Natural death, doctor-assisted dying or euthanasia?

The Buddha taught that death is part of life, the key that unlocks life's mystery. By understanding death, we begin to understand life, he said. Once we understand the purpose of death, we begin to understand the purpose of life.

And since death, like taxes, is one of life's certainties, it makes sense to come to terms with it.

I must confess I haven't made much headway along that road. But occasionally in my line of work, I have the privilege of meetings with remarkable men who take me down interesting philosophical paths.

The most recent is South African-born human rights lawyer Joel Joffe, a member of former president Nelson Mandela's defence team during the Rivonia treason trial in 1963, and now a British Lord. I interviewed him at his manor home in England recently, and published the interview in Health News last month.

If you're wondering what his life journey has to do with my preoccupation with death, well, it has a lot. Lord Joffe is best known for his life's work on voluntary euthanasia, or doctor-assisted dying as it is now known in the UK, and the bill he has drafted to make it legal.

Euthanasia means different things to different people, but in short: voluntary euthanasia is when a doctor injects you, at your request, with a drug that ends your life; doctor-assisted dying is when a doctor gives you, at your request, a lethal drug to self-administer to end your life.

In both cases, you, the patient, must be mentally competent, terminally ill, and give informed consent - after considering all other options, such as palliative care or hospices, says Lord Joffe. The doctor must comply with an array of safeguards designed to prevent abuse.

Voluntary euthanasia is legal in Holland and Belgium (only for citizens). Doctor-assisted dying is legal in a few states in the US, and in Switzerland. Lord Joffe is confident it will be legal in the UK in the not too distant future.

I asked which he thought was easier - voluntary euthanasia or doctor-assisted dying. He felt it was easier to get someone else to kill you, than to kill yourself. On reflection, I agree.

Yet no matter whether it's voluntary euthanasia or doctor-assisted dying you're after, the driving force behind legalising it is simply dignity in death.

Against that backdrop, my eye fell on the headline of an article in a recent issue of the South African Medical Journal: Euthanasia - no dignity in death in the absence of an ethos of respect for human life, by the editor, Dr Daniel Ncayiyana.
He says the case for legalised active voluntary euthanasia is "compelling". He quotes the late Pretoria University law professor JMT "Lappies" Labuschagne, in the Journal of Contemporary Roman-Dutch Law in 1998: "(I)t is harder morally to justify letting somebody die a slow and ugly death dehumanised, than it is to justify helping to avoid it."

Dr Ncayiyana has a vital caveat: "It does not follow that (South Africa) is a safe and appropriate place for liberalised voluntary euthanasia legislation".

That can only be justified, he says, in a country with "the very best medical care for all, a well-organised and universally accessible palliative care and support system, stable and well-functioning (particularly judicial) institutions, and a strong culture of respect for human life".

He is damning on all fronts, given the "extraordinarily violent society" we live in, and the "pervasive lack of an ethos of respect for human life".

He is also scathing of medical staff who "think nothing of downing tools, and walking off, abandoning critically ill patients, or blocking ambulances with critical emergencies from entering health facilities during labour disputes".

He says there's a real danger that voluntary euthanasia might replace proper care for the elderly and terminally ill in this country. Thus euthanasia cannot top "the wish-list of things that need to be accomplished to improve the human condition of South Africans".

Lord Joffe agrees that in South Africa, voluntary euthanasia could be a "real danger to patients, in a dangerous society with poor health care". Not so with doctor-assisted dying.

With adequate safeguards included in any legislation to change the law, he says doctor-assisted dying would not be a substitute for proper care for the terminally ill in South Africa or the UK and abuse would be effectively prevented.

That's because the key in the case of assisted dying, Lord Joffe says, is that "both the decision and the implementation of the decision should be that of the patient, not that of the doctor, the patient's relatives or anyone else, including the state".

In my view, it would also help if doctors stopped trying to play God, and considered the view of a pro-euthanasia doctor that "neither the Hippocratic Oath nor classical tradition provides a compelling professional or ethical prohibition of physician-assisted suicide".

And we would all do well to consider the words of Mark Twain: "The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time."

Source: Business Day via I-Net Bridge.