My mother, Prof Felicia Huppert, was an amazing person—a pioneering psychologist, transforming research into everything from dementia to wellbeing, an inspirational mentor, and a brilliant mum.
But I don’t want to write about her life; I want to write about her death.
She died three months ago, in Sydney, Australia, from metastatic breast cancer. The cancer was originally detected and treated in 2012, but came back two years ago in the bone, and in the brain and around the stomach. The first two of those were treatable, but the spread to the stomach and abdomen was too much for medical science. After a period in intensive care, and then in a hospital ward, she was released to be at home until she died.
She wasn’t in pain, and her mind was as sharp as ever, but she was often exhausted. The cancer had stopped her stomach from working, so she was fed for 16 hours a day through a nasojejunal tube that carried processed food material through the nose directly to the intestines. She had 24-hour home care, with nurses present to provide injections, deal with the feeding tube, and clear the all too frequent blockages when they could.
She could have kept going that way until something went catastrophically wrong, such as a stroke, and she died quickly. Or until she caught Covid, or pneumonia, or something else that would hasten her death. Or until she became thinner and weaker and more exhausted and eventually passed away.
But because of the recently passed law in New South Wales, she could instead choose to apply for Voluntary Assisted Dying (VAD). She was still in hospital when she found out this was a possibility, and said it gave her the most unbelievable feeling of happiness and security. She was immensely reassured that she would get to decide and be in control, rather than be at the mercy of her disease. The process was rigorous: she had to be individually assessed by two doctors, to confirm that she understood what she was asking for, and really wanted to have the ability to end her life peacefully on her own terms. She then had to wait—surprisingly nervously—for the NSW Voluntary Assisted Dying Board to approve her application.
Once approved, nothing much changed. There was no pressure at all for her to make her decision, but she did benefit from more support; a lead VAD doctor, who made himself available astonishingly generously to talk to her whenever she wanted a discussion or advice, and a “VAD Navigator”—an experienced nurse who would help her deal with the intricacies of the health system.
She also had support from the palliative care team, who were mostly good, but when they made a mistake (prescribing a medicine too large to go through the feeding tube without clogging it irreversibly), it was the VAD team who identified the problem and found the surgeons to fix it.
Finally, on Friday 2nd August, she decided the time had come. She contacted the VAD team, who needed two days’ notice, to book her death date, Tuesday 6th August. This gave her time to talk to friends and family for a last time, sometimes telling them it was the last conversation, sometimes not. She got to spend some last time with her grandchildren, giving them sage advice for years to come. She could have one last walk on the headland she loved so much. She could leave her life and her relationships as she wanted to.
I spent the night before she died with her talking of the future, reminiscing about the past, and choosing the last music she wanted to listen to—Vikingur Ólafsson playing the aria from Bach’s Goldberg variations. On the day itself, the VAD team came over early to check she still wanted to go ahead, to cannulate her for the injections and at long last remove the nasojejunal tube that had fed her for months. We got a last photo of her without the feeding tube, outside, and free. We moved her favourite painting to be in front of the bed she had been sleeping in, and some of her favourite plants. She had a last drink of her favourite Persian tea. For the first time in months, she was able to swallow without fear.
Then we moved to the bedroom—Mum, my brother and I, and her sister. The VAD team had brought a two-metre long tube, so that they could give the three sequential injections from the far end of the bed without interfering with the family gathering. Mum had time to talk to the three of us, passing on some last thoughts and wishes.
As the doctor was about to give the first injection, Mum asked for a pause. They stopped immediately. She had remembered that she meant to thank the VAD team and the nurses who had looked after her so well and made her last weeks and months so good. Then she gave the three of us her last words—“love lasts longer than life”—the music started, and the first injection went in. We watched her, holding hands, until she died.
Mum’s death has been a blow. But spending months beforehand preparing for it—pre-grieving—knowing that she would have control over how and when she died, made it so much easier to bear.
There’s been much written about a “good death” and what it might be like. If someone dies in their sleep, someone else has to bear the shock of discovering it. If someone dies naturally, surrounded by their loved ones, they must have been in a pretty bad way to know what was about to happen. Mum had the best of deaths: pain-free, prepared for, with her loved ones, how and when she wanted it.
I was in favour of Voluntary Assisted Dying in theory from when I was young. Having lived through it, I cannot imagine depriving others of the opportunity to choose such a good death. They deserve as good an ending as my mother received.
