By Dr Pooja Aashan Singh — Emergency Medicine
Palliative care is comfort care. It’s what happens when the goal shifts from cure, to living as well as possible for whatever time remains. Pain better controlled. Breathlessness eased. Nausea settled. Difficult conversations held gently, early and with the respect that it deserves. It is legal, and in South Africa it’s quietly heroic and desperately under-resourced. Most people who could benefit from it never reach it, and many who do reach it far too late.
Let’s clear up the confusion first, because it costs families dearly at the worst possible moment. Euthanasia, on the other hand, a doctor ending a patient’s life at their request, remains illegal in South Africa. So does assisted dying, where a doctor helps a patient end their own life.
In April 2015, a Pretoria High Court judge ruled that a terminally ill man, Robin Stransham-Ford, had the right to be assisted to die, the first South African ruling of its kind. He died of cancer just hours before the order was handed down, before it could ever be acted on. The State appealed anyway, and in December 2016 the Supreme Court of Appeal set the ruling aside, not because it disagreed on the merits, but because Stransham-Ford had already died: there was no longer a living case for the court to decide, so the deeper question of whether assisted dying should be legal was never actually answered. The door opened for a few months and was then closed on a technicality. The law hasn’t moved since, and the debate hasn’t gone away, but the debate and the law are two different things, and only one of them governs what happens at your loved ones bedside tonight.
This is what the law does allow, and what too few families know. You have the right to refuse treatment, even treatment that’s keeping you alive. You can decline the ventilator, the feeding tube, the next round of chemotherapy. Your doctor may lawfully withhold or withdraw treatment that’s become futile, only prolonging dying rather than restoring life. And your doctor may give you enough medication to control severe pain, even if, as a side effect, it shortens the time you have. Easing suffering is legal. Intending to kill is not. That line is fine, and it’s real, and understanding it changes how these final weeks unfold.
So why does this conversation so rarely happen properly? Because palliative care isn’t evenly available, and dignity shouldn’t depend on your postal code or your medical aid. Because doctors are trained to fight death and are often clumsy at sitting with it. And because we haven’t yet had the grown-up conversation, as a society, about what a good death looks like and who gets to decide.
But you can be ready as a family, and that’s where the power actually sits. Ask the questions before the crisis, not during it. Ask what palliative care exists near you. Ask your person what matters to them: where they want to be, what they’d trade and what they’d never trade, what “enough” looks like. Write it down. Tell the whole family, not only the one who agrees with you. Discuss a living will with your family and what you would and would not consent to, and under what circumstances. If you’re not sure where to start, ask your GP or specialist whether a palliative care team could be part of this. You don’t need a terminal diagnosis to ask, and asking early gives everyone more room to plan well instead of scrambling in a crisis. Most provinces have hospice organisations offering home visits, and many private hospitals have palliative teams who work alongside your existing doctors, not instead of them.
Whether South Africa should legalise assisted dying is a question I hold with real humility, and I won’t pretend the answer is simple. It asks us to balance two deeply held values that often come into conflict: the duty to preserve life and the obligation to relieve suffering. For some patients, assisted dying represents dignity, autonomy and freedom from unbearable suffering. For others, it raises profound concerns about the sanctity of life, the protection of vulnerable people, and the possibility of coercion or abuse. There are no easy answers, only difficult questions that deserve careful, compassionate, and evidence-informed discussion.
REFERENCES 1. Stransham-Ford v Minister of Justice and Correctional Services and Others [2015] ZAGPPHC 230 (North Gauteng High Court, order 30 April 2015, reasons 4 May 2015). 2. Minister of Justice and Correctional Services and Others v Estate Late James Stransham-Ford and Others (531/2015) [2016] ZASCA 197; 2017 (3) SA 152 (SCA) (6 December 2016). 3. Health Professions Council of South Africa (HPCSA). Guidelines for the Withholding and Withdrawing of Treatment, and ethical guidance on end-of-life care, Booklet 12. 4. Hospice Palliative Care Association of South Africa (HPCA). Information on hospice and home-based palliative services. hpca.co.za.