PhysicianAssisted Suicide in South Africa and the Netherlands
Physicianassisted suicide in South Africa and the Netherlands
Theissue of legalization of the physician-aided suicide has beencontroversial for several decades. The issues have received supportas well as opposition in equal measures. A debate regarding thelegalizing of the physician-aided suicide is based on three key areasthat include the legal aspects, ethical or moral issues, andreligious beliefs (Landman, 2012, p. 17). This paper will compare theissue of legalization of physician-aided suicide in the Netherlandsand South Africa, ethical, and religious Although Netherlandslegalized physician aided suicide while South Africa is in theprocess of formulating a new bill to legalize the practice,legislators have been forced by the court rulings in the twocountries, since they had been held back by cultural as well asreligious beliefs.
Legalaspects of physician assisted suicide in South Africa and theNetherlands
Theissue of physician assisted suicide is still controversial in SouthAfrica, whereby traditional beliefs that a human being should be leftto die without any artificial intervention is held, not only by themembers of the public, but also by the majority of legislators. Thishas hampered the efforts to formulate and enact a law that will givethe South Africans the right to determine their fate and make theirend of life decisions. The first attempt to make such a law was madein 1998, when the South African Legislators made the first draftknown as “the End of Life Decision Act” (Landman, 2012, p. 5).The bill could not be passed in the parliament and the subsequentbills presented before the parliament in 2003 and 2015 have failed,which has denied the South African people autonomy over their end-oflife decisions. In other words, physician assisted suicide is stillillegal in South Africa, given that there is no law to support itspractice or shield physicians who help their patients to die.
However,a court order issued by the Supreme Court of South Africa in the year2015 provided a precedence that could be used to protect physicianswho aid their patients to die, even in the absence of legislations.RJ Stransham-Ford made an application to the Supreme Court required acourt’s interpretation of the bill of rights with regard to theright of a patient to get physician assisted suicide services(Pieters & Doodnath, 2015, p. 1). The order allowed the applicantto make a request for physician aided suicide, and held that suchphysicians could not be held criminally or civilly accountable. Ithas been argued that the judgment changed the South African law,which could reshape the debate on the physician aided suicide andother end-of life decisions.
TheNetherlands has been going through similar struggles like the SouthAfrican in the process of legalizing physician-aided suicide.Although many people believe that the “Termination of Life onRequest and Assisted Suicide Act” enacted in the year 2001permitted physicians to help their patients to die, it is evidentthat other legal instruments still consider physician assistedsuicide to be illegal and unacceptable in the Netherlands. Forexample, Article 293 and 294 of the Dutch Penal Code holds that anyform of assisted suicide and euthanasia is still illegal (PatientRights Council, 2013, p. 1). Similar to the case of South Africa,legislators were reluctant to pass a law that could protect physicianof criminal liability by helping the clients to die, by the courtruling made in 1984 re-shaped the debate on the issue ofphysician-aided suicide.
TheSupreme Court heard the case of Alkaamar and held that physicianassisted suicide could be performed in pursuit of the Article 40 ofthe Dutch Penal Code, which protect accused persons who areconsidered to have acted out of irresistible compulsion (Canady,2000, p. 308). The court ruling re-opened the debate that culminatedin the enactment of the “Termination of Life on Request andAssisted Suicide Act” in 2001, making the Netherlands the firstnation to legalize physician assisted suicide. The Supreme Courtopened the Pandora’s Box by creating a precedence that shieldedphysicians who aided their clients to die, but there was nolegislation to regulate the practice, which forced the legislators toformulate the act. South Africa is in the same situation where theSupreme Court has allowed physician aided suicide by citing the humanrights as stipulated in the constitution of South Africa, which willforce the legislators to enact a law to prevent the abuse of thecourt ruling, but this is yet to happen.
Ethicalaspects of physician assisted suicide
Theneed to observe the ethos of medicine is among the key issues thatmade it difficult for the stakeholders in South Africa andNetherlands to agree on the legalization of physician-aided suicidebefore the intervention of the Supreme Courts in the two countries.The objectives of the stakeholders in the medical field include thepromotion of health, healing, health care, prevention of suffering,and alleviation of pain (Raingruber, 2011, p. 2). Attempts to createlaws that allow physicians to help their clients to die contradictall the aforementioned objectives of medical practice, which is adeparture from the conventional ethos of medical practices. However,four principles of ethics support the formulation of law willregulate the practice of physician-aided suicide.
Theethical principle of autonomy holds that giving patients the freedomto make choices regarding their health as well as life in general isthe key feature of human identity. This implies that patients have aninherent right to die with dignity and it would be more unethical todeny this right through physician aided suicide (Adedayo, 2014, p.8). In this context, the issue of dying with dignity comes from thefact that patients who request for physician’s help to die areeither living in extreme pain or their living is only facilitated bythe life support machines. In most of these circumstances, physiciansare able to determine with certainty that the patient will not beable to recover from the current illness, which implies that thetreatment offered to such a patient is futile. Denying patients theright to make decisions to die and seek the help the physician in theprocess of dying leads to undignified death. Although the opponentsof the patients’ tight to physician aided suicide argue thatterminating the client’s life denies them the autonomy to enjoylife, it is evident that a patient who will not recover from acurrent illnesses would desire accelerated as opposed to prolongeddeath.
Theethical principle of justice holds that fairness is achieved whenresources, benefits, and burdens are shared in a way that appreciatedthe concept of equity. In other words, like cases should be treatedalike in order to ensure that justice has been administered to allpeople. Competent, people who are suffering from terminal illnessesare given the legal right to refuse therapy that is intended toprolong their death (Adedayo, 2014, p. 5). However, patients who aresuffering, but their living is not dependent on life support therapy,refusing treatment may not hasten their death, in spite of the factthat they are suffering unbearable pain. In such a case, it wouldonly be just to allow them to seek for physician assisted suicide inorder to ensure that the right to make the end of life decision isadministered equally to all suffering patients, including those underthe life support treatment and those who are suffering but not yetput under the life support machines.
Theethical principle of non-maleficence imposes the duty not to causeharm to other people intentionally. This principle was used by theopponent of the idea of allowing patients to request their physiciansto help them die in South Africa and Netherlands to make an argumentthat giving patients drugs that tend to hasten their death is anintentional harm (Adedayo, 2014, p. 5). By subscribing the argumentsof these opponents, the lawmakers delayed the enactment of a law thatcould help people die with dignity. However, the principle ofnon-maleficence should be interpreted in the correct way toillustrate that it is more harmful to let a patient writhe in painwhile it is certain that the patient will not recover from theillness than to allow the physician to help such a patient to die(Adedayo, 2014, p. 4). Therefore, the correct interpretation of theethical principle of non-maleficence supports the administration ofphysician-aided suicide services.
Underthe ethical principle of beneficence, it is generally agreed upon byboth the opponents and supporters of the idea of physician-aidedsuicide that the health care professionals should focus on enhancingthe quality as well as the well-being of their clients. However,opposition arise when the issue of which of the two between helpingthe patient to die or giving them the pain killers as well as othermedications that can prolong their death is the acceptable approachfor enhancing the wellbeing and the quality of patients’ health(Adedayo, 2014, p. 4). The quality of life for patients with terminalillnesses reduces with time and treatment becomes futile since theyhave no chances of recovering. The principle of beneficence supportsthe physician-aided suicide for patients whose treatment has beendetermined to be futile.
Religiousaspects of physician-aided suicide
Religiousgroups are part of the stakeholders who have made s significantcontribution to the debate on the issue of legalization ofphysician-aided suicide. The Netherlands and South Africa have thelargest proportions of Christians compared to other religious groups.Christians in South Africa, especially the Catholics, have made anactive participation in debate by opposing the legalization ofphysician assisted suicide (Ncayiyana, 2014, p. 1). These Christiangroups argued that facilitating human death under any circumstance isan indication of the lack of respect for human life. However,religious groups in South Africa have recently been divided with onegroup arguing that allowing physicians to administer poison toterminally ill patients is different from letting them die naturally,which implies these Christians believe that physician-aided is aneffort to legalize murder (Bogaert, 2011, p. 68). Similarly,Christians, Jews, Muslims, and Buddhists in Netherlands have remainedopposed to the legalization of the physician-aided death to-date. Forexample, the Catholic group in Netherlands argued that human life hasa value and meaning until its very end, and this value is independentof one’s mental or physical condition (Torr, 2004, p. 103).Therefore, the majority of the religious groups oppose thelegalization of physician-aided suicide by support the notion thevalue of human life ought to be respected.
However,a few religious individuals and groups in both South African and theNetherlands presented contradicting arguments that supported thelegalization of physician-aided suicide. For an instant, DesmondTutu, A South African Archbishop, stated he would not like his lifeto be prolonged artificially, but rather he would prefer a physicianto help him die in case of a terminal illnesses (Lipscombe &Barber, 2014, p. 19). Tutu presented a new dimension to an ongoingdebate by indicating that the value of life ought to be respected,but not at all costs, including the artificial prolonging of death.Similarly, a group if the religious group in Netherlands argued thatphysician-aided suicide die not contradict religious belief in thevalue of life since such services are offered to patients whose deathhas been predicted with certainty (Bogaert, 2011, p. 40). Therefore,the majority of members of religious groups oppose legalization ofphysician-aided suicide, while a few of them support it. This impliesthat the judgment on the quality as well as the value of life is asubjective matter.
Boththe Netherlands and South Africa have been put under pressure tolegalize the physician-aided suicide by decisions made by the SupremeCourts indicating the decision to seek for physician’s help to diein the case of a terminal illness in a fundamental right ofindividual patients. The Netherlands has managed to legalize thepractice of physician-aided suicide, but the South Africa is yet tolegalize the practice. However, it is evident that no one will beable to sue the physician for aiding their clients to die since theSupreme Court of South Africa have already set a precedence in theprotects physicians from criminal liability. Moreover, all ethicalprinciples (including the principle of justice, beneficence,autonomy, and non-maleficence) support the practice ofphysician-aided suicide. Although the majority of religious groupsoppose the physician-aided practice, a few of religious leader andgroups support it by arguing that the value of life ought to beprotected, but not through artificial means, such as the life supporttherapy.
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