SA med students becoming more open to legalising euthanasia

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More than half of medical students at Stellenbosch University feel the practices of euthanasia and physician-assisted suicide (PAS) should be legalised in South Africa, and if a patient had a terminal disease with intractable suffering, 41.9% of participants would terminate the patient’s life upon request.

A Cape Times report says this emerged in a study conducted by researchers at the Stellenbosch University Centre for Medical Ethics and Law, faculty of medicine and health sciences. They aimed to determine the views of future doctors regarding euthanasia and PAS, and to ascertain their stance on their legalisation.

The report says South African law regards both euthanasia and PAS as unlawful, and the person giving the assistance could be convicted of murder. The study analysed the responses of third- to fifth-year medical students.

About 277 students participated with 146 (52.7%) saying they felt that the practices of euthanasia/PAS should be legalised.

“Euthanasia/physician-assisted suicide have been a controversial topic for a long time. A recent judicial case has seen the topic debated again. Consensus on accepting or abolishing these practices here has yet to be reached. All relevant role players need to be adequately engaged before policy can be informed,” the researchers said.

The report says responses in this study varied depending on patient morbidities. While 36.1% of participants stated that they would have no part in ending a patient’s life, 35% said that they would be comfortable with providing the patient with the correct means to end their life (PAS).

The majority (80.1%) of participants indicated that they would prefer a dedicated ethics committee to decide. Many factors influenced participants’ responses, but differences in opinion between and within the various religious groups were evident. Most respondents in all the groups (52.3% of Christians, 73.9% of Islamic students, 57.1% of Hindus, 87% of agnostics and 100% of those who did not list a religious affiliation) agreed that euthanasia/PAS should be legalised in South Africa. “Participants of Islamic religious affiliation were largely opposed to assisting patients in hastening their death in any of the given scenarios,” the researchers said.

In a 2011 study, 34% of local doctors surveyed had already had patients request life-ending interventions, but it was noted that fear of prosecution contributed to doctors’ reluctance to perform these procedures.

The report says various cases have been brought before the judicial system in recent years. Two cases dealt with acts of euthanasia in which the motive for killing was to end useless existence and (intractable) suffering, respectively. In both cases it was found that the accused acted unlawfully. Judgment passed in these cases found the accused guilty of murder. However, light sentences were imposed. Most recently, South African courts had to consider a request for PAS from advocate Robin Stransham-Ford.

In 2015, an application was brought to the North Gauteng High Court for assistance in dying with the subsequent exoneration of the physician. The application was granted, but the applicant died just hours before the ruling was passed. The report says the Supreme Court overturned the High Court’s decision on appeal but acknowledged euthanasia as “a doctrine which may be in the womb of time, but whose birth is distant”.

The majority of the Stellenbosch participants (57%) believed that the patient should have the final decision in choosing to end their life, but only 47.7% believed that doctors should be allowed to help these patients fulfil their requests.

More than 63% would still attempt to persuade a patient to choose a palliative treatment method instead of a life-ending intervention.

Abstract
Background: Euthanasia/physician-assisted suicide have been a controversial and sometimes taboo topic for a long time, not only in South Africa (SA) but also internationally. A recent (SA) judicial case has seen the topic debated again. Consensus on accepting or abolishing these practices in SA has yet to be reached. All relevant role players need to be adequately engaged before policy can be informed.
Objectives: To determine the views of future doctors (medical students) regarding euthanasia and physician-assisted suicide (PAS) and to ascertain their stance on its legalisation in South Africa (SA).
Methods: A paper-based, semi-quantitative descriptive study design consisting of 16 questions, using convenience sampling of third- to fifth-year medical students at Stellenbosch University, was used.
Results: The overall response rate was 69.3% (N=277). In total, 52.7% of participants (n=146) felt that the practices of euthanasia/PAS should be legalised in SA. Responses varied depending on patient morbidities. If a patient had terminal disease with intractable suffering, 41.9% of participants would terminate the patient’s life upon request. A further 36.1% of participants stated that they would have no part in ending a patient’s life, while 35.0% said that they would be comfortable with providing the patient with the correct means to end their life (PAS). The majority (80.1%) of participants indicated that they would prefer a dedicated ethics committee to decide who receives euthanasia/PAS. Many factors influenced participants’ responses, but differences in opinion between and within the various religious groups were particularly evident in the responses received.
Conclusions: More than half the respondents in this study were open to legalising euthanasia/PAS, substantially more than in previous studies. However, only 41.9% of respondents would consider actually performing euthanasia/PAS, for certain patients. Views of other healthcare workers as well as the public are required before policy can be informed.

Authors
R K Jacobs, M Hendricks

Cape Times report (subscription needed)
SA Medical Journal abstract


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