A controversial campaign to legalise doctor-assisted suicide and active euthanasia was launched in Cape Town on Thursday, spearheaded by the Ethics Institute of South Africa (EthicsSA) and Dignity SA.
The launch comes two weeks after the much-publicised return to South Africa of Dignity SA founder Sean Davison, following his five-month house arrest in New Zealand for assisting his aged mother to die.
Davison, professor of forensics at the University of the Western Cape, was initially charged with attempted murder, but this was reduced to “counselling and procuring attempted suicide”.
Dignity SA is now running an online petition to garner support for the legalisation of assisted dying.
“This is one of the greatest challenges facing humanity,” Davison told the Mail & Guardian. “It takes brave thinking and brave decisions”.
Davison added that he had received “overwhelming support” in both New Zealand and South Africa.
In a position paper released on Thursday, titled End of life decisions, ethics and the law, Professor Willem Landman, executive director of EthicsSA, calls for “statutory legal clarity and reform” in the areas of terminal pain management, life-sustaining treatment and assisted dying.
“Competent persons have a moral right to make their own choices, including choices about their own continued life in clearly defined conditions, and to act upon these choices. We have an ethical obligation to respect that right,” writes Landman.
Legal debates about assisted dying first surfaced in 1998 when a report produced by the South African Law Reform Commission led to the drafting of a Bill, provisionally called the End of Life Decisions Act 1998. But, according to Unisa law professor Melodie Slabbert, the Bill “was not enacted and also not clearly rejected”.
“One can only speculate about the reasons for this,” added Slabbert, who is also an executive member of Dignity SA. “It has clearly not been viewed as a priority issue on the government’s health agenda.”
Department of health spokesperson Fidel Hadebe was unable to comment on the current status of the draft Bill, but referred the M&G to the department of justice and constitutional development. “State law advisors may be in a better position to shed light on this matter,” Hadebe said.
Assisted dying: the case for and against
The latest campaign by EthicsSA and Dignity SA is likely to generate fierce opposition – especially from organisations like Pro-Life SA, which “seeks to ensure that society upholds its respect for human life”.
“Our mandate [as medical practitioners] is to control pain. Once the medical profession thinks it is permissible to kill anyone, then that society is on a slippery slope to Auschwitz,” says the organisation’s former president, Dr Claude Newbury.
Landman believes that when it comes to moral guidance on issues like assisted dying, South Africans can find “common ground in the spirit, values and rights embodied in the Constitution”.
“Killing is not part of our Constitution,” he says.
Ultimately, those who value “sanctity of life” are pitched against those who value “quality of life”.
Suffering vs pain control
Dignity SA and EthicsSA argue that “death may become the only deliverance” in cases where there is “all-consuming pain”, or “intractable distress”.
“If a competent person freely judges that death is the only escape from suffering, then assisting that person to die would not wrong or harm them, but be in their interest,” Landman writes.
Pro-life lobbyists like Newbury are not convinced. They argue that the legalisation of assisted suicide leads to abuse. Newbury suggests that in countries like Switzerland, where euthanasia is not outlawed, “they’ll bump you off”, even if “you’re [just] feeling terribly depressed”.
Nobody should “die in screaming agony”, he adds. “If they do, it is because the medical professional is incompetent.”
Assisted dying vs withholding life-sustaining treatment
The proponents of assisted dying say there is no moral difference between actively assisting a person to die, and withholding and withdrawing life-sustaining treatment.
“The mere fact that one action is an omission or ‘passive’, while the other is an act or ‘active’, does not in itself render the former morally acceptable and the latter morally objectionable,” says Landman.
Newbury sees it differently.
“If a person is falling from a building and you shoot him just before he hits the ground, you have done an infinite evil,” he says.
For Newbury, it would not matter that the victim would have died anyway. However most Pro-Life lobbyists do not oppose “advance directives” – including living wills – which allow someone in the last stages of their life to request that life-sustaining treatment is withheld or removed.
“We have no problem with end of life decisions, if nothing is done to shorten [a person’s] life,” Newbury explains.
Most religious leaders agree.
“To save and preserve life is a holy obligation and every effort must be made to fulfill this duty,” Chief Rabbi Warren Goldstein told the M&G. “However, there are end-of-life situations in which the ‘halacha’ (Judaism’s system of law and ethics) allows for treatment to be withheld.”
Goldstein added that “a competent rabbinic expert in Jewish medical law and ethics must be consulted on a case-by-case basis” in such situations.
An ethical minefield for medical practitioners In 2011 EthicsSA interviewed 120 doctors at the medical schools of the University of Pretoria and the University of the Free State.
One in four said they would consider injecting eligible patients with lethal drugs if the practice was legalised. A Johannesburg doctor, who has been practising for 40 years and who asked to remain anonymous, told the M&G that medical practitioners help their patients to die more often than is realised.
“A doctor will increase morphine by increments until the person dies,” he said. This frequently happens without the family being consulted, “because that causes trouble”.
In an SAfm talk show on May 7, a caller named Ruth shared her “terrifying” experience: “I have a brain-injured child. There were many times in hospitals when doctors would actually say to me: ‘Do you want me to treat him aggressively?’ The first time I heard that, I didn’t know what the heck he meant, and then he explained: ‘well, you know… do you want me to let him go?'”
Doctor Natalya Dinat, former head of the Centre for Palliative Care at Wits University, says that she had heard of many cases where doctors had assisted patients to die, “although they cannot openly admit it”.
Dinat believes that doctors often lack sufficient skills to provide competent palliative care to patients in the last stages of their lives.
“Proper palliative care will mitigate most people’s desire to die, leaving a tiny minority with intractable pain and suffering who may have a case for assisted dying,” she said. Dinat feels that current debates about euthanasia and doctor-assisted suicide should be broadened to include the role of palliative care techniques.
“People want to live,” she says. “If they have meaning in their life, they don’t want to end it.” – Thalia Randall