Khadija Magardie
As the Netherlands Parliament this week became the first in the world to legalise euthanasia the South African government says it has shelved discussion on the subject at least for the time being. The South African Law Commission (SALC) released a report on the subject in mid-1999, but it is currently gathering dust in the minister of health’s offices. According to the SALC, the report, entitled Euthanasia and the Artificial Preservation of Life, was submitted to Minister of Health Manto Tshabalala-Msimang, as well as to Minister of Justice Penuell Maduna. It contains various recommendations regarding decisions around the termination of life, as well as the treatment of terminal patients. Because the SALC report sets out different options for euthanasia in a draft Bill, which option to go with would be at the discretion of the minister of health. According to Tshabalala-Msimang’s adviser, advocate Patricia Lambert, there is no specific attention being paid to the report at present, nor will there be in the near future. “It is not on the parliamentary programme for this year,” she said. The law as it stands forbids the termination of a person’s life in order to end unbearable suffering, even if it is clear that death is inevitable. Taking such a life, even if the person expresses the wish to be killed, remains a punishable offence. But the withholding of life-sustaining medical treatment from a patient or terminally ill person is permissible under specific circumstances and conditions. According to a paediatrician at a Johannesburg hospital, it is standard practice, for instance, not to ventilate a newborn that weighs below 1kg. “We will give the infant all necessary care, but we don’t try to keep it alive when it’s clear it won’t,” he said. The SALC report says its exploration of the issue stems from the increased importance, worldwide, being attached to “patient autonomy”, and the rights of a mentally competent patient to refuse medical treatment, or “to obtain assistance, should he or she so require, in ending unbearable suffering by the administering of a lethal substance to a patient”. It also emphasises the ethical dilemma posed to health professionals, who want to act in the best interests of the patient but fear being exposed to claims, or even criminal prosecution, as a result. The law approved by the Dutch Senate this week is governed by strict conditions, such as a long doctor-patient relationship. Moreover, a patient would have to be undergoing incurable suffering, and have to be made aware of all other medical options, as well as to have sought a second professional opinion. The new law allows patients to leave a written request for euthanasia, giving doctors the right to use their discretion when patients are too ill to decide. But it stipulates that doctors cannot suggest euthanasia as an option the patient must make the request independently. Health professionals can be punished for failing to meet the law’s codes. The SALC report makes specific recommendations. A medical practitioner may, under certain circumstances, authorise the withholding of all further medical treatment to a patient whose life functions are being artificially maintained. A competent person may refuse life-saving treatment with regard to specific incurable illnesses, even though such a refusal may hasten the cause of death. The report also contains recommendations giving doctors discretion in deciding on a patient’s life, where the patient has left a will stipulating a request for euthanasia, or where it is the wish of the patient, who is unable to communicate. The aspects of the report likely to prove tricky are the three options that the health minister is to decide upon with regards to voluntary euthanasia. The first is confirmation of the present legal position, which prohibits voluntary euthanasia, and physician-assisted suicide. The second suggests that active euthanasia could be regulated, in a way that gives effect to patient wishes, or those of his or her family. The third option advocates the establishment of a panel or committee which would consider requests for euthanasia, according to strict criteria. l Meanwhile, an Australian proponent of euthanasia, Dr Philip Nitschke, has announced his plans to charter a Dutch-registered ship to perform mercy killings off the coast of Australia, where a law legalising euthanasia was passed by a state but later struck down by the government.