Dying with dignity – advance directives
To the Editor: We may be grateful to Dr Larsen for drawing our attention to the recent launch of Dignity SA.1 Dignity SA aims to support the provision of palliative care plus an option of legalised assisted dying; their website is http://dignitysa.com/. In this aim, they reflect the UK organisation: Dignity in Dying, with its years of experience and their ‘Campaign for choice, for compassion, for change’. Their website, www.dignityindying.org.uk, and that of their companion organization, www.compassionindying.org.uk, are well worth visiting.2
Strongly faith-based discourses make debate difficult. Indeed, the 1998 South African Law Commission, in its report to the Minister of Justice, argued that it was inappropriate for the legislature to seek to balance religious views in a pluralist society.
There need not be polarisation between voluntary euthanasia and high-quality palliative care. Jan Bernheim and colleagues3 published a valuable article entitled ‘Development of palliative care and legislation of euthanasia: antagonism or synergy?’ which described ‘how in Belgium the two camps grew up side by side to mutual benefit’. Clare Dyer4 has just reported in the British Medical Journal (BMJ) that the European Association of Palliative Care, comparing six European countries, reports that the legalisation of assisted dying does not undermine the provision of good palliative care.
The way forward depends on acknowledging the right to choice. This is expressed in a letter in the BMJ under the heading ‘Assisted dying debate’ and titled ‘Time to be neutral?’ by Peter Bruggen:5 ‘I can see no reason for those who want themselves and others to wait for nature’s time to seek to forbid those who want to die when they choose. It’s a permissive bill we are after. Other people would be able to continue their lives as long as they want to. Some may think it morally wrong to take your own life; but if that is the case, I expect they can respect the ‘‘right’’ of others to be morally wrong.’
Of course ‘dying individuals are extremely vulnerable; their problem-solving skills are frequently impaired, and it is very difficult for an observer to assess them accurately’.1 That is why advance directives, made while a person is of sound mind, and predicated upon a prior sharing with close family and general practitioner, carefully thought through and revised when necessary, make a valuable contribution to end-of-life care.6
Hillcrest
KwaZulu-Natal
inglerf@iafrica.com
1. Larsen JV. Death with integrity. S Afr Med J 2011;101:780,782.
2. South African Law Commission. Euthanasia and the artificial preservation of life. Report 86: Nov 1998. Obtainable from the Secretary of the Law Commission, Private Bag X668, Pretoria 0001.
3. Bernheim JL, Deschepper R, Mullie A, Bilsen J, Deliens L. Development of palliative care and legislation of euthanasia: antagonism or synergy? BMJ 2008;336:864-867.
4. Dyer C. Legalising assisted dying ‘does not harm palliative care’. BMJ 2011;343:871.
5. Bruggen P. Time to be neutral? BMJ 2011;342:458.
6. Ingle RF. Advanced directives are valuable. South African Family Practice 2009;51(6):517.