Durban - Euthanasia - or assisted dying - may become an alternative to proper care.
This is the fear of the Durban’s Highway Hospice, based in Sherwood, which weighed in on the controversial debate through its umbrella organisation, the Hospice Palliative Care Association.
The discussion has been thrust to the fore this week, after the suicide of IFP MP Mario Oriani-Ambrosini in the early hours of Saturday morning. He had been battling lung cancer over the past 16 months.
The practice is defined as the purposeful ending of a life with a larger aim of alleviating pain and suffering.
The association said in a statement, following Daily News enquiries in South Africa, that there was a lack of respect for human life.
“This uncomfortable reality, together with severe constraints on health-care facilities, means that there is a real risk of euthanasia becoming a substitute for proper care in the South African situation.”
It said that discussions about euthanasia had evolved out of a Western consumerist society’s desire to control everything in life - from the manner and time of birth to the manner and moment of death.
“There is also fear and mystique around dying and a reluctance to recognise that death is a normal part of life. There is an aversion to not being able to control how one dies, a desire to avoid pain, an imagined fear about the manner of dying. Gaps in the South Africa health-care setting include the training of health-care professionals in palliative care, including pain management, so that adequate pain and symptom management can be available to all South Africans.”
The focus, the association said, should be on effective care, recognising that the duty of the medical doctor was to heal, relieve suffering and provide care that would benefit patients, in the best interests of the patient.
“There should be no exception to this principle, even in the case of incurable disease. The primary responsibilities of the doctor and care team in end-of-life care are to assist the patient in maintaining an optimal quality of life through controlling symptoms and addressing psycho-social and spiritual needs, and to enable the patient to live and to die with dignity and in comfort.”
While the group recognised that patients had a right to be involved in the decision-making process, caregivers needed to explore the request carefully.
UKZN head of the programme of Bio and Research Ethics and Medical Law associate Professor Sylvester Chima also weighed in on the issue as an ethicist and medico-legal expert.
“The major ethical and legal conflict surrounding the issue of assisted-dying is the conflict between an individual’s right to autonomy and self-determination versus the constitutionally protected right to life.
“In terms of South African law, the right to life is a constitutionally protected right, which is why there is no death sentence.”
He said recognising the right to assisted-suicide might require some form of constitutional amendment to recognise this exception to right to life.
“Generally, there is no legal conflict when an individual decides to kill him or herself (commit suicide). Killing oneself is not a criminal offence and no one can be prosecuted for suicide.”
He said that the moral and ethical dilemmas associated with assisted-dying arose, when another person, either a family member or a health-care professional was required to assist an individual who wished to die but was unable to do so by themselves.
“In this case, this act of assisted-dying may become a criminal offence or culpable homicide and anybody assisting such a person is deemed to have committed a crime punishable under the current laws.
“The dilemma here arises because such individuals are very vulnerable and could be exploited by their caregivers, for example family members, or even a member of the health-care team who feels that such an individual has become an excessive burden, and therefore would be better off dead.
“It also occurs sometimes that such a sick individual may feel that they have become a burden to their families or caregivers and may request to die in order to relieve their family of this burden,” he said.
Chima said the issues surrounding assisted-dying, if not carefully considered, might open the floodgates for others acting on their own interests who might hasten the death of vulnerable people and patients.
“It could even lead to a situation where an individual who is chronically poor or an incurable drug addict, may request for assistance to terminate their life because they are not happy with the direction in which it is going.”
He said diverse religious and cultural considerations also had to be taken into account.