Euthanasia or assisted suicide is arguably, now, both legal and illegal in South Africa. Here’s an attempt to explain. Three preliminary points are required.
Firstly, it’s important to understand that what is at issue is whether killing in euthanasia is unlawful (just like for self/private defence). It is a question of unlawfulness because the issue is whether the consent given to be killed is valid and recognised in our law.
Secondly, only decisions of our courts that are consistent with the Constitution actually reflect what the law is. Any decision inconsistent with the Constitution is invalid and not law. The importance of the Constitutional Court is that it has the last say on what it is that the Constitution permits or requires. This has implication for what the law is, even before the Constitutional Court decides what it is. The law is whatever the Constitution permits or requires ever since the coming into effect of the Constitution. This is crucial and bears repeating. Since the coming into effect of the Constitution, our law has been whatever the Constitution permits or requires, no matter what any legislation or any Court (other than the Constitutional Court) says it is.
Thirdly, the question raised in cases of euthanasia or assisted suicide is judged by the “legal convictions of the community”, now, as informed by the values in the Constitution (Carmichele [2001] ZACC 22).
Currently our law is in a state of conflict. There are several old Appellate Division (AD), now known as the Supreme Court of Appeal (SCA), decisions that euthanasia is unlawful (Robinson 1968; Grotjohn 1970).
There is also the case – progressive for its time – of Clarke v Hurst (1992 D) and now, that of Stransham-Ford in the Gauteng North High Court (of 29 April 2015), holding that euthanasia is lawful. Both are Provincial Division decisions.
To complete the picture, it must be mentioned that the Law Commission has recommended (in 1999) that passive euthanasia/assisted suicide be legalised – in terms of which it will be lawful to withhold care or medication. However, the Law Commission took no position on the issue of active euthanasia/assisted suicide – where one actively does something, such as administer a lethal dose of a drug, to hasten death. The status of this commission report is that it has gone nowhere and certainly doesn’t have the status of law. It does however give us a glimpse that the law commission is leaning in favour of the recognition of euthanasia/assisted suicide.
Returning to the court decisions we have the Provincial Division decisions which are in conflict with the AD/SCA decisions. Although AD/SCA decisions ordinarily override Provincial decisions, as indicated above, only decisions that are consistent with the Constitution actually reflect the law.
This leads to the obvious question here: which decisions reflect the Constitution? For this reason we need, at the very least, an appeal to the SCA to resolve the conflict between its own old decisions and the Provincial division decisions, but ultimately we need the Constitutional Court to tell us what the Constitution says. An appeal against the decision in Stransham-Ford’s case is therefore to be welcomed. It will drive the issue towards the Constitutional Court.
Until then, and despite the recent decision in the case of Stransham-Ford, no one can claim to know whether euthanasia or assisted suicide is lawful or not. It leaves those who are terminally ill, who are suffering and who want to die, their families and the doctors who want to help, in a state of uncertainty that can only cause more suffering.
In the meantime the inevitable question persists – what is the position in our law? I can’t answer that. This is for the Constitutional Court to say. I can only guess that it will give prominence to an individual’s right to dignity and to die with dignity.
What I can say in the meantime is what this state of uncertainty does for criminal liability. It is worth considering the possibilities given the importance of this question. There are, of course, two possible outcomes: that euthanasia or assisted suicide is either: 1) lawful; or 2) unlawful.
If the Constitutional Court finds that euthanasia/assisted suicide is lawful, it will mean that it was always lawful, since the inception of the Constitution. In this scenario, there can be no liability – no murder or culpable homicide conviction, even if the conduct is/was committed prior to the Constitutional Court decision saying so. There is an interesting scenario, still within the parameters of it being lawful, in which a person proceeds on the mistaken though firmly held belief that it is unlawful, although it is not. This is what is known as an attempt at the legally impossible, and also attracts no liability.
The second alternative, in which the Constitutional Court declares that euthanasia/assisted suicide is unlawful, will mean that it remained unlawful despite the inception of the Constitution.
I expect some may regard this as a silly proposition given that “ignorance of the law is no excuse”. However, in South Africa, since 1977 this is not our law (S v De Blom AD). A mistake of law is indeed a defence. It would undermine the requirement of intention for murder, and, probably, also the requirement of negligence for culpable homicide. To be clear, the effect of a mistake is to undermine the fault requirement of murder or culpable homicide.
If someone proceeded to kill another in circumstances that one can describe as euthanasia/assisted suicide, but knew/believed that it was unlawful, s/he could be convicted of murder.
However, if someone were to believe – mistakenly on this scenario – that euthanasia/assisted suicide was/is lawful, and was to proceed on this basis, s/he cannot be convicted of murder. This follows from simple and unquestioned principles of mistake in our law. The more difficult question arises though whether this person could be convicted of culpable homicide. This is the question whether making such a mistake is reasonable – could the reasonable person make this mistake? Remember, unlike intention, which is a subjective enquiry (what was the accused actually thinking), negligence is an objective enquiry. Negligence is concerned, not with what the accused did think, but with what s/he should have thought and done. The bottom line is that an accused is regarded as knowing only as much as would be reasonable for him/her to know.
In cases where the issue has been an error of law our Courts have distinguished between complete lay people and those who engage in a particular sphere of activity. Those who engage in a sphere of activity are expected to know the law pertaining to that sphere of activity (De Blom 1977 AD; Du Toit 1981 C). Thus, a builder is expected to know the law and regulations relating to building, a motorist is expected to know the law and regulations relating to his or her mode of transport). This follows from the notion that the reasonable person would know the law pertaining to the sphere of activity in which s/he is engaged. It would probably be considered reasonable for a lay person to think that, given the right to dignity in the Constitution, or following the decision in Stransham-Ford, euthanasia/assisted suicide is now legal in South Africa.
The standard required of Doctors is going to be higher. They will be expected to know the law pertaining to their “sphere of activity”. In the circumstances what can the reasonable Doctor be expected to know? The law on the issue is unclear and we are waiting for the SCA and ultimately the Constitutional Court to interpret the Constitution and declare the law (and what it has been since the inception of the Constitution). We may guess that the Constitutional Court will probably recognise the right to die with dignity, but we have no certainty until they decide. What should a Doctor do? Ultimately the question is going to be this: would a reasonable Doctor foresee the significant possibility that the Constitutional Court may find that euthanasia/assisted suicide is unlawful? Is there a significant possibility that the Constitutional Court may find that it is unlawful? Regrettably, as much as I think the Constitutional Court should and will find that euthanasia/assisted suicide is lawful, there remains a chance that it will not – that it may find that it is unlawful. I say regrettably because I have to acknowledge a degree of uncertainty here that is unacceptable. If this is so, that there is a possibility that the Constitutional Court would find that euthanasia /assisted suicide is unlawful, it will not be a stretch for a Court to find that a reasonable doctor would have foreseen this prospect and would not have assisted. Regrettably again, given the uncertainty, I expect this is a basis upon which Doctors may pause in anticipation of the desperately needed clarity on this issue. However, much as I must acknowledge the possibility that the Constitutional Court may find euthanasia/assisted suicide to be unlawful, I doubt it could amount to a significant risk. The only case (that of Stransham-Ford) that has considered this question in light of the Constitution has concluded that the Constitution permits euthanasia/assisted suicide as lawful. Indeed, even pre-constitutionally, but as we approached our new Constitutional dispensation in 1992, the court in Clarke v Hurst found that the “legal convictions of the community”, the all-important test for unlawfulness, require that euthanasia/assisted suicide is lawful. Given these two judgements, that the AD/SCA decisions are old (1968 & 1970) and certainly pre-constitutional, and that the only other indication we have is from the law commission apparently in favour of euthanasia, it would seem entirely reasonable for a Doctor to believe that when this does finally reach the Constitutional Court, that Court will find that it is lawful. What would a reasonable Doctor make of the uncertainty? I expect a reasonable Doctor would acknowledge the uncertainty, would decry the uncertainty, but would, in my view, regard the risk that the Constitutional Court could find that euthanasia is unlawful as too remote and ultimately insignificant. Unfortunately, this is only, and can only be, a best guess.
In summary then, despite the conflicting court decisions in our law, whether euthanasia/assited suicide is unlawful or not is to be determined by reference to the Constitution. If anyone (lay person or Doctor) were to assist another (who is terminally ill and suffering) to die, no liability can attach to that conduct were the Constitutional Court to declare that such conduct is lawful, and always was (since the inception of the Constitution). If the Constitutional Court were to find however that such conduct remained unlawful despite the inception of the constitution, the fault requirement of the crimes of murder and culpable homicide may offer a defence to both lay persons and Doctors. As indicated, Doctors bear a higher burden than lay people in respect of the law and regulations applicable to the practice of medicine. But ultimately it must be recognised that right now, no one can claim to know what the law is and all we have to go on are the indications in the law commission proposal and the two provincial division decisions in favour of euthanasia being lawful.
Ultimately, and assuming whoever assists another to commit suicide genuinely believes that it is the right thing to do and that this belief will be vindicated by the Constitutional Court, s/he cannot incur liability for murder, no matter what the Constitutional Court decides. Assuming it is reasonable to hold this view, as I suspect it is, no one can be convicted of culpable homicide for doing so, again, no matter what the Constitutional Court decides.
These conclusions are by no means an attempt to reduce the importance of a decision on this from the Constitutional Court. It recognises that that decision is desperately needed and ultimately all important. In the meantime though, for those who are suffering, with no prospect of recovery, for their families and loved ones, and for the Doctors who want to help, I hope this answers some questions.
– By James Grant (@JamesGrantZA)
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* In honour of Robin Stransham-Ford and my mother. I am grateful to Professor Marius Pieterse of Wits University for his guidance on the constitutional law discussed here. All errors remain, naturally, all mine.
** This discussion is an attempt to answer some abstract questions that arise given the apparent state of legal conflict. It’s purpose is to provide a framework within which questions relating to the specific circumstances of any particular person may be considered. It is not encouragement or a licence to kill anyone. It cannot be regarded as legal advice which must be sought in every individual scenario in order for the specific circumstances to be considered and advised upon.