‘As medical practitioners, we should assist patients to have as gentle and peaceful a death as possible’

Seven leading doctors and academics have come out in support of euthanasia, or assisted suicide, in South Africa, arguing decriminalising this practice will reduce the suffering of terminally ill patients, who often die in agony. 

The doctors — including professors, oncologists, ethicists and anaesthesiologists — penned an article in the latest SA Medical Journal (SAMJ), saying legalising assisted death would allow doctors to help patients “have as gentle and peaceful a death as possible”.

It would also conform to the principles of medical ethics, which is to do no harm, promoting the best interests of the patient, respecting their autonomy and treating them fairly. 

They said, responsibly practised, assisted dying “conforms to all four of these principles”. But it was important that “medically assisted dying is patient-initiated and patient-driven”. 

“We understand that medically assisted dying means ending one’s own life with the means supplied by someone else [physician-assisted suicide] or having the means supplied and administered by someone else [physician-administered euthanasia]. 

“Medically assisted dying hastens death to spare the patient suffering from a condition with no prospect of further beneficial treatment. It should only be a response to an initiative of and request by the patient, after free and unencumbered deliberation and choice,” they said. 

The group, which includes Prof JP van Niekerk, former dean of health sciences at the University of Cape Town, neurosurgeon and former chair of Stellenbosch University Council Dr Paul Cluver, anaesthesiologist Dr Edwin Hertzog, who is the founder and past chair of Mediclinic International and Prof Mariana Kruger, former executive head of paediatrics and child health at Stellenbosch University, said they supported a looming court challenge by DignitySA to decriminalise medically assisted dying in the country. 

“We understand that DignitySA is pleading with the high court to declare the general common-law prohibition of medically assisted dying unconstitutional and invalid, and to advise parliament to write a law legalising and regulating assisted dying.” 

The issue of assisted suicide was thrust into the limelight in recent years after right-to-die activist Prof Sean Davison revealed that he had given his cancer-stricken mother a lethal dose of morphine while in New Zealand. She died at the age of 85 in October 2006. 

In 2019, Davison, who was the head of the department of biotechnology’s forensics laboratory at the University of the Western Cape, was found guilty by high court in Cape Town for assisting three men to die. 

He had been charged with murder after administering a “lethal concoction” to Dr Anrich Burger, who became a quadriplegic after a car crash in 2005. Burger had wanted to go to Switzerland for assisted dying, but could not afford it. 

A general legal prohibition of medical assistance in dying in the appropriate circumstances means abandoning patients in their final and dire need.

—  SA Medical Journal

Davison was also found guilty of assisting in the death of Justin Varian, who suffered a stroke in 2010 and was diagnosed with motor neuron disease in 2011. Varian was unable to move, had difficulty swallowing and had asked for assisted dying several times. In 2015, Davison ended Varian’s life by helium deoxygenation.

Richard Holland was the third person Davison assisted. He sustained brain damage during a cycling accident and was only able to communicate via a system of eye movements and agreement to a verbal alphabet via slight thumb movement. He suffered severe pain. Davison administered a lethal dose of phenobarbital to him in November 2015. 

Even though Davison received a suspended sentence of eight years for the crimes, which effectively resulted in house arrest of about three years with community service, after his arrest was lifted, he later declared that he did not commit any crime and was not a murderer.

In the SAMJ article, the public health experts argue that even though the public debate about assisted dying started more than 25 years ago and the SA Law Commission has drafted legislation on end-of-life treatment options, there remains no law that governs this form of death. 

They said countries that had legalised assisted dying such as the US, Canada, Colombia, the Netherlands, Belgium and Australia did this responsibly, with protocols and safeguards ranging from conservative to permissive. 

“Because of these considerations, we support medically assisted dying practised with responsibility, compassion, protection of the vulnerable, and respect for patients’ preferences regarding their bodily freedom and dignity.” 

They said in South Africa the time had come for medical assistance in dying to be recognised as a “compassionate, humane and caring end of life medical treatment option”.

“As medical practitioners, we should assist patients to have as gentle and peaceful a death as possible.”

This should be done along with end-of-life options such as palliative sedation, withdrawal or withholding of life-sustaining treatment. 

“A general legal prohibition of medical assistance in dying in the appropriate circumstances means abandoning patients in their final and dire need.” 

Other authors of the article include bioethicist and head of medical ethics at Stellenbosch University Prof Keymanthri Moodley, Prof Jonny Myers, director, occupational and environmental health unit and former head of school of public health at UCT; Prof Dan Ncayiyana, obstetrician and gynaecologist and emeritus professor at UCT; Dr Johan Snyman, adviser in the medical insurance and chair of the South African Medical Association (Sama) in the Eastern Cape.