Dying and 'euthanasia'.

Abstract

Medical progress, secularisation of life, growing acceptance of individual human rights (including the right to refuse medical treatment) and of shared decision-making in medicine have focused public attention on the ways in which life may, and perhaps even ought to, be allowed to end in our complex modern era. Intense and thoughtful bio-ethical debate over many years has 'unpacked' the many different understandings and interpretations of the word euthanasia. The consequent conceptual clarification together with recognition and acknowledgement of psychological implications has facilitated a growing rational consensus on openly accepting the withholding and withdrawing of treatment (under defined conditions) within the realm of sound medical practice. This is clearly distinct from assisted suicide and active euthanasia which are generally considered unacceptable perversions of medical practice. Given the ability to sustain life for prolonged periods, often in a permanent state of unconsciousness, the unrealistic expectations of some medical personnel and the lay public, the severe constraints on health care facilities in South Africa and the totally inadequate allocation of resources for highly effective medical treatments, it is appropriate to re-open public debate on the limits of 'striving officiously to keep alive' and on the distinction between 'allowing to die' and 'killing'. Concern that 'rational' arguments reflect moral decay rather than moral progress keeps the debate open and focuses attention on some 'slippery slope' consequences.