Euthanasia, broadly defined as intentionally ending a person’s life to relieve suffering, remains one of the most emotionally and ethically charged issues in medicine. For many terminally ill or severely suffering patients, the concept of a peaceful, dignified death can represent compassion, relief, and control when option after option has already failed. Yet across the world, and in our own country of South Africa, making that choice legal and socially acceptable remains deeply contested.

At its core, the debate over euthanasia raises fundamental questions.. Does a human being have the right not only to live, but to die with dignity when life becomes unbearable? Does the state and society have the moral duty to honour such a decision, or does it have a responsibility to protect life at all costs?

Legal Status of Euthanasia in South Africa..

Currently, in South Africa, active euthanasia and physician-assisted suicide remain illegal. 

The law draws a distinction between withdrawing or withholding life-sustaining treatment (which may be legal under certain circumstances) and active euthanasia or assisted suicide (which generally amounts to unlawful killing).  The official medical-ethical guidelines of the Health Professions Council of South Africa (HPCSA) make it clear that any medical intervention whose primary intention is to end life is both unethical and unlawful.  Over the decades, several court cases have attempted to challenge this status quo, but none has resulted in lasting legal change that broadly legitimises assisted dying.

Historic cases also reflect this.. in S v Hartmann (1975), a doctor who administered a lethal dose to his suffering father was convicted of murder, even though the motive was mercy. 

Thus, under current South African law, euthanasia is not legally permitted, medical practitioners who assist in ending life remain at risk of prosecution for murder or culpable homicide. 

Attempts at Legal Reform & Court Challenge..

Despite the legal prohibition, there have been repeated efforts in South Africa to change the law or at least challenge it.

As early as the early 1990s, the South African Law Commission (SALC) began investigating end-of-life issues, including euthanasia and “living wills.”  The SALC even drafted proposed legislation, sometimes called the End-of-Life Decisions Act, which would have provided a regulated framework for end-of-life choices. But that draft bill was never tabled in Parliament, it “gathered dust” and was never debated or put to public hearings. A landmark court case was Stransham-Ford v Minister of Justice and Correctional Services (2015). The applicant, terminally ill with cancer, asked the High Court for an order allowing a physician to assist him in ending his life. The judge found in his favour, arguing that a mentally competent, terminally ill adult has a constitutional right to end his life with medical assistance, without the doctor facing criminal liability.  However and crucially, because the applicant died just hours before the order was formally granted, the judgment was later set aside on appeal, making the decision moot. The court ruled that the case was not a proper vehicle to change common law on murder and euthanasia.  Since then, further attempts by individuals (e.g. patients + palliative-care doctors) to initiate new cases have met resistance, the government and medical regulatory bodies remain opposed to legalising assisted dying. 

In short, although significant steps have been taken, and the ethical and constitutional arguments have been clearly articulated in court, there is still no legal regime in South Africa granting a general right to euthanasia or assisted suicide.

Ethical, Medical, and Human Rights Considerations..

The debate over euthanasia is not just legal, it is deeply moral, medical, and philosophical. Here are some key considerations often invoked by proponents and critics:

✔ Arguments for Euthanasia / Assisted Dying…

Human dignity & autonomy, For many terminally ill patients, maintaining dignity is more than semantic, it is an essential affirmation of their humanity. As advocates often put it, if life becomes unlivable, unbearable, stripped of dignity, should not a person have the right to choose a merciful, peaceful death? Medical ethicists sometimes cite autonomy and bodily integrity as fundamental, meaning a person should have control over not only how they live, but how they die.  Relief from suffering. Modern palliative care aims to alleviate pain and distress, but there are conditions, aggressive cancers, degenerative neurological disease, extreme pain or loss of bodily functions, where suffering may become “incurable and unbearable.” In those instances, euthanasia may be seen as a compassionate alternative to prolonged agony. Critics of the ban often argue that forcing people to continue suffering is cruel. Consistency with other decisions. If a patient can refuse life-sustaining treatment, or refuse resuscitation, or have treatment withdrawn, why should they be prohibited from asking for active help to end life? Some see the current legal prohibition as inconsistent, arbitrary, or insufficiently sensitive to the realities of terminal illness and suffering. 

As one scholar wrote in the international context of “right to die” debates.. “The question is whether the right to life includes, or should include, the right to die with dignity.” 

✖ Arguments Against Euthanasia / Risks & Concerns..

Protection of life & societal value. The right to life, enshrined in the constitution of South Africa, is widely interpreted as a foundational human right. Critics argue that legalising euthanasia undermines society’s commitment to protect life, especially vulnerable lives (disabled, mentally ill, poor, elderly). Potential for abuse. Regulatory bodies such as the HPCSA warn that if euthanasia becomes legal, there is a risk of misuse, pressure on patients (especially poor or dependent ones), coercion, family or societal pressure, or even economic motivations influencing “voluntary” choices.  Slippery slope and ethical integrity of medicine. Many fear that permitting doctors to kill, even at the request of patients, corrupts the fundamental role of medicine, which should heal, relieve, and preserve life. The concern is that the line between “compassionate death” and “convenient death” may blur over time.  Lack of robust legal safeguards. Because South Africa never enacted the draft legislation proposed by SALC (e.g. the End-of-Life Decisions Act), there is no regulatory framework to ensure that euthanasia, if ever permitted, would be applied fairly, transparently, and with the full protection of patient autonomy, consent, and safeguards against coercion. 

The Human Side.. Why People Still Push for “The Last Right”

Behind the legal cases, draft bills, and court judgments are real people, terminally ill patients, families, palliative-care doctors, caregivers, for whom the debate is not hypothetical. The desire for a dignified death is rarely abstract, it is deeply personal.

For many, euthanasia is not about “giving up” but about refusing “prolonged suffering” and “meaningless agony,” about preserving dignity in the final stage of life. Some see it as a matter of autonomy, the right to decide not just how you live, but how you die. Others view it as a compassionate act, not only for the patient, but also for loved ones, who often suffer alongside, seeing prolonged pain, loss of dignity, decay, and helplessness can leave lasting trauma.

As one pro-euthanasia writer argued, if the option for a merciful death exists, and if terminal illness leaves no hope for quality of life, then denying a patient that choice may be a profound injustice. 

Conclusion & Reflection..

The issue of euthanasia in South Africa reveals a profound tension between two powerful truths..

The sanctity of life, long upheld in law, medicine, and moral tradition. The dignity of suffering human beings, their right to avoid unbearable pain, maintain control, and decide how they exit the world when life becomes an unbearable burden.

Despite decades of debate, draft legislation, and even court challenges, South Africa has not yet embraced a legal framework for euthanasia or physician-assisted death. The reasons, fear of abuse, ethical concerns, cultural resistance, regulatory caution, are serious and worthy of respect.

Yet the voices calling for “the last right” grow louder, citing constitutional rights to dignity, autonomy, bodily integrity, and compassionate relief of suffering. The debate is not just legal, it is deeply human.

If ever South Africa is to allow peaceful, dignified death for those who suffer beyond hope, it will require more than legal reform. It will demand a societal reckoning, with suffering, death, dignity, care, compassion, and with the kind of society we want to be.