RESPONSE TO SUPREME COURT OF APPEAL JUDGEMENT BY HPCA

The Hospice Palliative Care Association of South Africa welcomes the judgement of the Supreme Court of Appeal released on 6th December, 2016 which sets aside the court ruling of Judge Fabricius allowing Adv. Strantham-Ford physician-administered euthanasia or physician-assisted suicide. The ruling was set aside because of three reasons:

  1. Stranstham-Ford had already died.
  2. There was no full and proper examination of the present state of the law in this difficult area.
  3. The order was made on an incorrect and restricted factual basis.

The judgement states that this was not an appropriate case to develop the common law of murder and culpable homicide.

The right to live and die in dignity is one of the basic principles of palliative care. Palliative care can control pain and suffering and enable people to live well in comfort and dignity until the moment of their natural death.

The Supreme Court of Appeal judgement identifies that the law injects itself into the debate of how we should approach death because of the enormous strides modern medicine has made in its ability to prolong life and to postpone death. Palliative care practitioners have been considering this issue for some time and affirm that euthanasia (and doctor-assisted suicide) is not a palliative care practice and that palliative care “neither hastens nor postpones death.” This means no to euthanasia but yes to the choice of not prolonging dying through medical interventions that no longer help the person undergoing these interventions.

The Judgement quotes the summary of Adv. Stranstham-Ford’s care provided by the Health Professions Council of South Africa: “His symptoms were managed effectively enough for him to be able to die in a homely atmosphere surrounded by family and friends who cared for him. The impact of palliative care surpassed his expectations and defied his own predictions of a frightening, impersonal and undignified death.” It was also reported that he had spoken to his ex-wife and to his doctor asking whether, if the court order was granted, did he need to go through with it or could he change his mind.

The Hospice Palliative Care Association is dedicated to ensuring greater access to palliative care. It is unacceptable that less than 20% of people who need palliative care in South Africa have access to this care. We are encouraged to note that the Minister of Health established a National Steering Committee on Palliative Care to develop a policy framework and strategy for palliative care in South Africa to ensure greater access to this care. In addition, health care funders are ensuring access to palliative care benefits to their clients.

It is of great concern that traditional and social media is full of stories of poor end-of-life care and family members describing dreadful suffering as their loved ones died. This is totally unacceptable; but we do not believe the answer is euthanasia. We believe each person is of value and should be provided with compassionate care that changes their experience of serious illness. Pain and other distressing symptoms can be controlled; people can live as actively as their illness allows until the end of their natural life. Unfortunately, not all doctors and nurse are trained in palliative care and pain management. The 2014 World Health Assembly resolution on palliative care recommends that all health care workers are trained in palliative care and the HPCA has developed training to meet this need including training for staff in care homes, on-line learning for doctors, nurses and other health care professionals.

HPCA also recommends that people document their preferences for care in the event of a serious illness and complete an advance health care plan. An advance care plan gives people some control over the way they live until the moment of their natural death and the Hospice Palliative Care Association of South Africa have developed a document to guide people in documenting their wishes for care when they are seriously ill. This advanced health care planning document can be downloaded from the website www.hpca.co.za.

We should be putting all our efforts into ensuring that palliative care is available for all who need this care rather than supporting development of a law that will put the lives of vulnerable people at risk. We need to develop or maintain respect for others, not only in illness but in everyday life; in this way we learn to value people who are different from ourselves including those who are elderly, disabled or ill and we do not judge their lives as no longer being of any worth, resulting in a belief that death is a compassionate option.

Doctors and nurses know that death is not a good treatment for any illness; in palliative care we know we can relieve suffering whether physical, emotional or spiritual. Please support efforts to make this care available to all who need it.

For interviews contact Dr Liz Gwyther on 021 531 0277.