IN Sierra Leone in the early 1990s, Dr Elizabeth Wilson saw a slogan that blazed its certainty in just three words: "Unexpected always happens." It seemed the tailor-made mantra for her life. Today in Edinburgh the unexpected will happen once more, she says, when she is honoured by the Scottish Academy of Merit with the George Bell Award for Services to Medicine. "I really am amazed by this, because I haven't had any public recognition of any kind before," she says. "And now here I am at 80 receiving a delightful surprise."

This lack of decorations seems astonishing when one considers that Dr Libby, as she is known, has long been admired in medical and social circles as one of Britain's tireless pioneers in family planning; a courageous fighter of immense humanity who took contraception into some of the most appallingly neglected slums and ran one of the earliest VD clinics in Scotland. Seventeen years ago she retired from the Greater Glasgow Health Board as clinical co-ordinator of family planning and women's health. So why does she think she has been overlooked for the honours later given to her professional equivalents elsewhere?

Without hesitation or rancour, she answers: "Oh, because I was always going against the government - that's government with a small g, by the way. But, when I started, we were treading very controversial ground with hardly any resources and we had to battle prejudice all the way."

Our conversation takes place in the book-lined drawing room of Dr Libby's home in the west end of Glasgow. As she sits there, a wry and welcoming figure of grandmotherly plumpness, she gives no immediate appearance of cutting an anti-establishment dash. But, as her story unfolds, it is clear that some imperatives have never left her. On retirement she spent a year in Sierra Leone as medical officer with the Marie Stopes International family planning service, struggling again with next-to-nothing resources. And now she is involved with another controversial area, the assisted dying campaign.

That phrase, "unexpected always happens", runs like a thread through her experiences. For a start, there can't be many family-planning experts who have given birth to six children. "That's the joke, you see. But I always explain that, as my youngest child is 59, it all happened before the Pill became widely available in 1961 and '62." She sits further back in her chair as rolling waves of laughter fill the room.

Dr Libby began her career as a GP in Sheffield in the 1960s, later specialising in family-planning training. By 1966 she was hitting the headlines after she and a colleague launched a contraceptive centre for unmarried women. But far fiercer criticism came in 1967 when she and her brood moved to Scotland after her husband, Graham Wilson, was appointed Regius Professor of Medicine at Glasgow University. "I'd decided by then to concentrate entirely on family planning, and at that time everything up here was still quite old-fashioned," she says. "I mean, even the nurses who came to work with our team hadn't been taught how to take blood pressure. But the real crunch came when we had to train GPs in how to insert inter-uterine devices. Some of these old boys hadn't used a speculum since their student days, and they were so nervous their hands were trembling. You can imagine how frightened the poor patients felt.

"Inevitably we became involved with abortion, but the inequality in the distribution of this service in Glasgow, with a largely Catholic council, was absolutely incredible," she says. At certain hospitals, she remembers, senior consultants and nurses, who were also Catholic, held sway. But from her Claremont Terrace clinic, Dr Libby took on both the church and the councillors.

Gradually she built up a trusted cadre of male and female consultants who appreciated the physical and emotional cost to the poor of repeated pregnancies; doctors who understood the pressure on the city's most impoverished women, some with 10 children already and the likelihood that another birth would kill them. These mothers were broken individuals, she says, who reminded her of "paper boats, only just managing to stay afloat".

As she reflects on the home-visit service she instigated for women wanting contraception, a shocking picture of wretchedness emerges; a picture easily forgotten today, yet not consigned entirely to history. Scotland, after all, has the highest number of births among unmarried teenagers in Europe, and most of these mothers live in Glasgow's lingering areas of deprivation. So has her brave crusade failed?

"No. The services for family planning are all there, but the problems have been made more complicated by drug addiction. Today we have children on drugs - who themselves are the children of drug-users - having children. In my time, even in the grimmest circumstances, there was often a certain family life to which children could return. Now, family life scarcely exists at all. Mind you, that situation is not just confined to the poor."

On home visits, Dr Libby was always prepared for the unexpected. On one occasion she was trying to persuade a schizophrenic patient to have a contraceptive injection when the woman - living, she remembers, in a virtual hovel near the Saltmarket - suddenly rose from her orange-box seat and threatened her with an axe. At this point the doctor made a hasty retreat down the close stairs with the patient screaming: "And never come back!"

She also remembers one of her nurses repeatedly visiting a woman in Blackhill, because the nurse knew the patient's contraceptive pills would be running out. "But each time she chapped on the door, the husband said that Agnes was at her ma's, or the factor's, or some other excuse.

"Finally Agnes herself answered the door, and the nurse said, Well, I'm really glad to see you, because I've worn out shoe leather traipsing up and down these stairs.' To which Agnes replied, What size d'you take? I'll lift you a pair.'" In fact, Agnes's husband had been protecting her reputation. "She'd been in jail, you see."

Dr Libby's husband died of stomach cancer in 1977, the day before his 60th birthday. "Graham was very remarkable, really, because he was all for women working in what was still a male-dominated world, and he never put brakes on what I was doing. He said my medical qualifications were worth more than any life-insurance policy."

When he became ill, she repaid this vital encouragement with unstinting devotion to his nursing needs. Even though she was working full-time, she visited him in the Western Infirmary four times a day for months. "In his particular side ward at that time, the nursing was so awful that I would arrive before 8am to shave and change him and give him a bed-bath. Then I'd go back at lunchtime, teatime and in the evening."

BUT it wasn't her husband's cancer that prompted her interest in assisted dying. This is the movement which advocates that terminally ill patients, who are expected to die within months, be allowed a prescription of a drug such as nembutal which they may self-administer if their condition becomes unbearable. Dr Libby cites the situation in Oregon - the only American state which has had such legislation since 1997. "They have found that one-third of those who apply don't actually use the prescription. So there has been no slippery slope."

As for religious faith: she was, she says, a strong believer up to becoming a young woman. "From then on it just seemed so irrational. While I'm all for Christian ethics, Christian dogma - or dogma of any kind - seems absolute rubbish to me." And for Dr Libby there is no moral conflict in her commitment to assisted dying. "I see it rather as a continuity of ethics: a logical link between helping women to control their own fertility and helping those who are grievously ill to choose when and where they die."

Dr Libby remains in fine fettle. "I'm lucky to be very fit - if very fat. But I've had this fatness for about 25 years." Any final advice? "Keep away from doctors," she chuckles. It's not the answer one anticipates, but a small, teasing reminder that the unexpected always happens.

The CV: Dr Libby Wilson

  • Born: 1926.
  • Education: St Catherine's School, near Guildford; King's College Hospital, London.
  • Family: Married to the late Professor Graham Wilson, with whom she had six children.
  • Career: Began in Sheffield, where her contraceptive clinic for unmarrieds caused controversy. Arrived in Glasgow in 1967; retired as co-ordinator for family planning and women's health in 1990, then worked in Sierra Leone with Marie Stopes International.

Scottish Academy of Merit: the 11 other luminaries being celebrated today


The Scottish Academy of Merit, set up by the Institute of Contemporary Scotland, is dedicated to recognising outstanding contributions in the fields of science and technology, the environment, religion, justice, medicine, education, literature, the media, the arts, business, humanitarian and public services. The Herald is the media partner. Each year 12 new members are admitted as fellows. They will be received at a ceremony at the Roxburghe Hotel in Edinburgh. As well as Dr Wilson, this year's award-winners are:

The Rev Professor Frank Whaling
Churchman and academic.

A leading supporter of inter-faith activities in Scotland. Receives the James A Whyte Award for services to religion.

Dr Patricia Macdonald
Biologist, environmental researcher and artist-photographer. With her husband, Professor Angus Macdonald, runs the Aerographica Partnership, specialising in environmental research. Receives the Brian K Parnell Award for services to the environment.

Professor Grahame Bulfield, CBE
Geneticist; helped establish the Roslin Institute - famous as the home of Dolly the Sheep - as the world's leading farm-animal genomics and database centre. Receives the David Tedford Award for services to science and technology.

William McIlvanney
Novelist and poet. His works include the novels Laidlaw and The Big Man, and his collections of poetry, The Longships in Harbour and Surviving the Shipwreck.

Receives the Iain Crichton Smith Award for services to literature.

Lord Hope of Craighead
Judge and former Lord Justice General of Scotland. Now sits in the House of Lords as a Lord of Appeal. Receives the David Kelbie Award for services to justice.

Professor Walter Humes
Academic and educational thinker; currently research professor in education at the University of Paisley. Receives the John Aitkenhead Award for services to education.

Sally Magnusson
Broadcaster and journalist. Currently presents the BBC's Reporting Scotland and Songs of Praise. Receives the James Shaw Grant Award for services to the media. Her books include The Flying Scotsman, a biography of the athlete Eric Liddell.

John Byrne
Artist and playwright; author of Tutti Frutti and The Slab Boys. His portraits include Robbie Coltrane, Billy Connolly and the actress Tilda Swinton, to whom he is married. Receives the Tom Wright Award for services to the arts.

Lord Macfarlane of Bearsden
Industrialist, business leader and supporter of the arts. Founded N S Macfarlane and Co Ltd, is a former chairman of Guinness PLC, and a three- times Lord High Commis-sioner of the General Assembly of the Church of Scotland. Receives the George Younger Award for services to business and economics.

Kaliani Lyle
Champion of race equality and ethnic minorities. Has been chief executive of Citizens Advice Scotland since 1998. Practised as a pharmacist before turning to community education. Former CEO of the Scottish Refugee Council. Receives the Alastair Hetherington Award for humanitarian service.

Canon Kenyon Wright, CBE
Churchman influential in the movement for devolution. Former chairman of the executive of the Scottish Constitutional Convention, and ex-general secretary of the Scottish Churches Council. Began his career in the ministry as a missionary working in India. Receives the Kenneth Alexander Award for public service.