Stransham-Ford v Minister of Justice and Correctional Services and others [2015 ] 3 All SA 109 (GP) PDF

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StranshamFordvMinisterofJusticeandCorrectionalServicesandothers [2015]3AllSA109(GP) Division:

GAUTENGDIVISION,PRETORIA

Date:

4May2015

CaseNo:

27401/15

Before:

HJFABRICIUSJ

Sourcedby:

ESmitandSGeldenhuys

Summarisedby:

DPCHarris .Editor'sSummary.CasesReferredto.Judgment.

[1]ConstitutionallawRighttolifeSection11oftheConstitutionVoluntaryeuthanasiaConstitutionalguarantee safeguardsaperson'srighttolifevisàvistheStateandsocietySection11doesnotrequirethatapersonwhono longerdesirestoliveshouldbeforcedtocontinuelivingConstitutionalguaranteeoftherighttolifeisnotengaged whereaterminallyillpatientwithnoqualityoflifedesirestoendhislifethroughvoluntaryeuthanasiaorassistedsuicide butthirdparties,byreasonofmoral,religiousorphilosophicalconvictionsbasedonanotionofthesacrednessoflifeper se,contendthatthepatientshouldnotbepermittedtohaveamedicalpractitionerassisthimtoterminatehislife. [2]CriminallawMurderVoluntaryeuthanasiaPatientterminallyillanddesiringtoendhislifewithdignitythrough assistedsuicidebyamedicalprofessionalCommonlawimposingabsoluteprohibitionofassistedsuicideinsuch circumstancesSuchprohibitionunjustifiablylimitingthepatient'sconstitutionalrightstohumandignityandtobodily andpsychologicalintegritycontainedinsections10and12(2)(b)oftheConstitutionCommonlawprohibitiondeclaredto beinconflictwiththeConstitution. Editor'sSummary Theapplicantwasa66yearoldpractisingadvocateoftheHighCourtofSouthAfrica,intheadvancedstagesof terminalcancer.Hesoughttobeallowedtorequestamedicalpractitionertoadministeralethalagenttoendhis life,withoutthatmedicalpractitionerfacinganysanctionforhisconduct. HeldThecurrentlegalpositionisthatassistedsuicideoractivevoluntaryeuthanasiaisunlawful. Theapplicantreliedontheprovisionsofsection39oftheConstitution,whichrequiresacourttopromotethe objectivesoftheBillofRightswheninterpretinglegislationordevelopingthecommonlaw.Theconstitutionalright relieduponwastherighttodignity.TheCourtupheldtheapplicant'ssubmissionthatitisafundamentalhuman righttobeabletodiewithdignity,whichourcourtsareobligedintermsofsections1(a),7(2)and8(3)(a)ofthe Constitution,toadvance,respect,protect,promoteandfulfil. Theobligationtodevelopthecommonlawrequiresacourttoundertakeatwostageenquiry.Thefirststage wouldbetoconsiderwhethertheexistingcommonlaw,havingregardtothesection39(2)objectives,requires development.Thatenquiryrequiresareconsiderationofthecommonlawinthelightofsection39(2).Ifthatenquiry leadstoapositiveanswer,thesecondstageconcernsitselfwithhowsuchdevelopmentistotakeplaceinorderto meetthesection39(2)objectives.TheCourtfoundthattheabsoluteprohibitiononassistedsuicideinthecommon lawdidnotaccordwiththerightsrelieduponbytheapplicant. Page110of[2015]3AllSA109(GP)

Takingintoaccounttheapplicant'squalityoflife,thefactthathehadundergoneevaluationwhichprovedhimtobe ofsoundmindandcapableofmakinginformeddecisions,andtheabovementionedobligations,theCourtgranted thereliefsoughtbytheapplicant.Itdeclaredthatthecommonlawcrimesofmurderorculpablehomicideinthe contextofassistedsuicidebymedicalpractitioners,insofarastheyprovideforanabsoluteprohibition,unjustifiably limitedtheapplicant'sconstitutionalrightstohumandignity,andbodilyandpsychologicalintegrityandtothat extentweredeclaredtobeoverbroadandinconflictwiththesaidprovisionsoftheBillofRights. Notes ForConstitutionallawsee: LAWSASecondEditionReplacementVolume(Vol5(3),paras1334) · Cheadle,MH;Davis,DMandHaysom,NRLSouthAfricanConstitutionalLaw:TheBillofRights(2ed)Durban · LexisNexis2005(lastupdatedinApril2012) ForCriminalLawsee: LAWSASecondEditionReplacementVolume(Vol6,paras1408) · SnymanCRCriminalLaw(5ed)DurbanLexisNexis2008 · Casesreferredtoinjudgment SouthAfrica



AdvanceMiningHydraulics(Pty)LtdandothersvBotesNOandothers 2000(2)BCLR119(2000(1)SA815)(T)Referredto

117

BelPortoSchoolGoverningBodyandothersvPremierWesternCapeand another2002(9)BCLR891(2002(3)SA265)(CC)Applied

115

BernsteinandothersvBesterandothersNNO1996(4)BCLR449

117

(1996(2)SA751)(CC)Referredto BritishChemicalsandBiologicalsSA(Pty)LtdvSAPharmacyBoard [1955]1AllSA267(1955(1)SA184)(A)Compared

122

CarmichelevMinisterofSafetyandSecurityandanother2001(10) BCLR995(2001(4)SA938)(CC)Applied

117

ClarkevHurstNOandothers[1992]2AllSA397(1992(4)SA630)(D) Compared

118

GlenistervPresidentoftheRepublicofSouthAfricaandothers2011(7) BCLR651(2011(3)SA347)(CC)Referredto

116

LeRouxandothersvDey(FreedomofExpressionInstituteand RestorativeJusticeCentreasamicicuriae)2011(6)BCLR577 (2011(3)SA274)(CC)Referredto

117

MaarohanyeandanothervS[2014]JOL32451(2015(1)SACR337) (GJ)Referredto

118

MakgothovS[2014]JOL31577(2013(2)SACR13)(SCA)Referred to

118

MasiyavDirectorofPublicProsecutions,Pretoriaandanother(Centrefor AppliedLegalStudiesandanother,amicicuriae)2007(8)BCLR827 (2007(5)SA30)(CC)Applied

128

MinistervanJustisie,Exparte:InreSvGrotjohn[1970]2AllSA491 (1970(2)SA355)(A)Referredto

114

SvDeBellocq[1975]1AllSA6(1975(3)SA538)(T)Referredto

114

Page111of[2015]3AllSA109(GP)

SvDeBruynen'nander[1968]4AllSA211(1968(4)SA498)(A) Referredto

118

SvMakwanyaneandanother1995(6)BCLR665(1995(3)SA391) (CC)Referredto

116

SvMarengo[1991]3AllSA784(1991(2)SACR43)(W)Referredto

114

SoobramoneyvMinisterofHealth,KwaZuluNatal1997(12)BCLR 1696(1998(1)SA765)(CC)Compared

119 

Canada CartervCanada(AttorneyGeneral)2015SCC5Referredto

123 

UnitedStatesofAmerica CruzanvDirector,MissouriDepartmentofHealthetal497US261 (1990)343Referredto

119

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Judgment FABRICIUSJ: [1] Thisisanurgentapplicationwhichinmyviewrequiresanimmediatedecision,andaccordinglyinthelimited timeavailabletome,IhavedoneeverythingIcouldtoenablemetomakeanorderandgivewrittenreasons shortlythereafter.Havingregardtothetopicitwillbepreferableand,nodoubtthiswilloccurinduecourse, thattheConstitutionalCourtpronounceontherelevantprinciples.AtleasteightJudgeswillhavesufficient timetoconsiderallrelevantaspectsandtheyarealsoassistedbyqualifiedlawclerkswhowilldoallthe necessaryresearch.AsingleJudgeintheUrgentCourtisthereforesomewhatatadisadvantageinthis context.Nevertheless,onemustproceedwithcourageandfortitudenomatterwhatthetopicathandis.The idealofcoursewouldhavebeenthatLegislatureconsiderthewholetopicandthenproduceaBillwhichcould besubjecttothescrutinyoftheCourts.TheSouthAfricanLawCommissioncompiledareporton"Euthanasia andtheartificialpreservationoflife"inNovember1998,whichwassubmittedtothethenMinisterofHealth.The thirdrespondentsaidthatthereportdidnotreceivetheattentionoftheMinisterand/ortheLegislatureat thetime,becausetherewereotherurgentmatterswhichrequiredattentionsuchastheAIDSepidemic.Itis now16yearshenceandalthoughIcannotproscribethisforthesecondrespondent,thetopicisinmyview importantenough,havingregardtotherelevantprinciplescontainedintheBillofRights,thatserious considerationbegiventointroducingaBillonthebasisoftheSouthAfricanLawCommission'sReport,which suggestedanumberofoptions,butsupportedthedevelopmentofthecommonlawinthiscontext.Itis certainlyatopicthatdeservesbroaddiscussion,butinthecontextoftheBillofRightsespecially. [2] TheapplicantisanunmarriedadultmalepracticingadvocateoftheHighCourtofSouthAfrica.Heresidesin CapeTown.Hewasbornin1949.Heistheholderofanumberoflawdegrees,hasanMBAfromthe UniversityofCapeTownandanumberofotherdiplomas.Hehasworkedasanaccountantandtax practitionerinLondonandwasaChiefExecutiveofagroupofInsuranceBrokersatLloydsintheCityof London.Hehasbeenanadvocateforabout35yearsandwasalsoadmittedasan

Page112of[2015]3AllSA109(GP)

advocateoftheHighCourtofSouthAfricain2001,andwasamemberoftheJohannesburgBar.Hehaslived andworkedallovertheworld.Hehasfourchildren,threeofwhomareovertheageof25,andhasa daughterof12yearsoldundertheguardianshipofhermother,whoalsomadeaconfirmatoryaffidavitin theseproceedings.IsaythistoindicatethatIamdealingwithanapplicantwhoishighlyqualified,ofvast experiencealsointhelegalprofession,andwhoknowsexactlywhatherequiresandwhy.Aclinical psychologistalsoprovidedareportinthiscontext,dated10April2015.Shestatedthatapplicantwaswell engagedintheinterviewandshefoundnocognitiveimpairments.Therewasnoevidenceofanypsychiatric disorderandheparticularlyimpressedasbeingtotallyrational.Specifically,applicantdisplayedagood understandingandappreciationofthenature,causeandprognosisofhisillnessandclinical,ethicalandlegal aspectsofassistedsuicide. ViewParallelCitation

[3] Applicanthasterminalstage4cancerandhasonlyafewweekslefttolive.Thiswasnotanissue.[Hediedon thedayImademyorder.] [4] Intheseurgentproceedings,applicantseeksthefollowingorder: "2.

DeclaringthattheApplicantmayrequestamedicalpractitioner,registeredassuchintermsoftheHealth ProfessionsAct56of1974('amedicalpractitioner'),toendhislifeortoenabletheApplicanttoendhislifeby theadministrationorprovisionofsomeorotherlethalagent;

3.

DeclaringthatthemedicalpractitionerwhoadministersorprovidessomeorotherlethalagenttotheApplicant, ascontemplatedinprayer2supra,shallnotbeheldaccountableandshallbefreefromanycivil,criminalor disciplinaryliabilitythatmayotherwisehavearisenfrom:

4.

3.1

TheadministrationorprovisionofsomeorotherlethalagenttotheApplicant;

3.2

ThecessationoftheApplicant'slifeasaresultoftheadministrationorprovisionofsomeorotherlethal agenttotheApplicant;

Totheextentrequireddevelopingthecommonlaw,bydeclaringtheconductinprayers2and3supra,lawful andconstitutionalinthecircumstancesofthismatter."

[5] Applicant'squestions 5.1

Isitconceivablethatthehealthofapersonmaydeterioratetoalevel,wherehewouldbejustifiedin wishingtotakehisownlife("thesufferer");

5.2

Oughtthesuffererbepermittedtotakehisownlife;

5.3

Shouldanotherpersonbeallowedtoassistthesufferertoendhislife("theSamaritan");

5.4

Maythispersonbeamedicalpractitioner;

5.5

Whichsafeguardsneedtobeinplace?

[6] Theapplicant'shealth ApplicantwasprovisionallydiagnosedwithAdemacarcinoma(Gleasongrade9/10)on19February2013. DuringMarch2015,applicantunderwentanultrasoundbiopsyanditwasestablishedthatthecancerhad metastasizedinhislymphglands.AlsoduringMarch2015hewasadmittedtotheVictoriaHospitalasan emergency,andingreatpain.Hehassince Page113of[2015]3AllSA109(GP)

hadtohavehislymphremoved.Itwasfurtherdiscoveredthattheapplicant'scancerhadspreadtohislower spine,kidneysandlymphnodes.ThethirdrespondentobtainedareportofDrRAGDeMuelenaere,aradiation oncologistof26yearsstanding,andinprivatepracticesinceJuly1998.Thisreportisnotunderoath.Healso d i d  n o t ex am i n e th e p ati en t p er s o n al l y  an d  hi s  o p i n i o n  w as  b as ed  s o l el y  o n  th e c o n tents  o f  th e documentationcontainedintheCourtapplication.Inthecontextofthetestsrelatingtothediagnosisof prostatecancer,hesaidthatthefindingsweresuspiciousofcolorectalcancerincludingpancreasandliver cancer,notprostatecancer.Thisdebateisnotnecessaryherein,inasmuchasithasnotbeenputinissue thatthecanceristerminalandthattheapplicantonlyhasashorttimetolive.However,headdedthe followingandIwillhavebriefcommentstomakeaboutthishereunder: ViewParallelCitation "therearepalliativemedicaltreatmentsavailablewhichcanimprovethesituationforalengthyperiodoftime. IhavesympathyforapatientwithwidespreadmetastaticcancerandinmyworkIhavetodealwithsuch situationsonaregularbasis.Iunderstandapatientaskingfor'aneasywayout'butthereareimportant factorstoconsiderinacaselikethis.Widersocietalaspectsneedtobeaddressed,asinthedebatepreceding abortionlegislation.Allmoral,legalandethicalaspectsneedtobediscussed.Withmodernmedicineincluding highdosesofopioid(morphinelike)drugslessthan10%ofpatientswilldieinpain,regardlessofkidney function.(Dosescanbetritratedtopatientneedsandsideeffects). Hospicedoctorsandstaffspecialiseinsymptomcontrolofterminalpatientsandthisservicecanbeprovidedat homeinthevastmajorityofpatients.Mostmedicalfundswillallowhomenursingasabenefitandterminal caredefinitelydoesnotneedtobeprovidedinahospitalsettingforthemajorityofcasesifthatwouldbethe patient'swish.

AllandallIconsiderthisrequestfor'assistedsuicide'tobeagainstthecurrentmedicalpractice."

Applicantrespondedbysayingthatthispalliativecaredoesnotsatisfyhisneedandrighttodieindignity whilstfullyawareofthemomentofhisdeath. [7] Applicant'squalityoflife Applicant'squalityoflifehasdeterioratedmarkedlysincethemiddleofMarch2015andhesaysthathe: 7.1

Suffersfromseverepain,nausea,vomiting,stomachcramps,constipation,disorientation,weightloss, lossofappetite,highbloodpressure,increasedweaknessandfrailtyrelatedtothekidneymetastasis;

7.2

Heisunabletogetoutofbedandhasinjectionsanddrips;

7.3

Enduresanxiety;

7.4

Cannotsleepwithoutmorphineorotherpainkillers;

7.5

Usespainmedication,whichmakeshimsomnolent.

[8] Applicant'streatment 8.1

Thedoctors,theirdiagnosisandprognosis: Applicantwasexaminedbyaspecialisturologistandageneralpractitionerwholecturesandspecialises inpalliativecare,bothofwhomconfirmtheapplicant'sdiagnosisandprognosis.

Page114of[2015]3AllSA109(GP)

8.2

Medicine,proceduresandtraditionalremedies: Applicanthasundergonenumeroustreatments,medicinesortraditionalremedies,including: 8.2.1 Dendriticcelltherapy; 8.2.2 TraditionalChinesemedicine; 8.2.3 Vedicmedicine; 8.2.4 Surgery; 8.2.5 Cannabis; 8.2.6 Theinsertionofarenalstentforhiskidneysfromhiskidneystohisbladder; ViewParallelCitation

8.2.7 Theinsertionofacatheterfitter; 8.2.8 Morphine,Buscopanandotherpaininhibitors. Heiscurrentlyunderpalliativecare. [9] Imminentfuture 9.1

Acceptanceofdeath:

9.2

Worseningcondition:

Applicantisacutelyawareandhasacceptedthathisdeathisimminent.Thisissueisnotindispute.

Astimeprogressestheapplicant'sconditionwillbecomeprogressivelyworseandwilllateronrequire anevenstrongerdosesofopioiddrugssuchasmorphineandtopossiblybehospitalised. 9.3

Increasedfrailty: Heisbecomingweakerbythedayandneedsconstantassistanceinnormaldailyactivitiessuchas gettingupfrombed,bathing,brushinghisteethandeating.

9.4

Progressionofthedisease: Astheapplicant'sdiseaseprogressesanduntilhislastbreath,hewillbecomeconfusedandafraid.His lastbreathmightevenbewiththeaidofamachine.

9.5

Applicant'sfear: Applicantsaysthatheisnotafraidofdying,heisafraidofdyingwhilesuffering.

[10] Currentlegalposition Currentlaw Thecurrentlegalpositionisthatassistedsuicideoractivevoluntaryeuthanasiaisunlawful. See:SvDeBellocq1975(3)SA538(T)at539d[alsoreportedat[1975]1AllSA6(T)Ed]andSvMarengo 1991(2)SACR43(W)47AB[alsoreportedat[1991]3AllSA784(W)Ed]andExparteMinistervanJustisie: InreSvGrotjohn1970(2)SA355(A)[alsoreportedat[1970]2AllSA491(A)Ed]. Page115of[2015]3AllSA109(GP)

Developmentofthelawrequired ApplicantandhisCounselreliedonsection39oftheConstitutionwhichreadsasfollows:

"39InterpretationofBillofRights (1)

WheninterpretingtheBillofRights,aCourt,TribunalorForum

(2)

(a)

Mustpromotethevaluesthatunderlieanopenanddemocraticsocietybasedonhumandignity,equality andfreedom;

(b)

MustconsiderInternationalLaw;and

(c)

Mayconsiderforeignlaw.

Wheninterpretinganylegislation,andwhendevelopingthecommonorcustomarylaw,everyCourt,tribunalor forummust(Iunderline)promotethespirit,purporttheobjectsoftheBillofRights".

Further,section8(3)oftheConstitutionstatesthat: "whenapplyingaprovisionoftheBillofRightstoanaturalofjuristicpersonintermsofsubsection(2),aCourt

ViewParallelCitation (a)

InordertogiveeffecttoarightintheBill,must(Iunderline)apply,orifnecessarydevelop,thecommonlaw totheextentthatlegislationdoesnotgiveeffecttothatrightand

(b)

Maydeveloprulesofthecommonlawtolimittheright,providedthelimitationisinaccordancewithS.36(1)."

InBelPortoSchoolGoverningBodyandothersvPremierWesternCapeandanother2002(3)SA265(CC)the Courtat324[alsoreportedat2002(9)BCLR891(CC)Ed]saidthattheprovisionofremediesisopen endedandthereforinherentlyflexibleinthiscontext.Theappropriatenessoftheremedywouldbe determinedbythefactsoftheparticularcase. Itisthereforenotamatterofdiscretionorpersonal"inclination"asitwasputinCourt,butrathera constitutionalimperative.Mypersonalthoughtsandfeelingsareirrelevantanddonotenterthepictureatall inthedecisionmaking. [11] Basisofapplicant'srelief TheConstitution TheapplicantreliesonthefollowingprovisionsoftheConstitutionandinparticulartheBillofRights: 11.1 Chapter1: Foundingprovisions: Section1: "TheRepublicofSouthAfricaisone,sovereign,democraticStatefoundedonthe...