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South African courts will soon face the critical question of whether individuals have the right to choose how they die.
Non-profit organisation Dignity South Africa is in the final stages of preparing a High Court application to decriminalise and legalise assisted dying.
Assisted suicide remains illegal in South Africa, despite the concept raising critical questions about balancing the right to life, dignity and patient autonomy under the Constitution.
While patients can refuse life-prolonging treatment, no legal framework addresses euthanasia without criminal consequences.
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Associate professor of neuroscience at the University of Cape Town and an executive member of Dignity South Africa, Joseph Raimondo said that dying is one of the most important parts of living.
“We all want to die well, for ourselves and our loved ones.
“Although we might differ on what we think it means to die with dignity, we can all agree that somehow the manner of the deaths we wish for says something about our identities, how we see ourselves as individuals and how we see ourselves as a society.
“I don’t believe South Africans talk nearly enough about death and dying, and what it means to die with dignity,” he said.
“Death coach” Sean O’Connor helps individuals through the process of coming to terms with their mortality.
This includes helping people permit themselves to die, especially when they feel a burden to stay alive for others, despite suffering.
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He agreed with Raimondo and said that often clients, particularly those in palliative care already, just want to die.
“Some just ask for a pill to end it all,” O’Connor said.
Raimondo said that promoting dignity in dying includes ensuring access to much-needed palliative care for the terminally ill.
Euthanasia or assisted suicide in various forms is already legal in several European countries, some American states, Canada, Switzerland and Colombia.
A bill to legalise assisted dying for terminally ill adults is being debated in the House of Commons in the UK that could potentially result in England and Wales joining around 27 other jurisdictions where some form of assisted dying has been legalised or decriminalised.
The Catholic Church has defended human life from conception to natural death, rejecting euthanasia and excessive medical intervention as affirmations of human dignity and the right to care, even in incurable conditions.
Psychologist and medical practitioner Dr Jonathan Redelinghuys said that the possibility of a peaceful and dignified death for those with terminal conditions marked by declining function and worsening pain, may be one of the few comforts that a person in that position could hope for.
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O’Connor said in his experience many people, especially the elderly, wish for autonomy in ending their lives.
Dr Redelinghuys cautioned that assisted death also raises several ethical and moral concerns that must be considered when allowing its legalisation.
He argued that the concept of terminal illness poses an ethical dilemma.
“Definitions vary, from illnesses with no chance of improvement to those causing gradual decline and eventual death. But where is the line drawn,” Redelinghuys said.
“Is it days, months, or years before death? Conditions like ALS (amyotrophic lateral sclerosis) highlight the complexity.”
“If someone like Stephen Hawking had opted for assisted death at diagnosis, it would have preceded his significant contributions to science. When, if ever, should the law deem euthanasia appropriate in such cases?”
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However, according to Raimondo, as has been shown in multiple jurisdictions, it is possible to have sufficient safeguards to protect the vulnerable, while ensuring that those who need it have access to assisted dying, particularly those in palliative care.
“Despite access to the best quality care, a small number of people with terminal or irremediable illnesses will experience intolerable suffering and are not afforded the compassionate option of a medically assisted death in the manner and time of their choosing,” he said.
Raimondo said only 14% of South Africans currently have access to palliative care, which he said is essential for ensuring comfort and dignity in dying.
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He emphasised that legalising assisted dying not only supports autonomy but also positively impacts palliative care access.
Redelinghuys questioned the criteria for assisted dying, asking whether it should be limited to physical pain or include severe, untreatable depression.
He noted being depressed about one’s diagnosis or condition could lead to seeking assisted suicide and asked whether or not euthanasia in that case is ethical.
Raimondo hopes that Dignity South Africa’s case will spark greater public dialogue around the often avoided topics of death and dying.
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