Publisher Health

It’s 10am, and in a little over two hours, Wayne Hawkins will be dead.

The sun is shining on the bungalow where the 80-year-old lives in San Diego, California with his wife of more than five decades, Stella.

I knock on the door and meet his children – Emily, 48, and Ashley, 44 – who have spent the last two weeks at their father’s side.

Wayne sits in a reclining chair where he spends most of his days. Terminally ill, he is too weak to leave the house.

He has invited BBC News to witness his death under California’s assisted dying laws – because if MPs in London vote to legalise the practice in England and Wales, it will allow some terminally ill people here to die in a similar way.

Half an hour after arriving at Wayne’s house, I watch him swallow three anti-nausea tablets, designed to minimise the risk of him vomiting the lethal medication he plans to take shortly.

Are you sure this day is your last, I ask him? “I’m all in,” he replies. “I was determined and decided weeks ago – I’ve had no trepidation since then.”

His family ask for one last photo, which I take. As usual, Stella and Wayne are holding hands.

Shortly after, Dr Donnie Moore arrives. He has got to know the family over the past few weeks, visiting them on several occasions alongside running his own end-of-life clinic. Under California law, he is what is known as the attending physician who must confirm, in addition to a second doctor, that Wayne is eligible for aid in dying.

Dr Moore’s role is part physician, part counsellor in this situation, one he has been in for 150 assisted deaths before.

On a top shelf in Wayne’s bedroom sits a brown glass bottle containing a fine white powder – a mixture of five drugs, sedatives and painkillers, delivered to the house the previous day. The dosage of drugs inside is hundreds of times higher than those used in regular healthcare and is “guaranteed” to be fatal, Dr Moore explains. Unlike California, the proposed law at Westminster would require a doctor to bring any such medication with them.

When Wayne signals he is ready, the doctor mixes the meds with cherry and pineapple juice to soften the bitter taste – and he hands this pink liquid to Wayne.

No one, not even the doctor, knows how long it will take him to die after taking the lethal drugs. Dr Moore explains to me that, in his experience, death usually occurs between 30 minutes and two hours of ingestion, but on one occasion it took 17 hours.

This is the story of how and why Wayne chose to die. And why others have decided not to follow the same course.

We first met the couple a few weeks earlier, when Wayne explained why he was going ahead with the decision to have an assisted death – a controversial measure in other parts of the world.

“Some days the pain is almost more than I can handle,” he said. “I just don’t see any merit to dying slow and painfully, hooked up with stuff – intubation, feeding tubes,” he told me. “I want none of it.”

Wayne said he had watched two relatives die “miserable”, “heinous” deaths from heart failure.

“I hate hospitals, they are miserable. I will die in the street first.”

Wayne met Stella in 1969; the couple married four years later. He told us it was something of an arranged marriage, as his mother kept inviting Stella for dinner until eventually the penny dropped that he should take her out.

They lived for many years in Arcata, northern California, surrounded by sweeping forests of redwood trees, where Wayne worked as a landscape architect, while Stella was a primary school teacher. They spent their holidays hiking and camping with their children.

Now Wayne is terminally ill with heart failure, which has already brought him close to death. He has myriad other health issues including prostate cancer, liver failure and sepsis which brings him serious spinal pain.

He has less than six months to live, qualifying him for an assisted death in California. His request to die has been approved by two doctors and the lethal medication is self-administered.

It was during our first meeting that he asked the BBC to return to observe his final day, saying he wanted terminally ill adults in the UK to have the same right to an assisted death as him.

“Britain is pretty good with freedoms and this is just another one,” he said. “People should be able to choose the time of their death as long as they meet the rules like six months to live or less.”

Stella, 78, supports his decision. “I’ve known him for over 50 years. He’s a very independent man. He’s always known what he wants to do and he’s always fixed things. That’s how he’s operating now. If this is his choice, I definitely agree, and I’ve seen him really suffer with the illness he’s got. I don’t want that for him.”

Wayne would also qualify under the proposed new assisted dying law in England and Wales. The measures return to the House of Commons later this month, when all MPs will have a chance to debate and vote on changes to the Terminally Ill Adults (End of Life) Bill.

The proposed legislation, tabled by Labour MP Kim Leadbeater, says that anyone who wants to end their life must have the mental capacity to make the choice, that they must be expected to die within six months, and must make two separate declarations – witnessed and signed – about their wish to die. They must satisfy two independent doctors that they are eligible.

MPs in Westminster voted in favour of assisted dying in principle last November but remain bitterly divided on the issue. If they ultimately decide to approve the bill, it could become law within the next year and come into practice within the next four years.

There are also divisions here in California, where assisted dying was introduced in 2016. Michelle and Mike Carter, both 72 and married for 43 years, are each being treated for cancer – Mike has prostate cancer that has spread to his lymph nodes, and Michelle’s advanced terminal ovarian cancer has spread throughout much of her body.

“I held my mother’s hand when she passed; I held my father’s hand when he passed,” Michelle told me. “I believe there’s freedom of choice however for me, I choose palliative care… I have God and I have good medicine.”

Michelle’s physician, palliative care specialist Dr Vincent Nguyen, argued that assisted dying laws in the US state lead to “silent coercion” whereby vulnerable people think their only option is to die. “Instead of ending people’s lives, let’s put programmes together to care for people,” he said. “Let them know that they’re loved, they’re wanted and they’re worthy.”

He said the law meant that doctors have gone from being seen as healers to killers, while the message from the healthcare system was that “you are better off dead, because you’re expensive and your death is cheaper for us”.

Some disability campaigners say assisted dying makes them feel unsafe. Ingrid Tischer, who has muscular dystrophy and chronic respiratory failure, told me: “The message that it sends to people with disabilities in California is that you deserve suicide assistance rather than suicide prevention when you voice a desire to end your life.

“What does that say about who we are as a culture?”

Critics often say that once assisted dying is legalised, over time the safeguards around such laws get eroded as part of a “slippery slope” towards more relaxed criteria. In California, there was initially a mandatory 15-day cooling off period between patients making a first and second request for aid in dying. That has been reduced to 48 hours because many patients were dying during the waiting period. It’s thought the approval process envisaged in Westminster would take around a month.

Outside Wayne’s house on the morning of his death, a solitary bird begins its loud and elaborate song. “There’s that mockingbird out there,” Wayne tells Stella, as smiles flicker across their faces.

Wayne hates the bird because it keeps him awake at night, Stella jokes, hand in hand with him to one side of his chair. Emily and Ashley are next to Stella.

Dr Moore, seated on Wayne’s other side, hands him the pink liquid which he swallows without hesitation. “Goodnight,” he says to his family – a typical touch of humour from a man who told us he was determined to die on his terms. It’s 11.47am.

After two minutes, Wayne says he is getting sleepy. Dr Moore asks him to imagine he is walking in a vast sea of flowers with a soft breeze on his skin, which seems appropriate for a patient who has spent much of his life among nature.

After three minutes Wayne enters a deep sleep from which he will never wake. On a few occasions he lifts his head to take a deep breath without opening his eyes, at one point beginning to snore softly.

Dr Moore tells the family this is “the deepest sleep imaginable” and reassures Emily there is no chance her dad will wake up and ask, “did it work?”

“Oh that would be just like him,” Stella says with a laugh.

The family start to reminisce about hiking holidays and driving around in a large van they converted to become a camper. “Me and dad insulated it and put a bed in the back,” says Ashley.

On the walls are photos of Emily and Ashley as small children next to huge carved Halloween pumpkins.

Dr Moore is still stroking Wayne’s hand and occasionally checking his pulse. For a man who Emily says was “always walking, always outdoors, always active”, these are the final moments of life’s journey, spent surrounded by those who mean most to him.

At 12.22pm Dr Moore says, “I think he’s passed… He’s at peace now.”

Outside, the mockingbird has fallen silent. “No more pain,” says Stella, embracing her children in her arms.

I step outside to give the family some space, and reflect on what we have just seen and filmed.

I have been covering medical ethics for the BBC for more than 20 years. In 2006, I was present just outside an apartment in Zurich where Dr Anne Turner, a retired doctor, died with the help of the group Dignitas – but California was the first time I had been an eyewitness to an assisted death.

This isn’t just a story about one man’s death in California – it’s about what could become a reality here in England and Wales for those who qualify for an assisted death and choose to die this way.

Whether you’re for or against the proposed new Westminster law, the death of a loved one is a deeply personal and emotional time for a family. Each death leaves an imprint, as will Wayne’s.

Additional reporting by Josh Falcon