Gill Pharaoh and the myth of the slippery slope

In his latest column, Dr. David Amies examines the case of Gill Pharaoh, a 75-year-old British former nurse who travelled to Switzerland to access assisted dying, despite being in fine health. Her case has sparked controversy in the U.K., where an assisted dying bill is set to be debated in Parliament this fall.

Gill Pharaoh, aged 75, British and a retired nurse, decided to end her life at the Lifecircle clinic in Switzerland in July. She was in good health, mentally competent and suffering from no unpleasant condition. Her reasons for her action were that she feared growing old and that she had nursed many elderly people and had formed the impression that, ‘… aging was no fun’.

Her course of action has provoked much comment and has given the slippery-slope merchants who oppose physician assisted dying under any circumstances, much fuel for their arguments.

Presumably, anyone can decide to end his or her own life at any time. They do not require permission. There are many means of killing oneself. Suicide used to be a criminal offence but is no longer. Who is to stop the determined person from jumping off a cliff or from throwing themselves in front of an on-coming train? In general, all sentient creatures refrain from activities that will end in their own demise. There seems to be an in-built horror of death, which is a useful protective mechanism. We know that persons suffering from various serious mental diseases are prepared to cast this mechanism aside. Presumably they decide that their particular circumstances are so awful that death is a better option.

Smart laws to prevent abuse

In places where assisted dying has been made legal, the authorities have been at pains to ensure that anyone asking for help to die is in sound mental health. Here in Canada, where such enabling legislation is presently under review, it looks very likely that physician assisted dying will not take place without at least two independent medical opinions being obtained. The obvious reason for such caution is to ensure that any applicant is not just depressed. Such a person could be offered treatment, which would restore a measure of mental balance and lead to a decision that life was worth hanging on to for a little longer, after all.

Competent doctors are good at one thing above all: they can spot the abnormal. They may not be able to put a name to the abnormality but they are usually able to take useful action when they are faced with it. A doctor faced with Gill Pharaoh would be placed in a dilemma. Her desires have a touch of the eerie about them. Her behavior might be described as cavalier. After all, she was fit, in full possession of her faculties — at least on the surface. She was prosperous and had a warm relationship with her partner and her family. And yet, she decided that she did not wish to grow old. Press reports revealed her wandering. around Basel, hand in had with her partner, on the eve of her planned death and then enjoying a fine dinner before going to bed. However, growing old in her view, was so beset with difficulties and problems that she did not think she could cope. All in all, a very strange story.

She lived in England, where assisted dying is unavailable, hence the trip to Switzerland. One assumes that those who run Lifecircle have measures in place to weed out the mentally unhinged. How interesting it would have been the fly on the wall during her consultations with the staff at the clinic.

Physicians must do their job

Personally, I am a staunch advocate of right-to-die legislation. I am unhampered by any religious beliefs concerning the matter. I was trained in London and was at no time asked to take the Hippocratic oath but was told that my job as a doctor was to do no harm. Faced with Mrs Pharaoh, I would have been placed in a quandary. On the one hand, I would have been forced to take her request seriously. But on the other, It would, however, have come so far out of left field, bearing in mind her circumstances, that I would have sought advice from suitable colleagues. As I mentioned earlier, competent doctors ought to be able to spot the abnormal and her request would have appeared to me to have strayed from the usual.

My advice to her would have been that she should hold her fire and review her decision regularly. Once her mobility began to diminish — inevitable; once her cognitive powers fell away, also inevitable, then I would have been more ready to come to her aid. Dementia does not turn up overnight. Immobility is not sudden. One is not in good shape today and a wreck tomorrow.

In summary, I am surprised at the course of events that has occurred in Mrs. Pharaoh’s case and sorry that it ended as it did. I am especially sorry that cases like this will have given those who oppose dying with dignity much ammunition in what is a very emotional argument. Let us hope that wise heads will deem her story to be an odd one-off and that those, who will make the decisions about end of life management, here in Canada, will not use it to influence their views. I cannot envisage any laws ever being enacted here that would allow such persons as Mrs. Pharaoh to take such a casual view of their continued existence. 

Dr. David Amies is a retired doctor in Lethbridge, Alta., and a member of DWD Canada's Physicians Advisory Council.

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