/ 28 March 2013

Granting a death wish: South Africa’s euthanasia debate

Granting A Death Wish: South Africa's Euthanasia Debate

On Monday October 23 2006, Sean Davison, a forensics professor from the University of the Western Cape, described the condition of his 84-year-old mother: her body wracked with a progressive cancer, the diminutive white-haired psychiatrist with a quick mind and steel-blue eyes had refused to eat anything for the past 30 days and would drink only water. She had signed a living will requesting no antibiotics, no resuscitation and no attempts to make her eat. 

“When I agreed to this, it seemed such a reasonable thing,” wrote Davison in his diary. “No one questioned her decision for a second. But no one could have foreseen the sight that is before me now. No one could have imaged her skin bruising and sticking to my fingers, the smell of her rotting flesh, a tongue that is completely decayed and bed sores that make you wince at their sight. 

 “This is ghastly. Mum is literally falling to bits. What kind of sane person would keep their mother in a bedroom to rot to death? 

“This is horrific and sickening. How can this be happening?”

Desperate to die, Pat Ferguson had asked her GP to help her to end her life. Initially, he said he would do it. But later he reneged, balking at the repercussions of assisting a suicide. She had asked her best friend’s son. He said he “couldn’t do it”. 

So now, in his mother’s book-lined home in a sleepy suburb in Dunedin, New Zealand, Davison, who had come to the country to be with his mother during her illness, lived the daily horror of watching her trying to starve herself to death. 

“As I rearranged her pillow tonight, she pleaded, ‘No, put it on top of my face.’ I told her that a pillow was no way to die. Tears ran down her face. Mum has no morphine in her system now. I ask her clearly, ‘Do you really want me, your son, to be the person to give you your death wish?’

Doing the unthinkable
“She replied, ‘Please, I want you to help me die.’ And then, ‘You really are a good boy.’ 

“I have no choice,” he wrote, “but to do the unthinkable.” 

In 2006, euthanasia was illegal in New Zealand, as it was in South Africa. It still is today. In fact, there are only a handful of countries that allow assisted dying, and they differ in their approaches. In Europe, it is allowed in Belgium, Luxemburg, Switzerland and the Netherlands. In the United States, it is allowed in Oregon, Washington and Montana. 

Belgium and the Netherlands have the most liberal approach, allowing for the active euthanasia of people who qualify. In these countries, a medical professional can administer a lethal injection or dose of barbiturates without fear of legal repercussion. In contrast, Switzerland and the US only allow for assisted suicide. A doctor can provide the means, but the patient must take the final step to end his or her own life.

Assisted suicide candidates in the US are required to have lived in the state for a certain number of years before death. But Switzerland’s famous assisted suicide Dignitas organisation accepts candidates from any country, and has even been accused by Swiss politicians of cultivating “suicide tourism” owing to the international patrons it draws (there have been about 150 Britons euthanised there at last count). 

Notwithstanding the few countries in which euthanasia is legal, the “right to die” debate is heating up in several countries across the world. In February, France’s medical ethics council outlined a “duty to humanity” to allow someone “suffering from an ailment for which the treatment has become ineffective” to die. 

This month, Australian state Tasmania received more than 300 submissions arguing for and against legislation for voluntary assisted dying, proposed by Tasmania’s Premier Lara Giddings. This will be the second time euthanasia laws are being considered in the country. Physician-assisted suicide was legalised in 1995 in the Northern Territory, but was overturned by the country’s federal government in 1997. 

The South African debate
The South African debate began 15 years ago. President Nelson Mandela engaged the South African Law Commission to carry out a project addressing end-of-life decisions. The result was the proposed End of Life Decisions Act — a Bill that was tabled in Parliament in 2000 but did not get further than that. 

“For a decade it gathered dust on the desk of the then minister of health, Manto Tshabalala-Msimang,” said Willem Landman, executive director of non-profit organisation Ethics SA. 

It was never debated or opened for public comment. When the Mail & Guardian questioned the department of health last year as to its whereabouts, spokesperson Fidel Hadebe could not comment, and referred the newspaper to the justice and constitutional development department. 

When approached this year on the same subject, he did not respond to a request for comment before going to press. The proposed Act does not appear on Parliament’s list of Bills to be discussed.  

‘Mum,” wrote Davison, “you always said how similar I am to your father. I’m not sure if you meant it or just wanted to believe it. This role has become a heavy one for me to bear. Now I do feel like your father, and you my dependent daughter. What would he do now? He was always there for you, yet here I am beside you, uncertain and unwilling. In your dying moments you see me for the first time hesitating to assist you. 

“This is a terrible dilemma. No son should have to go through this.”

Collective conscience divided
The South African collective conscience is as divided as Davison’s own feelings leading up to the death of his mother. On the one side is Dignity SA, an organisation founded by Davison that is lobbying for assisted suicide to be legalised in South Africa. Also on the executive committee are Landman and Melodie Slabbert, a law professor at the University of South Africa. Dignity SA is canvassing for public support on social media and hopes to approach Parliament to examine the End of Life Decisions Act next year. 

But according to Landman, the matter has no political champions, and is unlikely to get the attention of South African politicians in the near future. “But it doesn’t negate the fact that there is this group of people who have no political clout and no adequate voice who need to be helped.”

Most vocally opposing a law change is an 1 800-member strong doctor’s organisation called Doctors for Life. “There are very good reasons why the vast majority of the world’s medical organisations oppose the legalisation of assisted suicide, especially in developing countries,” wrote the organisation in a press release. 

“Assisted suicide is a practice that is almost impossible to police, especially in a country like ours, with poorly functioning police and justice systems. It is then too easily abused, as numbers of good scientific studies have shown.”

Opposition doctors also believe that the threat is greater than an administrative one. To legalise assisted dying would be to embark on “a slippery slope”, they believe. Doctor Claude Newbury, former president of Doctors for Life, told the M&G in an interview last year: “Once the medical profession thinks it is permissible to kill anyone, then that society is on the slippery slope to Auschwitz. We are then using killing as a treatment.”

His concerns are highlighted by recent events in Belgium and Switzerland that suggest a broadening of accepted cases of euthanasia. In December, deaf 45-year-old identical twin brothers were euthanised in Belgium after discovering they would also soon go blind. They felt the agony at not being able to see one another again was “unbearable”. 

'Weariness of life'
On March 13, Britain’s Daily Mail reported that an 80-year-old businessman from England planned to end his life soon at Dignitas because he suffered from dementia. 

Although 21% of Dignitas’s suicides are already committed by people who suffer from “weariness of life” rather than a terminal illness, the Briton (whose name is not publicly known) is the first candidate to be approved for assisted suicide with dementia as his only complaint. 

As such cases are made more public, the ethical arguments become more steeped in controversy. And there is no sign of resolve: as Landman said, they always end in a “stalemate”. 

The way to break the impasse, he said, is to consult the Constitution. “The only thing is to see what values and principles the Constitution allows. It allows things many people don’t agree with, such as polygamy and abortion,” he said, adding that, at last count, 70% of the country disagreed with abortion and yet it is upheld by the law. “Peoples’ religious ideals should not be the basis of this decision; the Constitution should.”

Pat Ferguson’s house, Dunedin, New Zealand, 7.30pm on October 25 2006: “There was no doubt now,” wrote Davison. “I prepared what I calculated would be a lethal drink of crushed morphine tablets. 

“I held it in front of her and said, ‘If you take it you will die.’ I wanted to be sure, so absolutely sure, that there was no hesitation. She answered ‘You are a wonderful son.’ I needed to hear it at that moment. 

“I held the glass to her lips and gently poured the liquid into her mouth. She looked at me with a gentle smile. I said, ‘It is not how you planned it. It is not what I planned. This is an event that will live long after you die.’” 

Fear of legal prosecution
A year later, Davison decided to share his story by publishing his personal diary. Out of fear of legal prosecution, Davison’s New Zealand publisher, Chris Catley, convinced him to remove the direct confession from his book. 

His older sister Mary, a medical doctor living in Melbourne, was incensed by his unflattering portrayal of her in the book and hired a lawyer to make sure he sanitised large portions of the text. She told him that she would be reporting him to the police “for killing our mother”. 

In September 2010, Davison was arrested and charged by the New Zealand police, about a year after his book, Before We Say Goodbye, was published by Cape Catley. The soft-spoken, self-effacing academic became the centre of a whirlwind of media attention. 

“Son confesses: I killed mum”, screamed the front-page headline of New Zealand’s Herald on Sunday. “Professor arrested in New Zealand for mercy killing”, read the front page of the South African Sunday Times a few weeks later. “Murder or mercy?” asked the Daily Maverick, summarising the raging debate that Davison’s arrest had awakened. 

A highly public police investigation ensued, and then a costly criminal trial. On the day of the judgment, a small group of supporters gathered outside the Dunedin court wearing T-shirts with the slogan, “Every mum should have a Sean”. 

When handing down the sentence, High Court Judge Christine French told Davison: “Although in my view there was significant premeditation, you acted out of compassion and love and not for any personal gain.” He was an “exceptionally devoted and loving son”, but was still aware he was committing a crime. 

He was sentenced to five months’ house arrest in New Zealand for “procuring and counselling assisted suicide”. 

'I just wanted to tell my story'
Waiting in South Africa were his partner, Raine Pan, her wheelchair-bound mother and their two children, two-year-old Flynn and 18-month-old Finnian. 

“I never wanted to campaign for a cause. I just wanted to tell my story,” said Davison. Nevertheless,  in the year since he returned to South Africa after serving his time in New Zealand and as the face of Dignity SA, his life has become interwoven with the stories of others seeking advice and help. 

Before work every morning and before bed every night, Davison listens to tales of suffering and death. “If I think of the last two weeks, every single night it’s been intensive bordering on counselling for a handful of people. I find myself starting to live their lives,” he said. 

“Today I met a woman who is 99. She told me about her life. She’s only six months off getting to 100, and she says to her it’s no big milestone at all – she’s just had enough! She wants to die. And she says she doesn’t want to live just to keep people happy that she’s got to 100. Her brain is sharp, she’s right there, but the body’s just falling to pieces.”

But, though empathetic, Davison can do very little to help. Even the law change proposed by Dignity SA would not cover her case. It only proposes euthanasia for those deemed terminally ill. 

'Not a hope in hell'
“The reason for that is to have a chance of the law passing,” said Davison. “If you leave it a little bit vague, like ‘unbearable suffering at the end’, or chronic illnesses or severe physical disability, it will never get through Parliament. There’s not a hope in hell in this country at the moment.” And he “can’t advise her on [a lethal dose of medication] to take,” he said. “That wouldn’t be acceptable at the moment at all.” 

That said, she could always visit exitinternationa.net and buy The Peaceful Pill Handbook: an $85 digital book advising her how to die using carbon monoxide, cyanide, detergent or barbiturates (See “Famous lobbyists for euthanasia”). 

Davison is a reluctant crusader; the masthead of a movement to which he feels “fated”. 

“I’m not to let this take over my life,” he said. We talked over Skype, probably on the same account with which he phoned his family during the five months he did time overseas.  His sons were in the room with him: Finnian (now two) scrambling on his father’s lap; four-year-old Flynn making an impassioned plea for “something to write on!”.

“I’m hoping that if I am one day terminally ill and needing help, I won’t need to ask them,” said Davison. “I’ll have to ask them, do they mind if I go to the South African Dignitas clinic. I’m now 90, and life is unbearable and I’m in great pain. And they will understand. Rather than saying, ‘Dear Flynn, do you mind, I can’t crush up these tablets. Will you kill me?’ ”

Famous lobbyists for euthanasia

Jack Kevorkian
Jacob Kevorkian was a medical doctor from Michigan, United States, born in 1928. Early in his career as a medical doctor, he began to advocate controversial ideas about death, such as proposing that inmates on death row voluntarily submit to medical experimentation under complete anaesthesia in lieu of the death sentence. Between 1990 and 1998, he claimed to help more than 130 people to end their lives.

The state of Michigan revoked his medical licence in 1991. In September 1998, Kevorkian videotaped himself giving a lethal injection to Thomas Youk, who suffered from Lou Gehrig’s disease. The tape and a live interview with Mike Wallace was aired on the American investigative TV show 60 Minutes. He was convicted of second-degree murder six months later. Kevorkian was sentenced to 10 to 25 years in prison, but was released on parole for good behaviour after eight years. He died a natural death at the age of 83 after suffering from liver cancer. Widely known as Doctor Death, his work catalysed the euthanasia debate in the US. 

Diane Pretty
Born in 1958 in Luton, England, Diane Pretty was diagnosed with terminal motor neuron disease in early adulthood. She applied to Britain’s highest court to uphold an application for her husband to assist her to die without criminal prosecution. The director of public prosecutions published interim policy suggesting that, under certain guidelines, those who assist a loved one to commit suicide would not be prosecuted.

Despite this, the British courts turned down her application. Pretty died naturally the same year at the age of 43. Her case catalysed public debate around euthanasia in the UK. In 2003, the Assisted Dying for the Terminally Ill Bill was introduced and debated four times in the British Parliament. It is due to be discussed again later this year. 

Philip Nitschke
Philip Nitschke is a medical doctor who was born in 1947 in South Australia. In 1995, he successfully campaigned for euthanasia to be legalised in the Australian state of Northern Territory. The Rights of the Terminally Ill III Act of 1995 allowed people to euthanise themselves or to procure the assistance of a physician in their suicides.

Nitschke legally administered the first recorded voluntary lethal injection in 1996 to Bob Dent, a 66-year prostate cancer patient. He helped between three and four other people to die before the law was overturned in 1997. In response to the law change, Nitschke founded Exit International, an end-of-life choices information and advocacy organisation. 

Thalia Holmes is a staff reporter at the Mail & Guardian.