Interviewer: Torrin Wilkins

Interviewee: Brigitte Tampin

Torrin Wilkins: My name is Torrin Wilkins, the Director of Centre Think Tank, and I am joined by Brigitte Tampin. Today, we will be discussing the system of assisted dying used in Western Australia. Brigitte is the widow of Paul Tampin and has a personal experience of the assisted dying system within Western Australia.

Paul grew up in London and then moved to Australia. He was diagnosed with stage four lung cancer, which had spread to his liver. Paul decided to access assisted dying in 2022. So thank you so much for joining me today and for sharing your experiences, Brigitte.

Brigitte Tampin: You are very welcome. I am happy that I can do it.

Torrin Wilkins: So, for my first question, before any of this happened, did you have any thoughts at all about assisted dying generally and the new statewide system for assisted dying in Western Australia before Paul was diagnosed? Was this a completely new experience for you?

Brigitte Tampin: Well, we had talked about dying because Paul and I had quite an age difference. Paul was 16 years older than me, so he was 77 when he died. And he always used to say, “I go first” because of the age difference. So we actually talked about this pretty openly.

Paul was a person full of life and always in control of his life, right from a young age, and always very independent. For him, it was very important to have control over decisions and over his life.

So we talked about if he became disabled and had a terminal illness, we would go to Switzerland, where it is legal to end your life because he just did not want to become dependent on anyone. He wanted to preserve his dignity. That was the most important thing for him.

So that is why we talked about this. We knew that assisted dying was implemented in W.A. in, I think, July 2021. We got the diagnosis in October 2022. Actually, on that day we were in the hospital, and he was told the diagnosis, we sat in the garden of the hospital and talked about things, and he said, “I would like to use voluntary assisted dying.”

But we did not know anything about the procedures and, you know, what is involved and how you go about it. So I just said, “That is fine by me. We will investigate it as soon as we are home,” which is what we did. Yeah.

Torrin Wilkins: This is something I have heard a few times, but how helpful was being able to have those discussions in advance? Did that feel like it was a lot less of a struggle than it might have been had you then found out about the system just as Paul was diagnosed, and then had to make what I suppose would be another enormous decision on top of everything?

Brigitte Tampin: I think probably yes. I mean, the more I can see it now, comparing what we had to other couples. I think we were very fortunate that we could speak openly about dying. You know, it was not an issue. And it was fantastic throughout the whole four months, I can tell you other things later. So, I think it is extremely helpful when you have that openness, you know, and you can really talk about it. And I felt the same as Paul; I would not want to be dependent on other people. So I could totally understand where he was coming from, and what he wanted.

And it was always my wish that if he really would go before me, he could go in the way he wanted to. And also, one of my biggest wishes was that I would be with him when this happened. And that was given to me, which is very special too.

Torrin Wilkins: And so when he was making that decision and you were discussing it as well, what kind of considerations, what factors went into making that decision? What was the driving force behind him saying “This is an option for me”?

Brigitte Tampin: Well, like I said right from the beginning, he did not want to suffer. He did not want to be dependent on anyone to walk; he did not want to become bedridden, unable to go to the bathroom, and so on. He wanted to be independent with that. And really, it was really important for him to have that control that you would be able to say, you know, “This is it for me.” I mean, there was a long, long process in these four months. So when he said, “I would like to use this,”  I said, “Okay, we have to investigate what it is about.”

So we came home the next day, and I went on the internet on the website of the West Australian Health Department. And I listened to a webinar which was about the experience in the first six months that was made by the doctors, the board of the health department that controls all the legal aspects and the experience of the family members, people who had died.

And I remember I was watching this, and Paul was sitting in his recliner watching the golf or whatever. And then he called me and he said, “What are you doing?” And I said, “I am actually listening to this seminar to find out information.” And he burst into tears, and he said, “It is so wonderful that you do this for me.” So he was really, really grateful for this. And then after the seminar, I told him these are all the things I have learned. And the next point is that I have to ring them and find out, make contact with them. “Would you like to do this?” And he said, “Yes.” So the next day I rang the service, the care navigator, and this person, the nurse, was absolutely fantastic.

I was nervous because I had learned in the webinar that I had to find a doctor who would do this, who would help me. And I knew that his GP would not do this. So I thought, you know, how can we find a doctor? How does this work? So I spoke with the nurse and she explained to me the process, and then I told her what had happened with Paul, and how sick he was. Because the first four weeks before he got diagnosed, he was just terribly sick with nausea. And he lost 12 kilos in four weeks, so it was the worst time we had.

And so Meg said that in order to proceed with all this, I first have to speak with Paul himself to hear that he really wants to get information about this. So we then called her with Paul on the phone, and he said, “Yes, please, I would like to get information.” And she said, “That is fine. We can send someone out to explain things to you.”

And the next day, we had our first visit with the oncologist. And the oncologist told him that he could try chemotherapy and immunotherapy. I was not even sure that he would want to do this because he had been extremely sick. We both felt that when we got the diagnosis, we thought he probably did not have more than two months, and he would not see his birthday on the 8th of December. That is what we felt. And then the oncologist said, “I can offer you some chemotherapy.” And Paul agreed with this because he decided he wanted to give us as much time as we could have. That was his, you know, his reason.

And so we came home, and then I said to him, “Do you still want me to call voluntary assisted dying?” And he said, “Well, maybe I do not need this at the moment because I would try chemotherapy,” even though we did not know if he would be strong enough to have this. And he asked me, “What do you think?” And I said, “Maybe we should contact them. Maybe someone should come out just to tell us the process. That does not mean that you do this, but the more information you have about it, the more you can make an informed decision.” And he said, “Great idea.” So I called again the next day, the nurse, and she said someone could come on Monday afternoon, and then on Tuesday, he was scheduled to have the first chemo.

The service from when I was there was just unbelievable, Torrin. You know, first of all, the first contact, how they talk to you with so much empathy, and I felt really in good hands. Maybe it was special for me because I do not have family in Australia. It is just Paul and me. So to have such a great connection with this nurse at the other end was just really, really amazing.

So it was scheduled for Monday at two o’clock, and a nurse would come to tell us about the whole process. And two hours beforehand, I got a text saying, “I am so sorry. I will not make it on time because I am held up with another patient. We could either send you someone else, or we can come tomorrow.” They tried to avoid you meeting many different people; that is why they suggested the person come tomorrow. But because we had the chemotherapy the next day, we said, “No, we want this today.”

So we said, “Can we please have someone come today?” And this person came. And again, she was wonderful. She told us the whole process and that we will have an assessment with a doctor. They will find us a doctor to do this. And they need some information from the treatment specialist about his condition to find out if Paul is eligible or not.

You are only eligible if you have not more than six months to live as a prognosis. And I said, “That is fine, we can give you information,” because I had already collected some things like results from CT scans and so on. And so I could give these to her. And the next day, we saw the oncologist. Paul told him, “I am considering I probably want to do voluntary assisted dying; could you give us a letter stating my prognosis?” And again, the oncologist was fantastic. Within two hours, I received an email with the letter confirming that. So that went all really well for us.

Paul was very sick, so he was just borderline to have chemotherapy because he could hardly eat. So the oncologist said, “We try today, but you have to stay overnight because we have to make sure you can eat when you go home.” The next morning, Paul woke up and he felt the best he ever felt in the last two months. It was just brilliant. Like the typical Paul, I know. Anyway, and then we went home, and then a day later, he was already downhill.

So then two days later, the doctor came, and this was Anna. Paul was not well on that day. And again, she was wonderful, really empathetic, calm, nice; probably helped that both were from the UK, my husband and Anna, so immediately there was a bond between Anna and my husband. He was a very, very jolly person, you know, always joking and laughing. And even if he felt sick, you know, he would be able to make a little joke. So, he certainly felt really good with Anna. And she explained the process; she said, “I have no doubts you are eligible for this.”

But the next step is that another doctor has to assess you independently of me. Only if both doctors confirm you are eligible, then we can make the next step, which is that I come again in ten days time. And that would then be to discuss, if you go ahead at some point, in what way you would like to die. Drinking something or getting an injection.

So that was fine, we understood. Anna was really good, and she said that if anything happens in the meantime, you can always reach me on my phone if you have any questions or if your condition changes. So that was really very reassuring to hear that. So it was planned that Anna would come ten days later.

And then the next day, the nurse again from the VAD called me and said, “We are trying to find a second doctor to assess Paul; are you actually able to travel or not to a practice?” I said, “Look, we can maybe manage half an hour, but not more than that because he had sickness with nausea and so on.” And then she said, “Okay, just leave it with me.” That was Friday. And on Sunday, Paul felt absolutely terrible. I think he felt he did not have much longer to go. So he said to me, “I need this second assessment as soon as possible. Can you please contact Anna?”

So I sent her a text because it was a Sunday. Within an hour, I had a reply. And she just reassured us. She said, “Look, do not worry. I have a colleague who always helps me when things are urgent. So I will get back to you. But just stay calm, do not worry. Everything will be fine.” We knew this from the first visit, where she explained to us, that usually it is ten days until you have the second assessment. But there have been cases where things had to happen really quickly within a few days, and even then, they managed to do this. So we really factored this in.

And then four hours later, I got the most empathetic and beautiful SMS from another doctor saying that Anna had forwarded him medical reports for Paul. And again, he did not have any doubts that he would be eligible. And then he said so kindly, “May I assist you in your journey?” and “Would you be free tomorrow afternoon for a video call?” We were gobsmacked by how kind they were, how efficient, that it happened so quickly; we did not have to leave the house, we could stay at home. It was just unreal.

So the next day at two o’clock, we sat there with the laptop and at the other end was this very kind doctor with his headphones on, and he was 800 kilometres away in Kalgoorlie. His first question to Paul is, “Why do you want to do this?” So he had to explain this, which is also what Anna had asked, “Why is it that you would like to do this?” So Paul explained it. And it was maybe ten, fifteen minutes. Our call was not much longer. And then the doctor explained, “I will send you some documentation.” So Paul has to sign a document that he would like to set in place. But you will need two independent witnesses, so I could not be a witness for this.

So I got this paper an hour later and rang up our friends, and they came that evening at five o’clock, signed all the papers, and it was done. And then Paul said, “Can you now please ring Anna to come?” So I called Anna, and then she explained, “No, I cannot come because there are rules.” And the rule is that there must be ten days between the first assessment and the other one. That is just how regulation is. I mean, it is the law; you cannot break this unless something drastic happens. She explained that if Paul is bedridden and cannot really do anything, then obviously we can expedite things and arrange things much quicker. But if that is not the case, you have to wait until next Monday for me to come. And we said, “Okay, fine.”

And interestingly enough, Torrin, the next morning, Paul woke up and he was much better. He was actually in good form. He did not have nausea anymore, and I think maybe it was the chemotherapy that helped him. And that morning, we sat together, and he wrote his eulogy for his service. So that was that. Since that time, we really had two months with more good than bad days. Because he lost his nausea with the chemotherapy, he was able to make phone calls. We could speak with family, and have video calls overseas. Friends could come over for one or one and a half hours for a visit. So it was amazing.

We had planned to go away for three months to ride across the Nullarbor, which obviously we could not do. So he just said, “Well, we are just having another holiday in ‘Canning Vale” which is the suburb where we live. So we had an amazing time. Really amazing.

Because there was a time in between when he was so bad, and we both thought now it would not take long and then he would decide. I said to him one day, “Do you know how people feel about you?” And he said, “No, because if people do not tell you, you do not know.” And because we only had two weeks left possibly I actually told everyone, family overseas and friends. If there is anything you want to tell him, you have to do it now, because we do not know how much longer we have.

And people were amazing because everyone was nervous and it was very difficult to confront this, you know, to think I am speaking on the phone to someone who will die very soon; I know that is very challenging or confronting. But people did fantastic things. I mean, they would make a video and tell him in the video what they feel about him and just send it off to us. And so we could watch it. And then the next day, we might do the phone call. So then there was already some tension gone.

And Paul was also amazing because he used to say to everyone, “I had a fantastic life. I am 77 years of age. I am in control because I can say stop if I do not feel well. And that is fantastic”. And that was his attitude. And in regard to what assisted dying gave us, we felt always supported and in good hands. They told me, because I am on my own, to get palliative care through Silver Chain. It is a place where you can call them 24 hours a day if you need any help. Because I was on my own, that was very reassuring for me.

And then we had one hiccup on Paul’s birthday; it was his first follow-up with the oncologist. He had another CT scan, and he now had metastasis in the brain. So that was possibly new. So immediately, the thought was “What happens with his choice of voluntary assisted dying?” Because you also have to be cognitively aware to do this. So again, we rang Anna immediately, basically, and said, “Look, this is happening. What does it mean to us?”

Even the oncologist told us it will take longer until you are cognitively impaired. And she said, “It will take some time. When I come, if you choose to end your life, when I come on the day, you have to be able to recognise me, to know why I am coming, and you have to tell me why I am here.” And when I ask you if you want to proceed with this, you must be able to respond with a nod; you do not have to say yes, nodding is sufficient. So you have to be, you know, alert. And again, that gave us an amazing calmness and reassurance that we would be okay.

When Anna came for the second time, Paul was good; that was a week after he had signed the papers. And she was amazed to see him the way he was. She said, “I am so glad I met the real Paul.” And we talked about how he would go about it if he chose this path. Initially, he wanted to drink the substance. But because he had this nausea, or history of nausea, we thought maybe that was a bit too unsure. So we decided that he would get an injection. And he did say to Anna, “How do I know when it is time?” And she just said, “You will know.” That was all. And she also explained on the day, “OK, this is now set up. But it does not mean that you will use it. You can use it in two weeks. You can use it in four years. It can take that long. You might not use it at all.” And again, you know, that just gave Paul so much comfort. He was absolutely happy about that.

We still had Christmas, which was great. But he did become weaker. And I remember one day after Christmas, he said, “I think I know what Anna meant when she said you will know.” And he said to me, “It is coming soon. But we had no clue.” So that was somewhere after Christmas in that year. 

So one Monday morning, 9th January, he could not get out of the chair. He did not have the strength. He was not walking with his walking aid, he did not have the strength to get up. So I just managed with much effort to get him up and get him to the bathroom, and then he sat down and he lost his strength. So then I had to call palliative care, and we had to call the cancer centre, and he was admitted to the hospital.

The oncologist said we had to do some tests because he did not know whether it was the reaction to the chemotherapy, the cortisone he was on, or what. And then it was Wednesday morning, a neurologist came and he explained he suspected that he had metastasis in the spinal cord, and that would cause the weakness. To confirm it, he would need an MRI. Paul was claustrophobic, so it would be an MRI under a general anaesthetic, Paul said, “Yeah, I am happy to have an MRI, you know, but if I do not come out of this, no resuscitation. I signed the papers with it. I am fine with this.” And that is when I said, “Let us just hang on. So even if you have a confirmed diagnosis, it is metastasis in the spinal cord. What is the treatment? Because your aim is you want to come home. You want to be able to walk by yourself, you know, to the bathroom.” And then the neurologist said, “Well, I cannot guarantee that. I do not know what the treatment is.” And then Paul said, “OK, that is it. I want to go. Thank you very much for your service.” The neurologist walked out of the room, and at that moment, the oncologist came in, and Paul told him what he was thinking. And the oncologist said, “Well, and I have CT scans from yesterday. The cancer has spread. All treatments have failed. I am really sorry.” Paul shook his hand and said, “Thank you very much,” and added, “Please call Anna.” And he wanted to go that day.

And so we spoke with Anna at lunchtime, and she explained she could not do it so quickly because she had a theatre list. So the earliest was Friday afternoon. And he was in a private hospital where you cannot do voluntary assisted dying. That is not allowed. We also wanted to be at home. So we just had to coordinate to stay in the hospital to the last day and then come home. And that was the course of the four months.

Torrin Wilkins: And so with Paul, how much control do you think he had over the process? Was he able to end the process or pause it if he wanted to? I know one of the big debates in the UK is around coercion and people being pushed into or pulled out of the process when they do not want to. So, how much control did he have over it?

Brigitte Tampin: One hundred per cent. I mean, there was no coercion at all because I only did what he wanted, and he wanted this. I supported it because I would feel the same. But there was never any coercion. Absolutely not. And I believe, I mean, I have not been in that situation, but I am pretty sure that the staff from voluntary assisted dying would be extremely cautious with these things and be aware of these things. And it has to be that person to say, “I want to go.” Absolutely.

Torrin Wilkins: It sounds like they have to come up with their reasoning and their own belief in why they want it. As you mentioned earlier, their reason and their idea of why.

Brigitte Tampin: Absolutely. I have no doubts that it could be in any other way. It has to be the person wanting it and deciding on this.

Torrin Wilkins: And what kind of safety net did that offer Paul? I know a lot of people have the substance but often never actually use it. And so it was something that comforted him, knowing that he had this option there, should he want it? He did not have to go through anything else if he did not want to, but if he wanted to kind of carry on then he could carry on.

Brigitte Tampin: Yeah, absolutely. It was the biggest gift that could have been given to him, seriously. Because he knew, I mean, he was lucky with cancer; he did not have any pain, and he knew, you know, as soon as he would have lots of pain if he would not be able to tolerate that, then he could say, “I do not want to live anymore.” He was, for these last few months, very jolly, very content. And he told everyone. He was always an optimistic and positive person, always a glass-half-full person. He was just amazing.

One day, friends came to visit, and this friend said, “We should have a wake for you, but not when you have died. We should have it beforehand.” So we did that. The week before Christmas, we had all these friends around, and it was just jolly and fine. So it gave him an enormous peace of mind that he could say when he wanted to go, and that he was in control. The other thing I think for myself, what I can see now, seeing other couples going through it, it was also really nice for me that I did not have to see him suffer.

You know, one of his friends, one of his golf mates, was diagnosed with cancer at the same time as Paul, and they had the same oncologist. He came to visit a few times, and he said to me one day that Paul was his role model because he chose assisted dying, and he was so content and everything. So he wanted to do the same thing, but he missed out. He and his wife always thought, “We have more time to do this.” And in the end, they did not. And he died last year. And his wife told me the last two weeks were just horrible. And she is so sorry that they never made it because she then would not have to go through this.

It is the people who are left behind. It can be such a relief not to see your partner or your loved ones suffer. Because when you lose someone and you think back on them, I think in the first instance, you first think of the last few hours, days, and months you had with that person. And if you can say, in my case, we actually had a really good time despite the bad days, but overall, it was a very good experience. I am very grateful for that.

People should think of that. It is only for people who are dying. You know, there is no question they will die. So it is just a question of how you die. It is with dignity. It is how you want it. It is absolutely beautiful.

What do you think it gave you? I know you said before about the time to say goodbye, and also, by the sounds of it, a bit of home renovation as well.

Well, I mean, the home renovation was not because of assisted dying. That was really Paul; he wanted to do everything he could to help me go further. So he wanted the roof to be renovated and new solar panels. He wanted a new fence in the garden, and everything was supposed to happen before Christmas, which obviously could not be. He bought me a little table to do gardening so that I would not have to bend down when I plant plants and, you know, all sorts of things. So he just wanted to make sure that I was okay when he was gone, but that was not necessarily part of voluntary assisted dying. It was just the reason I think why he chose to try chemotherapy to give us as much time as we had.

But what did it do for me? I think really, for me it was a great gift because I knew this was what he wanted and I could assist him with this. I can make it happen for him so that he can go with all his wishes being fulfilled. I can be there. That is the other gift that I feel, you know, I could do all this for him. I could be there with him. It was beautiful. And it was, in a sense, perfect. It sounds silly, but it was just peaceful and lovely.

And I feel it probably gave me also some strength, you know, knowing I was able to do everything I could, and he could go in the way he wanted to. He was always afraid of how he would die. He was never afraid of dying. He always said, “I do not want to be disabled; I do not want to have a stroke.” He even said this, you know, when he was sick, “I am still lucky; I am still able to walk, I am still independent, I do not have a stroke or whatever.” So, there are still lots of positives.

Torrin Wilkins: And one thing I noticed was the telehealth service, and that Paul had much more choice over where he died, and he could die at home. So, how important was that ability to choose and to have more of an option about where he died?

Brigitte Tampin: Well, that was very important because you are in your home, where we have lived for 25 years. We came home at 10 a.m. from the hospital. And I had organised that we had a video call with family in Germany and with family and his brother in England. That was all scheduled for 1 and 2 pm so that he could say his final goodbye and they could do this, and he was just comfortable in his recliner chair watching golf in between if he did not sleep, and that was his lovely environment. I think it is highly important, and you would not have that, you know, that surrounding if you were in a hospital.

And finally, looking back at your whole experience, and again, thank you so much for sharing it all today, but if there is one thing that you could tell politicians and the public back here in the UK about the assisted dying system in Australia and maybe how it works or anything like that, what would you try and tell them?

I think the most important thing is that, as you said already, many people think people are coerced or that people are dying even though they do not want to die. I mean, this is a totally voluntary thing, and it is only available for people who are dying anyway. So it is really about fulfilling their wishes and dying peacefully, with dignity, reducing suffering for the person who is dying, but also for the people who are left behind.

Note on interview transcripts:

All interviewees gave informed consent for their quotes to be used within the publication and for their interviews to be published separately. They also had the opportunity to review, approve, and suggest edits to the final transcript before publication to ensure clarity. These interviews have also been edited for grammar by the interviewer. This written version of the interview is the final and definitive version.