First it was abortion on demand and now it may be death, following the example set by Holland
Gustav Thiel
THE medical fraternity, still battling with its conscience over the recent advent of legalised abortion in South Africa, will soon have a new medical and ethical dilemma to confront, with the release of proposals to consider legalising euthanasia.
The South African Law Commission is preparing a discussion document for release later this month that will include the pros and cons of active euthanasia – in which a doctor acts deliberately to cause the death of an already dying patient.
Appeal Court Judge Pierre Olivier, who is chairing the investigation for the commission, said it is too early to speculate on legislation that may emerge from the discussion document. “We want the discussion to be as broad as possible,” he said.
And that meant, he said, that it would address the issue of active euthanasia. He said it would go so far as to suggest that South Africa consider following the lead of the Netherlands and Australia’s Northern Territory, where doctors can legally speed the dying to their end.
Those already involved in the debate predicted that Parliament is likely to enact legislation legalising what is commonly known as passive euthanasia, defined as withdrawing life support, or withholding life-saving treatment.
Trudie Stohr of the Living Will Society said passive euthanasia should be legalised because it is already common practise, a fact that she said should be recognised by the commission and the legislators.
A recent survey by the Medical Association of South Africa found that a surprising 12% of doctors who responded said they had actively helped terminally ill patients to die, which is essentially euthanasia, even though it is currently illegal and presumably a violation of the profession’s own Hippocratic Oath.
But though the practice may exist already, medical and legal professionals predict that the report of the commission and any legislation that comes out of it will elicit strong responses.
Professor Selma Browde, a leading specialist in the field who made a submission to the commission, said she hoped that the discussion document would draw a clear distinction between palliative medicine and euthanasia.
“Legal clarification is necessary to get away from old definitions and formulate new ones so that doctors, nurses and the public will no longer be confused about their legal and moral duty to relieve pain and other distressing symptoms,” she said.
Part of the problem, she said, is that the term euthanasia has often been used for situations to which it did not apply, and there has been confusion in the use of the terms passive and active.
In fact, she said, passive euthanasia is a term that should no longer be used.
And palliative medicine, she says, is none of the above. She defines palliative medicine as providing for the medical and nursing needs of a patient for whom cure is no longer possible, and for all the psychological, social and spiritual needs of the patient and family for the duration of the illness.
The confusion stems to some extent from fear on the part of medical professionals that by giving a patient medicine to relieve pain they may end up shortening the life of the patient, which could be regarded as a form of euthanasia.
The principle, which is known as the “double effect”, needs to be clarified and such fears put to rest, she said.
The distinction between giving pain relief that ends up shortening a patient’s life, and euthanasia, she says, is “intention”.
“In euthanasia the intention is to terminate life, but when the intention is to relieve the suffering of a dying patient and the secondary effect is the possible hastening of the moment of death it becomes known as the secondary effect and is no longer euthanasia but palliative medicine,” she said.
Commission members privately say the outcome of the discussions after the document is released will create “quite a stir” but say legislation is needed to provide legal certainty.
The Medical Association’s survey of 1400 doctors, of whom about a third responded, found that while 12% of respondents had actively helped terminally ill patients to die, nearly 60% had performed “passive” euthanasia and 9% had participated in physician-assisted suicide.