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1.1 The South African Voluntary Euthanasia Society (SAVES), which has since changed its name to SAVES The Living Will Society, suggested in a letter to the Commission, dated 14 October 1991, that the Commission should consider legislation regarding a document known as a "Living Will". This proposal was subsequently substantiated in a memorandum dated 27 December 1991, which contained more detailed information about the Society and its objectives as well as references to applicable overseas legislation, articles and newspaper reports.
1.2 On 27 January 1992, at a meeting of the Working Committee, the Commission approved the proposal submitted by SAVES as a research project. However, it was decided that issues relating to the termination of life should, for the sake of completeness, also be investigated under the heading "Euthanasia and the artificial preservation of life".
1.3 In the initial stages of the investigation the Commission concerned itself only with instances of cessation of treatment as well as with the question regarding the legality of the Living Will. As a result of the developments in regard to active euthanasia in other countries, most notably in the Netherlands, Northern Australia and certain states of the USA as well as enquiries by respondents in this regard, the Commission however decided to address the question relating to end of life decisions in its entirety. The investigation was therefore broadened to include the question of active euthanasia.
1.4 From the start it was clear that the subject under discussion readily lends itself to theorisation and moralising. However, the Commission’s research has indicated that it is especially in this field that a sober and practical approach will be most fruitful.[2]
1.5 Research also showed that the subject under discussion lends itself to confusion with regard to the terminology used. An analysis of the situation brought the Commission to the conclusion that there are basically three categories within which the preservation of life and questions relating to actions that hasten death should be discussed, namely:
(a) the artificial preservation of life after clinical death has set in;
(b) the preservation of life where the patient is competent to make decisions; and
(c) the preservation of life where the patient is incompetent to make decisions.
Terminology and definitions used, are discussed below.[3]
1.6 The advances made in medical science and in the application of medical technology have resulted in patients living longer. For many patients this signifies a welcome prolongation of meaningful life, but for others the result is a poor quality of life which inevitably raises the question whether treatment is a benefit or a burden.
1.7 Having created a situation in which lives are routinely saved, transformed or prolonged by medical intervention, we can hardly pretend that the process of dying, and that alone, must be ‘left to nature’.[4] Simplistic aphorisms, which might have had more general truth fifty years ago such as "while there is life there’s hope" or "killing is killing" are inadequate to address the present state of medical expertise which is capable of keeping ‘alive’ irreparably sick or damaged patients who in the recent past would not have survived at all.[5]
1.8 Worldwide, increased importance is furthermore being attached to patient autonomy. The need has therefore arisen to consider the protection of a patient's right to refuse medical treatment and to receive assistance, should he or she so require, in ending his or her life. This is also important in cases where the patient has strong views regarding his or her treatment and is concerned that he or she may in future be incapable of communicating his or her wishes to the doctor. In this regard the so-called living will may be relevant.
1.9 Since matters concerning the treatment of terminally ill people are at present being dealt with on a fairly ad hoc basis, there is some degree of uncertainty in the minds of the general public and medical personnel about the legal position of terminally ill and dying people. Doctors and families want to act in the best interests of patients, but are unsure about the scope and content of the obligation to care. It was felt that this uncertainty may lead to unnecessary tension and conflict within the treatment team; between the team and the next of kin of a patient; and amongst family members themselves. Such conflict and tension when people need to make difficult emotional and moral decisions are not to the advantage of anyone, least of all the patient.[6]
1.10 Doctors are furthermore afraid of being exposed to civil claims, criminal prosecution and professional censure should they withhold life support systems or prescribe drugs which may inadvertently or otherwise shorten the patient’s life even if they are merely complying with the wishes of the patient. Consequently patients are suffering and the court has to be approached at great cost to decide the question of whether a patient should be allowed to die.
1.11 In accordance with the Commission's policy to consult as widely as possible, every effort was made throughout the investigation to publicise the investigation and to elicit response from interested persons and organisations as well as from members of the public.
1.12 In 1994 the Commission published a Working Paper entitled "Euthanasia and the artificial preservation of life".[7] Working Paper 53 contained an exposition of the present state of our law regarding the circumstances in which actions that could indirectly end a person's life may be justified; the role that the wishes of the patient should play in this regard and what conduct would be acceptable in cases where no instructions or requests have been received from the patient. The paper included an investigation of similar systems in other jurisdictions and preliminary proposals on ways in which the abovementioned problems could be dealt with in this country. The draft bill contained in the paper elicited a live and varied response. Written comment was furthermore received from 60 persons and institutions.[8]
1.13 On 22 June 1994 the Commission held a workshop which was attended by 80 persons, including experts in the fields of medicine, law, religion and ethics. This was followed up by a second smaller workshop held on 18 October 1996.
1.14 During the course of 1996 the magazines You and Huisgenoot invited their readers to contact the Project Leader in connection with their personal experiences and opinions regarding the cessation of life of family members or themselves. Close to a hundred letters were received by the Project Leader.
1.15 In the light of the great interest displayed by the public in this investigation and the evident need for more comprehensive discussion of the whole problem of euthanasia and the artificial preservation of life the Commission published a second Discussion Paper for general information and comment. [9] Since the question of euthanasia had at that stage never been put before the South African public in its entirety, this working paper set out to state all issues regarding end of life decisions objectively and neutrally without proposing specific measures.
1.16 In addition to the issues discussed in the first working paper, the aim of this Discussion Paper was to investigate further whether and in what circumstances actions that could directly end a person's life may be justified. A distinction was made between cases where clinical death had set in, cases where the terminally-ill person had contractual capacity and cases where the terminally-ill person lacked contractual capacity. For the purposes of focussing attention on the various problem areas and to evoke discussion and debate, a draft bill was enclosed in the paper for comment. For purposes of easy reference the Bill, hereinafter referred to as the Discussion Paper Bill is set out hereunder:
BILL
To regulate end of life decisions and to provide for matters incidental thereto.
_________________________________________________________________________
To be introduced by the Minister of Justice
__________________________________________________________________________
BE IT ENACTED by the Parliament of the Republic of South Africa, as follows:
Definitions
1. (1) In this Act, unless the context otherwise indicates-
(i) ‘competent witness’ means a person of the age of 18 years or over who at the time he witnesses the directive or power of attorney is not incompetent to give evidence in a court of law and for whom the death of the maker of the directive or power of attorney holds no financial benefit;
(ii) ‘court’ means a provincial or local division of the High Court of South Africa within whose jurisdiction the matter falls;
(iii) ‘life-sustaining medical treatment’ includes the maintenance of artificial feeding;
(iv) ‘medical practitioner’ means a medical practitioner registered as such in terms of the Medical, Dental and Supplementary Health Service Professions Act, 1974 (Act 56 of 1974);
(v) ‘palliative care’ means treatment and care of a terminally ill patient, not with a view to cure the patient, but rather to relieve suffering and maintain personal hygiene;
(vi) ‘terminal illness’ means an illness, injury or other physical or mental condition which-
(a) will inevitably result in the death of the patient concerned within a relatively short time and which is causing the patient extreme suffering;or
(b) is causing the patient to be in a persistent and irreversible vegetative condition with the result that no meaningful existence is possible for the patient.
Conduct of a medical practitioner in the event of clinical death
2. (1) For the purposes of this Act, a person is considered to be dead when two medical practitioners agree and confirm in writing that a person is clinically dead according to the following criteria for determining death, namely -
(a) the irreversible absence of spontaneous respiratory and circulatory functions; or (b) the persistent clinical absence of brain-stem function.
(2) In the event of a person being considered to be dead according to the provisions of sub-section (1), the medical practitioner responsible for the treatment of such person may withdraw or order the withdrawal of all forms of treatment.
Mentally competent person may refuse treatment
3. (1) Every person above the age of 18 years and of sound mind is competent to refuse any life-sustaining medical treatment or the continuation of such treatment with regard to any specific illness from which he or she may be suffering.
(2) Should it be clear to the medical practitioner under whose treatment or care the person who is refusing treatment as contemplated in subsection (1) is, that such a person's refusal is based on the free and carefully considered exercising of his or her own will, he or she shall give effect to such a person's refusal even though it may cause the death or the hastening of death of such a person.
Conduct of medical practitioner in relieving distress
4. (1) Should it be clear to a medical practitioner responsible for the treatment of a patient that the patient is suffering from a terminal illness and that such a patient’s pain and distress cannot satisfactorily be alleviated by ordinary palliative treatment, he or she may, in accordance with responsible medical practice-
(a) with the object to provide relief of severe pain and distress; and
(b) with no intention to kill
increase the dosage of medication (whether analgesics or sedatives) to be given to the patient, even if the secondary effect of this action may be to shorten the life of the patient.
(2) No medical practitioner shall treat a patient as contemplated in subsection (1) unless the condition of the patient concerned has been confirmed by at least one other medical practitioner who is not directly involved in the treatment of the patient concerned, but who is competent to express a professional opinion on the patient’s condition in view of his or her expertise with regard to the illness with which he or she is affected and on account of his examination of the patient concerned.
(3) (a) A medical practitioner who treats a patient as contemplated in subsection (1) shall record in writing his findings regarding the condition of the patient and his conduct in treating the patient.
(b) A medical practitioner as contemplated in subsection (2) shall record in writing his findings regarding the condition of the patient concerned.
Cessation of life
5.(1) Should a medical practitioner be requested by a patient to make an end to the patient's suffering, or to enable the patient to make an end to his or her suffering by way of administering or providing some or other lethal agent, the medical practitioner shall not give effect to the request unless he or she is convinced that-
(a) the patient is suffering from a terminal illness;
(b) the patient is subject to extreme suffering;
(c) the patient is over the age of 18 years and mentally competent;
(d) the patient has been adequately informed as to the terminal illness from which he or she is suffering, the prognosis of his or her condition and of any treatment or care that may be available;
(e) the request of the patient is based on an informed and well considered decision;
(f) the patient has had the opportunity to re-evaluate his or her request, but that he or she has persisted; and
(g) euthanasia is the only way for the patient to be released from his or her suffering.
(2) No medical practitioner to whom the request to make an end to a patient's suffering is addressed as contemplated in subsection (1), shall give effect to such a request, even though he or she may be convinced of the facts as stated in that subsection, unless he or she has conferred with an independent medical practitioner who is knowledgable with regard to the terminal illness from which the patient is suffering and who has personally checked the patient's medical history and examined the patient and who has confirmed the facts as contemplated in subsection (1)(a), (b) and (g).
(3) A medical practitioner who gives effect to a request as contemplated in sub-section (1), shall record in writing his or her findings regarding the facts as contemplated in that subsection and the name and address of the medical practitioner with whom he or she has conferred as contemplated in subsection (2) and the last-mentioned medical practitioner shall record in writing his or her findings regarding the facts as contemplated in subsection (2).
(4) The termination of a patient's life on his or her request in order to release him or her from suffering may not be effected by any person other than a medical practitioner.
(5) A medical practitioner who gives effect to a patient's request to be released from suffering as contemplated in this section shall not suffer any civil, criminal or disciplinary accountability with regard to such an act provided that all due procedural measures have been complied with.
(6) No medical practitioner is obliged to give effect to a patient's request to assist with the termination of the patient's life.
Directives as to the treatment of a terminally ill person
6. (1) Every person above the age of 18 years who is of sound mind shall be competent to issue a written directive declaring that if he or she should ever suffer from a terminal illness and would as a result be unable to make or communicate decisions concerning his or her medical treatment or its cessation, any medical treatment which he or she may receive should be discontinued and that only palliative care should be administered.
(2) A person as contemplated in subsection (1) shall be competent to entrust any decision- making regarding the treatment as contemplated in that subsection or the cessation of such treatment to a competent agent by way of a written power of attorney, and such power of attorney shall take effect and remain in force if the principal becomes terminally ill and as a result is unable to make or communicate decisions concerning his or her medical treatment or the cessation thereof.
(3) A directive contemplated in subsection (1) and a power of attorney contemplated in subsection (2) and any amendment thereof, shall be signed by the person giving the directive or power of attorney in the presence of two competent witnesses who shall sign the document in the presence of the said person and in each other’s presence.
(4) When a person who is under guardianship, or in respect of whom a curator of the person has been appointed, becomes terminally ill and no instructions as contemplated in subsection (1) or (2) regarding his medical treatment or the cessation thereof have been issued, the decision-making regarding such treatment or the cessation thereof shall, barring any court order or the provisions of any other Act, vest in such guardian or curator.
Conduct in compliance with directives by or on behalf of terminally ill persons
7. (1) No medical practitioner shall give effect to a directive regarding the refusal or cessation of medical treatment or the administering of palliative care which may contribute to the hastening of a patient’s death, unless-
(a) the medical practitioner is satisfied that the patient concerned is suffering from a terminal illness and as a result is unable to make or communicate decisions concerning his or her medical treatment or the cessation thereof; and
(b) the condition of the patient concerned, as contemplated in paragraph (a), has been confirmed by at least one other medical practitioner who is not directly involved in the treatment of the patient concerned, but who is competent to express a professional opinion on the patient’s condition in view of his or her expertise with regard to the illness with which the patient is afflicted and his or her examination of the patient concerned.
(2) Before a medical practitioner gives effect to a directive as contemplated in subsection (1) he shall satisfy himself, in so far as this is reasonably possible, of the authenticity of the directive and of the competency of the person issuing the directive.
(3) Before giving effect to a directive as contemplated in subsection (1), a medical practitioner shall inform the interested relatives and family members of the patient of his findings, that of the other medical practitioner contemplated in paragraph (b) of subsection 1, and of the existence and content of the directive of the patient concerned.
(4) If a medical practitioner is uncertain as regard to the authenticity of the directive or its legality, he shall treat the patient concerned in accordance with the provisions set out in section 8 below.
(5) (a) A medical practitioner who gives effect to a directive as contemplated in subsection (1) shall record in writing his or her findings regarding the condition of the patient and his conduct giving effect to the directive.
(b) A medical practitioner as contemplated in paragraph (c) of subsection (1) shall record in writing his findings regarding the condition of the patient concerned.
(6) A directive concerning the refusal or cessation of medical treatment as contemplated in subsection (1) and (2) shall not be invalid and the withholding or cessation of medical treatment in accordance with such a directive, shall, in so far as it is performed in accordance with this Act, not be unlawful even though performance of the directive might bring about the hastening of the moment of death of the patient concerned.
Conduct of a medical practitioner in the absence of a directive
8. (1) If the chief medical practitioner of a hospital, clinic or similar institution where a patient is being cared for is of the opinion that the patient is in a state of terminal illness as contemplated in this Act and for this reason unable to make or communicate decisions concerning his or her medical treatment or its cessation, and his opinion is confirmed in writing by at least one other medical practitioner who has not treated the person concerned as a patient, but who has examined him and who is competent to submit a professional opinion regarding the patient’s condition on account of his expertise regarding the illness of the patient concerned, the first-mentioned medical practitioner may, in the absence of any directive as contemplated in section 6(1) and (2) or a court order as contemplated in section 9, grant written authorisation for the cessation of all further life-sustaining medical treatment and the administering of palliative care only.
(2) A medical practitioner as contemplated in section (1) shall not act as contemplated in subsection (1) if such conduct would be contrary to the wishes of the family members or close family of the patient, unless authorised thereto by a court order.
(3) A medical practitioner as contemplated in section (1) shall record in writing his findings regarding the patient’s condition and any steps taken by him in respect thereof.
(4) The cessation of medical treatment as contemplated in subsection (1) shall not be unlawful merely because it contributes to causing the patient’s death.
Powers of the court
Option 1:
9. (1) In the absence of a directive by or on behalf of a terminally ill person as contemplated in section 6, a court may if satisfied that a patient is in a state of terminal illness and for this reason unable to make or communicate decisions concerning his or her medical treatment or its cessation, on application by any interested person, order the cessation of medical treatment.
(2) A court shall not make an order as contemplated in subsection (1) without the close family having been given the opportunity to be heard by the court.
(3) A court shall not make an order as contemplated in subsection (1) unless it is convinced of the facts as contemplated in that subsection on the evidence of at least two medical practitioners who are knowledgeable with regard to the patient’s condition and who has treated the patient personally or has checked his or her medical history and has personally examined the patient.
(4) A medical practitioner who gives effect to an order of court as contemplated in this section shall not suffer any civil, criminal or disciplinary liability with regard to such an act.
Option 2:
10. (1) In the absence of a directive by or on behalf of a terminally ill person as contemplated in section 6, a court may if satisfied that a patient is in a state of terminal illness and for this reason unable to make or communicate decisions concerning his or her medical treatment or its cessation, on application by any interested person, issue an order for the performance of any medical procedure which would have the effect of terminating the patient’s life.
(2) A court shall not make an order as contemplated in subsection (1) without the close family of the patient having been given the opportunity to be heard by the court.
(3) A court shall not make an order as contemplated in subsection (1) unless it is convinced of the facts as contemplated in that subsection on the evidence of at least two medical practitioners who are knowledgeable with regard to the patient’s condition and who have treated the patient personally or have checked his or her medical history and have personally examined the patient.
(4) A medical practitioner who gives effect to an order of court as contemplated in this section shall not suffer any civil, criminal or disciplinary liability with regard to such an act.
Interpretation
11. The provisions of this Act shall not be interpreted as though a medical practitioner is obliged to do anything that would be in conflict with his conscience or any ethical code to which he feels himself bound.
Short title
Option 1:
12. This Act shall be called the Rights of the Terminally Ill Act 1997.
Option 2:
12. This Act shall be called the End of Life Decisions Act 1997.
1.17 Four hundred and three discussion papers were distributed to identified interested persons and bodies, including the various religious denominations, medical institutions, law societies, bar councils, registrars of the Supreme Court, the Appellate Division, foreign law reform agencies and non-governmental organisations representing the public at large. The availability of the discussion paper was also publicised through a notice in the Government Gazette and by way of a media statement circulated to the public media. A substantial number of publications, radio and television programmes[10] covered the investigation and drew attention to the fact that the public could comment on the Commission's proposals.[11] Representatives of the Commission also participated in discussion groups, a telephone conference and various meetings[12]. A copy of the Discussion Paper was also available on the Commission's Internet site. A further 258 copies of the Discussion paper were sent out upon telephonic and written requests by interested parties following the release of the media statements.
1.18 One hundred and eighty-four respondents acted on the Commission’s invitation and submitted written comment in respect of Discussion Paper 71. A list of names of respondents is enclosed as Annexure B to this report. It was especially the question in respect of the possible decriminalisation of active euthanasia that drew most comment. Submissions ranged from passionate calls for the legalisation of euthanasia to outright condemnation of any act associated therewith.
1.19 The submissions received, the discussions that followed, the points raised at the two workshops, the participation of the general public, all assisted the Commission in its task. All points of criticism and suggestions for improvement were duly considered. We take this opportunity to thank all who responded to the Working Paper and Discussion Paper as well as the Commission’s other requests for submissions.
1.20 Throughout this report the position set out in Discussion Paper 71 in regard to the different issues will be stated,[13] followed by a discussion of the submissions received in each case and in conclusion, the recommendation of the Commission.
1.21 A question that was discussed throughout the investigation was whether there was in fact a need for legislation in this area or whether uncertainty in this field could not be addressed more adequately by the education of medical personnel, health care professionals and the public at large.
1.22 There were commentators who argued that the law was an inappropriate instrument for the sensitive decision making needed in situations at the end of life and that additional education was preferable to additional legislation.[14] This was however a minority opinion.
1.23 The majority of respondents who addressed this issue recommended formal legislation on end of life issues to remove legal uncertainty for doctors, patients and family.[15] Commentators however differed in so far as the content of the legislation was concerned.
1.24 Some respondents supported legislation that would reaffirm the current prohibition on intentional killing, whether by act or omission, and that would clarify the distinction between medical treatment and basic care.[16]
1.25 On the other hand there was also support for public-policy regulation of end-of-life decisions which would remove and decriminalise actions that respondents felt should not be crimes but should be seen to be both merciful and respectful of autonomy.[17]
1.26 It was argued that should such legislation be consistent with the new Constitution[18] and its entrenched Bill of Rights, it would bring a measure of legal certainty. This would be reassuring to patients, their next of kin and the medical personnel in whose care terminally ill and dying patients are. It would furthermore provide a basis for those who counsel the elderly, terminally ill and dying when they enter a hospital or nursing home. [19]
1.27 Respondents contended that it was very difficult for medical personnel to raise matters such as for example advance directives with patients in the absence of legislation which governs them. They feared that it may sound as though they were suggesting something illegal since the directives are not formally governed by law. It was also difficult for medical practitioners as non-lawyers to explain the relevant legal position to patients in the absence of hard and fast rules.[20]
1.28 Respondents furthermore strongly supported the idea that legislation could be used to include strict safeguards that would protect both the patient and the health care professional in any given situation.[21] There was general agreement that legislation should include a conscientious clause.[22]
1.29 It was however emphasized that although changing the legal framework would be an important step in expanding people's rights to die with dignity, this development would have a hollow ring unless substantial efforts were made to inform and educate patients and providers and to make available the necessary support to implement these changes. Respondents emphasised the fact that strategies had to be implemented to inform individuals, families, and health care providers about their rights, responsibilities and choices. The implementation of these proposals would include advice regarding the mechanisms for redress should an individual or family member feel that his or her rights have been violated.[23]
1.30 The Commission considered all the arguments stated above carefully. The Commission agrees with the viewpoint that legislation in this field would enhance the treatment of terminally ill and dying patients. It is therefore recommended that formal legislation on all end of life issues should be implemented.
[2]An excellent example of such an approach is found in the Report of the Select Committee on medical ethics of the British House of Lords, published on 31 January 1994 (hereinafter referred to as "Report of the Select Committee").
[3]Para 2.1 on 18.
[4]See Kuhse, H "'No' to the intention/foresight distinction in medical end-of -life decisions" (Paper presented at the 11th World Congress on Medicine and Law held at Sun City July 28 - Aug 1 1996) as well as her reference to Van der Maas, PJ, Van Delden, JJM, Pijnenborg, L and Looman, CWN "Euthanasia and other medical decisions concerning the end of life" Lancet 14 September 1991 at 338: Death is no longer the natural event it once was. Rather, most patients die in institutional settings, as the result of a medical end of life decision. Nearly 40 % of all deaths and 54% of all non-acute deaths are the result of a medical end of life decision - the foregoing of life-sustaining treatment, the administration of potentially life-shortening pain- and symptom control and of euthanasia.
[5]Voluntary Euthanasia Society, England.
[6]Alfred Allan, Department of Psychiatry, University of Stellenbosch.
[7]South African Law Commission Euthanasia and the artificial preservation of life Working Paper 53 March 1994 (hereinafter referred to as "Working Paper 53").
[8]A list of respondents is enclosed as Annexure A.
[9]South African Law Commission Euthanasia and the artificial preservation of life Discussion Paper 71 April 1997(hereinafter referred to as "Discussion Paper 71").
[10]Monitor, RSG; Janine Lazarus Show Radio 702; Talk at Will, SAFM; News insets: Radio 702, SAFM, RSG; 5FM; Radio seSotho, Bloemfontein; Radio Highveld; SABC Radio News; Punt Radio; Cape Talk; Two Way Street, SABC2; Carte Blanche, M Net; Felicia Mabuza-Suttle Show.
[11]As far as the Commission could ascertain the following articles appeared in the press in anticipation and response to the paper being published : "Report backs the right to die" Sunday Times April 13, 1997; "SA dokters erken hul pas genadedood toe" Die Beeld 28 November 1996,"Law Commission report on euthanasia released" The Star 18 April 1997; "SA debates a new law" Readers Digest, Aug 97; Woza Internet: today/news, April 11, 1997;"The Right to Die- Should you have the choice" Sunday Tribune Feb 25, 1996; "First steps to legal euthanasia" Electronic Mail & Guardian, April 11, 1997; "SA confronts 'death on demand' Electronic Mail & Guardian Feb 25, 1997; "So when are you legally declared dead?" The Saturday Paper (Natal) 27 July 1996; "And now for death on demand" Mail & Guardian Feb 21-27 1997; "Genadedood"editorial Die Beeld 15 April 1997; "Draft bill looks at eight aspects of the road to ending a life" The Star April 18 1997; " Law Commission report on euthanasia released" The Star April 18, 1997; "Genadedood lok reaksie van baie" Die Beeld 27 May 1997; "Religious bodies united in condemnation of 'termination'" The Leader 25 April 1997; "Regsekerheid oor genadedood lyk moontlik" Die Beeld, 10 April 1997; "SA Law Commission looks to revamp euthanasia laws" Business Day April 11 1997; "Euthanasia laws are probed" The Citizen 11 April 1997; "Way opened for death on demand" Mail & Guardian 11-17 April 1997; "Euthanasia" editorial The Citizen 14 April 1997; "SA dalk eerste om gendadedood te wettig" Naweek-Beeld 12 April 1997; "Gendadedood: bydraes ingewag" Naweek-Beeld 12 April 1997; "Doctors for Life oppose euthanasia" The Citizen 15 April 1997; "Euthanasia legislation among the most liberal in inethe world" Pretoria News June 25 1997; "Prokureurs oor genadedood" Die Beeld 3 Julie 1997; "Euthanasia law to be explored" The Star June 27 1997; "Euthanasia impasse" Pretoria News 2 July 1997; "Lawyers differ on euthanasia" The Citizen 2 July 1997; "Gendadedood: mens moet nie God speel" Die Kerkbode 18 April 1997; "Genadedood: nog reaksie ingewag" Die Beeld 27 Junie 1997; "Houdings teenoor genadedood aan't verander: regskommissie wag menings in" Die Beeld 2 Julie 1997; "Legal clarity on euthanasia needed: SA to get 'right to die' law" The Cape Times 27 June 1997.
[12]See eg SA Council of Churches workshop; Catholic Church The Right to Live Campaign, telephone conference on Sunday 29 June 1997; University of the North Pharmaceutical Society workshop.
[13]Information has been updated where possible.
[14]See eg. Hospice Association of South Africa; Africa Christian Action; The Christian Lawyers Association.
[15]See eg SA Nursing Council; Department of Health; Christian Medical Fellowship of SA; Mandisa Sonqishe, Cancer Association; Voluntary Euthanasia Society, London; Dr Willem Landman; Prof JG Swart, Faculty of Medicine, UP; Alfred Allan; National Primary Health Care Network(hereinafter referred to as "NPHCN").
[16]Christian Medical Fellowship of SA.
[17]Dr Willem Landman.
[18]Constitution of the Republic of South Africa 108 of 1996.
[19]Alfred Allan.
Alfred Allan.
[21]Director General, Department of Health (hereinafter referred to as "Department of Health").
[22]Alfred Allan.
[23]NPPHCN.
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