How to Die: Simon's Choice
Review of the BBC2 documentary shown on Wednesday 10 February 2016.

On Wednesday 10 February, BBC2 broadcast the 90-minute documentary, How to Die: Simon’s Choice.  It was the story of Simon Binner and his decision to commit assisted suicide at the so-called Eternal SPIRIT Foundation ‘clinic’ in Basel, Switzerland.

Simon Binner the man
Simon, by his own admission, was an alpha-male.  He was a Cambridge graduate, affluent, sporty, fun-loving, articulate, quick-witted and a strong-minded business man.  He was married to Deborah and had three step-daughters, Zoe, Hannah and Chloe – the latter had died from bone cancer in 2013, a month before her 18th birthday.  Outwardly, it was a happy, well-off family – inwardly, it was already acquainted with tragedy.  That heartbreak was ratcheted up in early 2015, when Simon was diagnosed with an aggressive form of motor neurone disease (MND) and a prognosis of between 6 and 24 months.

Simon, we learn, had decided in the car on his way back home from the hospital diagnosis on 7 January 2015 that he would either kill himself or be euthanized.  He is hugely frustrated.  He can speak four languages, but not for long.  He can play with his grandson, but not for long.  He can walk and talk, but not for long.  The issue of palliative care is raised, ‘I’m not doing that.  I’ll chose a date.’  And he does – his 58th birthday, Monday 2 November.  And so he begins to make the arrangements.  He even announces his pending death plans on LinkedIn.

Simon Binner the patient
On the other hand, Deborah has ‘… always been quite anti-assisted dying.’  In fact, she is ‘utterly terrified of it.’  From the beginning she, ‘feels so strongly that this isn’t the right thing to do.’  But she confesses that she and Simon, ‘Don’t, can’t talk about it.’

Enter, Dr Erika Preisig, vice-president of the Eternal SPIRIT Foundation, which she established in the summer of 2011 to deliver an AVD, an assisted voluntary death.  She demonstrates her method.  ‘This is the medication’ she blithely understates as she shows us the bottle containing the lethal ‘30 times the normal dose of anaesthetic’, which allows the patient ‘to fall asleep within 30 seconds’ and ‘within 4 minutes’ she informs us, ‘the heart stops beating and they are dead.’

Simon and she correspond and she grants an initial approval for his assisted suicide.  Meanwhile, we are taken to various gatherings of Simon and his long-standing friends.  Their united message is that Simon has ‘not thought it through’ and that ‘he is going too soon.’  They agree that he has a tendency for the big gesture and his stubbornness about that fixed date is so typical of the man.  Simon admits that he now feels vulnerable, but a few minutes before we had heard him accepting that the vulnerable must never be pushed into assisted suicide.  But he now affirms, 'I am in a different category, I have thought it through and I want to die.’  His exasperated wife exclaims, ‘The things you bloody put me through!’

Simon Binner the dying
In September 2015, Simon begins to deteriorate fast.  He can no longer walk his beloved dog, Ralph, and he now employs a care worker to shower and dress him.  Surveying his lot, he writes in his large notebook, ‘Humiliation.  Helplessness.  And above all UNMANLY.’  Despite the anguish, Simon admits that, ‘Debbie is adamant she wants me to stay.  She is incredibly loving to me but refusing to accompany me to Switzerland.’  Debbie declares to camera, ‘I cannot take him to Basel.  One, I don't think it's the right thing to do, and two – and most importantly – I don't believe he really wants to go.’  It now, at last, begins to dawn on Simon that he has other responsibilities – it’s not all about him.  He even hints at reconsidering his decision, but no, he remains obdurate.

The film pauses to record the 11 September debate in the House of Commons of Rob Marris’ Assisted Dying (No. 2) Bill 2015-2016.  It was eventually defeated by 330 votes to 118.  Any hopes of legalising assisted suicide in the UK were dashed.  Danger had been averted, good medicine had been reinstated, the vulnerable had been protected.

By 4 October, Simon is in a wheelchair.  By 9 October, he can feel his hands going and soon it will be his last chance to communicate by writing.  On 12 October, he tries to hang himself.  It is a pivotal event.  He now wants to go to Basel earlier than planned, on 16 October.  This is not possible, but the Eternal SPIRIT Foundation arranges for his last day to be Friday 19 October.

He has a small farewell lunch party on the previous Friday.  Simon has had enough.  Debbie concedes, ‘I feel furious, tender, loving, protective, so pleased I married him and I will miss him terribly.’  Simon writes, ‘I’m VERY glad I met Deb.’  His mother pluckily resigns herself, ‘I can’t get another son, can I?’

The following Sunday, Simon, Debbie and a few friends fly out to Basel.  We cut to Alison Saunders, the UK’s Director of Public Prosecutions, who explains the current law on assisted suicide – up to 14 years imprisonment for anyone who ‘... aids, abets, counsels or procures the suicide of another’, but probably nothing if it is done ‘compassionately’.  Simon and his wife are visited by a second Swiss doctor, who rehearses the procedure and confirms the persistence of Simon’s wish.

Simon Binner the dead

The fateful Monday arrives.  At the ‘clinic’, there is additional form-filling.  Dr Preisig explains that even when the ‘medicine’ drip is set up, Simon can still change his mind and go home.  But, because it is an ‘assisted’ death, he himself must open the drip valve and to prove his actions to the Swiss authorities, his last moments will be filmed.  Simon plays a recorded final message to Debbie, his wife of 14 years, ending with, ‘Anyway, time and tide wait for no man, I love you very much Debbie.  Goodbye.'  At 9.38 am, he then, with a smile on his face, moves the drip valve to ‘open’.  Debbie and four friends, but not Hannah or Zoe, witness it all.  Rather than show the corpse, apparently cut from the original film because of pressure on the BBC from The Samaritans, the camera fades to a black screen.  We next see a coffin being loaded into a Fiat limousine.

Debbie is interviewed two weeks later.  She has forgotten huge chunks of what happened in Switzerland.  But she recalls some tender little episodes – how she loved putting his cufflinks on and making sure his shoes were done up properly.  But she acknowledges that she is still in shock and trauma.  She is angry, missing him and guilty.  ‘Did I do enough?’, she repeatedly asks herself.

The conclusions
‘Poignant’ is perhaps a good word to describe this documentary.  To be fair, it was not overtly championing assisted suicide, though its very broadcast could be construed as such.  There is a fear that such a film could 'normalise' assisted suicide, especially as it contained so little about the positive alternatives of hospice and palliative care.  Assisted suicide should be countered, not advertised.  The BBC has previously, in 2011, been criticized as a 'cheerleader for assisted suicide' after screening Choosing to Die, a documentary fronted by the vocal supporter, Sir Terry Pratchett.  Other sensible arguments come from terminally-ill and disabled people, who fear that such documentaries create an atmosphere of fear and hopelessness, so that suicide is regarded as a proper ‘treatment’ for their conditions.

Motor neurone disease (MND) is horrid.  It is a fatal, rapidly progressing disease that affects the brain and central nervous system.  There are about 5,000 sufferers in the UK – six are diagnosed every day and six die every day.  There is no cure, but there is compassionate end-of-life care.  Simon understood the former, but disdained the latter.

Yet How to Die: Simon’s Choice was undoubtedly moving – dying and death always are.  Here was a terminally-ill patient, who was determined to play the autonomous man and to take his own life.  That was his first mistake.  His second was to refuse palliative care.  His third was to discount his wife, family and friends.  As with all suicides, it is those left in the aftermath who suffer most, theirs is the emotional toll.  Their bereavement is invariably hard.  The Binner family needs to grieve well – I hope they can do just that.  In a recent conversation with a The Daily Telegraph journalist, Deborah Binning said, 'I would still have preferred him not to go.  There is a beauty in caring for someone who is dying.  I loved Simon, I would have loved to nurse and cherish him to the end.  Campaigners for assisted dying underestimate how terrible it is for those of us left behind
I know I am not the only one still traumatised by Simon’s choice.' 

So, is assisted suicide ever the answer to tragic medical circumstances?  Never.  Those who believe otherwise and insist on going to Switzerland to die are a peculiar set of people, a true minority – there are only about 25 each year from the UK, compared with the 500,000 or so people who die here naturally.  They are so often the strong-minded, eloquent and relatively rich.  They are unlike the rest of us.  Indeed, they deem themselves different.  They want special service.  Suffering is not for them.  And they are typically agnostic, if not entirely atheistic – God has no place in their world, their lives, or their deaths.

How to Die: Simon’s Choice was watched by some 1.2 million people.  That is not many considering its widespread publicity and potential number of viewers.  Only a handful of complaints were received by the BBC.  Is the British public really so disinterested in these matters of life and death?  Or is assisted suicide just so unnatural and so unwatchable?

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