On the 21st of July 2015 at a Swiss euthanasia clinic, Gill Pharaoh, a retired palliative care nurse, ended her life. She had been involved in the care of several terminally ill patients, and had had a long and successful life, but Ms Pharaoh was not terminally ill. Her decision to end her life was based purely on a fear of old age. As she told the Sunday Times, her nursing experience had led to the awareness that growing old was “awful”, and that she did not want to be remembered as “a sort of old lady hobbling up the road with a trolley”.

It was in 2010 that, following a serious bout of shingles, that she had started to become preoccupied with her health and feeling that she was deteriorating. It would be five years later when her life would end. It is tempting to speculate whether an increasing preoccupation with health, withdrawal and eventually assisted suicide was secondary to an untreated depression. However the sheer threatening perspective of a person deciding to end their life purely to avoid old age must be considered.

The challenge of the individual facing their final stage in life is the hardest battle that any person can face. Determining what constitutes “healthy ageing” is difficult. SANE Australia’s report on “Growing Older, Staying Well” found that access to mental health services, avoiding social isolation, the appropriate management of loss and grief, and dealing with the stigma of ageing was essential for successful ageing. Notably, the report identifies “the experience of ageing can bring many challenges, yet these challenges are poorly understood in our communities”.

Perhaps the best real-life attempt to quantify what ageing entails is Harvard University’s Study of Human Development, which has charted the lives of 724 over 60 years. Interestingly, the study’s former director, Professor George Vaillant, identified a new milestone for late-life development –what he termed Keeper of the Meaning, which was “conservation and preservation of the collective products of mankind”. This fundamentally translates to the older person finding an identity by means of maintaining and disseminating wisdom – with roles in mentorship and teaching. However he himself notably deals with the question of positive ageing by considering that it’s all about “joy, of love, and of learning something that we did not know yesterday.”

In 2004, a 1 year study from Verpoort  in Belgium (where euthanasia is legal) of palliative care nurses’ views on euthanasia found that the majority were not in favour of euthanasia. In the old age psychiatry service where I work in, we regularly see people in their 70s to 100s who exhibit a wide variety of late-life endeavours – from the suffering arthritic individual dreading his upcoming nursing home residency, to the swinging socialite juggling boyfriends. It is certainly true that a fundamental aspect to healthy ageing is good physical health, with good decisions and medical care earlier in life to minimise complications at a later stage. But after this, comes the interesting perspective that society doesn’t tend to know what to expect of a 60-plus year old person apart from occasional babysitting duties. The most successful patients I have seen, are those who have embraced this lack of guidelines with the freedom that life truly presents.

I recall a nursing home resident in her early 60s with multiple physical illnesses who had a severe psychotic anxiety disorder, that required several months of inpatient treatment. Following a long battle, we were amazed to see a considerable improvement in her functioning, to the point that she was no longer obsessed with self-destruction and had a level of sanity in her dealings with the world. However during one of my last visits with her, with the self-awareness that comes with a sane mind, she expressed deep distress to me about what do with her life from here on. I suggested that she should do whatever she wanted.

It was a month later when the nursing home arranged an internal exhibition of her artworks, and invited all the residents to view her remarkably fine cross-stitch creations. According to the staff, in the years of knowing her they had never seen her so happy, and so full of joy.

When one is 10 years old, life is about early friendships and imagination. When one is 30, it is about family and career. When one is 60 and over, there is no template, and one is free to do whatever they want.

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