Director of NED & ME, Lorna Nickson Brown meets academic, Dr Isra Black, academic at York Law School and specialist in Healthcare Law and End of Life issues.

IB: Why does Ned decide to end his own life?

This is an important question and one which writer, Lizzie Clarke and myself discussed at length before making the film. Ned decides to die because he wants an empowering death. He has a terminal illness and he is accepting of this. For Ned, dying before debilitating illness kills him is an act of empowerment. He is taking ownership of his body.

IB: Why does Ned want assistance to die?

LNB: Ned is unable to die in the way he wishes without assistance. For Ned, dying this way is empowering and it is something he has fully come to terms with. I think he wants to celebrate his life, feeling safe beforehand and so he needs to connect fully with someone to really do this.

IB: Why do you think he chooses Mia?

LNB: My favourite line in the script is when Ned tells Mia before he dies that she looks like his mum. He says that when he first met her, he thought she was ‘so beautiful, like she’d swallowed a star.’ Actor, Graham Short’s connection to this idea is astonishing and in this moment, I really understand why he has asked Mia to help him. In a way, he is closer to his mother, through Mia, and he comes full circle with her or at least, a reflection of her, in birth and in death.

IB: I noticed that there is a warmth and almost celebratory atmosphere prior to the death. Does Mia know that he wants her to help him to die?

LNB: Ned has asked for Mia’s assistance prior to their meeting that day so it’s not a surprise to her when he ultimately asks for her help, although the realisation of its magnitude is a shock. I wanted to create a real sense of Mia’s hesitation and internal conflict prior to meeting Ned. She is very late to meet him and I think that’s because she’s consumed with doubt.

The warmth you speak of in the dance, prior to Ned’s death was key for me. I wanted to depict proximity to death on camera, and to surround it by joy and fearlessness. I worked with composer, Stella Roberts who created an original piece of music for Birmingham salsa band, Del Camino. The music is vibrant and full of energy. We discussed that Ned was a traveller his whole life, a  talented musician and his apartment was full of incredible pieces he had collected on his travels. The song, Las Manos De La Libertad, meaning ‘The Hands of Freedom,’ is performed in the style of Buena Vista and really has that sensual, exuberance that makes you just want to dance. I like to think Ned played drums on that track! When Mia and Ned dance together, their connection represents courage and acceptance of death. In this moment, Ned’s liberation is so complete that he is able to offer a momentary freedom to Mia too - and she, in turn, expresses her love for him in the best way she knows how.

IB: What’s in it for Mia; why does she assist Ned to die?

LNB: I love the ambiguity of Mia’s motivations. Doubt is at the forefront of my vision: Mia’s own doubt; our doubt about her motives; and my uncertainty over the ethics of euthanasia. At the start of the film, we see a client leave Mia’s nan’s flat and we learn that she is a sex worker. She deposits her earnings in a cupboard in her nan’s hallway. After Ned passes, Mia deposits the cash earnings from Ned into the same cupboard for safe keeping. Mia’s motivations appear to be love and compassion but can we really be sure her motives are so pure when she receives a fee for the transaction, in the same way she does for sex?

IB: At the end of the film, Mia and her mother visit the seaside. What is she experiencing at that moment?

LNB: When Mia and Rose eat ice cream by the sea, time has moved on, but it is not clear that Mia has moved with it. The sea, like Mia, can change in a moment, and nothing is certain. Mia worries whether she did the ‘right’ thing. In such momentous, transformative actions, how can we know if we have made the ‘right’ choice? And the ‘right’ choice for whom? Mia might have helped free Ned, but will this have a long-term effect on her own wellbeing?

LNB: What’s the legal status of Mia assisting Ned to die by euthanasia in the UK?

IB: Although we don’t see it, the implication is that Mia injects Ned with a lethal substance. This is clearly unlawful, since the law makes no distinction between euthanasia and murder. Ned’s consent (or his request for assistance to die) is irrelevant. None of the partial defences that sometimes apply in euthanasia cases (eg diminished responsibility) seem applicable here. So Mia runs a significant legal risk by assisting Ned. In the event that Mia is convicted of Ned’s murder, the sentence she receives (life with a minimum term of imprisonment before parole can be considered) may be reduced if she can show she believed euthanasia in Ned’s case was an act of mercy. However, the  sentencing issue may be complicated by the fact that there is a transactional element and the event was planned, as well as the possibility that a court might regard Ned as being vulnerable in virtue of his age and health status (even if he would not share that point of view).

LNB: Would it have made a difference if Mia had assisted Ned’s suicide?

IB: Possibly, but perhaps not on the facts. In the UK, The Suicide Act 1961, section 2 prohibits encouraging or assisting suicide, although prosecution for the offence requires the consent of the Director of Public Prosecutions (DPP). The DPP has a policy on assisted suicide, which sets out the evidential and public interest factors that go to the decision to prosecute. Here, imagining Mia had assisted Ned’s suicide, I think the most weighty public interest factors would relate to whether Mia was ‘wholly motivated by compassion’ and whether Mia received payment for assisted Ned’s death. The fact that Mia acquires an apparently large sum of money for helping Ned to die is a factor that tends in favour of prosecution in itself, and may provide evidence that Mia was not wholly motivated by compassion (and thus provide a reason for prosecution).

LNB: Campaigns to change the law to permit assisted death are often in the news. Would you expect to see a case like Ned’s to be covered by proposed legislation?

IB: I suppose it depends how we understand Ned’s ‘case’—whether we mean Ned’s health circumstances or whether we mean Ned’s death, assisted by Mia? The proposals for law reform on assisted death that Parliament has considered recently would carve out a narrow exception to the prohibition on assisted death: they seek to legalise physician assisted suicide for individuals who are terminally ill. However, Mia is not a doctor and in any event, she helps Ned to die through euthanasia, rather than assisted suicide. For these reasons, even if physician-assisted suicide were lawful in England and Wales, Mia’s assistance of Ned’s death to die would still be illegal. Of course, if physician-assisted suicide were lawful, Ned could have seek assistance of a doctor to end his own life, but this might not address all of what he wants to achieve in choosing Mia to help him to end his own life, as Lorna describes.

LNB: Why don’t proposed changes in the law capture the kind of death Ned has in the film?

IB: I think the main worry about having broader permissions on assisted death relates to the control of the consequences of legalisation, often expressed as a worry about ‘safeguards’. It’s often thought that there’s a trade-off between allowing access to assisted death for individuals whose suffering is such that they have formed a well-considered wish to die and blocking access to assisted death for individuals who might be subject to pressure to request an assisted death, or who might perceive that there is a social expectation to request  assisted death. So proposed legislation is limited to the terminally ill not because they’re the only people who suffer in ways that might lead us to accept assisted death in their circumstances, but because they’re thought to be more readily identifiable as a class of people who may suffer in this way. And assistance is limited to doctors because they’re a profession in whom we place a lot of social trust. Of course, it’s heavily disputed whether there really is a trade off between broad access to assisted death and exposing people who should not receive assisted death to the risk of harm. Relatedly, there’s debate about whether we might devise a safe regime for assisted death other than physician-assisted suicide for the terminally ill.

Two further points on why we might only permit certain people to assist others to die deserve brief mention. First, access to safe means. Ned uses drugs, probably opioids or sedatives, that he’s presumably stockpiled. At present, only certain health professionals are permitted to prescribe these controlled substances to people. Given this restriction as well as their existing health related roles, this group may seem the ‘natural’ choice in terms of who ought to provide lawful assisted death. We might also wish to permit only physician or professional-assisted death because we worry about ‘amateur’ assistance leading to botched suicides. It’s worth noting, however, that in Switzerland doctors prescribe the medication used for assisted suicide, but volunteers of the right to die associations accompany the person who dies, including preparing lethal medication. Indeed, we see in the film that what Mia does is not especially complicated.

Second, we might wish to restrict who can assist death because of the potential for psychological trauma. Most of us (thankfully) won’t have any direct experience of participating in ending life of any variety. We might think that this kind of experience is unlike other things we’ve done in our lives. This makes it hard to predict what the effect of assisting death would be on us. We may think we’ll be fine, but not be after the fact. This may be the case even if we have good moral reasons for assisting death, such as wanting to respect another’s wish to die, and believing them when they say death now is better than continued life. There may be a hint of trauma or at least ambivalence in Mia at the end of the film. The thought is that if we professionalise assisted death, assistors can distance themselves personally from the act of participating in ending life or internalise it as part of their accepted professional norms. Mia is an interesting case, because she has a quasi-professional relationship with Ned, but at the same time seems unable fully to distance herself from the consequences of assisting Ned to die. NED & ME provides a thought-provoking challenge on this issue and many others relating to assisted death.