1. End of Life Decisions WMA – SEYCHELLES BASIC CONCEPTS IN ETHICS SEMINAR, 10 TH & 11 TH JULY 2015 (July 2015) Professor A Dhai Immediate Past-President SAMA Director: Steve Biko Centre for Bioethics HoD Bioethics Discipline Faculty of Health Sciences University of the Witwatersrand, Johannesburg South African Unit of the UNESCO International Network in Bioethics

2. Ethical aspects of end of life decisions Relationship between euthanasia and murder Legal position on end of life decisions Living Wills Presentation Plan

3. 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

4. “ 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

5. 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

6. 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

7. 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

8. “… 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

9. 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

10. Proponents of euthanasia Proponents palliative care Dignity

11. 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

12. 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

13. Source Document

14. Thank you