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SA not ready for euthanasia

- By Kemantha Govender

“South Africa is not a safe and appropriate place for legalised euthanasia at this time,” says Professor Dan Ncayiyana. This is one of several arguments heard at a debate on end-of-life decisions at Wits on 14 May 2015.

The Steve Biko Center for Bioethics with the Hospice Palliative Care Association of South Africa and the School of Public Health in the Faculty of Health Sciences hosted the discussion which provided an array of views on the subject. 

Ncayiyana, from the Department of Health, argued that South Africa does not have a “functional and reliable framework of supervision” to monitor the implementation of legalised euthanasia. South Africa is not alone in this struggle; Ncayiyana said that even “sophisticated countries” struggle with this issue.

“South Africa has a dismal record when it comes to regulation, certainly in the health and medical landscape.

“I don’t believe we have the capacity to supervise the implementation of a euthanasia programme, and this will place vulnerable groups at great risk of being the victims of the perverse application of the euthanasia policy,” said Ncayiyana.

Ncayiyana said South Africa is a highly unequal society in terms of income, wealth and education and he is concerned that active euthanasia in the country will reflect the inequalities by benefitting only the well-off.

Ncayiyana is also concerned about the real risk of euthanasia becoming the default option to make up for deficiencies in care and competence.

He argued that South Africa lacks an ethos of respect for human life. “We are an extraordinarily violent society with over 45 murders committed every day. Mob justice, brutal police killings and xenophobic murder have become part of our social fabric.”

“Without seeking to malign health professionals most of whom are both competent and caring, the fact remains that needless deaths occur regularly in our hospitals through staff neglect and indifference. Health professionals have been known to down tools and abandon critically ill patients during labour disputes, and blocking ambulances from entering health facilities,” said Ncayiyana.

Meanwhile, Dr Liz Gwyther, CEO of the Hospice Palliative Care Association of South Africa, contended that assisted dying is an unnecessarily extreme measure.

She said that palliative care affirms life and regards dying as a normal process. She added that this type of care intends neither to hasten nor postpone death.

However, based on personal experience and working in palliative care for over 20 years, Gwyther stressed the importance of pain management for patients.

 “I am alarmed that so few doctors in the country are trained in good pain management. I changed my pain prescription after my surgery for cancer,” she said.

Gwyther argued that the duty of doctors is to heal and where possible to relieve suffering.

“For the most of the patients I have worked with, knowing their time is short, each day is precious especially if it can be lived free of distressing symptoms,” said Gwyther.

Meanwhile, Professor Willem Landman from Dignity South Africa strongly argued that the Constitution is the ultimate authority.

He said that the public debate on this contentious issue must stay clear from personal, religious or cultural beliefs and that it is important for public policy to be developed on the basis of the spirit, values and rights of the Constitution.

Landman said that doctors have special moral duties where death is inevitable and suffering is unbearable.

“It is not for the state to say we should choose other options, such as palliative care, since we have a constitutional right to dignity,” he said.

Former President Nelson Mandela’s final months were also discussed. Gwyther said that Mandela did not require euthanasia. She said he required that his medical team and proxy decision-maker agree to allow natural death and not to have his life prolonged by artificial means.

Landman said that if Mandela could have, he would have thought the “last six months of his life an assault on his dignity, orchestrated by a manipulative and self-interested government.”

Dr Mzukisi Grootboom, Chairperson of the South African Medical Association, said that patients must be included in discussions affecting their lives.

“If a doctor decides that nothing can be done to save a patient’s life, the patient must be included in the discussions. It must not just be a technical exercise.”

“The family and all the psychological and psychosocial aspects of the patient must be taken into account, including their spirituality,” said Grootboom.

“Humanity gave you, as a medical student, a right to learn from them (patients) when they are alive and also learn from them when they are dead. Your duty is to heal,” said Grootboom.