Why I do not support active euthanasia

I read with great interest the column by Eusebius McKaiser and his reasons for supporting active euthanasia. He tells us about the stories he heard from other people and, like most people, he does not want to die a horrible death and rather chooses active euthanasia. He is a rational man and makes his own decisions, both how to live and how to die. That is his decision, but the problem is that the South African law forbids doctor-assisted suicide and active euthanasia.

As a doctor who trained in the Netherlands and practiced there for 22 years, I have seen the practice of euthanasia first hand. I also got a number of requests from patients to assist them with the active termination of their life. I have seen how this practice has changed over the past 30 years. I suggest that people who want to know more about this read the book by journalist Gerbert Mark van Loenen, Do You Call This a Life? Blurred Boundaries in The Netherlands’ Right-To-Die Laws.

The Dutch euthanasia practice resulted in a medical profession that lost its palliative care skills, compared with their British colleagues. When the Dutch medical association realised this, they developed a programme to improve palliative care skills of the doctors in the Netherlands.

Doctors and nurses can do much more today to alleviate all sorts of symptoms and suffering than they could in the past.

I fully agree with McKaiser that people should not die a horrible and painful death. No one in their right mind will argue that suffering is necessary and good for you. Doctors are called “to cure sometimes, to relieve often, and to comfort always”.


But we are not very good in the last two and that leads to a loss of trust in doctors and the health system and leads to requests for euthanasia. The request for euthanasia should be a signal to the clinician that the care and information given to the patient can and must improve.

Proper palliative care training should ensure that all healthcare workers have the basic palliative care skills. In my experience the people working in palliative care are among the most compassionate healthcare workers willing to go an extra mile.

When it comes to autonomy we should look at the definition [because] people can only make an informed decision when they are given all the information. Most of my patients were not aware which palliative care measures a doctor can take and were unaware of terminal sedation.

If somebody is not in favour of active euthanasia that need not be “overreaching conservatism” but it can be a deep conviction based on a person’s worldview and spirituality. The SEP cycle is a simple model where the spirituality of the person (patient or doctor) determines their ethical values and medical practice.

In a country where spirituality and faith play such an important role, the rational argument will not convince.

Some people argue that doing euthanasia is an act of compassion but to travel all the way with the patient till the end and address all the issues that crop up will need real commitment and compassion.

People in South Africa do not need to travel to Europe to have a dignified death, but more needs to be done to make that possible in hospitals, in hospices and at home. 

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Martin Bac
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