In recent years South Africans have been directly confronted by the complex issues surrounding the uncomfortable subject of dying.
In December 2013 the public witnessed the undignified and unnatural death of Nelson Mandela, five months after doctors declared him to be in a vegetative state. No humane person could have been unmoved by this.
Soon the subject of switching off life support machines, Advance Directives, and assisted dying, were topical in the media. Mandela may not have been aware of it but he got us talking about death.
The next year we heard the much publicised comments of Desmond Tutu expressing his support for assisted death in certain circumstances. His words reached an audience that previously was not receptive to the idea of an assisted death because of the supernatural consequences of not having a “correct death”.
Most recently the North Gauteng High Court in Pretoria ruled that a terminally ill man, Robin Stransham-Ford, could have a doctor assist his death by lethal injection or lethal medication. Although Judge Hans Fabricius said the ruling only applied in this case it has set a legal precedent to approach the court for assisted death.
Because of this ruling, Parliament is now obliged to approve a bill on a proposed legal change on assisted dying, so that the laws that criminalise this compassionate act are consistent with the court’s recognition of a person’s human rights.
It is disappointing that the government is not accepting this court ruling. It is difficult to believe our lawmakers cannot find a way to make assisted dying possible, while at the same time protecting those who need safeguarding.
There is a real lack of political will.
The question must be asked: what country lets its citizens suffer so horrendously, despite their clear and informed wish to die, because the issue is too controversial?
The religious argument will be the most influential one in the proposed law change. Some people will argue that Christian teachings of the Bible do not permit another to end a life, no matter how much a person is suffering. There does not seem to be any scripture in the Bible which condemns euthanasia. In any case, a religion that views assisted dying as immoral should not be imposed on anyone else. What makes a life worth living is subjective and specific to each individual; what is satisfactory to one person is not necessarily satisfactory for another.
Now is the time for the public to look at the issues surrounding death, and become involved in the debate around the likely law change. Our society has already embraced issues that were once uncomfortable to deal with, such as sexuality, gay rights, AIDS, and abortion. These are no longer taboo but are the subjects for dinner tables and classrooms; this has surely led to a better educated and more understanding society.
Although the government will be challenging the recent ruling in the Constitutional Court, since the judge made his ruling based on our constitution, it is reasonable to expect that the Constitutional Court will strike down this challenge on the same grounds. Subsequently Parliament will have to change the law to reflect the ruling.
When a bill is presented to Parliament it will be open to public submissions and comment.
As the founder of DignitySA I would like to offer the following opinion on the matters I hope we all consider around the proposed law change.
Although religious and emotional feelings for and against this decision are by no means unimportant, this process ultimately should earlier than natural. In fact, the development of the medical profession to thwart death reflects this judgment. If playing “God” is the objection to offering suffering patients a hastened death, then we should draft a law that prosecutes all doctors for the services they now perform!
The ‘do no harm’ principle of the Hippocratic Oath is not being guided by an analytical understanding of the cognitive roots of a request for death as a form of treatment to end one’s suffering. The medical profession IS doing harm by not offering assisted dying to those who want it.
In countries where assisted dying is available people are less likely to attempt to end their lives prematurely. It is also worth noting that such requests imply mental competence on the part of the individual making an assisted dying request.
Although the latter concern is not an unimportant factor to discuss, the bulk of efforts should be directed towards establishing a strict set of safeguards that ensure as best as possible that a distinction is made between voluntary euthanasia and murder. Suicide is legal, and because assisted suicide is not, the law discriminates against people who cannot do it themselves.
Countries where some form of assisted dying is legal typically have an independent panel of professionals from various fields to assess components of an individual’s request, so no abuses take place. The focus of this panel should be to nudge an individual toward life, not to impose any treatment options on the individual.
Another factor that is important, but should not be the centrepiece of the law-writing process, is what kinds of suffering should be legal for a doctor to assist. Opponents of a law change often refer to a ‘slippery slope’, where the right to an assisted death is incrementally extended from terminal illness, to other categories of unbearable suffering, such as physical disabilities and mental illness. However slippery slopes aren’t necessarily bad. An example of what society would agree is a positive slippery slope is the gradual extension of voting rights to groups who were left out of the democratic process.
If concern of being flooded with requests for assisted dying is an issue, then opponents of this law have not only provided support for it, but also owe an apology to the many individuals who have been left suffering in silence for so long.
DignitySA founder Sean Davison was sentenced to five months’ house arrest in New Zealand for assisting his mother’s death.