On 10 February 1984, my mother Margaret died in bed at her home. About a year before she had been diagnosed as having breast cancer. She had a mastectomy soon after, followed by radiotherapy. For the next nine months she seemed mostly her usual optimistic self. She looked forward to coming to Sydney every three months to see her oncologist. At her November 1983 visit, it was discovered that the cancer had metastasised into her lungs. She came from the hospital straight to my office, where, looking at my face for the slightest sign of hope, she told me that she had made up her mind to fight it.

After I started university in 1970, Mum would sometimes come and have dinner with me and my student friends. She threw herself into every conversation about politics, sex and all the big topics. Then, as at home, I recall her many times saying things like, “Heavens, when my time’s up, I don’t want to linger around in pain and misery . . . I’d like to just go off at a time of my own choosing.” If someone had knocked on the door with a survey about voluntary euthanasia, she would have told them the same.

But from the moment she was told the news about her lungs, all this changed. There was not a moment when even a crack appeared in her resolve to “fight it”. She dredged up all that fighting spirit stuff – the sort that had been with her during the London Blitz, which had allowed her to live in the drab back room of her first business after migrating to Australia, knowing she would work her way out of it. From that morning on, her life became focused on how she was going to beat this thing.

Two days later she went back into hospital and was knocked sideways with chemo- and radiotherapy. I visited her every day in a huge barn of a public ward and sat with her as she lay almost motionless, screened off by a thin white curtain. I had never seen anyone looking so sick. Still through this, she would cling to the smallest fragment of hope passed to her by the doctors and nursing staff trying to give her comfort. “The doctor said it had all gone well . . . he said I’d be feeling much better in a week or two, and then it will be wait and see.” “The way I see it, if I don’t give it a go, then I’d never give myself a chance, would I?”

After two weeks she came home and was so exhausted she could barely bother to walk a few yards into the back garden to get some sun. She insisted on cooking us what would be her last Christmas dinner.

As the cancer grew, her breathing became increasingly shallow and rapid. Three weeks before she died an oxygen cylinder was brought in beside her bed. When you can’t breathe properly, every moment of your life becomes preoccupied with getting the next breath. Lack of oxygen – hypoxia – causes disorientation and confusion. My sister and I had been taking it in turns to go down to her house in a small town and help. In the evenings we would sit with her and feed her junket through a straw. When we left the room, we left a bell near her hand so she could ring it if she needed anything.

I was sleeping on the floor in the next room the night she died. Dad woke me at 4 am and asked me to come and see if Mum was alright. I could see straight away that she was dead. The bell had fallen to the floor. Her body was still warm. Dad felt it right that the local doctor should be phoned right away so she could come down and tell us what was obvious. I pretended to phone and then sat with Dad drinking scotch, every now and then going back in with him to hold Mum. The last thing she said to me was about how the next day she was going to tell the doctor that she wanted to go back into hospital for another try with “the treatment”.

When the news about her lungs came through, we knew Mum was going to die. We didn’t know when, but we knew it could be soon. All we wanted to do was comfort her, give our love and hope that it would happen with minimal suffering. Both my sister and I stifled the impulse to talk with her as we would have normally. We said to each other, “She’s going to die. The only thing she has to look forward to is this crazy hope she clings to. Who are we to try to take that away from her?” Dad has always been frightened and appalled by talk of death, regarding it as profane and unseemly. This made us keep him away from our often angry discussions about the way medicine conspired with the fear of death to build these optimistic artifices that were deceitfully called “treatment”. So the option that she take no further therapy was never really discussed.

I fell upon the phrase that the treatment she received after her November lung cancer diagnosis was in fact a form of medically sanctified torture. I said this to everyone I met when they asked how things were going. I did literature searches in oncology journals, confirming my understanding that the probability of the treatment she was getting giving any decent remission was practically zero.

The last weeks of her life were appallingly wretched. She existed in total exhaustion between the kingdoms of fear and anger, whipped along by what we sensed was an unflagging burden of virtuous stoicism. There seemed no respite from this tyranny of false hope. Our temptation to ease the subject into the open with her retreated beneath the force of the plea behind her often terrified eyes that we didn’t. One night as I stroked her arm, she angrily brushed my hand away.

Where does this false hope, this “Break my bones, but don’t dare take away even the tiny chance I have” thing come from? Partly it must come from our culture’s denial and sanitisation of all things to do with death. Expressions like “brave”, “battle with cancer” and “never stopped trying” say much about the way we spurn any resignation about imminent death.

Yet how needless much of her suffering all seemed. I tried to put myself in her consultant’s shoes. Here was a warm, articulate woman only 64 years old, begging for hope . . . pleading with them to do something, jumping at any nuance of a chance, stoically prepared to weather any misery involved. Was it fair of me to expect him to deny her any chance, no matter how remote or at what suffering? If her two children, with a lifetime of talking with her, were not prepared to raise the subject of putting up the white flag and accepting death, why should I expect him to do it on the basis of having known her for a cumulative total of perhaps a few hours?

It seems to me that above everything else, many in medicine feel the need to do something in the face of threatened death. It is almost as if it is sacrilegious to do nothing, particularly in circumstances when death may be still months away. If it can muck in with techno-chemical heroics which signify the defiance of all odds, there will be plenty of people there to cheer it along, and very few who will feel it reasonable to be angry if these attempts fail as they almost invariably do in cases like my mother’s. Culturally, medical heroics dovetail with the arrogance of our collective belief in our earthly immortality. They represent the institutional expression of the cultural denial of death. For doctors trained and expected to rescue, revive and restore, the open recognition of the limits to medicine can come close to an admission of failure.

And if the decision to be frank about doing nothing is difficult, what of hurrying things along – what of the attitude that says, “If I am honest with this person, I will not seek to hide that it is nearly certain they will die within weeks. These weeks are likely to become progressively miserable and will become more devoid of hope for any reprieve. Is part of my duty of care at such times to offer to end this suffering if it is requested?” In my mother’s case this misery did not mean pain that could be relieved with drugs, giving the doctor a valued and sanctioned palliative care role. It meant instead that she would slowly suffocate to death over several weeks while becoming increasingly disoriented. She would have never wanted that. Who in their right mind would? And what sort of medical ethics says that she should just have to put up with it?

If her doctor had not tempted her with treatment, she would have developed hypoxia but avoided the weeks of nausea and misery brought on by the treatment. The local GP who attended her in her last weeks did not offer and Mum did not ask if her life might end with a sedative injection or drink. Each day she visited I would ask as Mum lay gasping in the next room, “How much longer do you think she has?” The answer was always indeterminate. Medicine devoid of any vocation to actively assist in the right to die has no answer to such pointless suffering.

There are those who argue that there is some point to such suffering. I say let them feel free to exercise that option with their own deaths if it brings them a higher comfort. But I have only contempt for ethics that insist such degrading suffering should be compulsory for those whose fates select such paths. Any laws or codes of conduct which institutionalise a denial of the dying’s right to determine their time of death do not reflect a civilised view of the end of life. The hastening of death in such circumstances, when the dying who have requested it are often incapable of taking action themselves, will require assistance. It follows for me that doctors and others should be able to assist such deaths with impunity where it is beyond any doubt that the dying person has consented.

Would my mother’s experience have been any different if she had lived her life knowing that as well as tending you all through your life when you are sick, doctors could be there, like priests, to come at your call and give you the medical equivalent of the last rites? To supply you with a way of choosing your own time to go? If she had grown up in a culture when it might be as natural as day and night to say, “My time is near, let’s have the doctor help me avoid the worst of the suffering”, would she have felt impelled to put herself through so much wretchedness for what was really no chance at all?

And how different might her death have been if her doctor had decades of a medical tradition behind him which better enabled him to be frank rather than surreptitious about what lay ahead; about the futility of aggressive chemicals and radiation in prolonging her life; and who could instead offer options of assisted, painless death at a time of her choosing.

So yes – to both questions.