Let the dying choose a quick and peaceful end - brain surgeon
Retired British brain surgeon Henry Marsh has his own suicide packet, a little bundle of appropriate drugs he has stashed away.
"All perfectly legally acquired," he says, then starts laughing, "but they do not come with a use-by or best-before date, which is a metaphor for life itself."
"Whether I would have the guts to do it myself, I don't know," he says. But his little drug packet makes a dramatic point.
In his just-published second book, Admissions, The Life of a Brain Surgeon Marsh argues dying people should be allowed to choose their own manner of death.
The book follows on from his eye-opening, behind-the-scenes expose of the world of brain surgery in Do No Harm.
That was shocking for its honesty on how brain surgeons walk a tightrope between helping or ruining patients. He wrote of his own cases when people had died or been left in a vegetative state because of decisions he'd made inside their brains.
Admissions has more of the graphic, exciting, frightening anecdotes of opening up heads and removing tumours, but it's much more darkly reflective. Marsh explores deeper themes around our "overpowering urge" to prolong life.
Working at the very tip of medical technology that does just this has left him doubting much of our effort to prolong life when death is close.
He quotes American Medicare figures that estimate that 75 per cent of all of a person's spending on health is spent in their last six months of life.
On the phone from the UK, he is bright and chirpy. He's about to lecture to medical students. He happily talks about things most doctors don't.
Marsh believes assisted deaths should be an option for dying people - the way it works in Holland and Belgium and some states in the US.
He says this "help" for the dying is particularly necessary now because people are living so much longer. Cancer and dementia are mainly diseases of ageing. Pre-modern medicine, most humans died long before they got them, usually from infectious diseases.
"We treat people in very poor health or who are are very elderly and with very little realistic chance of useful survival," Marsh says.
"We all find it very difficult to give up and say 'it is time to die', and doctors find it very difficult to say 'go away and die'.
"Hope makes fools of us at the end of the day. It makes sense to fight with every fibre of your being to stay alive when young, but is it worth it when you are 80 or 90? Clearly there has to be a point where you stop. Perhaps I am being terribly ageist?"
Marsh wants his death to be peaceful and quick. "I've seen so many people die over the years... dragged out to the bitter end as if there is some moral requirement to drag it out as long as possible. It does strike me as daft."
He doesn't believe in an after-life and says fear of being dead is irrational because death means nothing. It's exactly the same for everyone.
But how people die can vary enormously. "It can be sudden, it can very slow, it can be very distressing physically. There are an infinite number of ways of dying and I would like some choice in the matter if I am faced by a particularly unpleasant disease, or way of dying."
Marsh, 67, says he became a brain surgeon because it was glamorous and challenging. He also thought it might reveal the meaning of human life. But the brains he held, probed and cut revealed nothing.
"Understanding that all our behaviour, all our thoughts and feelings are produced by electrochemical activity in the physical matter of our brains doesn't actually help you live. It doesn't tell you anything much other than my consciousness, my talking to you, is actually electrochemistry."
He operated on patients who were awake (only the scalp needs anaesthetic) and watched their own brains on a monitor. They could talk and see the part of the brain that was doing the talking for them.
"You feel there must be some philosophical equivalent of acoustic feedback, but there isn't. It's just crazy," Marsh says.
He's looked at brains and knows they hold everything a person is. Yet the face is still the person. Emotionally we need that.
Sometimes he has tried to think of his brain in his head, but he can't. He's never seen a scan of his own brain and doesn't plan to.
"I don't want to see the atrophy and shrinking that comes with age. I've seen so many people at work who have had a brain scan for a fairly flimsy reason, like a headache, and some new problem has been discovered and then it's 'do we treat it or not?'. It's a huge mixed blessing.
"I'm too frightened to go there."
* Admissions: A Life in Brain Surgery, Hachette, available May 16. $38