented to die through assisted suicide, and that the clinicians followed all necessary legal safeguards and eligibility criteria, including affirming that the patient is terminally ill and of sound mind.

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Failure to submit this documentation isn’t just a statutory offense. Medical providers and pharmacists who fail to “make a good-faith effort to file required documentation in a complete and timely manner”, as Washington state law instructs, risk losing “immunity protection” for the criminal act of assisting someone’s suicide. Yet a Department of Health report found that physicians improperly reported compliance for a third of all assisted suicide deaths in the Evergreen State. Indeed, Washington is missing 515 compliance forms entirely for the period between 2009 to 2023, according to my calculations based on annual reports, and is also short of 293 “written request” documents that patients are required to sign attesting that they wish to die by suicide. In Colorado, my calculations find that almost 1,800 compliance forms have remained missing since 2017. 

States can’t answer the most basic question: how many physician-assisted suicides have been facilitated by clinicians in America? Across Colorado and California, state authorities have no record of the type of “aid-in-dying drugs” that were prescribed to more than 1,000 patients, according to my analysis of state reports, including the California End of Life Option Act 2024 Data Report. In Oregon, the health authority has records on 376 assisted suicides completed in 2024, but for another 178 cases in which medications were prescribed, authorities don’t know if the patient died by ingesting the drugs, or even died at all. 

Assisted-suicide physicians aren’t the only ones to blame. The proverbial smoke detector keeps going off, but state overseers are choosing instead to remove the batteries. In 2022, Washington state announced that its Department of Health is diverting “all available funding” for its assisted-suicide compliance-review program to “data entry of submitted forms”, due to lack of funding from the state. Data entry is commendable. But by law, the state is also required to “review” reporting compliance and issue an annual report. Instead, this summer, a pop-up appeared on the department’s website: “Important Note: Due to funding cuts, the Death with Dignity Program at the Department of Health is suspended. … A 2024 annual statistical report will not be released.” 

Washington state’s decision surprised even assisted-suicide clinicians. Jessica Kaan, the medical director for End of Life Washington, an institution which facilitates assisted suicides in the state, warned on a forum for providers that “no one will even be monitoring or responding to emails or phone calls that come into the DOH [Department of Health] about the DWD [Dying With Dignity] program”. Kaan called it “a grim situation”. After this pushback, the state announced that it will release the 2024 report after all — but it will be the last one ever to be released. 

Washington isn’t alone. When New Mexico legalized assisted suicide in 2021, state legislators mandated annual compliance reporting, which has never happened. Instead, the state Department of Health’s website described these reports as “coming soon” — until this summer, when, according to internet archives, the promise was quietly taken down. 

This systematic disregard of safeguards is happening as the process is being fast-tracked: states are removing requirements that applicants reside in state; allowing less-credentialed providers, such as social workers, nurses, and physician associates, to perform assessments instead of psychiatrists and psychologists; and reducing minimum waiting periods. In Oregon, which waived waiting periods in 2020, clinicians have reported in Oregon’s annual Death with Dignity Act report that assisted suicides routinely occur on the same or next day the patient makes the request. Since in some cases it takes up to five days for a patient to die from ingesting the death cocktail, it is possible that it will take a patient longer to die than to receive lethal prescriptions.

The proportion of deaths of vulnerable patients has also increased by magnitudes. In the first year of Washington state’s program, 16% of patients mentioned “the physical or emotional burden on family, friends, or caregivers” as a reason for their decision to die, and 2% were concerned about “the financial cost of treating or prolonging the patient’s terminal condition”. By 2023, according to the state’s reporting, the number concerned with “feeling like a burden” jumped to half of all assisted-suicide deaths, and a 10th were concerned about “financial implications of treatment”. 

A similar trend is unfolding in Oregon. In 2009, the first year that the program was available, no patients told their assisted-suicide clinician that they were choosing to die because of financial concerns, and only 12% felt like a burden. By 2024, the state’s reporting revealed that it was 9% and 42% of all assisted suicide deaths, respectively. No other states even report this data. The “attending physician follow-up form” in California, which records patient concerns that contribute to the choice of “aid-in-dying”, doesn’t have “financial concerns” or “feeling like a burden” on its otherwise identical menu of options. 

The lack of both governmental and physician compliance with legally mandated oversight is resulting in a dangerous situation for patients. Craig New, who told me on the telephone that he’s the sole employee of the Oregon Health Authority responsible for monitoring compliance reporting, says that “ultimately the things usually get resolved because we bug them until they finally send in the paperwork”, but even so, his office has reported around a dozen physicians to the Oregon Medical Board for violations of compliance reporting. Thanks to privacy laws regarding medical licensing, it is impossible to know whether the reported physicians faced repercussions, but my review of the Oregon Medical Board’s investigations reveals that few offenses are prosecuted. 

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One example is Rose Jeannine Kenny, a family doctor, who in 2016 was sentenced to five years probation by the Oregon Medical Board for dozens of alleged prescription violations. Later the board received “credible information” that Kenny may have again violated the same provisions she was previously reprimanded for, and may possibly have committed “violations of the Oregon Death with Dignity Act”, such as failure to ensure consent, follow the rules of written and oral assisted-suicide requests, abide by the minimum waiting period, and file compliance records. Kenny once again kept her license, this time by agreeing to “participate in all physician steps” for 10 more assisted suicides, supervised by a mentoring physician from Compassion & Choices — the largest lobbying group for assisted suicide in the United States. (UnHerd was unable to reach Dr. Kenny at any of the medical practices with which she is associated online.)

The states are the only entities able to keep records on assisted suicides and the only entities available to monitor them. Neither researchers nor law enforcement are allowed to systematically access records due to confidentiality laws regarding physicians and patients. In some states, such as Oregon, records are routinely destroyed after a year, and in most states, death certificates by law can’t mention assisted suicide.

Recent court proceedings in Maryland eerily echo the lawsuit regarding Jane. Angela Guarda, the director of the Eating Disorders Program at Johns Hopkins Hospital, testified that she was contacted by an ex-patient of Jennifer Gaudiani, the physician who coined the term “terminal anorexia”, and who has prescribed assisted-suicide medication to at least one patient. The concept of terminal anorexia was meant to apply only to patients over age 30; for younger patients, Gaudiani stressed in a paper for the Journal of Eating Disorders that “every effort should be made to promote full recovery and continuation of life”.

The ex-patient reported that her assisted-suicide assessor told her “she would ‘make an exception’ for me and ‘allow’ me to die”. The patient reported feeling coerced. She eventually weaned herself off morphine and hospice drugs and, 18 months later, reports that she’s doing well, with a job, a group of friends and a new puppy.

Patients like these, who need hope the most, are facing much more than their illnesses. They also confront an assisted-suicide regime that blatantly and routinely violates the legal safeguards that were meant to ensure their protection from a death they might not want.

Correction: An earlier version of this essay misstated the entity that lodged the Jane lawsuit.

He had to do something. So he went to the courts. The legal claim he filed on that frigid winter day would put Wade on a quest no father should have to face: saving his daughter’s life from a Canadian health system that at times appears more committed to delivering death than protecting health. By taking legal action, he managed to delay Marge’s death for a while. But he is set to lose the battle.

Wade and Marge aren’t the real names of this story’s subjects. The case is under a Canadian publication ban issued by a provincial court in Alberta, leaving Marge’s family reluctant to speak on the record. Yet with the pro-euthanasia Liberals re-elected to power in Canada and assisted-suicide legislation swiftly clearing obstacles in Britain and New York state, among other jurisdictions, their story must be told: for it highlights the slippery-slope expansion of the categories of patients deemed eligible for suicide-by-doctor, once the practice is legalized.

After the January notice came the details. The last physician to assess her for assisted suicide, a family doctor practicing with the Alberta Health Services (AHS), took fewer than 24 hours to review and approve her application. And although the neurologist treating her for fatigue and pain assessed her as “normal”, another family doctor, unknown to her parents, declared her to be terminally ill. The clinic at which this family doctor practices referred UnHerd’s request for comment to AHS, which told UnHerd that “as this is before the courts, we are unable to provide comment”.

“She tells us that she’s getting [Medically Assistance in Dying], and of course we freak out”, Wade tells me. “I was new to MAiD. I didn’t know anything about it.” He describes his daughter, Marge, as an intelligent young woman. He loves her, and he was saving money for her to be independent, to move her from the family home to her own apartment. She was healthy, but convinced she was sick.

Her only diagnosed conditions were autism and ADHD, which made it difficult for her to keep in touch with her friends during Covid lockdowns or to hold down a job. Her life was nocturnal and online, and that worried him, as did the sort of online peer pressure that bears down especially on younger women. Wade says: “For the last eight years, she has spent a lot of time online researching medicine and adverse medical conditions”. She slept through the day and stayed up most nights until 4 a.m. or later as she accessed “online support groups and chat rooms with other people who share her sickness”.

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Canada has become a warning light for the limits of enforcing safeguards for euthanasia. Even though hundreds of reported violations of Canada’s criminal law on euthanasia were never fully investigated by authorities, Marge’s story is different. She has thus far refused to make public the diagnosis on which she based her application for suicide. Her father, however, insists that it’s her autism that has caused to her become fixated with being sick — terminally so.

In Canada, intellectual disabilities or mental illness alone are no reason for people to receive MAiD. That’s unlike the Netherlands, where at least five people with intellectual disorders younger than 30 cited autism as their primary motivation for euthanasia. Canada is supposed to be different — at least, until 2027, when the country will expand the law to approve assisted-suicide requests for cases of mental illness alone.

As it is, to qualify for euthanasia in Canada, you need any two physicians or nurse practitioners to say you meet the eligibility requirements. You must be over 18 years of age, mentally competent, eligible for health care, and have a “grievous and irremediable” physical illness or disability. Marge’s autism, her parents have argued in court, means that his daughter “is vulnerable and is not competent to make the decision to take her own life”.

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It was 2021 when Marge first filled out the form — without telling her parents — asking to die. AHS, the public health-care system, connected her with two physicians. Although one physician deemed her eligible without any diagnosed physical symptoms, according to Wade, the second denied her application, presumably because she had no terminal illness. She seems to have only met some of the requirements, although it is impossible to know for sure without access to her MAiD assessment. Alberta’s policy was that in the case of a tie, the suicide would not proceed.

But Marge was determined.

In 2022, she went doctor-shopping. She found another physician, an Alberta family practitioner, who intervened and supported her (their clinic didn’t reply to UnHerd’s request for comment). Unknown to the family, this doctor signed a change in her “Goals of Care Designation”, which is the medical standard used in Alberta to indicate how severely ill someone is. The doctor switched it to the most extreme category, which in some Canadian provinces indicates the likelihood of imminent death; that was almost three years ago.

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The following year, in 2023, she applied for assisted dying a second time. Once again, the two physicians consulted disagreed. (The clinics at which these two practice didn’t reply to UnHerd’s request for comment; AHS declined to comment, citing the court case.) This time, however, the so-called MAiD navigator, who sherpas patients through the process, connected Marge with a third doctor as a “tiebreaker”. The chosen physician was the same one who had approved Marge’s MAiD application the first time, and did so again, within 24 hours.

It was only then that her parents found out from Marge that she had been approved for assisted suicide. Her parents pushed back. Tempers flared. And the MAiD navigator claimed that Wade was a “safety risk given his threats” fewer than two weeks before she was set to die.

Her father couldn’t understand how any doctor could think Marge was qualified to die. “I thought MAiD was for, like, you’re dying anyway. So, we’ll just speed it up because you’re suffering. That’s what I thought it was for”, he tells me. “And I’m thinking, well, how could this be for Marge?” So, the day before her “MAiD provider” was meant to pay a final house visit, when a physician and a nurse would bring the lethal but now routine injection of a sedative, a coma-inducting agent, and a neuromuscular tranquilizer, Wade filed a last-minute court challenge. He claimed that Marge did not have a “grievous and irremediable medical condition”, that her only diagnosed illnesses were mental, not physical, and that her second tie-breaking assessor was not independent.

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That day, an initial judge granted the temporary injunction to block physicians from ending the life of Wade’s daughter. But then the case went to trial.

This was the first time anywhere in North America that a legal assisted suicide for a non-terminally ill patient, approved by any two physicians, was stopped by a court, at least in its preliminary stage. The judge, Justice Colin Feasby, of the Court of King’s Bench, Alberta, ruled that Marge’s father had a reasonable cause of action that the correct protocols around assisted dying weren’t followed. Marge had no terminal illness. Neither of the MAiD assessors appeared to be experts on Marge’s autism. And the independent assessor appointed as tiebreaker wasn’t, either.

Once it came to ruling on the substance of the dispute, however, the judge wouldn’t consider whether Marge qualified for assisted suicide; no evidence was accepted on even naming the condition for which she was approved. Any criminal prosecution, the judge ruled, could only happen after Marge is dead: “Parliament has put its trust in doctors and nurse practitioners, and it is not for this Court to second guess that choice.”

In Britain, Kim Leadbeater — a member of Parliament whose proposal to legalize the practice is set for a critical vote in the House of Commons this May — recently claimed that “there would be an injunction” by the parents of a person with a learning disorder if their child was choosing to die for the wrong reasons. In response to this, Wade says, “I know it won’t work”. When his injunction was thrown out, the judge ruled that his doubt didn’t matter. “As a court”, Judge Feasby held, “I can’t go second-guessing these MAiD assessors … but I’m stuck with this: the only comprehensive assessment of this person done says she’s normal”.

The ruling was no surprise. Since the Supreme Court of Canada decriminalized euthanasia, scarcely any judges in Canada have found problems with euthanasia safeguards. Rather, past rulings reinforced that MAiD wasn’t expansive enough. The 2019 Truchon v. Canada case expanded the practice to include nonterminal illnesses. Failing those who weren’t dying, the ruling said, would be tantamount to discrimination against people without a terminal illness.

One of the two plaintiffs, Jean Truchon, a 51-year-old euthanasia advocate with spastic cerebral palsy, requested to die because he was suffering from a severe disability that prevented the use of his arms. Yet Truchon also told a friend that he would have chosen to live if he received adequate support at home.

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The Trudeau government chose not to appeal the decision, despite opposition from virtually every prominent disability-rights organization in Canada.

In Marge’s case, too, Canadian disability groups mobilized against the ruling; they agreed with Wade that disabilities shouldn’t be compared to a terminal illness. At stake is a future where disability supports are neglected for immediate and cheaper death-on-demand, only for those whose disabilities are too profound or serious for the state to support.

In September, some of the largest Canadian disability groups launched a constitutional challenge against euthanasia based on nonterminal disabilities. The suit claimed it is an “appalling injustice” to offer suicide just on the grounds of disability. “It is not just wrong”, says Krista Carr, the executive vice president of Inclusion Canada, in an email to me. “It is discriminatory and violates our most fundamental rights.”

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Yet even if that constitutional challenge triumphs, it will be too late for Wade. He says he has spent more than $150,000 in legal fees, half of it through credit-card debt; a further legal appeal would have to come from money he doesn’t have. But the expense did not bother him: “This is just money. We can make it. We can’t go to the store and buy another Marge. I don’t regret it at all.”

His legal challenge failed, but it restarted Marge’s assisted-dying process from the beginning. He tells me she had applied again. Meanwhile, in April 2024, Wade appealed the court’s decision, which delayed any further assisted-suicide approval until October that year, when his appeal case was to be heard. But Marge began starving herself that June, so he dropped the appeal a week later.

More recently, I received another message from Wade. Marge’s third application to die had been approved. Wade waits, angry and terrified, to receive the scheduled appointment of his daughter’s death. It could happen anytime.

Now compare the experience of Linda van Zandt. In 2016, on the day of her aunt’s assisted suicide in California, an Uber arrived bearing thousands of dollars worth of lethal medication. That included 100 capsules which had to be crushed, dissolved and swallowed within the hour. Wearing latex gloves and wielding toothpicks, the family frantically scraped the white powder from the capsules, combining it with a sugar syrup to make a bitter sludge so “vile” that van Zandt broke down in tears. Afterwards, she sat at her kitchen table wondering: “Who wrote this law?”

That, to be clear, isn’t everyone’s experience — but then nor is the romanticised picture presented by assisted-suicide advocates. The vision of people like Pratchett “is not the clinical reality”, says Mark Taubert, palliative care consultant and professor of medicine at Cardiff University. Claud Regnard, a retired consultant, points out that only two studies have compared “quality of death” by assisted suicide and by nature taking its course. Both studies, one in Oregon, one in the Netherlands, concluded that they were as good, or bad, as each other.

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Assisted suicide relies on lethal drugs. But how reliable are the medications themselves? An article in a leading medical law journal remarks: “The pervasive belief that these, or any, noxious drugs are guaranteed to provide for a peaceful and painless death must be dispelled; modern medicine cannot yet achieve this.” On every point — the supply chain, the means of administration, the risk of complications — the reality is far from straightforward. But that reality is about to hit Britain as the Leadbeater Bill on assisted dying is being debated by MPs on 29 November.

Take Mehdi Alavi’s Dream Pharma — which operated out of the Elgone Driving Academy in Acton. In 2011, this one-man firm was suddenly placed under the spotlight of an international human rights story, as it emerged that it was supplying Arizona’s death penalty system with deadly chemicals.

Why did Arizona have to rely on a man at a driving school in Acton? Welcome to the strange world of lethal drugs, a shadow world largely unmonitored by health authorities, where supply chains can suddenly disappear, where new experimental mixtures come and go, and where best practice remains decidedly unclear.

When it comes to the physical stuff doctors depend on, assisted suicide and the death penalty are entwined. In the early 2010s, European companies launched tough new restrictions on the export of certain drugs to the US because the drugs were being used for capital punishment. That explains the emergence of individual suppliers such as Mehdi Alavi. But these small-scale alternatives were soon banned by American courts too. US pharma companies also stopped making the drugs used in assisted suicide — possibly because there are few other medical uses for them.

The shortage caused problems for penitentiaries and assisted-suicide clinics alike. One chemical, until then a popular choice in assisted-suicide states, practically disappeared from the market. Assisted-suicide doctors’ groups scoured America looking for the drug, but to no avail. Next they turned to another chemical which was supplied by a company called Valeant. The company was plagued by scandal and investigated for price gouging; the price of the drug rose from around $400 to almost $3,000 per lethal dose between 2010 and 2016.

In the end, American assisted-suicide doctors had to come up with their own solutions. But the blend of toxic substances caused “severe pain” , so physicians tried out other combinations, tweaking the formula half-a-dozen times. Across the globe, meanwhile, there are countless variations: more than 30 chemicals are used in the different forms of oral or intravenous assisted suicide.

As with death penalty procedures, then, there is no gold standard, but rather a great variety of options, none of which has established itself as the most appropriate. According to an article in The Lancet, complication rates with assisted suicide may be even more frequent than those with the death penalty.

How serious are those complications? The data is extremely patchy, but some have attempted statistical estimates. With oral methods, a third of assisted suicides take between 90 minutes and 30 hours. Up to 9% have trouble swallowing the dose; up to 10% vomit it up; up to 2% re-emerge from their coma. There are also horror stories, such as the Dutch woman with Alzheimer’s who recovered consciousness and was held down by her daughter and husband while a doctor finally euthanised her.

Then there are the unknowns. Baroness Finlay, a palliative care specialist, told the parliamentary committee on assisted suicide last year that during executions by lethal injection, “four-fifths probably regained a degree of consciousness”. Finlay said that though there is an obvious need for more research on consciousness in euthanasia and assisted suicide, nobody has ever done a proper study.

Not everyone is so sceptical. As Silvan Luley of Dignitas has claimed: “There has been not one case that did not work, in the sense of the person not reaching the goal in a dignified way.” Dr Lonny Shavelson, of Bay Area End of Life Options, has made similar claims. “These,” he says, “are lovely deaths.”

But every claim and counterclaim should be qualified by the fundamental point: the evidence base is inadequate. No drug regulatory authority anywhere has approved any drugs for use in assisted suicide. The 2019 protocol from the Canadian Association of MAiD Assessors and Providers acknowledged that there had been “little to no research” on their recommended combinations, and “no peer-reviewed literature to guide best practice”.

In the British context, meanwhile, supporters of assisted suicide seem conscious of the need for more research. Dignity in Dying told me in a statement that assisted-suicide drugs “are under constant review amongst clinicians and that best practice is constantly developing”, and that the UK procedure would depend on “engagement with healthcare bodies and regulators”, drawing on other jurisdictions “where they are confident that the drugs used are safe, effective and provide dying people with a dignified death”.

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Which drugs might a future UK assisted suicide programme adopt? The Leadbeater Bill mentions none specifically, simply stating that the “Secretary of State must, by regulations, specify one or more drugs or other substances”. Leadbeater has not given any view on the subject; her chief of staff Lance Price tells me that it would be a matter for NICE and other regulators. NICE didn’t respond to a request for comment. For their part, UK doctors themselves seem unaware of the challenges. As a 2016 report by the British Medical Association found, some physicians were “surprised” to learn that assisted suicide could come with complications.

Dr Regnard, who is not against assisted dying per se, told me that the introduction of such unevidenced drug combinations would be completely unprecedented. “I think it puts us back 100 years to when there was no regulation, basically people could do pretty well what they wanted.”

In the end, the assisted suicide debate will hinge less on these questions, though, and more on the familiar trade-offs between personal autonomy and threats to the vulnerable. Yet that shadow world of lethal drugs suggests a broader point: that taking life is, at the very least, an awkward fit with healthcare — and that when these cocktails are introduced into a medical system, the system itself inevitably changes. You can call Kim Leadbeater’s proposal brave or reckless. But it would surely be the biggest experiment ever conducted on the NHS.

You can call Samaritans for free on 116 123, email them at jo@samaritans.org, or visit www.samaritans.org to find your nearest branch.

Yet even though she was prepared, her death would still be messy: both for her and the family she left behind. Tensions between my siblings had escalated over the months, as we negotiated a difficult and stressful process. Let down by the officials who were meant to help us, it would be fair to say that assisted suicide killed my family along with my mother. 

Mine isn’t just a personal tragedy. As euthanasia inches towards legality in Britain, with a private member’s bill on assisted dying potentially being debated in the Commons this month, we must think seriously about the logistics of death. Ignore it and we risk wreathing a nation in trauma — long after bereaved families leave their loved ones behind. For whether a longed-for release or slow and painful menace, death is a painful business. 

The protocols, though, are simple enough. Following the Oregon Dignity in Death Act, passed in 1998, the Volunteer Assisted Dying Act in New South Wales encompasses 11 distinct steps and a host of safeguards. It is only available to over-18s who have an illness that will cause death within 12 months, or is causing suffering that cannot be relieved. Patients must undergo three assessments and write a declaration of their intentions.

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Beyond these tight theoretical rules, however, the practicalities of VAD are less proscribed. For one thing, unlike in the US, assisted dying is free. And therefore more accessible. But far more important is the way in which amateur family members are roped into the protocols. My mother, as part of the process, nominated one of my sisters as her Key Person who would help her navigate the path to euthanasia.

This, though, was a difficult emotional burden for my sensitive sister, who struggled with poor health. To make matters worse, she was estranged from my other siblings. My mother selected this sister simply for her own ease. Another, more pragmatic sister had long been Evelyn’s Power of Attorney, but when new papers were drawn up, her name was misspelled and Mum wouldn’t sign incorrect legal documents. Instead of having the papers corrected, and waiting until her daughter could make the six hour-return drive to sign them, Mum was impatient.

Instead, she defaulted to the most convenient solution: her most available child. KP worked part-time, due to her health issues, while my other siblings work full-time. For my part, I live in the UK. At any rate, the newly bestowed Power of Attorney laid the groundwork for my KP sister being named as the primary support person. It was treated as a coup against my other sister who mum had always sought advice from on important matters or during a family crisis. In fact, that sister was the family vault on all serious matters. The animosity from one sister to the other was established years before my birth.

So I was commissioned as an intermediary, offering updates from my mother and KP to the other side of the family. I had also been passing along the various visiting times and dates of my siblings, so they could avoid each other at the care home. It was exhausting.

In theory, this muddle shouldn’t have mattered. After all, the rules also provide each family with a so-called VAD “coordinator”. These professionals are there to guide and support families through the challenging process. Empathy, it goes without saying, is key. 

Alas, these theoretical safeguards were inadequate. After attending a couple of assessments, my sister was struggling to cope. Even the most resilient adult will find it challenging to accompany a parent who is arranging their own death. My mother, for her part, made the process trickier. Evelyn’s dark humour — once funny — was now hurtful as she took to saying that she was “being put down.” 

That ominous sign would soon be echoed elsewhere. In January, Evelyn passed her third and final medical assessment, and was formally granted permission to undergo euthanasia. She was elated. “I feel like a huge weight has been taken off my shoulders,” I remember her telling me, “I haven’t felt this free in years.” She sounded so relieved and happy that of course I wondered whether she would go ahead with it. But the date was set. February 22, 2024, the wheels were set in motion — and the trouble really started. 

In January, I took a flight from Heathrow to Chicago for a research assignment, in the belief that she would not go ahead with it. Between long flights and epic time differences, my role as intermediary collapsed, as my sister refused to share information with the other side of the family. Soon enough, I received frantic phone calls from other siblings desperate for crucial information. It seems that information is power and that information was being tightly held.

Now, my KP sister and one of her adult children had started to tell me when I could and couldn’t call my mother. They had established themselves as Mum’s guardians. Of course, I ignored their instructions, and Evelyn was annoyed by their interference — but ultimately did nothing to intervene.

I know, of course, that many families are dysfunctional — and VAD can’t be blamed for our internal squabbles. Yet the shallow, inflexible support offered families makes a miserable process far worse, triggering sleepless nights and agony for all of us. 

Then, on February 15, just a week before she was due to die, staff shortages meant the date had to be postponed. A tough woman, not given to weeping, she crumbled. She could not stop crying. She was terrified of dying and had psychologically prepared herself for it, only to be undone by a bureaucratic bungle. Again, I asked her on the telephone why she was going ahead with it when she was clearly afraid. “I’m more terrified of living,” she told me. 

The delay, though, did offer me the opportunity to say goodbye. So I flew out with my daughter, Ava, to Sydney. And my mother was fascinated by the granddaughter she hadn’t seen in so many years. I sat on the bed watching, mesmerised as they laughed and exchanged ideas. The deep interest Mum showed in Ava’s life made it even harder for me to reconcile her decision to be injected with a lethal dose of barbiturates the following day. The notion that she would be dead in 24 hours had not landed. It would not land.

But my mother was determined. And on February 23, we arrived at the hospital early in the morning. A social worker was assigned who, after a whispered conversation with my KP sister, promptly left the room and didn’t reappear. Unable to sit still, I roamed the sterile corridors until I noticed one of my nieces sitting alone in the public waiting area. Such was her distress I hardly recognised her. The social worker, though, was nowhere to be seen. 

Evelyn arrived at midday, dosed up with painkillers, awake and chatting. Only now did it seem real. When we all entered her room, the VAD coordinator was there, having suddenly reappeared after weeks of silence. There she was at Evelyn’s bedside, acting like nothing had happened. Speaking only to my KP sister and Mum, she merely offered a nod of acknowledgement to the rest of us. As so often, our apparent invisibility felt crippling.  

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My mother was oblivious. And after she had whispered a private message of farewell to each person in the room, an anaesthetist ended her life. Just after 1pm on February 23, 2024. Nothing in Evelyn’s life became her like the leaving of it, such was her grace and courage. 

In 2018, my father-in-law died a merciless death in England. The former country GP had Parkinson’s disease and had been in residential care for several years. When he could still make decisions, he made clear that he did not want to live if he could not eat or drink. Specifically, he refused a feeding tube.

When he was no longer able to swallow his death began. It took five days for him to die of thirst. I remain haunted by the harrowing nature of his departure.

So beyond the beauty of her passing, what have I taken from Evelyn’s death? Would I recommend it? Yes, in a sense I still would. I firmly believe NSW Health has opened a much-needed service for the terminally ill. But the system has a long way to go if it isn’t to destroy an ocean of other families. Even the most cohesive units can fracture under such immense strain. The trauma for our family will never be healed. My KP sister didn’t come to the scattering of my mother’s ashes. And none of my other siblings is in touch with her. Going through the VAD process has turned a once close sisterly bond into something uncomfortable and unwanted.

So as Britain begins its serious discussions over assisted dying, it must obviously consider ethics and morality. But equally important is to create an intelligent, reactive system of euthanasia, which cares for both individuals and their families. Failing to create that risks causing even more suffering — which would be an irony indeed. 

As part of the public health precautions against the spread of coronavirus, ministers have warned that older people will be told to stay in their homes for a period of no less than 12 weeks. If, as seems likely, the instruction is issued this weekend, it will be late June before those over-70s will be able to move around freely on our streets and open spaces. The whole of spring will have passed them by.

Similar restrictions will apply to those considered vulnerable because of other medical conditions, but the over-70s will be subject to such draconian restrictions only because of their age. The rationale is that, as observed in China, Italy and elsewhere, the Covid-19 virus is far more likely to prove serious, even fatal, among people in that age group. Indeed Italy’s elderly population is advanced as a reason why that country has been especally hard hit.

Precisely why older people are more susceptible to the virus is not clear. The factor most often cited is that the immune system tends to decline with age, but it could also be that older people who catch Covid-19 are more likely to already have other medical problems. The message, though — as leaked to the media and subsequently confirmed by the Prime Minister and other ministers — is that, as the virus spreads, the over-70s will have to stay at home.

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It has not yet been spelled out how complete this confinement is intended to be. Transport secretary Grant Shapps suggested that people would be able to take their dog for a walk, and that solitary promenades could be permitted. Shopping, however, and anything that might mean encountering other people, will be discouraged or ruled out. This includes entertaining the grandchildren at Sunday lunch, as they could carry the virus, with dire consequences for someone older.

While the whole intention, they were told, was to keep them safe, this was not appreciated by all seniors. Letters pages, social media and phone-ins were at once flooded with protests from those of a certain age, most calling to insist that theirs was a defiant generation and they intended to carry on going out as they pleased. If that meant the prisons were full of bolshie geriatrics, so be it.

Broadcaster and campaigner, Esther Rantzen (79), was one of few who said that she had been self-isolating from early on and regarded it as the responsible course. There were also those who pointed to something not made explicit in official pronouncements; put crudely, that while the Government might indeed have the safety of the UK’s elderly population at heart, there was another priority, too, which was to minimise, so far as possible, the number of elderly people taking up precious hospital beds — beds that could, dare one say, be more productively used by those needing shorter stays and more likely to get better.

So advising the over-70s to stay within their four walls for months was not entirely or even primarily for their own protection; it was also, even mainly, to stop them clogging up the NHS. Given that older people have been around long enough to sense an ulterior motive, it might have been preferable for officials to set out the calculation straight. How about: if you don’t withdraw from circulation, if you insist on selfishly swanning around in society, you could find yourself taking up a bed and depriving your son, daughter or grandchild of treatment they might need.

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That is a fair case to make — but it cannot be the last word. By singling out over-70s, the burden has been placed on them to self-isolate rather than on others to keep what is now described as their social distance. But it has also risked the perception that older people are the main problem. My hair is barely greying, but I have been told several times in the past week by complete strangers that I should not be out on the streets — as though I was a danger to them, rather than they to me.

Given that older people are no more of a risk to others than anyone else, why should over-70s not be left to decide for themselves whether to stay at home, isolated, for the prescribed 12 weeks or not? For some, perhaps many, there will be a calculation to be made.

For those at the older or frailer end of the spectrum,  this could be the last spring they expect to see. If you were in your 80s or 90s, reasonably alert and mobile, would you choose to gamble on the prospect of another few years at the cost of what could be a long period of incarceration, or would you prefer to keep a measure of your freedom now? It hardly needs to be said that not everyone has a garden or private open space, or even much space at all.

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In leaving the choice open, would that not risk a disproportionate number of elderly Covid-19 sufferers clogging intensive care in the NHS? One solution might be for over-70 “refuseniks” to place their decision on the record, along with a signed statement akin to a “living will”, to the effect that they will require only palliative care if they become seriously ill.

UK medical professionals have been agitating for official guidance on the sort of life and death choices that their Italian colleagues have faced, when confronted with many acutely ill patients and limited resources. These are indeed agonising choices, but they are hardly unknown in the NHS.

A declaration from an elderly patient, stating that he or she agrees not to take precedence for an intensive care bed or a ventilator or whatever, preferring to accept that their time has come, could nonetheless be helpful. Might it come perilously close to assisted suicide — a course that both the courts and Parliament have declined to legalise? I don’t think so.

As of now, there are young people blithely discounting all the health warnings in the belief that they have little to fear from Covid-19 — as would indeed appear to be the case. If they carry the virus, however, they are far more of a danger to their elders than their elders are to them.

Those over 70 should be informed of the risks they are taking, and encouraged to do the right thing as individuals. If they were then to decide that three or more months in a personal prison was too high a price to pay for however many more months or years of life they might judge they had left, they should be allowed that choice. It should be theirs and theirs alone.

Yet at the same time, there’s still some part of me that hankers after integrity. That is, if I choose a particular value, I want to hold it across the board. I don’t want to affirm it in one place and deny it in another, recall it here and forget it there. That’s why I find myself also repelled by tribalism in politics.

For the bundling up of myriad moral issues into ideological “package deals” has meant that my coveted acceptance by one tribe has become conditional upon my automatically accepting all manner of other positions, positions I can’t reconcile with my deepest convictions, and even — when I really examine them — theirs.

For example, when I went off and tried to make friends with conservatives, I thought I would be an attractive, indeed ideal, candidate. When it comes to the family, I am prepared to bite the bullet and say that family structure is crucial and marriage does matter. I believe that while there are critical exceptions — cases of psychological and physical abuse, for example — when family breakdown is the norm, children fare worse than they do in home where parents struggle through.

Whether it is being subject to the merry-go-round of changing relationships, or being constantly on the move — not knowing how long their dresses and trousers will hang in the wardrobes, not knowing whether their suitcases will or will not gather dust under their new beds — I think the ideal of the married two-parent family is worth fighting for. That is a fairly standard, orthodox conservative position.

Yet when I divulged these convictions, to my surprise I found they weren’t sufficient. “Family Values” apparently stood for a wider bundle of beliefs, and there was other baggage I had to carry, other commitments I had to approve. If I believed that intact families to be a condition of flourishing, I had also to accept that family breakdown was a main cause of poverty.

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Now on one level it is obvious that there is some truth to this. When family breakdown entails the loss of a second income, and a previous partner’s alimony payments are insufficient, parent and child will be worse off. The question, however, is what is causing that family breakdown in the first place?

The conservatives whose company I craved explained it as “cultural trickle-down”. According to that story, it was the lamentable behavioural change resulting in the nosedive of marriage among the elite, the rise of “expressive divorce” as the chance to “make oneself from the inside out, to refurbish and express the inner self” (in the words of sociologist Barbara Whitehead). Their assumption was that the persistence of such behaviour explains the concentration of family breakdown in the poorest communities today.

But try as I did to absorb it, that conclusion grated with me. What it overlooked, I felt, was the profound effect of scarcity on “intellectual bandwidth”. As sociologists Sendhil Mullainathan and Eldar Shafir posit in their book Scarcity: “When we function under scarcity, we represent, manage and deal with problems differently.” Not well, that is, since pressure does not focus the mind, as we might like to think. No, it affects people’s fundamental “orientations” — that is, their concern with the future as well as the present; it erodes their sense of agency — all crucial to sustaining a marriage.

The longer I cavorted with conservatives the more clearly I saw how the insistence on the “culture of poverty” thesis — the belief that family breakdown causes poverty, and not the other way round — sustains a larger package deal in which fidelity to the family is wrapped together with a commitment to unfettered capitalism fundamentally at variance with it. Bluntly, if it is not lack of financial resources that affects the stability of marriage, then fixing an economic system which punishes the working poor need not be a priority if you want to tackle family breakdown.

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And so, finally finding myself unable to make a home on the Right, I assessed my options. Maybe I’d been knocking on the wrong door, courting the wrong team? I started thinking seriously about the alternative tribe: the liberal-Left. But no sooner had I started to take soundings, then I found myself facing exactly the same problem: yet another package deal.

What I thought might endear me to the Left was the two years I spent leading a review into the conditions of life for the poorest older people. What had confronted me at every juncture was the depth of marginalisation, the realisation that despite the phenomenal rise in life expectancy, Britain is for many no country for old men.

I visited care homes where residents told me, “the outside world never comes in here”. I met carers in circumstances so isolated that they and the parent they were caring for had become “each the other’s world entire”. I conducted a telephone poll revealing that 40% of those older people who were going to be home alone for Christmas had children living in the same country. And I found that marginalisation expressed itself most frequently in older people’s fear of being a burden — upon the state, upon society and upon the family.

Inspired by the Left’s historic value of inclusion of the elderly — most notably, the campaign by the Fabians and Liberal Party to provide pensions to older people left high and dry by industrialisation — I assumed that I would feel at home with their attempts to transform the lives of the elderly. Instead, however, I found that for many the next great reform was assisted suicide.

Again, this grated with me. For in a society where older people increasingly fear becoming burdensome, it struck me that putting the assisted suicide option on the table would prove disastrous. Having learnt so much from the Left about power, and the way coercion can operate subtly beneath the cover of consent, I found questionable the assurances of assisted suicide advocates that no one would ever be pressured to die. How are doctors really going to know that, at the deepest level, a terminally-ill older person has not been put under pressure?

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Where, then, have I ended up? Have I found a home, an ideology to underwrite my existence? One towering temptation I’ve felt is to renounce the culture wars altogether and insist that ultimate ethical questions are kept out of political discourse. We should focus on building a common political life together, many contend, and for the sake of that we should set aside trying to resolve vexed moral quandaries.

The problem with this solution, however, is that there are actual lives at stake. Sexual consumerism, family breakdown and the mindlessness of marijuana are real threats to human flourishing. How we think of the beginning and end of life, about the entrances and exits of human beings in the world, has lasting consequences.

Instead, as I argue in my book Vexed: Ethics Beyond Political Tribes, an etch-a-sketch approach to ideology is called for. We need to start from first principles and decide, undetermined and undeterred by our historic political identifications, which positions on the weightiest moral questions align with the good.

We need to be prepared to concede that our historic ideological enemies, whichever tribe they come from, may have got it right when it comes to a particular controversy. This pick-n-mix approach is very different from carving out some amiable middle ground; it means taking substantive positions on specific issues, but from across the political spectrum. For difficult though this may be, failing to do so ensures a kind of moral stagnation we should all find unacceptable. The deals may give us mates, but they cannot deliver genuine progress.

There is something totalitarian about package deals, and having our thinking governed by the constellations of opinions which are but the product of historically contingent coalition-building. And because of this, I find inspiration in the Vaclav Havel  essay The Power of the Powerless and the Czech playwright’s exhortation that “the primary breeding ground for what might be understood as an opposition in the post-totalitarian system is living in the truth”. It is, he wrote, a drama “originally played out in the theatre of the spirit and the conscience of society”.

Deciding where we stand as individuals on moral questions, irrespective of political parties, may not be the terminus. But it is the place to begin.

James Mumford’s Vexed: Ethics Beyond Political Tribes is published by Bloomsbury on 5 March