HPCSA’s view on Euthanasia & Assisted Suicide Professor Samuel Mochichi Mokgokong HPCSA’s view on Euthanasia & Assisted Suicide

INTRODUCTION The prohibition on the intentional killing of a human being is the cornerstone of society and human relationships. It protects the life, equality and dignity of all members of society, especially the vulnerable.

The World Medical Association's View The World Medical Association's Declaration on Euthanasia, adopted by the 38th World Medical Assembly, Madrid, Spain, October 1987 and reaffirmed by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 states: "Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient's own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness."

The World Medical Association's View The WMA Statement on Physician-Assisted Suicide, adopted by the 44th World Medical Assembly, Marbe la, Spain, September 1992 and editorialy revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 likewise states: "Physicians-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline or withdraw medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient."

The World Medical Association's View The World Medical Association reaffirmed its strong belief that euthanasia is in conflict with basic ethical principles of medical practice, and The World Medical Association strongly encouraged all National Medical Associations and physicians to refrain from participating in euthanasia, even if national law allows it or decriminalizes it under certain conditions.  

HIPPOCRATIC OATH When doctors begin their career, they take the “Hippocratic Oath” and pledge to do all they can to preserve life and not do anything that will intentionally harm or result in the death of a patient. i.e. beneficence and non-maleficence

RECENT CASE Recently the High Court in Pretoria had granted an application, by Adv Stransham-Ford, to be assisted by a willing qualified medical practitioner to end his life either by the administration of a lethal agent or by providing him with the necessary agent to administer himself. The High Court ordered that a medical practitioner who acceded to applicant’s request to be assisted in ending his life would not be acting unlawfully and therefore would not be subjected to criminal prosecution or disciplinary proceedings by the Health Professions Council of South Africa.

RECENT CASE The court made it clear that this is not a free for all. Anyone who seeks the assistance of the medical practitioner to commit suicide may approach the Court on application for permission. Each application will be considered on the basis of its different circumstances. Each application will be considered on its own merits. The court declared that the common law crimes of murder or culpable homicide in the context of assisted suicide by medical practitioners, insofar as they provide an absolute prohibition, unjustifiably limited the applicant’s constitutional rights to human dignity and his freedom to bodily and psychological integrity; to that extent it was declared to be overboard and in conflict with the provisions of the Bill of Rights.

HPCSA’S ETHICAL VIEW Both the State, representing the Minister of Justice and Constitutional Development, the Minister of Health and the Director of Public Prosecutions, as well as the HPCSA, decided to appeal the decisions and lodge notices of application for leave to appeal the decision. As the HPCSA we say…. “Something may be lawful, but at the same time unethical” This is the distinction between Ethics and Law.

HPCSA’S ETHICAL VIEW Council finds active euthanasia, or the willful act by a health care professional to cause the death of a patient unacceptable, notwithstanding whether or not such an act is performed at the request of the patient or his or her closest relatives or of any other person. The health care professional may alleviate the suffering of a terminally-ill patient by withholding treatment, i.e. allowing the natural process of death to follow its course, provided there is consultation with another health care practitioner who is an expert in the field, and where available, discussions with the closest relatives.

HPCSA’S ETHICAL VIEW The withholding of treatment does not exempt the health care professional from the duty to assist the dying person by providing him or her with the necessary medication in order to alleviate the terminal phase of illness. The health care professional shall refrain from employing unusual methods of treatment which are of no benefit to the patient.

ALTERNATIVE OPTION - PALLIATIVE CARE Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and careful assessment and treatment of pain and other problems – physical, psychosocial and spiritual (Prof Cameron). The challenge to us all today is how we are going to respond to ensure that every dying patient receives the kind of care that helped Mr Robin Stransham-Ford to die at home, pain free, at peace and with dignity? (Prof Cameron)

WAY FORWARD The HPCSA plans on convening a special Symposium to address the issue of doctor-assisted death to which experts and members of the constituent Boards will be invited so that this matter is fully resolved…for now. The following areas will be considered:- why it is important to the medical profession that the prohibition on intentional killing remains; medical evidence on the reality of assisted suicide, and, in particular, whether it is as peaceful and painless as proponents of assisted dying say it is; the link between treatable depression and requests for assisted dying in terminally ill patients; and the problem of suicide in South Africa and the effect of the legalisation of assisted suicide on the problem of suicide in general

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