euthanasia should be legalised in south africa essay

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South African Journal of Psychiatry    |    ISSN: 1608-9685 (PRINT)    |    ISSN: 2078-6786 (ONLINE)

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SAMJ: South African Medical Journal

On-line version  issn 2078-5135 print version  issn 0256-9574, samj, s. afr. med. j. vol.108 n.6 pretoria jun. 2018, http://dx.doi.org/10.7196/samj.2018.v108i6.13089 .

Medical students' perspectives on euthanasia and physician-assisted suicide and their views on legalising these practices in South Africa

R K Jacobs I ; M Hendricks II

I MB ChB; Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa II BA Hons (Psych), HDE, MA (Clin Psych), LLB; MPhil (Bioethics); Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Correspondence

BACKGROUND. Euthanasia/physician-assisted suicide have been a controversial and sometimes taboo topic for a long time, not only in South Africa (SA) but also internationally. A recent (SA) judicial case has seen the topic debated again. Consensus on accepting or abolishing these practices in SA has yet to be reached. All relevant role players need to be adequately engaged before policy can be informed. OBJECTIVES. To determine the views of future doctors (medical students) regarding euthanasia and physician-assisted suicide (PAS) and to ascertain their stance on its legalisation in South Africa (SA). METHODS. A paper-based, semi-quantitative descriptive study design consisting of 16 questions, using convenience sampling of third- to fifth-year medical students at Stellenbosch University, was used. RESULTS. The overall response rate was 69.3% (N=277). In total, 52.7% of participants (n=146) felt that the practices of euthanasia/PAS should be legalised in SA. Responses varied depending on patient morbidities. If a patient had terminal disease with intractable suffering, 41.9% of participants would terminate the patient's life upon request. A further 36.1% of participants stated that they would have no part in ending a patient's life, while 35.0% said that they would be comfortable with providing the patient with the correct means to end their life (PAS). The majority (80.1%) of participants indicated that they would prefer a dedicated ethics committee to decide who receives euthanasia/PAS. Many factors influenced participants' responses, but differences in opinion between and within the various religious groups were particularly evident in the responses received. CONCLUSIONS. More than half the respondents in this study were open to legalising euthanasia/PAS, substantially more than in previous studies. However, only 41.9% of respondents would consider actually performing euthanasia/PAS, for certain patients. Views of other healthcare workers as well as the public are required before policy can be informed.

The medical practice of euthanasia and physician-assisted suicide (PAS) remains a controversial topic, not only in South Africa (SA) but throughout the world. Euthanasia and PAS are defined as two distinct means by which an end to a patient's life can be brought about. According to Materstvedt et al .,[ 1] euthanasia is defined as 'a doctor intentionally killing a person by the administration of drugs, at that person's voluntary and competent request'. While PAS is defined as 'a doctor intentionally helping a person commit suicide by providing drugs for self-administration, at that person's voluntary and competent request', [1] SA law regards both euthanasia and PAS as forms of active euthanasia. [2] The South African Law Commission [3] holds that 'such an act 'euthanasia and/or PAS1 would undoubtedly be unlawful and the person giving the assistance could be convicted of murder', as both euthanasia and PAS contain the definitional elements of murder. Despite the fact that 34% of SA doctors surveyed in 2011 [4] had already had patients request life-ending interventions, it is evident that fear of prosecution contributes to doctors' reluctance to perform these procedures. Given past requests for euthanasia and PAS, the time to consider legislative change is fast approaching, and to pre-empt the legislative review it is prudent to explore the attitudes of doctors towards these life-ending practices. [5]

In the past, various cases have been brought before the SA judicial system. Two cases, S v De Bullocq[ 6] and S v Hartmann, [7] dealt with acts of active euthanasia, in which the motive for killing was to end useless existence and (intractable) suffering, respectively. In both cases it was found that the accused acted unlawfully. Judgment passed in these cases found the accused guilty of murder. However, lighter sentences (i.e. no imprisonment, the usual sentence for murder) were imposed, indicating the court's sympathy for the plight of the accused and the deceased. Most recently, SA courts had to consider a request for PAS from Advocate Stransham-Ford. In 2015, an application was brought to the North Gauteng High Court for assistance in dying (PAS), with the subsequent exoneration of the physician. [8] The application was granted, but the applicant died just hours before the ruling was passed. '81 The SA Supreme Court overturned the High Court's decision on appeal, but acknowledged euthanasia as 'a doctrine which may be in the womb of time, but whose birth is distant'. [5]

The euthanasia discourse is re-emerging against the backdrop of an ageing population [9] and the advancement of medical technologies that ultimately ensure longevity under dire medical circumstances, including longevity of patients with intractable mental illnesses. [10] So far the courts have taken centre stage in the euthanasia debate, but with the recent developments, particularly in the Stransham-Ford case, the need to engage medical professionals has become urgent.

To ascertain the views of future doctors on euthanasia and PAS in SA.

A paper-based, semi-quantitative descriptive study design was used to assess the views of third- to fifth-year medical students at Stellenbosch University on euthanasia and PAS in SA.

Ethical considerations and approval

The study was approved by the Stellenbosch University Undergraduate Research Ethics Committee (ref. no. U16/03/004). Institutional approval was granted by the Stellenbosch University Institutional Research and Planning Division. The participant information sheet as well as a briefing from the principal investigator reiterated the voluntary and anonymous nature of participation in this study. Written informed consent was obtained, as per individual questionnaires. Question 1 sought consent in the form of a pre-flight checklist and subsequent tick-box.

Convenience sampling was used. The principal investigator sought the views of a sample of third- to fifth-year medical students who were present in a lecture hall on the days when the data were collected. Students who were absent were excluded. Final-year medical students were excluded because they were not available. Third- to fifth-year medical students have already covered most of their theoretical modules (including an introductory or more formal bioethics module) and have been exposed to the working or clinical environment to varying degrees. They were deemed suitable candidates for this study as they (theoretically) have a better appreciation of the subject matter than their junior (first- and second-year) counterparts.

The questionnaire

A questionnaire containing 16 questions was used. Some questions used in the questionnaire were adapted from a survey conducted by Leppert et al. [11] Three main categories of questions were used in the questionnaire. Table 1 elaborates on the specifics of each question relating to the topic. Questions 1 - 5 dealt with demographic information on the participants, namely consent, gender, ethnicity, year of study and religious affiliation. The questionnaire was piloted on 20 random third- to final-year medical students, for validation.

Data collection and analysis

The study was conducted from April 2016 to April 2017. Owing to the semi-quantitative descriptive study design, data collection and interpretation were two-fold. The quantitative data were captured and recorded in a Microsoft Excel (2016) workbook (Microsoft, USA) and subsequently analysed using descriptive statistics by means of frequency tables. Qualitative data were grouped and summarised (using thematic analysis) in a Microsoft Word (2016) document (Microsoft, USA). Each questionnaire was read and scrutinised twice by the primary investigator, to avoid missing or repeating any aspects that would skew the results.

Of the 400 questionnaires that were distributed, 277 (69.3%) were returned completed. 'Incomplete' questionnaires were not included in data analysis. Of the 277 completed questionnaires, 33 (11.9%) were responses from third-year students while 99 (35.7%) and 145 (52.3%) were responses from fourth- and fifth-year students, respectively. Fig. 1 shows the religious affiliations of the respondents.

Category 1 questions

Category 1 questions explored students' attitudes towards life-ending requests and the legalisation of life-ending interventions in SA. The majority of the participants (57.0%, n=158) believed that the patient should have the final decision in choosing to end their life, but only 47.7% (n=132) believed that doctors should be allowed to help these patients fulfil their requests. Most participants (52.7%, n=146) were in favour of legalising the practice of euthanasia and PAS in SA, but 63.5% (n=176) would still attempt to persuade a patient to choose a palliative treatment method instead of a life-ending intervention.

Variations among participants with different religious affiliations were noted. Most respondents in all the groups (52.3% of Christians (n =102), 73.9% of Islamic students (n =34), 57.1% of Hindus (n =4), 87% of agnostics (n =20) and 100% (n =6) of those who did not list a religious affiliation agreed that euthanasia/PAS should be legalised in SA. Higher proportions of respondents in most of these groups felt that patients should be allowed to decide if they want to end their lives prematurely, and that doctors should be allowed to assist them. However, while the majority of Islamic students (56.5%, n =26) felt that euthanasia/PAS should be legalised in SA, the same proportion also felt that doctors should not assist patients in ending their lives prematurely. Some Islamic students (39.1%, n =18) maintained that patients should not be allowed to decide to end their lives prematurely. In contrast, nearly half of the agnostic medical students (43.5%, n =10), presumably with a naturalistic world view, would not attempt to persuade the patient to opt for palliative care. Fig. 2 highlights the differences in the numbers of participants who would or would not attempt to persuade a patient to opt for palliative care, according to religious affiliation. Of the group as a whole, 50.2% (n =139) said that they would be supportive of a loved one who wanted to end their life prematurely owing to intractable disease. Islamic students differed from their peers in this regard, with only 23.9% (n=11) stating that they would be supportive of such a decision taken by a loved one.

Arguments supporting and opposing euthanasia/PAS

The main arguments presented by respondents in support of and opposing the legalisation of euthanasia/PAS in SA are outlined in Table 2 . The results indicate that the views of these future SA doctors on this topic resonate with those of medical practitioners nationally and internationally. [11-17] These arguments are covered in greater detail in the discussion section of this article.

Category 2 questions

These questions explored students' opinions regarding patient groups in which they would be more or less likely to perform or assist with active euthanasia or PAS. Four scenarios briefly detailing the morbidity of the patient who wished to hasten their death were presented. Results were largely unanimous across each specific question. With regard to the two questions on patients with painful, incurable disease, where the scenarios were similar but with a minor difference relating to duration of life remaining, responses were significantly different, 41.9% (n=116) of participants stating that they would assist in hastening death in a terminally ill patient with intractable suffering who was unlikely to live for much longer, but 71.1% (n=197) indicating that they would not hasten the death of a patient with the same morbidity (terminally ill with intractable suffering) if the patient had a longer time to live - although no exact time frame was provided. Nearly all the students (90.6%) (n =251) said that they would not assist a patient with life-ending interventions if the patient had no known treatable medical illness, and 54.2% (n =150) said that they would not assist a psychiatric patient to end their life prematurely. Participants of Islamic religious affiliation were largely opposed to assisting patients in hastening their death in any of the above scenarios. Reasons provided by respondents regarding which patients they would or would not consider assisting with euthanasia/PAS are set out in Table 3 .

Category 3 questions

These questions explored students' preferences for consultation regarding decision-making for patients requesting life-ending interventions. The majority of participants (80.1%, n =222) indicated that they would prefer to have a dedicated ethics team decide on which patient is eligible for euthanasia/PAS. Only 10.1% (n =28) of the respondents said that they would prefer to refer the patient, and the remaining 9.8% (n =27) indicated that they would choose either to decide for themselves or to consult a colleague. Responses to the question relating to who should decide if a patient should be granted their wish to hasten their death are outlined in Table 4 .

Method of hastening death

There were variations among respondents regarding methods by which they would assist a patient to hasten their death. Only 10.5% of students (n=29) indicated that they would opt for active euthanasia, while 35.0% (n=97) indicated that PAS would be their preferred method of hastening a patient's death. Notably, 36.1% (n=100) indicated that they would rather not have any part in ending a patient's life, if they were afforded this option. Reasons for the students' choices of method of hastening death are set out in Table 5 .

The findings of this study differ from equivalent studies conducted both locally and internationally. In our study, which explored the views of 277 medical students, 47.7% of students (n=132) were of the opinion that doctors should be allowed to help patients hasten their death upon a competent patient's request. In the only other SA study, conducted in 2011, [4] it was found that the majority of doctors were opposed to legalising PAS and active euthanasia. The results of the 2011 study concur with those of international studies, which focused on both qualified doctors and medical students. International studies conducted from 2006 to 2015 [11-17] reported that the majority of respondents were opposed to either legalising or practising euthanasia/PAS.

Arguments supporting legalisation of euthanasia/PAS

At present, the most widely used argument supporting the legalisation of euthanasia/PAS, both by respondents in this study and those reported in international articles, is that of respect for patient autonomy. The word autonomy, deriving from the Greek auto (self) and nomos (rule), refers to a person's ability to make independent choices about his/her life. Autonomous, competent individuals have a fundamental right to decide what they deem to be good and necessary for themselves after reviewing all their options, with specific reference to healthcare and, by extension, life. [18-20] In SA, a patient's autonomy is recognised as part of their inalienable constitutional rights, as expressed in the Constitution of South Africa [21] and the National Health Act. [22] Proponents of patient autonomy argue that the right to decide when one dies is or should be included in the understanding of this legislation. Internationally, patient autonomy and the significance thereof with regard to terminal illness and the wish for euthanasia/PAS are recognised and comprehensively detailed in the World Medical Association Declaration of Venice on Terminal Illness. [23]

A second argument used in support of euthanasia/PAS is that of the prevention of or relief from intractable suffering, related to the autonomous person's right to a dignified life and death. [19] The right to dignity is acknowledged in and one of the founding values in the Constitution (section 10). [21] Furthermore, it is widely held that no one should have to be constrained by or live with extreme suffering, if it is believed that the only way in which the suffering can be relieved is through death. [19] Offering the patient the option of euthanasia or PAS could therefore be seen as allowing the patient to die with dignity. [20]

Arguments opposing legalisation of euthanasia/PAS

Arguments opposing the legalisation of euthanasia/PAS by students in this study concur with international data. Euthanasia/PAS are considered wrong on the basis of personal and religious morality and on the basis of the universally acceptable principles of biomedical ethics. The biomedical ethics principles of beneficence (to act in the best interests of your patient) and non-maleficence (to ensure that no harm befalls your patient following your actions) are often used as arguments opposing the legalisation of euthanasia/PAS. The merits of these principles, when viewed (by some) in isolation, seem strong enough to oppose the legalisation of euthanasia/PAS.

Additionally, the 'slippery slope' argument presented by respondents in this study follows international trends opposing euthanasia. The slippery slope argument infers that the consequences of certain actions (such as legalising euthanasia and/or PAS) may, on their own, be worse than the actual anticipated consequences of prohibiting the said action. [24] The single most widely used slippery slope argument states that by legalising (active) euthanasia and/or PAS, one is at direct risk of pushing the society concerned down a slope that would ultimately resemble that of Nazi Germany. [25] The Nazi Germany analogy aims to accentuate the point that those who practise euthanasia and/or PAS may become 'dehumanised', resulting in non-beneficent killing.

What type of patient would medical students assist with euthanasia or PAS?

The majority of the participants in this study were opposed to assisting patients with no known medical condition and those with psychiatric conditions to hasten their death. Most participants expressed the view that they would be more likely to assist a patient with a known terminal illness and intractable suffering with a poorer prognosis, compared with patients with the same morbidity but a better prognosis (i.e. a longer remaining duration of life). This finding concurs with the earlier SA study, '41 in which respondents indicated that they would not consider PAS/euthanasia for a patient without a terminal illness.

The seemingly high percentage of respondents who exhibited reluctance to assist with life-ending interventions to patients with intractable psychiatric illness raises questions regarding the teaching medical students receive on treating intractable psychiatric illnesses: namely, would these (and future) students be more liberal in their opinions about euthanasia/PAS for patients with intractable psychiatric illness if they better understood the concept of futility of treatment in psychiatry, thereby aligning their views with those held internationally - where there is an increase in support and lobbying for these life-ending interventions, as seen in the mental health literature. [10,26]

How would students choose to participate in euthanasia/PAS?

The proportion of participants who indicated that they would participate in either euthanasia or PAS differed from the earlier SA study, [4] in that participants in the current study were more willing to perform euthanasia/PAS.

Conclusions

This study explored medical students' attitudes towards euthanasia and PAS and the prospects of legalising these practices in SA. In light of the renewed interest in the debate and the changing legal landscape, it was considered important to ascertain the views and opinions of these future doctors with regard to euthanasia and PAS, as it is believed that their views may determine their behaviour towards patients and peers. [12] Furthermore, should euthanasia/PAS be legalised, these young doctors, even though they are not obliged to implement the policies, would potentially need to perform or assist in these procedures and practices. [5]

From this study it is evident that there is a difference in attitude towards the practice and legalisation of euthanasia/PAS between future SA doctors and present doctors (i.e. those who participated in the 2011 study). While concerns regarding the legalisation of euthanasia/ PAS do exist (for the reasons given above), if the information provided by this study holds true for medical practitioners, it is safe to accept that SA will not proceed down the slippery slope, as the majority of respondents demonstrated that they are fairly discriminatory about who to perform these life-ending interventions for. Additionally, safeguards such as developing a dedicated ethics committee to rule on case-specific applications, as well as adhering to the safeguards already outlined in the South African Law Commission's report, [3] would further prevent the 'misuse' of these practices in SA. However, since SA is a democratic country, the views of the public should also be considered before moving to legalise or completely abolish these practices - as the SA Constitution regards individualism as equivalent to communitarianism. [27]

Recommendation

Although the responses garnered were largely unanimous across all questions, variations exist between respondents from different religious groups. These differences within as well as between various religious groups should be considered when discussing life-ending matters. These differences in opinion should be explored further in future research relating to euthanasia/PAS, as religion and culture have a significant influence on individuals' opinions and responses. [28,29]

Acknowledgements. The authors express their heartfelt gratitude to Prof. Keymanthri Moodley, Professor and Director, Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, for her constant and continuous support in this research project and for assisting in obtaining both institutional and ethics approval. This article would not have been possible without her invaluable support and input.

Author contributions. RKJ: principal investigator; study conception and design; data acquisition, analysis and interpretation; article drafting. MH: supervisor; study conception and design; article revision and final approval.

Funding. None.

Conflicts of interest. None.

2. Scott H. Assisted suicide and the South African constitutional order. Responsa Meridiana 1998;1-17.         [  Links  ]

3. South African Law Commission. Euthanasia and the artificial preservation of life. Paper 71 Project 86, 1997. www.justice.gov.za/salrc/dpapers/dp71_prj86_1997.pdf (accessed 5 May 2015).         [  Links  ]

4. Ethics Institute of South Africa. Survey of Doctors' Attitudes to Assisted Dying. Johannesburg: Ethics Institute of South Africa, 2011.         [  Links  ]

5. Stransham-Ford v the Minister of Justice and Correctional Services and Others 30 April 2015, Case no. 27401/15 (NGHC).         [  Links  ]

6. S v De Bellocq 1975 (3) SA 538 (T).

7. S v Hartmann 1975 (3) SA 532 (C).

8. Minister of Justice and Correctional Services v Estate Stransham-Ford (531/2015) 2016 ZASCA 197 (6 December 2016).         [  Links  ]

12. Ahmed AM, Kheir MM. Attitudes towards euthanasia among final-year Khartoum University medical students. East Mediterr Health J 2006;12(3/4):391-397. http://www.who.int/iris/handle/10665/117098 (accessed 5 May 2015).         [  Links  ]

19. Landman WA. The ethics of physician-assisted suicide and euthanasia. S Afr Med J 1997;87(7):866-869.         [  Links  ]

20. Egan A. Should the state support the 'right to die'? South Afr J Bioethics Law 2008;1(2):47-52.         [  Links  ]

21. South Africa. Constitution of the Republic of South Africa. Pretoria: Government Gazette, 1996.         [  Links  ]

22. South Africa. National Health Act No. 61 of 2003.         [  Links  ]

23. World Medical Association. Declaration of Venice on Terminal Illness. World Medical Association, 2006. https://www.wma.net/policies-post/wma-declaration-of-venice-on-terminal-illness/ (accessed 7 May 2015).         [  Links  ]

25. Lamb D. The slippery slope argument. In: Lamb D, ed. Down the Slippery Slope: Arguing in Applied Ethics. London: Croom Helm, 1988.         [  Links  ]

27. Wing AK. Communitarianism vs. individualism: Constitutionalism in Namibia and South Africa. Wisconsin Int Law J 1992;295(11):295-380. http://ir.uiowa.edu/law_pubs/1495 (accessed 12 May 2015).         [  Links  ]

Accepted 1 February 2018

Sunday, 01 September

Decriminalising euthanasia in SA: The legal battle to die with dignity

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Revisiting assisted suicide or euthanasia in South Africa from a dignity perspective : a comparative analysis

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The right to die

1 September 2020 - Beth Amato

Q&A: Professor of Philosophy, Kevin Behrens explains why euthanasia is not simply a matter of life and death.

Physician assisted suicide, or euthanasia, is banned in South Africa. Euthanasia is one of the most contested ethical subjects in the world, shaking our spiritual, political and social values to the core.

What are your thoughts about the “two sides of the story” regarding physician assisted dying? One side feels that under certain conditions, like extreme pain and terminal illness, people should have the right to end their own life. Conversely, others say that knowingly ending a life is an anathema to healthcare.   

I am strongly of the opinion that continued life is sometimes more of a harm than dying, that euthanasia and assisted dying are morally justifiable under certain conditions, and that the current South African law is wrong and should be changed to allow for these acts. Everybody ought to have the right to decide on how they die, and it should be up to them to choose a shorter life over an extended life of pain or distress. We have no choice when it comes to being brought into this world, but we should have the choice about whether or not we want to stay in this world. 

I therefore take the fairly radical position that it is a person’s right to make a choice to end their life under any circumstance in which they are honestly convinced that this is in their best interests.

This is easiest to justify in cases where patients have a terminal illness and are experiencing intractable physical pain and distress. These clear cases also serve to guide us regarding what is right in some of the more controversial cases, such as if a patient has suffered from major depressive disorder for many years. It is morally irrelevant to only justify euthanasia in terminal illness cases.

What counts morally is that a person is in pain and is distressed, and has come to a reasonable conclusion that the best way to be freed from this pain and distress is by ending their life.

Regarding health professionals participating in euthanasia at the request of patients: I do not see it as a negation of the “do no harm” principle. Harms are relative. We are often forced to do some harm to prevent greater harm. Death is not always the greatest harm that can be done to a person. Sometimes continuing to live is more harmful.

Is euthanasia just another example of how humans attempt to exert domain and control on the so-called uncontrollable and unknown?

If there is anything over which we ought to have dominion or control, it is our own life and death.  It is when we interfere with the choices and rights of others that we over-reach. I do think that death is just a natural part of life, and that it is sometimes a blessing for people. Death is not always harm, and we should sometimes welcome and embrace it as something that offers relief for others or even ourselves.

We probably have over-medicalised natural processes, including those at the beginning and the end of life. We have turned the prolonging of life into an absolute moral good, whereas it is not.  It is often our own inability to accept the reality and inevitability of death that makes us – especially physicians – blindly believe that it is always best to prolong life whenever it is possible. Such myopia can lead us to make decisions that cause far more harm than good to patients.

If euthanasia is not an option, is the answer high quality palliative care to improve the patient’s quality of life while not treating the cause of suffering?

High quality palliative care, which is meant to alleviate stress and adverse symptoms associated with a serious illness, should be available to everyone who needs it. The fact is this is not the case. Even in wealthy countries very few people have access to good palliation. However, even if it were available to all who need it, it would not put an end to the need for euthanasia. Not even the best palliative medicine can completely free all patients from pain and distress. Many patients continue to experience significant pain even under the care of palliative physicians. Furthermore, the distress patients experience is also psychological. Many patients find being dependent, helpless, incontinent, confused, etc., to be a serious threat to their dignity. Palliative care does not necessarily free patients from these indignities, and may add to them.

Are there any advocacy efforts for dignified dying through euthanasia? How are you involved?

Globally there are many organisations that advocate for euthanasia. In South Africa, probably the most well-known organisation is DignitySA. I am not involved in any euthanasia advocacy groups. I use my classroom as an opportunity to raise awareness about these issues, and I have published one article on assisted dying. I try to provide my students with the intellectual schools and cognitive skills to make their own decisions about moral issues rather than using the classroom to promote my own views.

• Professor Kevin Behrens holds a PhD in Philosophy. He is the Director of the Steve Biko Centre for Bioethics at Wits. He answers these euthanasia-related questions in his personal capacity and his views are not necessarily those of the Centre or of the University.
• Beth Amato a freelance writer.
• This article first appeared in  Curiosity ,  a research magazine produced by   Wits Communications  and the  Research Office .
• Read more in the 10 th issue, themed: #Mood how our mental health and wellbeing are impacted by the socio-economic, political, psychological, legal, ethical, cultural and technological interpretations of our world.

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Euthanasia in South Africa: Philosophical and theological considerations

2017, Verbum et Ecclesia

Debates on euthanasia (or �mercy killing�) have been a concern in moral, philosophical, legal, theological, cultural and sociological discourse for centuries. The topic of euthanasia inspires a variety of strong views of which the �slippery slope� argument is one. The latter warns that the principle(s) underlying any ethical issue (including euthanasia) may be distorted. Scholars� views on euthanasia are influenced mainly by cultural, personal, political and religious convictions. In South Africa, the issue of euthanasia has arisen from time to time, but the question of whether it should be legalised was not seriously considered until it recently attracted attention because of a particular case, that of Cape Town advocate Robin StranshamFord. Although euthanasia is still illegal (this is because the Stransham-Ford ruling is confined to this particular case only), as stated in the ratio decidendi by Judge Hans Fabricius of the High Court in Pretoria, the Court granted leave to appeal...

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The present case concerns the legality of assisted suicide and active euthanasia in South Africa. This particular issue has been a major point of contention, having been debated in South Africa and elsewhere for many years and is generally accepted to be unlawful. In November 1998, the South African Law Commission submitted a report to the then Minister of Health on this issue, entitled “Euthanasia and the Artificial Preservation of Life”. At the time of its submission, the country was facing a number of imposing crises, including the HIV/AIDS epidemic. As a consequence of this, this report did not receive the necessary attention of either the Minister of Health or the legislature at the time. Sixteen years have since passed and in the interim South Africa became a democracy (in 1994). A Constitution was promulgated that inter alia guarantees fundamental human rights to all persons. However, the status quo on euthanasia and assisted suicide has remained unchanged in South Africa.The...

Eron Fasser

In this thesis I explore the issue of voluntary assisted suicide in a South African constitutional context through the tri-coloured normative prism of autonomy, dignity and human well-being. I will focus on the way South Africa, as a secular society, ought to engage with this highly emotive issue in light of the socio-legal framework in which we are embedded and which framework carries with it profound normative implications. I divide the discussion into two broad sections. In the first section I articulate, from an ethical standpoint, what I take to be the strongest positive case for South African society to permit voluntary assisted suicide. I argue that by permitting voluntary assisted suicide South African society would be giving proper expression to (i) individual autonomy (ii) human dignity, and (iii) human well-being. In articulating the positive case I also analyse the triumvirate concepts of individual autonomy, dignity and human well-being as well as their relationship to each other. I argue that individual autonomy is an essential component of a good human life, that is to say, a worthwhile life and that to speak of a dignified life is, in turn, to speak of the sort of life that is worthy of respect, reverence and honour. I then turn to an examination of two of the principal ethical arguments against the moral permissibility of voluntary assisted suicide in the literature, namely (i) the Sanctity of Life Argument, and (ii) the Social Harm Argument. I argue that neither argument is sufficiently persuasive to rebut the positive case in favour of voluntary assisted suicide. However, certain critical considerations are raised that do speak to the need for effective oversight and regulation of such a practice in South African society. Accordingly, I advance the view that, in light of the failure of these two principal arguments (and in the absence of any stronger arguments) voluntary assisted suicide ought to be permitted in South Africa subject to uniform, public and specifiable oversight criteria applicable to each individual who wishes to end his life with the assistance of another. In the second section, I describe the South African legal standpoint on voluntary assisted suicide in light of (i) the normative underpinnings of the Constitution of the Republic of South Africa, 1996 (and in particular the Bill of Rights) and (ii) the present legal status of voluntary assisted suicide, taking into account both the common law and the South African Law Commission Report on Euthanasia and Artificial Preservation of Life, 1998. This analysis involves an examination of (i) the recent decision of Stransham-Ford v Minister of Justice and Correctional Services & Others handed down on 4 May 2015 in which the North Gauteng High Court granted, for the first time in South African legal history, an application allowing a terminally ill man the right to die and to be actively assisted to do so by a consenting physician; as well as (ii) the subsequent Supreme Court of Appeal decision in The Minister of Justice and Correctional Services & Others v Estate Late Stransham Ford that overturned the original decision. I argue that the best way to understand the socio-legal framework in which we find ourselves is as a social contract that ‘instantiates’ or ‘gives expression to’ a rights-based ethic, which in turn protects vital human interests. I argue further that this constitutional legal framework is capable of tracking and incorporating the positive ethical case for voluntary assisted suicide admirably. Finally, I posit that the quickest and most effective way to implement a permissive policy for voluntary assisted suicide is through the development of the common law. In the process, I tentatively suggest what appropriate safeguards and oversight of voluntary assisted suicide might look like, the practical implementation of which would allow South African society – specifically through the judicial branch of government - to more sagaciously and compassionately judge lives.

nomfundo sipunzi

Gabriella Bellairs-Lombard

This essay will aim to explore discourses surrounding euthanasia in South Africa. This will be done through a critical discourse analysis of responses on social media to Archbishop Desmond Tutu’s statement in favour of assisted suicide, with the use of various news articles. I will discuss the context of this statement and the events surrounding it, and will then move on to provide an outline of the theoretical framework that serves to inform this research

Loyola of Los Angeles law review

John Finnis

Sigismund N . K . Phixon-Owoo

Euthanasia is increasingly gaining prominence in countries across the globe but despite this, it remains one of the least researched areas. It is self-evident that every community of civilized states has unanimously conceded to the right to life as a basic human right (probably the most basic). However, its antipode-the right to die, has not been the subject of a plethora of academic work

Ελληνικό Περιοδικό της Νοσηλευτικής Επιστήμης

Andreas Tsounis

Introduction: Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering. Aim of this review is to present different views and arguments about euthanasia and to discuss the Legal regulations and the way that modern societies confront the inevitable dilemmas that it brings in surface. A literature review was conducted on google scholar for articles about the theme using as key words: euthanasia, active, passive, pros/cons, legislation. Results: The results of the literature review came up with its pros and cons of it. Some of the pros are that it provides a way to relieve extreme pain, a way of relief when a person's quality of life is low and an insurance of the rights of dignity and self-determination. The basic cons of it is that it devalues human life, it has become a means of health care cost containment and that there are objections about the expressions of willingness for people under High psychological pressure or for population groups like older people with dementia or mentally ill. Under the pressure of the new circumstances in the last decades, Euthanasia became the subject of legislative interventions in a number of countries. But even the most complete regulatory framework cannot predict all the aspects. Every different case will always be a confrontation with important existential and emotional issues. Conclusion: Before resulting in Euthanasia, a person must consider the situation. There are a lot of circumstances under which euthanasia is a reasonable and responsible choice. Each case is different from another

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• DOI: 10.7196/SAJBL.2018.V11I2.635
• Corpus ID: 57453618

Legalising physician-assisted suicide in South Africa: Should it even be considered?

• Published in South African Journal of… 30 November 2018
• Law, Medicine

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2 Citations

Personhood and euthanasia in african philosophy, public policy in als/mnd care: south african perspective, 12 references, should the state support the 'right to die', physician assisted suicide: the great canadian euthanasia debate., legal physician-assisted dying in oregon and the netherlands: evidence concerning the impact on patients in “vulnerable” groups, physician-assisted deaths under the euthanasia law in belgium: a population-based survey, how does legalization of physician-assisted suicide affect rates of suicide, euthanasia and physician-assisted suicide: a review of the empirical data from the united states., euthanasia and physician-assisted suicide: a view from an eapc ethics task force, the great slippery-slope argument., how long will we live, the ‘slippery slope’ argument: uses and misuses, related papers.

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A Proposal for Legalizing Assisted Suicide and Euthanasia in South Africa

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• Willem A. Landman 6  

Part of the book series: Philosophy and Medicine ((volume 67))

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There is a serious initiative in South Africa (S.A.) to legalize physician-assisted suicide (PAS) and voluntary active euthanasia (VAE). In 1991, the S.A. Law Commission (the Commission) was requested to consider legislation regarding a “living will.” This is a statutory 1 advisory body, appointed by the President, whose aim is the continuing renewal and improvement of South African law. It agreed to hear this request, but expanded its task to include the whole spectrum of end-of-life health-care decision-making issues, including physician-assisted suicide and voluntary active euthanasia.

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Landman, W.A. (2001). A Proposal for Legalizing Assisted Suicide and Euthanasia in South Africa. In: Kopelman, L.M., De Ville, K.A. (eds) Physician-Assisted Suicide: What are the Issues?. Philosophy and Medicine, vol 67. Springer, Dordrecht. https://doi.org/10.1007/978-94-010-9631-7_13

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The many faces of euthanasia in South Africa

Euthanasia is one of the most contentious subjects across the world. South African common law dictates that active forms of euthanasia are illegal, while the withdrawing or withholding of life support is legal where a patient has given an advance directive, or where further treatment is considered futile. Considering the constitutional right to human dignity (enshrined in article 10 of the Bill of Rights), this distinction is particularly perplexing and highlights the need to ​​confront the tension between the common law and the Constitution. The debate around euthanasia was heightened recently by the case of Professor Sean Davison, who was charged with three counts of murder after helping individuals who asked for assistance in their deaths. It is noteworthy that Davison’s punishment of house arrest as the sentence for three charges of murder would seem to indicate a significant shift towards legalising euthanasia. – Nadya Swart

The right to die: unpacking an ethical dilemma in South Africa

Sean Davison, the euthanasia activist and co-founder of DignitySA , recently completed a sentence of house arrest in South Africa for his role in the deaths of three people. He said he had not committed a crime or murder, but had helped these people because they were desperate to die. Anrich Burger, Justin Varian and Richard Holland were suffering unbearably with no hope of recovery and were unable to end their own lives.

Late South African emeritus Archbishop Desmond Tutu, in whose honour Davison wants to fight to change the laws around assisted suicide, once wrote that he would want the option of an assisted death. Tutu argued that dying people should have the right to decide how and when they wanted to leave this life.

Legislation in Canada, and a number of US states and European countries, for example, allows assisted suicide. But there are still billions of people around the world, as in South Africa, who do not have this right. The question of whether this is a right is a debate that has been raging for years in medical ethics and in religious groups.

This article is not about the religious or strictly legal aspects of the debate, but grapples with the ethical tension between arguments for and against active forms of euthanasia 

Arguments against active euthanasia

There are broadly three arguments against active forms of euthanasia:

• only God has the authority to dispose over life and death
• it is the role of medical doctors to preserve life, not to cause death
• a doctor could abuse his or her position to take the lives of vulnerable patients, or patients might be killed against their wishes.

Although these arguments must be considered, I prefer to put forward the arguments in support of  active euthanasia. But for the sake of clarity, let’s first look at two forms of active euthanasia.

Two kinds of active euthanasia

One is known as voluntary active euthanasia. This is when the death of a patient who is competent to make such a decision is intentionally brought about, and where death is reasonably believed to be in the interests of, and based on, an informed request by the patient. The doctor’s act is the proximate cause of death.

The second form of active euthanasia is where a doctor assists a patient in suicide, called “physician-assisted suicide”. The doctor intentionally provides the means to a competent individual who then takes his or her own life.

In South Africa, both forms of euthanasia are illegal.

Constitutional and other supportive perspectives

In a constitutional democracy, active euthanasia should not be dealt with primarily as a theological issue. Of course, people of faith may express their beliefs about it, but they should not expect to dictate the law. There are many citizens who do not share religious values.

Although legislation in South Africa prohibits active forms of euthanasia, I believe that it is not against the constitution . The bill of rights includes three relevant rights:

• human dignity (article 10)
• freedom and security of the person, including the right not to be treated or punished in a cruel, inhuman or degrading way (article 12(1))
• bodily and psychological integrity, including the right to security in and control over one’s body (article 12(2)).

There is another point in favour of active euthanasia. The development of medical science means that people have more control over death and life than ever before. Although life has high value, it is not absolute.

People make decisions throughout their lives about their health. But when they are terminally ill, often in unbearable pain and suffering – and sometimes even losing their dignity – they are not allowed to decide when they want to die.

If someone is terminally ill and suffering, can a strong moral case not be made that such a person – within prescribed medical-ethical parameters , such as the patient’s suffering, prognosis, mental competence, informed decision-making and clear communication – should be assisted with the dying process?

In support of active euthanasia

Three arguments have been put forward in support of active euthanasia:

Personal autonomy should be respected. This implies that a competent person has a moral right to make his or her own choice.

Unbearable suffering should be prevented. Nobody should be forced to endure suffering – often at high medical cost.

When life is no longer good, and death is no longer bad, and when death is therefore preferred to continuing life, the role of medicine could change from healing and preserving life to helping someone die in a way that is compassionate, kind, gentle and respectful.

I believe everyone should be allowed to choose his or her “moment”. For me, active forms of euthanasia are not so much the termination of life, but rather the shortening of suffering and the dying process.

Moral equivalence. Physician assisted suicide is like other practices that are already morally acceptable – such as passive euthanasia.

To withhold treatment is viewed as an omission while physician assisted suicide and voluntary active euthanasia are regarded as acts. But people are morally and legally responsible for both acts and omissions.

South Africa is a country where people hold strong and various opinions. This diversity of opinions must always be considered, according to the Constitution. South Africans did it with the termination of pregnancy (which was legalised) and the death penalty (which was scrapped).

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Home — Essay Samples — Social Issues — Euthanasia — Why Euthanasia Should Be Legal: Analysis of Arguments and Counterarguments

Why Euthanasia Should Be Legal: Analysis of Arguments and Counterarguments

• Categories: Assisted Suicide Euthanasia Right to Die

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Introduction, why euthanasia should be legal, works cited, counterarguments.

• Corder, Mike. “Dutch Euthanasia Center Sees 22% Rise in Requests in 2019.” WAVY.com, 7 Feb. 2020, www.wavy.com/news/health/dutch-euthanasia-center-sees-22-rise-in-requests-in-2019/. Accessed 10 March 2020.
• Davis, Jacky. “Kevin Davis Deserved Choice.” Dignity in Dying, www.dignityindying.org.uk/story/kevin-davis/. Accessed 13 March 2020.
• De La Torre, Esther B. The Right to Assisted Suicide, www.lonestar.edu/rightto-assist-suicide.htm. Accessed 19 March 2020.
• “Euthanasia Laws - Information on the Law about Euthanasia.” Information on the Law about Euthanasia - Suicide, Life, Act, and Mercy - JRank Articles, law.jrank.org/pages/11858/Euthanasia.html. Accessed 10 March 2020.

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Should euthanasia be legalised in South Africa?

Updated Sept. 13, 2017, 8:43 a.m. | By Damon Beard

Share this:

No one would like to see their loved one suffering from pain - especially when their loved one is terminally ill. But when it comes to saving them from their illnesses, should we be given the right to choose to end their life on behalf of them?

It's a difficult one though because sometimes the patient isn't able to ask for help and the decision is taken by the family to switch off life support. But in South Africa, you need to have the correct documentation lodged with the doctor and family or friends before this can happen. 

A doctor’s duty is to preserve life, and in this day and age, it's now possible to keep a patient alive for longer after the quality of life has gone.

A draft bill on the ending of life was put to Parliament in the late 1990s, but there are no signs that it will be passed into law soon, so South Africa still has no legislation regarding euthanasia.

Read:  SA not ‘educated enough’ for euthanasia

The South African Constitution allows a woman to decide if she wants to terminate a pregnancy, so why, you may ask, can we not decide then if we'd want to end the life of someone who's terminally ill? I've been in the position where I've been at the bedside of both my mom and dad as they passed away. Both slipped away peacefully, but watching them battle in their last days is something that I'll never forget. I'm sure if euthanasia was permitted, they would have asked to go without any pain or suffering.

So if euthanasia was allowed in South Africa, if your mom, dad or partner was in serious pain and they asked you to let them go, would you have the courage to do so?

Also read:  Emotional moment dog says final goodbye to dying owner

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