End of Life DecisionsWMA – SEYCHELLES BASIC CONCEPTS IN ETHICS SEMINAR, 10TH & 11TH JULY 2015 (July 2015)

Professor A Dhai Immediate Past-President SAMA

Director: Steve Biko Centre for BioethicsHoD Bioethics Discipline

Faculty of Health Sciences University of the Witwatersrand, Johannesburg

South African Unit of the UNESCO International Network in Bioethics

• Ethical aspects of end of life decisions• Relationship between euthanasia and murder• Legal position on end of life decisions• Living Wills

Presentation Plan

• Scientific Advances : double-edged sword

• Life has natural end

• Point at which to change trajectory to palliative care

• Consultation with family – does not mean family consent

• HPCSA – wilful act causing death of patient – unethical & unacceptable, even where

requested by patient or proxy – duty to alleviate pain & suffering – hence withhold / withdraw life sustaining

treatments

• Doctrine of Double Effect

Ethical Aspects of End of Life Decisions

“ I will use my power to help the sick to the best of my ability and judgement. I will abstain from harming or wrongdoing any man by it. I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing”

Hippocratic Oath

• Unethical

• Does not prevent physician from respecting desire of patient to allow natural process of death to follow course in terminal phase of sickness

WMA Declaration on Euthanasia

• Palliative care – part of good medical care

• Palliative sedation to be used at end stages when symptoms refractory to standard management

WMA Declaration on End-of-Life Medical Care

• Euthanasia and physician-assisted suicide condemned as unethical

• Dying phase to be respected as important part of person’s life

• Ethical imperative to improve palliative treatment

• Physicians to respect right of patients to develop advance directive

WMA Declaration on Terminal Illness

“… any medical intervention where the healthcare professional’s primary intention is to end the patient’s life is both contrary to the ethics of health care and is unlawful.”

HPCSA – Booklet 12

• Euthanasia: Practitioners actively participate in causing death of patient

• Murder: unlawful & intentional killing of another person

• Clarke v Hurst NO 1992

• S v Hartmann 1975

Euthanasia & Murder

• Proponents of euthanasia

• Proponents palliative care

Dignity

• Advance directive stating if at any time a person suffers from incurable disease or injury which cannot be successfully treated, life sustaining treatment should be withheld / withdrawn and patient left to die naturally.

• Takes form of written document drawn up by person of sound mind and signed in presence of two witnesses who also sign the LW

Living Wills

• Furthers ethical principle of autonomy

• Reluctance on part of some practitioners to recognise validity of living will

• HPCSA : recognition of LW – patients to be given opportunity and encouraged to indicate wishes regarding further treatment and to place in writing directives for future care. “An appropriately drafted living will may be used for this purpose.”

• Patients’ Rights Charter: should inform practitioner on wishes regarding death

• WMA Declaration of Venice on Terminal Illness: doctors to recognise rights of patients to develop written advance directives

Ethical Aspects of Living Wills

• Source Document

Thank you