Die Smiling

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Julie Casson traces her husband Nigel’s true-life journey from diagnosis of motor neurone disease to his joyful decision to take control of his death

Die Smiling is about one man’s triumph over disease.

Following a multitude of tests, Nigel Casson, a successful businessman and father of three, is diagnosed with motor neurone disease. Nigel accepts the earth-shattering prognosis with immense bravery and Julie traces her husband’s journey, from diagnosis to his death at Dignitas in Zurich, ten years later.

Nigel battles the degenerative disease with boundless courage and prepares for each debilitating disability with gritty good humour, until, faced with the unimaginable torture of a slow, living death – his spirit crushed, his body a tomb – he takes control. He decides to go to Dignitas to end his life, while he is still able to die smiling.

The family carry out preparations for this enormous logistical and emotional challenge: the gruelling Dignitas process, the eight-hundred-mile road trip, and complete it with pragmatism and humour. They succeed in getting Nigel to Switzerland and his determination to deny the disease its victory, ensues. Nigel dies in the arms of his wife and children.

This is an intimate and uplifting portrait of a family coming together to navigate their shattered world. It is a thought-provoking and deeply moving book, where love, happiness and dignity prevail over horror. It sits in the heart of the debate on assisted dying and raises questions about the right to put an end to suffering and the right to choose how life should end.

– Sarah Wootton, Dignity in Dying

Die Smiling: A Memoir: The Sorrows and Joys of a Journey to Dignitas by Julie Casson is an unforgettable, deeply human non-fiction memoir that follows one family’s path through motor neurone disease (MND/ALS), enduring love, and the search for dignity, autonomy, and end-of-life choice.

When Julie’s husband, Nigel, begins to lose control of his speech, the couple are propelled into a baffling medical maze — appointments, tests, and the creeping knowledge that something serious is unfolding. The devastating moment arrives: Nigel is told he is believed to have motor neurone disease, “life-limiting” with “no cure.” What follows is not only an intimate portrait of living with terminal illness, but an unflinching account of what it means to love someone through progressive loss — voice, movement, independence — and still fight for joy, humour, and meaning.

Written with candour, elegance, and sharp-witted warmth, Die Smiling is at once a caregiver memoir, a story of family resilience, and a compassionate exploration of palliative care, hospice realities, and the emotional labour of long-term caring. Julie takes readers behind the scenes of everyday life with MND: the practical challenges, the shifting relationships, the private grief, and the fierce tenderness that can exist alongside exhaustion. It is also a memoir that insists on seeing the whole person — Nigel’s character, his humour, his determination, and the way laughter can survive even when circumstances are bleak.

Central to this true story is the question of control. Nigel’s belief in choice becomes a guiding force, leading to the decision that the family will travel to Dignitas in Zurich, Switzerland—a name often surrounded by myth, and here described plainly and thoughtfully. Julie clarifies that Dignitas is not a clinic; it is a not-for-profit members’ society supporting “self-determination, autonomy and dignity.” As the administrative steps intensify and the date approaches, Nigel’s motivation is heartbreakingly simple: he wants to die while he is still himself — “while I can still smile.”

The final chapter of this journey is both intimate and startling in its ordinariness: planning, travel, a confirmed date — 25 April —a nd the family’s last day together in Switzerland. When the end comes, Julie records it with clear-eyed restraint: “Just before noon. Swiss time.”

For readers seeking books about assisted dying, death with dignity, right-to-die debates, euthanasia ethics, MND/ALS lived experience, or simply a powerful memoir of marriage and devotion, Die Smiling offers a rare blend of honesty, empathy, and profound love — an extraordinary story, told with grace.


– I salute the courage of his family in writing and sharing it. Take the time to read it no matter what you think. It’s a beautiful story' – MTT

What a remarkable man Nigel was, courageous, fun-loving family man. Julie and her family are unbelievably supportive.' – B2NYC

Julie is a fantastic writer and should be encouraged to write a novel. It is one of the best memoirs I have read for a long time and have learnt so much about MND and Dignitas.' – K Matthieson

describing the initial diagnosis of her husband's MND through to the sad, yet uplifting conclusion at the Dignitas establishment in Switzerland. Throughout the book, the strength and importance of family is clear to see. Moments of intense sadness are counterbalanced with typical northern humour...often, on the same page.' – David Chard

Heartbreaking and heartwarming but also hilarious.' Customer

I laughed as much as I cried.' – P.M Swaine





1. Looking Back 3

2. Death’s Calling Card 6

3. Brenda and Methuselah 15

4. Tests, Tests and More Tests 23

5. The End of ‘Normal.’ 32

6. Life with MND Begins 44

7. Breaking the News 53

8. The Wailing Weeks 67

9. Spain 81

10. The Bucket List 85

11. Where Hope Dies 91

12. Not Ready for This 98

13. Our Spanish Love Affair 103

14. Two Steps Ahead 112

15. MND Declares War 122

16. Don’t Forget Me 126

17. Cost More Than our First House 132

18. Starting to Die 137

19. 22 July 2011 147

20. Every Day is a Bonus 157

21. Don’t Laugh at my Cock 164

22. Toileting Matters 179

23. When the Laughter Stops 191

24. It’s All About Control 203

25. Apply to Die 210

26. The Provisional Green Light 226

27. Last Christmas 238

28. The Recce 247

29. Appointment with Death 264

30. Twenty-five Days Left to Live 283

31. The Goodbyes 295

32. The Hotel and the Doctor 303

33. One More Day 314

34. Nigel’s Cure 328

35. Nigel’s Last Goodbye 345

Acknowledgements 356

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