Experts: Life support can last for years

2013-06-30 10:00

As reports emerged this week that former president Nelson Mandela was on life support, South Africans were asking: Who decides to switch off the machines?

Machines that can keep patients alive include ventilators for breathing, dialysis machines that help to clean failing kidneys and remove waste products from the blood, and advanced heart-support machines.

A patient could remain on life support for years, depending on their condition, say medical law experts.

Bioethicist Professor Sylvester Chima of the University of KwaZulu-Natal said the decision to keep a patient on life support “is usually made after considering issues of scarcity of resources, the best interests of the patient, medical futility, and chances of recovery and quality of life after recovery”.

Keymanthri Moodley, associate professor at the Centre for Medical Ethics and Law at Stellenbosch University, said the patient could have a “living will”, which makes their desires known, but if there is none, “the family and doctors discuss the situation and take a joint decision”.

Chima said: “The primary person with the responsibility for switching off a life-support machine is the spouse, followed by children and siblings.

“But in the case of a cultural and global icon such as Mandela, such a decision is not easy. The family, cultural elders and doctors will have to sit down and have a care conference. This group will try to make a joint decision after discussing all relevant issues,” Chima said.

Phathekile Holomisa, leader of the Congress of Traditional Leaders of SA, said: “In our culture, nobody decides to take the person’s life. The matter is left to our ancestors.”

Holomisa added that Madiba’s current medical condition could be connected to his ancestors, who are not pleased with the manner in which Mandla Mandela exhumed the remains of Madiba’s children.

“The moving of graves is a very ­serious matter because one can’t ­simply be moving graves around. It ­upsets the spirits of those people.”

He did not want to be drawn into the matter of the removal of the Mandela graves, but said a simple AbaThembu ritual would be followed.

Elders will speak to the ancestors and inform them that they are being “disturbed again”. A cow will probably have to be slaughtered.

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