The poison’s still in the fridge, but perhaps I don’t want it after all

When Jo Beecham was diagnosed with cancer three years ago, her first instinct was to control the moment of her death, to bypass the worst of the pain. In fear, she bought some life-ending drugs, and in July this year, she gave an account in these pages of the challenges of living with poison hidden behind the bags of salad in the fridge. That was about the time that Lord Falconer’s bill to legalise assisted dying received its second reading in the House of Lords.

Jo’s health has deteriorated quickly since then. But though the time to use it must be close, the poison has never felt more out of reach.

Is it fear that is stopping Jo from choosing to use the drugs, which once offered reassurance but now seem to ask for too much strength? Or has she found a different kind of succour – in the form of Annie Lister, an independent cancer and palliative care expert with 30 years’ experience?

When Annie first met Jo in late spring, Jo had a detailed plan for her death, and Annie had “a long in the tooth” palliative carer’s belief that legalised assisted dying might be “the start of a slippery slope”. After all, Annie’s life’s work has been to soothe difficult endings. But the intensity and intimacy of Jo and Annie’s conversations have lifted the debate out of a moral maze and made it a matter of personal friendship. Over the past five months, Jo and Annie have travelled so far towards each other emotionally and intellectually that both have changed their minds about what makes a good death. While Annie has become more sympathetic to the idea of legalised assisted dying, Jo has chosen to confront the approach of death with palliative care. Both agree that legalised assisted dying would open up the debate and allow people in Jo’s situation to speak openly with friends, family and carers.

These days, Jo says, the drugs “are not in my thinking”. She is lying back in bed, hands above her head, now and then tousling her hair. Annie is sitting in a wicker chair beside the adjustable bed that has been installed in the lounge – a sign of how time has overtaken Jo’s old worry that the stairs might complicate the journey from fridge to bed.

“I’ve got a drug I’m not sure about. Doing it alone is almost performing an aggressive act. I can find my own way around it, but actually if I had to go to the fridge, my friends would be shitting themselves. I would be shitting myself. I’m so weak. It requires too much fear. Too much from me emotionally. The poison has been an amazing companion. But once you get nearer to the real decision, it’s like, OK, what is this? What am I supposed to do with it? Too much? Too little? I’m a bit neurotic. It might kill me. Ridiculous!”

What has made the difference, Jo says, is “Annie’s experience, her calmness. I’m being accompanied. I’m not alone. When I’m in pain and I don’t recognise it, and it’s really strong, it panics me. I want Annie more and more to be here. I know she’ll calm me quickly.” One knee pokes up and lifts her fleece blanket like a sail.

“She was full of fear when I met her,” says Annie, “fear of symptoms that couldn’t be controlled.”

Has it felt challenging for Annie to care for someone who wants to anticipate the end, when her work is to manage symptoms until the end comes? “The truth is, I don’t think the palliative care world really had to think of assisted dying so seriously as I have in respect of Jo,” she says. “Palliative care professionals have hidden behind the fact that it’s illegal.”

n July, five friends had agreed to be present when Jo chose to take the drugs. But as the months have passed, the thought of what’s in the fridge has become more difficult for everyone.

“So, I feel I really understand this now,” Jo says quietly, her knees swaying under the blanket. “You really are on your own.”

“This is something that’s coming up more now,” says Annie. “Jo’s feeling that if she took that route, she would do it in isolation. What you’ve expressed to me, Jo, is that there was a sense of relief from your friends when you told them you’d chosen the option of palliative care. You said you felt that on the whole they were sighing with relief.”

“Yes. Of course, they’d go there with me, but it was like ‘Oh, good! Phew!’ I’m sure someone would be here, but it would be a sadder occasion.” Jo shuts her eyes. “I’ve gone through moments where I’ve thought: ‘If I take the stuff in the fridge, have I failed Annie?’ ”

Annie has travelled to a point of great sympathy with, and affection for, Jo. Does she feel she could be there, at her side, if Jo wishes to end her life?

“There is nothing professional to stop me being here, although I’m clear that I wouldn’t facilitate it,” says Annie. “As a citizen ... I don’t know. I really don’t know. And maybe I hesitate to think about it, hoping that we will go a different way. I have to confess to feeling relief myself when Jo said she felt she could no longer take that option.”

The drugs remain in the fridge, in the kitchen where the washing machine is whirring. The moment may have passed to take them. Or perhaps it has not. In July, Jo spoke of a line, when she would know the time had come. As the months have gone by, she feels “less the need to draw a line”. Maybe the line is behind her. Maybe it disappeared. Or maybe it retreats with passing time. Annie says when she met Jo, “she was much more aggressive with her activist views” and now she “trusts the process of palliative care”. Annie herself has not looked at the bottle, with its pictogram of a sheep’s head, and its unsettling precaution: Uso veterinario.

“I have felt from the beginning,” she says, “that if it was something Jo chose to do, that would be her choice, and I wouldn’t be able to control it.”

Would she feel that she had failed her patient? “I cannot honestly give an answer as to how it would feel in the event. I have a little worry that it may feel like a failure. I would need time, but I would know that I had given it my best shot to help her in this gentler, easier way for her, her friends and her family.”

It is difficult to know whether Jo’s feelings towards the drugs have changed because she has care now that works for her in the way that the poison once worked – making her feel safe, offering control over the unknown she fears. Or how far her physical weakness – yesterday, she had to crawl up the stairs and she avoids moving “because I don’t want to see how much weaker I’ve got” – has rendered unfeasible the exertion required to self-administer an illegal drug.

If assisted dying were legal, maybe an assisted death would be Jo’s chosen course; and perhaps it is only the illegality, considered in her severely weakened state, that makes the choice so hard to contemplate. Jo remains a firm advocate of the legalisation of assisted dying, alongside excellent palliative care, her experience of which has mellowed her position. The drugs no longer appear to be what she wants.

“They may not be,” she says quickly, moving to sit up. “But maybe they are. Just you saying that makes me feel antsy.” Their presence, if not their use, makes the future feel navigable.

“Sometimes feeling drowsy and nodding off is a relief, because that’s where I see I’m going,” Jo says. “My body is driving my thoughts now. I’m just going to sleep more, drift off and die. And not really be aware. And that’s OK. The beauty of what’s in the fridge is that it is there if you change your mind.”

Jo Beecham died peacefully at home, in the company of friends, on 15 October 2014, a week after this interview took place. The drugs stayed in the fridge until her friends disposed of them safely.