Albert Buhr looks at the movement to bring the new and contentious Assisted Dying Bill before parliament.
In our culture, the process of dying is usually sanitised and hidden from view. However, having appointed the South African Law Commission to write a report on end-of-life issues during his presidency, it is an issue that Nelson Mandela wanted us to face. Now, in his frailty, Madiba is bringing it to the forefront of our nation’s consciousness.
Euthanasia is an ultra-contentious issue fraught with moral ambiguities and grey areas, with parties for and against fighting tough on either side. Professor Sean Davison – head of the forensic laboratory in the biotechnology department at the University of the Western Cape – has recently become the spokesman for the right-to-die movement in South Africa, following his five-month house arrest in New Zealand for helping his mother end her life. She had been battling terminal cancer when Davison flew to New Zealand to visit her in 2006. Embarking on a hunger strike to hasten her departure, she became weaker and weaker, but death eluded her, until she finally begged her son to help her die.
Davison’s work involves, among other things, identifying bodies buried in mass graves during the apartheid years by means of DNA tests. Whilst awaiting trial, and with the support and assistance of the Dignity NZ Trust, Davison helped establish DignitySA, which campaigns for the option of legalised assisted dying in South Africa. In the organisation’s vision, end-of-life care would be offered via “dignity havens” that provide optimum palliative care along with a safe, supported and legal environment in which to consider, and if so chosen, receive an assisted death under robust and safe-guarded legislation.
DignitySA now has a three-year strategy to bring an Assisted Dying Bill before parliament. Says Davison: “We have a draft bill ready, similar to the Assisted Dying Bill which was tabled in the House of Lords in England in August this year. We know it won’t be an easy process for such a complex moral issue, and when you’re seeking a law change you have to be prepared for the long haul, as we are.”
Currently, South African law merely makes provision for a Living Will, in which a person can state that they do not want to be kept alive by medical intervention. No one can be forced to be treated, even if the treatment is life-supporting. A Living Will also over-rules the family’s desire to hold on – the loved one’s decision is what matters most. If a person chooses not to have a long, protracted death, or be sustained by a life-support system, the law states that their decision should be respected.
Dignity in death
There are as many vociferous anti-euthanasia organisations as those that are pro. At present, the position in South African law is that the consensual termination of a person’s life is unlawful, even when motivated to bring unbearable suffering to an end.
Advances in medical science have resulted in patients living longer, but this prolongation hasn’t always ensured a reasonable quality of life. Suicide rates within our elderly population have been causing extreme distress to families for decades.
The law that DignitySA is seeking will allow people to have an assisted death if they are terminally ill, of a sane state of mind, and have made a free choice without coercion. An independent panel of doctors will consider their request to ensure all conditions have been met. The panel will ensure there is no family pressure (the argument being that you persuade Auntie Doris to end her life so you can inherit her money). In countries where the law has changed there has been no evidence of such abuse.
Once the bill is before parliament it will be open to public submissions. Says Davison: “I am optimistic that this law change will be approved when it is tabled in parliament. Our country has a proud record on human rights issues, and this is a human rights issue: it is about human suffering. I hope that our politicians will put themselves in the position of their own elderly grandparents and parents and consider what they would want. Many people have terrible stories about how family members and loved ones died. How many times must we hear these stories before the law changes? All this suffering is so unnecessary in what we call a civilised society.”
A growing trend?
With our under-developed health-care system, especially in terms of palliative care, Willem Landman, a member of the South African Law Commission, suggests that many South African doctors would be willing to perform acts of euthanasia when it becomes legalised in the country. He expresses concerns, however, that with the lack of doctors in the country, it would be “difficult to put into practice”.
In the UK, a 2009 survey published in the journal Palliative Medicine showed 64% support among doctors in cases where a patient has an incurable and painful disease. Meanwhile assisted suicide is already legal in Belgium, Luxembourg, the Netherlands, Switzerland and three US states – Oregon, Washington, and Montana.
One of the principal reasons euthanasia remains illegal in the vast majority of the world’s countries is the “slippery slope” argument. Many critics have relied on the cases of “termination of life without an explicit request” in Holland as evidence for the slide from voluntary euthanasia to non-voluntary euthanasia. However, the most recent review paper on euthanasia in the Netherlands, “Two Decades of Research on Euthanasia from the Netherlands”, written by researchers from that country’s Department of Public Health in 2009, found that “public control and transparency of the practice of euthanasia is to a large extent possible” and that “no slippery slope seems to have occurred”.
Fewer people die peacefully in their sleep than we might like to imagine, while most of us will have parents and grandparents experience difficult deaths. And we may well ask: what about when it’s my turn?? Initially, says Davison, he had no intention of becoming a martyr for a cause. “What I did to help my mother at the end of her life I did for the love of my mother.” Davison and Mandela, each in their own way, are opening our eyes to this most urgent issue.