‘We need to talk about choice’: woman who ended life at Dignitas urges change to UK law

Paola Marra’s social calendar has been packed in recent weeks. The 53-year-old has been dining at some of London’s best restaurants, enjoying grand afternoon teas and meeting old pals at hedonist hotspots such as the Groucho private members’ club.

The Canadian-born former music industry and charity worker has lots of friends from 35 years living in England – but not everyone can get a slot to see her.

“My diary is full,” she said. “It’s hard because there are people who want to get in there. But I have a date.”

That date came this week. On Monday, she left home in East Finchley and flew alone to Zurich. At 10am on Wednesday she was due at Dignitas, the Swiss assisted-dying organisation. There, after suffering with terminal stage 4 bowel cancer since 2021 and following months of planning and paperwork, she ended her life.

“Bowel cancer has been brutal and non-stop,” she said from her hotel room overlooking Lake Zurich a day earlier. “I just feel ready … The thing that makes me break down is talking about my friends and having to say goodbye to people. The rest of it I can live with, or die with. I can deal with leaving.”

Marra decided to speak to the Guardian because people in Britain “need to talk about assisted dying … they need to talk about choice”.

“I’m not scared to die,” she said. “I’m scared of dying in pain.”

Assisted dying remains criminalised in the UK and, as she awaited her appointment at Dignitas, Marra said it would be “insane” if assisted dying was not legalised in the next couple of years.

“It’s important for people to hear us,” she said. “We are the ones who are dying. We should be the ones who choose how to die. And it should be allowed in this country. I think it’s really unfair that I can’t do it here.”

Before she left for Switzerland, Marra was relieved to have found a home for her elderly whippet, Stanley, near the golden sands of Gwithian on Cornwall’s Atlantic coast, so he can enjoy beach walks.

And this week, Marra found herself alone in a strange Swiss hotel that contained “really weird” food and 1980s decor, with the prospect of taking her life with the support of two Dignitas representatives she had never previously met.

Her decision to talk about her journey adds to the growing public pressure for reform – including from figures such as Jonathan Dimbleby, whose brother Nicholas recently died with motor neurone disease, and Esther Rantzen, who has lung cancer and calls the law in Britain “a cruel mess”. Since 1998 more than 530 Britons have had to travel to Dignitas to die, and more have been too unwell to get there or cannot afford costs of more than £10,000.

Yet opinion polls consistently record public support of more than two thirds for assisted dying with strict controls. Last week, the Labour leader, Keir Starmer, confirmed he wanted the law changed and MPs would be given a vote on reform in England and Wales under a Labour government.

Kit Malthouse, the Conservative MP who co-chairs the all-party group on choice at the end of life, said that with a new generation of MPs arriving, “there’s every chance we will have legislation”. The last time there was a vote, in 2015, it was defeated 118 to 330.

Assisted dying is already legal for terminally ill, mentally competent adults in their final months of life in 11 US states, in most of Australia, in New Zealand, Canada, Spain, Austria and Ecuador. Broader right-to-die laws apply in Belgium, the Netherlands and Luxembourg. In the UK, anyone assisting someone to die faces potential criminal prosecution. Law changes are, however, afoot in Jersey and the Isle of Man and a vote is expected on legalisation in the Scottish parliament.

“If people are for it, change it,” Marra said. “It bothers me. I wrote to my MP [Mike Freer] and he was against it and it just made me so angry.”

Freer tells constituents he had a friend who was diagnosed with a terminal illness who moved to the Netherlands to die by suicide, and six months after his death there was a breakthrough in drug treatments for his illness. This is not a prospect for Marra.

She first discovered she had breast cancer in 2017 but in 2020 bowel cancer was found and became incurable by 2021. Treatment has involved several “brutal” surgeries. She can no longer take many painkillers and if she had stayed in Britain “the way I will die will not be a good death” – with blocked bowels and in pain.

“I can feel my insides are starting to kink and twist and block and do all the things they always do,” she said on Tuesday from Switzerland. “So it’s absolutely the right time.”

In the preceding weeks, having stopped treatment, she has been enjoying the last of her life knowing she will not suffer too much at the end.

Earlier this year, her oncologist said she had about three to four months until tumours blocked what remains of her bowel after most of it was removed.

Describing an earlier procedure, she said: “They strip the whole inside. So all my female organs, everything, including my vagina. Everything is gone. They remove everything, put your organs back in that are non-cancerous, they fill your cavity full of chemo, they heat it up to 45 degrees and oscillate your body for two to three hours, then flush you out and stitch you back up. It’s brutal.”

She began the process of setting a date with Dignitas about two months ago. “It’s not a natural thing to do,” she said. “You’re literally standing at the cliff edge and you’re going to jump, so that was hard. It just became real.”

Her mother and father live in British Columbia; her brother, Tony, in Toronto.

It was when she set the date earlier this year, Tony realised “bang! I’m not gonna have my younger sister any more”.

The idea of knowing the “specific minute” she would die was “very odd”, he said. He would like to be by her side (“I hope she’s not lonely”), but she has decided to go alone and he understands that.

He “hates” the criminalisation of assisted dying in the UK mainly because it’s “costing her possibly a couple months of her life because she can’t decide to do it in the UK at a later date”.

His message to British parliamentarians who oppose assisted dying was: “It’s none of your goddamn business.”

Marra said leaving home in London on Monday was “manic”. “It’s like moving house and never coming back,” she said. “Throwing away my toiletries. It was weird.”

In Switzerland, Marra was due to have two meetings with doctors. She doesn’t think anyone in the hotel knows why she is there because “there are no pitying looks”. She was due at the clinic at 10am on Wednesday to take her own life with the help of the Dignitas team.

“Right now, it’s an idea,” she said. “It doesn’t feel real.”

But she said that when the moment comes her instinct is likely to be to get the process over with promptly.

After her death, Marra will be cremated in Switzerland before her ashes are returned to the UK by an undertaker she has paid to fly from London to Zurich as human remains cannot be sent by post or parcel service.

“It’s really bizarre,” she said. “I think his name is Richard. He’s going to go and pick me up … A group of friends will scatter my ashes.”

Arranging her death at Dignitas involved reams of paperwork, including dental records, marriage and divorce records and a birth certificate from Canada.

She initially found the tone of Dignitas’s “very matter of fact” communications “a bit weird”. She was expecting it to be softer somehow, but has got used to it and has become matter of fact about it herself, saying simply: “I go on the 18th and then I die on the 20th.”

Given the risk of criminal prosecution, British doctors must be circumspect when patients ask about assisted dying. But Marra said her medical team were “supportive without being supportive”.

Setting the date has give her time to say proper goodbyes.

“A lot of people don’t get that, especially people who do treatment right to the end,” she said. “I am spending the time that I have in the way that I want.”

Opponents of assisted dying warn that legalisation could lead to vulnerable people being coerced into an early death but Marra didn’t agree. “It’s so complicated to get approved,” she said. “There are so many people involved. I don’t understand how that could happen.”

She has seen the opposite happening with families coercing sick loved ones to try further treatment.

Another concern is that any initial law would be widened to include non-terminal illness, mental health problems and even children. Opponents of assisted dying warn that “guardrail” regulations would become viewed as restrictions on rights and widening the application could see more cases involving vulnerable people.

“I can’t see that happening here,” Marra said. “All of my terminal friends want the choice and if you don’t want to do it, don’t do it. It just seems kind of black and white to me.”

She does not feel negative about her decision. The alternative is suffering on a scale she understands too well from her treatments so far.

“It’s something I know I need to do for myself,” she said. “I don’t even really see it as an ending. It’s just a part of my life.”