Active euthanasia--potential abuse in South Africa.
Article Type: Letter to the editor
Subject: Terminal care (Analysis)
Euthanasia (Analysis)
Physicians (Practice)
Author: Larsen, J.V.
Pub Date: 04/01/2011
Publication: Name: South African Medical Journal Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 South African Medical Association ISSN: 0256-9574
Issue: Date: April, 2011 Source Volume: 101 Source Issue: 4
Topic: Event Code: 200 Management dynamics
Product: Product Code: 8011000 Physicians & Surgeons NAICS Code: 621111 Offices of Physicians (except Mental Health Specialists)
Geographic: Geographic Scope: South Africa Geographic Code: 6SOUT South Africa
Accession Number: 262037434
Full Text: To the Editor: The recent case in the media to motivate active euthanasia is tragic. A doctor dying of cancer in New Zealand, tried to starve herself to death, which suggests that she was deeply depressed, because suicidal ideation 'appears exclusively linked to mental disorder'. (1) Her son, from outside the country, was her lone caregiver and refrained from looking for help in terms of the wording of her 'living will'. He became drawn into her desperation, was not medically trained, and did not consider her to be depressed. At her request, he eventually gave her an overdose of crushed morphine pills that she had hoarded for the purpose. He was arraigned on a charge of murder.

This is a sad story of terminal care gone wrong, and a rebuke to her medical caregivers. Depression identified and properly treated leads to the withdrawal of a request for suicide in over 95% of cases. This case should surely not gain sympathy for an idea that medical practitioners have rejected since Hippocrates.

But surely such abuse can only happen with a government such as Germany had under the Nazis? Eugenics started as a 'good idea' before the Nazis took control. The regulations were initially tighter than those in our own Law Commission's draft regulations on voluntary euthanasia of 2000.

Consider the experience of Holland. In 1973, a physician gave her mother a lethal injection, which became the focus of a national campaign to legalise assisted suicide. In 1981, criteria for voluntary euthanasia for people with terminal illnesses were promulgated, with detailed regulations to prevent abuse. In 1982, voluntary euthanasia was made available for people with chronic illnesses. By 1985, non-voluntary euthanasia was taking place; (2-4) physicians were killing people without their consent on their own initiative or on the request of relatives. In 1989, infanticide for serious birth abnormalities became permitted. Since 1994, euthanasia for mental suffering has been allowed, and by 1997 doctors faced no penalties for not obeying the rules. (2-4) In 2001, euthanasia was bound into law, permitting 16-year-olds to decide on assisted suicide without parental consent. Holland has since lagged seriously behind other European nations in delivering terminal care, and has made infanticide legal.

South Africa is in many ways similar to the unstable Germany of the 1920s. We also have a massive unemployment rate, and have emerged from a warlike state and the severe political violence so spawned. Political assassinations are common in some provinces. We are also experiencing severe cultural stress: 80% of our population is in the process of transition to Western modernism. Our police and justice systems are overwhelmed by high levels of corruption and violence, and cannot even properly pursue the laws governing TOP. Our potential slide down the slippery slope of the abuse of euthanasia legislation would almost certainly be faster than Holland's. And we cannot be assured that our legalising of euthanasia would not be used as a tool for political oppression, which could too easily drift into forms of genocide.

As a profession, we must oppose every attempt to introduce active euthanasia in any form in our nation.

(1.) Brown JH, Hentleff P, Barakat S, Rowe CJ. Is it normal for terminally ill patients to desire death? Am J Psychiatry 1986; 143(2):208-211.

(2.) Van der Maas PJ, van Delden JJM, Pijenborg L. Euthanasia and Other Medical Decisions Concerning the End of Life: An Investigation Performed upon Request of the Commission of Inquiry into the Medical Practice Concerning Euthanasia. Amsterdam: Elsevier Science Publishers, 1992:178-182.

(3.) Van der Maas PJ, van der Wal G, Haverkate I, et al Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. N Engl J Med 1996;335:1699-1705.

(4.) Van der Wal G, van der Maas PJ, Bosma JM, et al. Evaluation of the notification procedure for physician-assisted death in the Netherlands. N Engl J Med 1996;335:1706-1711.

J V Larsen

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