The plight of people who feel that their suffering is unbearable or that their experience of disability is unacceptable to themselves should be a catalyst for South Africans to debate the meaning of compassion, writes University of Pretoria historian of medicine Julie Parle.
On 20 June 2022, professor of biotechnology Sean Davison was released from three years of enforced silence. He did not serve his time for murder in jail, but was restricted to his home.
He had been banned from discussing the reason for his sentence: assisting three men - at their request - to end their lives. Due to illness or disability, all three had been "incapable of ending their own lives"; palliative care had proven inadequate and no doctor could legally help them to die.
As the founder of Dignity SA, which lobbies "for assisted dying to be legalised, with stringent safeguards in place to protect the vulnerable", Davison called for lawmakers to recognise that assisted dying was an act of compassion.
That is having: sympathy for the suffering or distress of another, the desire to relieve it, and taking action. Davison's cause had been supported by cleric, human rights activist, and champion of compassion, Archbishop Desmond Tutu.
Euthanasia means a good or gentle death and has been discussed by many South Africans for at least a century. Author and politician HIE Dhlomo, who died in 1956, wrote the short story "Euthanasia by Prayer" which centres on whether there is a human or divine responsibility to end suffering. No one has been unanimous on the matter and since the 1930s many South African doctors wrestled with whether they had a duty to intervene.
Modern societies with advanced medical technologies have effectively divorced many human beings from a realistic relationship with death and dying.
The context of dying changed greatly from the 1960s. Medical tools such as respirators, organ transplants, and powerful medicines intensified expectations that doctors ought to extend a life "at all costs", in all circumstances. South Africa led in many of these medical breakthroughs, but their costly benefits were seldom available to black South Africans and almost never to the poor.
Foreshadowing Sean Davison's 2019 treatment, the Supreme Court in 1975, found Dr Alby Hartman who had intervened to end his father's life guilty of murder, but did not sentence him to prison. Instead, disciplining Dr Hartman was passed to the South African Medical and Dental Council (SAMDC). It also initially decided not to impose a penalty. But, in 1976, under direct pressure from its government-appointed president, it struck Dr Hartman off the medical register.
The Hartman trial triggered an open discussion of medical mercy killing in South Africa. Anonymously, many doctors admitted they performed mercy killings. In 1979, renowned heart surgeon Christiaan Barnard endorsed active euthanasia and the apartheid state threatened to ban his book Good Life/Good Death: A Doctor’s Case for Euthanasia and Suicide (1980).
The South African Voluntary Euthanasia Society (SAVES) was established in 1974 and lobbied opposition parties to introduce legislative change. It later moved the discussion of passive euthanasia into the political arena through the South African Law Commission (SALC), which began researching the issue in 1991.
In August 1992, the Supreme Court ruled that the artificial feeding of a comatose patient could lawfully be ended. In the same year, a survey of more than 9 000 doctors reported, "Nearly one in ten medical doctors in South Africa have deliberately taken clinical actions that would directly cause the death of a patient".
Anti-apartheid medical organisations, such as the South African Health and Social Services Organisation (SAHSSO), entered the debate. They recognised that euthanasia was practised, but rather than highlighting an individual choice in ending life, they spoke of "euthanasia apartheid". Inspired by an analysis of the racial and structural inequities of health care, they held that it was these that were effectively the cause of such deaths: the need for euthanasia would seemingly disappear once these were fixed.
The SALC drew up the Rights of the Terminally Ill Act 1997 and the End-of-Life Decisions Act 1997 to be debated in Parliament. In so doing, the commissioners trusted the democratic organs of the new South Africa to determine how compassion could be enacted by law. However, the government has yet to initiate such a debate.
In balancing the rights of individuals to choose an assisted death with those who reject that right, the legislature would need clear-sighted political will to steer it to consensus. There has been none. What is more, the ministries of Health and Justice, and the successor to the SAMDC, the Health Professions Council of South Africa, are currently opposing an application to the Gauteng High Court for assisted dying by two other South Africans, Dr Suzanne Walter and Diethelm Harck.
The plight of people who feel that their suffering is unbearable or that their experience of disability is unacceptable to themselves should be a catalyst for South Africans to debate the meaning of compassion. It is time for a reset of our debates about how we want to die.
- Julie Parle is a historian of medicine and is a Research Associate at the Department of Historical and Heritage Studies at the University of Pretoria. She is the Editor of Historia: the journal of the Historical Association of South Africa (HASA).
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