Should people be allowed to die if they have been declared brain-dead? Sean Badal looks at the some of the issues behind living wills
REMEMBER Nancy Cruzan, voted one of the “25 Most Intriguing People of 1990”? An American woman who was irreversibly brain-damaged in a car accident, she survived eight years in a coma on a life-support system.
Cruzon became an international celebrity when doctors refused to switch off her support systems, though her family argued that she had often expressed loathing at the idea of being kept artificially alive.
As a result of the media exposure, a new growth industry sprang up in the United States: organisations which assisted people in drawing up “living wills”, legal documents that make provision for people to be allowed to die if they are declared brain-dead. In the six months after the Cruzon case, more than 800 000 people in New York alone signed up with the Society for the Right to Die.
Many living wills are now slickly packaged _ for instance, the testator can speak directly to a doctor or a supreme court judge on video if the doctor proves recalcitrant _ but they still raise serious ethical issues in both the medical and legal fields.
A number of states in the US have made laws validating living wills in hospitals, but in South Africa the concept is clouded with doubt.
Explains attorney Rory McFarlane, author of a paper on the right to die: “There is no legal definition of a brain-dead person in South Africa. Exactly when someone is not capable of being brought back to consciousness is a grey area. The medical condition of being in a persistent vegetative state (PVS) might be a good starting point, but it’s not entrenched in the law.”
South Africa has also had its Cruzon-type case, although it was far less intensively covered in the press. “The case concerned a doctor who was in a PVS after a cardiac arrest,” says McFarlane. “He had signed a living will declaring that he did not want to be kept alive should he be irreversibly brain-damaged.”
The doctors, however, questioned whether this was still his intention and refused to switch off the life-support systems. His wife then applied to the courts to have his life terminated.
The judge held that she was justified in authorising an end to the artificial feeding of her husband, even though this would hasten his death. He was discharged from the hospital, and died at home.
How does one draw up a living will in South Africa? Says McFarlane: “Although we do not yet have a living will statute, the South African Voluntary Euthanasia Society (Saves) encourages people who agree with its objectives to sign a living will when they are in good health and of sound mind.”
One copy of the will should be kept by the member of Saves, he says. A second copy should be available to advise hospitals of the member’s wishes. A third should be lodged with the member’s medical practitioner, ensuring in good time that the doctor has no ethical objection to following the terms of the will. And a fourth copy should be held by the attorney in case legal action is required to enforce it.
The national secretary of Saves, Brigid Raw, is adamant that the organisation does not favour the approach of Jack Kervokian, the American medical practitioner known as “Doctor Death” who developed a “suicide machine” for terminally ill patients.
“We encourage passive euthanasia only, and in no way encourage people to take the law into their own hands,” says Raw.
“Our main aim is to ensure that people should be able die with dignity if they are being kept artificially alive.
“Saves has practical ways of ensuring that the terms of a living will are adhered to, and that people do not suffer unnecessarily. We have more than 28 000 people in South Africa who adhere to those principles.”
At least one local church has endorsed the living will principle. Says the head of the Methodist Church of South Africa, Bishop Peter Storey: “If the idea is to allow people some dignity in death, then I see no problem with it. In terms of Christianity, I don’t think there are any serious moral questions to be taken into consideration.”
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