222s view on Euthanasia Assisted Suicide) -...

Professor Samuel Mokgokong

HPCSA’S VIEW ON

EUTHANASIA & ASSISTED SUICIDE

• Statutory body established under the Health Professions Act 56 of

1974 and is mandated to regulate the health professions in the

Republic of South Africa.

• HPCSA has 12 Professional Boards operating under its auspices• HPCSA has 12 Professional Boards operating under its auspices

• The Professional Boards control the professions within their ambit

under the overarching coordination and guidance of the HPCSA

HPCSA POSITION IN NATIONAL HEALTH

Minister of Health

Parliament

Department of Health

Minister of Health

Health Professions Council of Health Professions Council of Health Professions Council of Health Professions Council of

South AfricaSouth AfricaSouth AfricaSouth Africa

CATEGORY NR

• Persons designated by Professional Boards

(At least one per Professional Board, the rest proportional to the number of

registered practitioners within each Professional Board)

16

• Person employed by Dept of Health, appointed by Minister of Health 1

• Person employed by Dept of Education, appointed by Minister of Education 1

• Person employed by SA Military Health Service, appointed by Minister of 1• Person employed by SA Military Health Service, appointed by Minister of

Defence

1

• Persons appointed by the Higher Education South Africa [HESA] 3

• Community Representatives who are not registered in terms of the Act,

appointed by the Minister of Health

9

• Person versed in Law, appointed by Minister of Health 1

TOTAL 32

Professional Board for Dental Therapy and Oral Hygiene 1

Professional Board for Dietetics and Nutrition 1

Professional Board for Environmental Health Practitioners 1

Professional Board for Emergency Care 3

Medical and Dental Professions Board 3

Medical Technology Board 1

Professional Board for Occupational Therapy, Medical Orthotics ,

Prosthetics & Arts Therapy

1


Professional Board for Optometry and Dispensing Opticians 1

Professional Board for Physiotherapy, Podiatry & Biokinetics 1

Professional Board for Psychology 1

Radiography and Clinical Technology 1

Professional Board for Speech, Language and Hearing Professions 1

TOTAL 16

Executive CommitteeExecutive CommitteeExecutive CommitteeExecutive Committee

Finance, Finance, Finance, Finance,

Investment & Investment & Investment & Investment &

TariffTariffTariffTariff

CommitteeCommitteeCommitteeCommittee

Audit Audit Audit Audit

&&&&

Risk Risk Risk Risk

ManagementManagementManagementManagement


Professional Professional Professional Professional

BoardsBoardsBoardsBoards

Pension & Pension & Pension & Pension &

Provident Provident Provident Provident

Trustee Trustee Trustee Trustee


Committee on Committee on Committee on Committee on

Undesirable Undesirable Undesirable Undesirable

Business PracticesBusiness PracticesBusiness PracticesBusiness Practices

Professional Professional Professional Professional

Conduct Conduct Conduct Conduct

Review Review Review Review


Human RightsHuman RightsHuman RightsHuman Rights

& Ethics & Ethics & Ethics & Ethics


CPD CPD CPD CPD

Committee Committee Committee Committee

Health Health Health Health


Human Human Human Human

Resources &Resources &Resources &Resources &

RemunerationRemunerationRemunerationRemuneration


Tender Tender Tender Tender


Quality Quality Quality Quality

AssuranceAssuranceAssuranceAssurance


HPCSAHPCSAHPCSAHPCSA

32 Members32 Members32 Members32 Members

Dental Therapy

& Oral Hygiene

Dietetics & Nutrition

Emergency Care

Environmental Health

Practitioners

Medical & Dental

Medical Technology

Occupational Therapy,

Medical Orthotics,


Optometry & Dispensing

Opticians

Physiotherapy, Podiatry

& Biokinetics

Psychology

Radiography & Clinical

Technology

Speech, Language &

Hearing Professions

HPCSA AdministrationHPCSA AdministrationHPCSA AdministrationHPCSA Administration

INTRODUCTION TO EUTHANASIA

The prohibition on the intentional killing of ahuman being is the cornerstone of society andhuman relationships.

It protects the life, equality and dignity of allmembers of society, especially the vulnerable.members of society, especially the vulnerable.

Human autonomy is the other side of the coin!

THE WORLD MEDICAL ASSOCIATION'S VIEW

The World Medical Association's

Declaration on Euthanasia, adopted by

the 38th World Medical Assembly,

Madrid, Spain, October 1987 and

reaffirmed by the 170th WMA Councilreaffirmed by the 170th WMA Council

Session, Divonne-les-Bains, France, May

2005 states:


"Euthanasia, that is the act ofdeliberately ending the life of apatient, even at the patient's ownrequest or at the request of a closerelatives, is unethical.

This does not prevent the physicianThis does not prevent the physicianfrom respecting the desire of a patientto allow the natural process of deathto follow its course in the terminalphase of sickness."

DEFINITIONS

Eu thanatos… good death;

Euthanasia … “good” death caused by another person;

Voluntary euthanasia… patient requests for it;

Non-voluntary euthanasia… patient can’t request;

Involuntary euthanasia… patient is against it;

Assisted suicide… patient causes own death, with

assistance

Physician assisted suicide… physician advises/provides


The WMA Statement on Physician-Assisted Suicide, adopted by the 44thWorld Medical Assembly, Marbela, Spain, September 1992 and editoriallyrevised by the 170th WMA Council Session, Divonne-les-Bains, France,May 2005 likewise states:

"Physicians-assisted suicide, like euthanasia, is unethical

and must be condemned by the medical profession. Wherethe assistance of the physician is intentionally andthe assistance of the physician is intentionally and

deliberately directed at enabling an individual to end his or

her own life, the physician acts unethically.

However the right to decline medical treatment is a basic

right of the patient and the physician does not act

unethically even if respecting such a wish results in thedeath of the patient."


The World Medical Association reaffiffiffiffirmed its strong belief thateuthanasia is in conflict with basic ethical principles of medical practice,and

The World Medical Association strongly encouraged all National MedicalAssociations and physicians to refrain from participating in euthanasia,

even if national law allows it oreven if national law allows it ordecriminalizes it under certainconditions.

THE HIPPOCRATIC OATH

• Oath taken before commencing practice

• Since about 500 BC

• Has been evolving with time e.g. abortion now excluded

• Fundamental principles remain: i.e.

Doing good … beneficence;

Doing no harm … non-maleficence.

• Society expects doctors to commit to some form of oath

HIPPOCRATIC OATH

When doctors begin their career,

they take the “Hippocratic Oath”

and pledge to do all they can to

preserve life and not dopreserve life and not do

anything that will intentionally

harm or result in the death of a

patient.

HPCSA’S ETHICAL VIEW

As the HPCSA we say….

“Something may be lawful but atthe same time it is Unethical”

This is the distinction between Ethics and Law.


Council finds active euthanasia, or the wilful act by a health careprofessional to cause the death of a patient unacceptable,notwithstanding whether or not such an act is performed at therequest of the patient or his or her closest relatives or of anyother person.

The health care professional may alleviate the suffering of aThe health care professional may alleviate the suffering of aterminally-ill patient by withholding treatment, i.e. allowing thenatural process of death to follow its course, provided there isconsultation with another health care practitioner who is anexpert in the field, and where available, discussions with theclosest relatives has taken place.


The withholding of treatment does not exempt thehealth care professional from the duty to assist thedying person by providing him or her with thenecessary medication in order to alleviate thesuffering during the terminal phase of illness.

The health care professional shall refrain fromemploying unusual methods of treatment whichare of no benefit to the patient.

THE WORLD’S VIEW

• On Euthanasia:

The Netherlands and Belgium are the only two;

The Halifax Conference of 2005 : “slippery slope”

• On Assisted Suicide:

Netherlands, Belgium, Switzerland and Luxemborg

USA: Only 4/50 states have legalised assisted suicide;

Compare 31/50 have legalised the death sentence!

THE CANADIAN PRACTICE

• Suicide is not illegal in Canada!

• Assisted suicide is not legal in any Canadian State

• Death in Dignity try to legalise it every 2-3years

• The parliament refused in all their attempts!

• Latest attempt: the Quebec State:

The Criminal Code is a national law; vs.

health care regulation (State responsibility)

Consider E/AS as part of “end of life care”!!

THE DOCTORS’ VIEW

• Dr Douglas Kinsella; Calgary bioethicist (Halifax congr.)

2005 doctors attending the congress;

47% supported physician assisted euthanasia;

39% opposed it (overdose medication);

11% were uncertain;

But 1 in 5 were unwilling to put a patient to death!

• One notable publicised exception in the world:

Dr Jack Kevorikan

DR JACK KEVORIKAN

• He practised physician assisted suicide;

• He developed the “mercitron” :-

Saline solution at the push of a button;

Sodium tiopental at the next push (sleep induced);

Potassium Chloride is next (cardiac arrest);

Pancuronium Bromide (muscle relaxant)…rapid

painless death!

• The community nicknamed him “Dr Death”!

ALTERNATIVE OPTION - PALLIATIVE CARE

Palliative care is an approach that improves thequality of life of patients and their families facingthe problems associated with life-threateningillness, through the prevention and relief ofsuffering by means of early identification andcareful assessment and treatment of pain andcareful assessment and treatment of pain andother problems – physical, psychosocial andspiritual (Prof Cameroon).

ALTERNATIVE OPTION - PALLIATIVE CARE

The challenge to us all today is how weare going to respond to ensure thatevery dying patient receives the kind ofcare that helped to Robin Stransham-Ford to die at home, pain free, at peaceFord to die at home, pain free, at peaceand with dignity? (Prof Cameroon)

GOOD PALLIATIVE CARE!!

• It is not the cheapest solution! In the Oregon State, it

costs only USD 35.00 to get an AS package.

• Hospices need to be built!

• Medical research needs to go on (alleviation suffering)

• Now only about 5% of pain cannot be cured!

• Enhance management team of experts in hospices e.g. • Enhance management team of experts in hospices e.g.

psychiatrist, clinical psychologists, family counselling,

and various relevant medical experts!

• The biggest challenges are higher mental functions!

THANK YOU!

222s view on Euthanasia Assisted Suicide) -...

Documents

Transcript of 222s view on Euthanasia Assisted Suicide) -...