Assignment (MPhil)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: This study was undertaken to evaluate whether a mentally competent mature human being, who is suffering an intolerable, irremediable existence resulting from an incurable agonising or devastating paralysing disease; has a moral, personal and civic right to end that life or have it ended by requesting assistance in meeting death in a humane, compassionate and dignified manner. ~ The righteousness of such assistance can only be gauged if it follows the repeated and voluntary request of someone who is presently not suffering from any psychiatric disorder, is presently mentally competent or had made such a written or verbal witnessed advance directive while mentally competent to do so. ~ This study will not deal with assistance in dying either active or passive which is performed on severely mentally and physically handicapped new-born babies with scant prospect of survival; nor with euthanasia for the relief of malignant or paralysing disease in those with life-long [anoxic, congenital, inflammatory or traumatic] mental incompetencies who have never had decision-making capacity. ~ This study will not address issues of aid-in-dying for mentally incompetent persons suffering from senile dementia, Alzheimer's disease, or permanent vegetative states due to brain pathology following anoxic, circulatory, infective, malignant or traumatic events, who have not made advance directives and who had never stated preferences concerning assisted euthanasia. The aim of this study is to outline the moral case advanced by those in favour of legalising Voluntary Assisted Euthanasia [VAE] also called Assisted Euthanasia [AE] and to develop ethically sound and practical proposals for policy and actions contributing towards the resolution of the moral dilemma faced daily by doctors when asked by mentally competent patients suffering from irremediable malignant or paralysing diseases or the agonising symptoms of end-stage Acquired Immune Deficiency Syndrome (AIDS) for assistance to end their lives. }ii> This study will cover and discuss the more important objections of those opposed to the legalising of assisted suicide for mentally-competent terminal patients who are irremediably suffering in their bodies or from dehumanising incurable endstage paralysing diseases and are near to an inevitable death. }ii> The insights of philosophers, theologians, physicians and sociologists on the subject of suicide and aid-in-dying, have been researched in the extensive literature that exists (both in print and in cyberspace) on these subjects and are presented with the study. }ii> The study tries to show that a competent adult in certain grim circumstances should have an inalienable human right, if not a constitutional one, to request assisted euthanasia or aid-in-dying or assistance in ending their lives. }ii> Such assistance must be subject to peer review, after careful assessment by a multidisciplinary team in the healing [both physical and spiritual] professions This paper will try to determine whether the actionalisation of voluntary assisted suicide or assisted euthanasia is murder or an act of compassion and empathy performed out of respect for a fellow human being's autonomy and in deference to their right to self-determination and self-realisation. ~ The relevance of this situation is that aid-in-dying is becoming one of the major, moral, religious, philosophical and bio-medical dilemmas at this time. ~ The author's position is that it is neither just nor ethical to prevent a mentallycompetent human being, who is tormented by agonising, incurable terminal physical or irremediable paralysing disease, from deciding to chose to die when he/she can no longer bear the torment and asking for professional assistance to effect this. This relief should be given not only to those who are able to make an enduring, informed contemporaneous decision, but also to those who [when they still had decision-making capacity] had previously made a considered informed advance directive about the use of ordinary and extraordinary medical methods of sustaining a life that had become merely an existence. / AFRIKAANSE OPSOMMING: Die studie is onderneem om te evalueer of 'n bevoegde, volwasse mens wat 'n onverduurbare en ongeneesbare bestaan het a.g.v. 'n ongeneesbare, folterende of vernietigende siekte, 'n morele, persoonlike of burgerlike reg het om daardie lewe te beeïndig of hulp te vra om dit te laat beeïndig, ten einde die dood op 'n menswaardige wyse tegemoet te gaan. ~ Die regverdigbaarheid van bogenoemde hulp kan slegs bepaal word as dit volg op die herhaalde en vrywillige versoeke van iemand wat nie, wanneer hy/sy dit versoek, ly aan 'n geestessiekte nie, wat bevoeg is of wat so 'n geskrewe of mondelinge versoek, met getuies, gemaak het terwyl die persoon kompetent was. ~ Die studie handel nie oor bystand-in-sterfte, aktief of passief, waar dit uitgevoer word op fisies of psigies ernstig gestremde pasgebore babas met 'n skrale kans op oorlewing nie; ook nie oor genadedood ter verligting van kwaadaardige of verlammende siekte in diegene met lewenslange [anoksiese, kongenitale, inflammatoriese of traumatiese] geestelike ongesteldhede, wat nog nooit besluitnemende kapasiteit gehad het nie. ~ Die studie ondersoek nie gevalle van bystand-met-sterfte waar inkompetente persone wat ly aan seniliteit, Alzheimer se siekte, of permanente vegetatiewe toestande a.g.v. brein patologie n.a.v. anoksiese, sirkulatoriese, infektiewe, kwaadaardige of traumatiese gebeure, nie direk gevra het vir genadedood of nooit die voorkeur vir geassisteerde genadedood uitgespreek het nie. Die doel van hierdie studie is om die morele saak van diegene ten gunste van die wettiging van Vrywillige Geassisteerde Genadedood, ook bekend as Geassisteerde Genadedood, te stel en om praktiese sowel as eties verantwoordbare voorstelle te maak vir beleid en optrede wat kan bydra tot die oplos van die morele dilemma wat dokters daagliks in die gesig staar wanneer hulle deur geestelik bevoegde pasiënte wat ly aan ongeneesbare, kwaadaardige of verlammende siektes, of die folterende simptome van die finale stadium van Verworwe Immuniteits Gebrek Sindroom [VIGS], gevra word vir bystand in die beeïndiging van hulle lewens. ~ Die studie sal die belangriker besware van diegene aanspreek wat teen die wettiging is van geassisteerde genadedood vir geestelik bevoegde terminale pasiënte wat ongeneesbaar ly of van dehumaniserende ongeneesbare finale stadium siektes en wat naby is aan 'n onafwendbare dood. ~ Die insigte van filosowe, teoloë, dokters en sosioloë oor bystand-met-sterfte en selfmoord, is nagevors in die wye literatuur beskikbaar is (beide in druk en kuberruimte) oor hierdie onderwerpe en word saam met die studie angebied. ~ Die studie probeer aantoon dat 'n bevoegde volwassene in sekere erge omstandighede 'n onvervreembare mensereg, indien nie 'n konstitusionele reg nie, behoort te hê om bystand tydens genadedood te versoek. ~ Sulke bystand moet onderworpe wees aan groepsevaluasie, na versigtige ondersoek deur 'n multi-dissiplinêre span in die gesondheidsprofessies [beide fisies en psigies]. Die studie sal probeer bepaal of die uitvoering van vrywillige geassisteerde selfmoord of geassisteerde genadedood moord is, of 'n aksie van empatie, uitgevoer uit respek vir 'n medemens se outonomie, sy/haar reg tot selfdeterminasie en self-realisasie. )lo- Die relevansie van hierdie situasie lê daarin dat bystand-met-sterfte besig is om een van die belangrikste morele, religieuse, filosofiese en biomediese dilemmas van ons tyd te word. )lo- Die outeur se posisie is dat dit nie regverdig of eties is om te verhoed dat 'n geestelik bevoegde mens, wat ly aan folterende, ongeneesbare terminale fisiese of ongeneesbare verlammende siekte, self kies om te sterf wanneer hy/sy nie meer die lyding kan verdra nie en vir professionele bystand vra om dit uit te voer. Die verligting behoort gegee te word, nie net aan diegene wat in staat is om 'n bindende en ingeligte besluit te maak nie, maar ook aan -diegene wat [toe hulle nog besluitnemende kapasitiet gehad het] vroeër 'n oorweegde, ingeligte vroegtydige versoek gemaak het aangaande die gebruik van gewone en buitengewone mediese metodes vir die verlenging van 'n lewe wat bloot 'n bestaan geword het.

Thesis (MA)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: Suicide is a truly philosophical problem. Judging whether life is or not worth living amounts to answering the fundamental question of philosophy. In Africa, suicide is not uncommon as evidenced by the Botswana experience. Suicide acts are the forefront of the daily existence even today. Suicide is felt in different areas of Botswana and while the study draws heavily on Africa especially Botswana, reference is also made to countries outside Africa. Hence, suicide in this thesis is not addressed in a restrictive manner. But its manifestation in essence is assessed in a general mode. This implies that the escalation of suicide is viewed from the sociological, psychological and philosophical implications. Although it is not easy to accept and live with suicide, people are beginning to accommodate it as an inevitable concept. However, the family and friends of a person who has committed suicide still feels ashamed, humiliated and sometimes guilty. The aim of this assignment is to analyse and evaluate the moral argument for and against suicide and to focus on the moral implications of committing suicide. While agreeing that individuals' autonomy are personal, the writer tries to suggest a way out of this self-destruction (suicide) which is just a means to an end and not an end in itself. The writer in the concluding chapter tries to explore the pros and cons of suicide, and comes up with the conclusion that the right to live should be given attention than the right to die, at least to preserve its generations which all creatures strive for. Areas of focus: • The concept of Suicide • The nature and incidence of Suicide. • Arguments in favour of Suicide • Arguments against Suicide • The Suicide I Euthanasia Debate / AFRIKAANSE OPSOMMING: Selfmoord is 'n ware filosofiese probleem. Om te oordeel of 'n lewe die moeite werd is om gelewe te word, vereis 'n antwoord op 'n fundamentele vraag van filosofie. In Afrika is selfmoord nie ongewoon nie, soos gesien in die geval van Botswana. Selfmoord kom baie algemeen daar voor. Selfmoord word aangetref in verskeie areas in Botswana, en, alhoewel die studie fokus op Afrika - en spesifiek Botswana, word daar ook verwys na lande buite Afrika. Maar die manifestasie daarvan word in essensie en in die algemeen aangespreek. Dit beteken dat die toename in selfmoord in terme van die verskynsel se sosiologiese, sielkundige en filosofiese implikasies aangespreek word. Alhoewel dit nie maklik is on selfmoord te aanvaar en mee saam te leef nie, begin mense dit aanvaar as 'n onvermydelike verskynsel. Maar die familie van 'n persoon wat selfmoord gepleeg het voel steeds skaam, verneder en soms skuldig. Die doel van hierdie werkstuk is om die argumente vir en teen selfmoord te analiseer, te evalueer, en om te fokus op die morele implikasies van selfmoord. Alhoewel die outeur saamstem dat individue outonoom is, word sterk teen die morele aanvaarbaarheid van selfmoord geargumenteer. In die gevolgtrekking ondersoek die outeur die voordele en nadele van selfmoord en eindig met die bevinding dat die reg tot lewe meer aandag behoort te kry as die sg. reg om te sterf. Areas waarop gefokus word: • Die konsep "selfmoord" as sodanig • Die aard van selfmoord en (hoe algemeen dit voorkom.) • Argumente ten gunste van selfmoord • Argumente teen selfmoord • Die selfmoord -genadedood debat

Master’s thesis submitted to Faculty of Humanities in partial fulfilment of Master of Arts: Applied Ethics for Professionals University of the Witwatersrand Department of Philosophy, 2017 / In this thesis I explore the issue of voluntary assisted suicide in a South African constitutional context through the tri-coloured normative prism of autonomy, dignity and human well-being. I will focus on the way South Africa, as a secular society, ought to engage with this highly emotive issue in light of the socio-legal framework in which we are embedded and which framework carries with it profound normative implications. I divide the discussion into two broad sections. In the first section I articulate, from an ethical standpoint, what I take to be the strongest positive case for South African society to permit voluntary assisted suicide. I argue that by permitting voluntary assisted suicide South African society would be giving proper expression to (i) individual autonomy (ii) human dignity, and (iii) human well-being. In articulating the positive case I also analyse the triumvirate concepts of individual autonomy, dignity and human well-being as well as their relationship to each other. I argue that individual autonomy is an essential component of a good human life, that is to say, a worthwhile life and that to speak of a dignified life is, in turn, to speak of the sort of life that is worthy of respect, reverence and honour. I then turn to an examination of two of the principal ethical arguments against the moral permissibility of voluntary assisted suicide in the literature, namely (i) the Sanctity of Life Argument, and (ii) the Social Harm Argument. I argue that neither argument is sufficiently persuasive to rebut the positive case in favour of voluntary assisted suicide. However, certain critical considerations are raised that do speak to the need for effective oversight and regulation of such a practice in South African society. Accordingly, I advance the view that, in light of the failure of these two principal arguments (and in the absence of any stronger arguments) voluntary assisted suicide ought to be permitted in South Africa subject to uniform, public and specifiable oversight criteria applicable to each individual who wishes to end his life with the assistance of another. In the second section, I describe the South African legal standpoint on voluntary assisted suicide in light of (i) the normative underpinnings of the Constitution of the Republic of South Africa, 1996 (and in particular the Bill of Rights) and (ii) the present legal status of voluntary assisted suicide, taking into account both the common law and the South African Law Commission Report on Euthanasia and Artificial Preservation of Life, 1998. This analysis involves an examination of (i) the recent decision of Stransham-Ford v Minister of Justice and Correctional Services & Others1 handed down on 4 May 2015 in which the North Gauteng High Court granted, for the first time in South African legal history, an application allowing a terminally ill man the right to die and to be actively assisted to do so by a consenting physician; as well as (ii) the subsequent Supreme Court of Appeal decision in The Minister of Justice and Correctional Services & Others v Estate Late Stransham Ford2 that overturned the original decision. I argue that the best way to understand the socio-legal framework in which we find ourselves is as a social contract that ‘instantiates’ or ‘gives expression to’ a rights-based ethic, which in turn protects vital human interests. I argue further that this constitutional legal framework is capable of tracking and incorporating the positive ethical case for voluntary assisted suicide admirably. Finally, I posit that the quickest and most effective way to implement a permissive policy for voluntary assisted suicide is through the development of the common law. In the process, I tentatively suggest what appropriate safeguards and oversight of voluntary assisted suicide might look like, the practical implementation of which would allow South African society – specifically through the judicial branch of government - to more sagaciously and compassionately judge lives. / XL2018

Thesis (MPhil)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Responsibility is either linked to duties and expectations, or it is linked to the freedom of an agent. These links are questionable. It is therefore necessary to investigate the freedom and context of commission and omission. There are numerous difficulties in evaluating suicide: - The problem to distinguish between successful suicide and failed pseudo suicide. - The problem of the mind: The limited accessibility of the emotions and attitudes despite its expressibility And the unexpressibility of the experiences despite its immediate accessibility. And the problem of other minds. - The problem of the freedom of the will. Prove is given that no aspect of the mind is free - despite our illusions of freedom. - The problem of the cause, origin and extent of an act. - The problem of the relation between brain and mind. This problem is important when we consider the origin of acts and the concept of the self. The important issues when solving the difficulties pertaining to suicide are: - Agency: The self is owner of all acts and instances of mind. The self is also the subject of all physical acts and acts of the mind. - The self is an open complex system. The self is entangled in relations of differences, conflict and deferment of meaning. The important conclusions when evaluating suicide are: - The agent is the owner and the subject of his acts. The agent has illusions of freedom. The agent is inseparable from his circumstances. - Acts originate in the context of these circumstances. - Responsibility exists in the context of power in society. - The answers to the questions of Why? Are logical reconstruction and politically correct confabulations - whatever the answer is, it is shared by all participants of the context.The evaluation of suicide: - The self-murderer`s act originates from the context of the circumstances of which he is a participant. - Suicide happens within the context of a pancheiria with aspects of autocheireō and heterocheireō. - The pancheiria started before the autocheireō. - The pancheiria continues after the autocheireō. The autocheireō is but an indication of the seriousness van the larger pancheiria. The self-murderer (autocheir) and his autocheireō persist as a silhouette in our midst. - The possibility of the self-murderer`s illusion of freedom does not liberate us from the silhouette`s accusations. - Neither does se sharing of guilt give as relieve from the silhouette`s accusations. - Neither will we benefit from any rationalization. Finally we can do nothing but to utter these statements of denial and confession : - Suicide is wrong. - But we have not done it. / AFRIKAANSE OPSOMMING: Verantwoordelikheid word óf aan verpligtinge en verwagtinge, óf aan die vryheid van die agent verbind. Hierdie verbindings word betwyfel. Daarom is dit nodig dat die vryheid van handeling en nie-handeling sowel as die konteks waarin die handeling en nie-handeling gebeur ondersoek word. Verskeie probleme ten opsigte van die beoordeling van die selfmoord word uitgewys: - Die probleem om die werklike geslaagde selfmoord te onderskei van die gefaalde selfmoordpoging. - Die probleme van die verstand. Naamlik die beperkte toeganklikheid van die emosies en houdings, alhoewel dit uitdrukbaar is. En die onmiddelike toeganklikheid van die ervarings wat dit te spyt nie uitdrukbaar is nie. Asook die probleem om ander verstande te ken. - Die probleem van die vryheid van die wil. Dit word aangetoon dat geen aspek van die verstand vry is nie. Dit nie teenstaande het ons steeds die illusie van vryheid. - Die probleem van die oorsaak, die oorsprong en die reikwydte van handelinge. - Die probleem van die verhouding tussen die brein en die verstand. Hierdie probleem is belangrik by die oorwegings van die oorspong van handeling en die siening van die self. Belangrike elemente by die oplossing van die beoordeling van selfmoord is: - Die agentskap: naamlik dat die self die eienaar van alle verstandsitems en handelinge is, en dat die self die subjek van alle verstandshandelinge en sigbare handelinge is. - Die self as `n oop komplekse stelsel wat in wederkerige verhoudings is van verskil, geskil en uitstel van betekenis.Gevolgtrekkings wat belangrik is by die beoordeling van selfmoord: - Die agent is eienaar en subjek van sy handelinge, het die illusie van vryheid, is deel van sy omstandighede. - Die handeling ontstaan in die konteks van hierdie omstandighede. - Verantwoordelikheid bestaan in die konteks van mag in die samelewing. - Die antwoord op Hoekom? en Waarom? is logiese herkonstruksies en politiese korrekte konfabulasie - maar wat ookal die antwoord is, dit word gedeel deur al die deelnemers aan die konteks. Die beoordeling van selfmoord: - Die selfmoordenaar se handeling ontspring uit die konteks van sy omstandighede waaraan hy `n deelnemer is. - Die selfmoord gebeur eerder binne die konteks van `n pancheiria met aspekte van autocheireō en heterocheireō. - Die pancheiria was reeds voor die autocheireō. - Die pancheiria duur voort na die autocheireō. Die autocheireō toon aan ons die erns van die oorkoepelende pancheiria. Die selfmoordenaar (autocheir) en sy autocheireō bestaan voort as silhoeët in ons midde. - Die moontlike illusie van vryheid van die selfmoordenaar kan ons nie die aanklag deur die silhoeët ontsnapping bied nie. - Net so min kan die verdeling van skuld ons van die aanklag laat ontsnap. - Enige rasionalisering van ons kant is nutteloos. Laastens kan ons net sê: - Selfmoord is verkeerd. - Ons het dit nie gedoen nie. Hierdie stellinge dien as ontkennings sowel as skuldbeleidenisse.

In this dissertation the literature on suicidal behaviour is reviewed, with particular emphasis on professional conceptualizations and understanding as informed by the psychiatric and sociological paradigms. Basic postulates of the Ecosystemic paradigm, as it is informed by Maturana's second-order cybernetic approach was discussed. The effect of such an approach on therapy with suicidal individuals was pointed out. It became clear that perceived methodological problems experienced when researching suicidal behaviour from a Newtonian/realist paradigm can be side-stepped when viewed from an Ecosystemic paradigm. It was finally proposed that an ethic of participation, as informed by a second-order cybernetic approach, be adopted when viewing the suicide situation. In the process ethics was reconceptualized as an awareness of the therapist's participation in whatever is created, and not in finding the ''right" way when working with suicidal individuals. / Psychology / M.A. (Clinical Psychology)

In this dissertation the literature on suicidal behaviour is reviewed, with particular emphasis on professional conceptualizations and understanding as informed by the psychiatric and sociological paradigms. Basic postulates of the Ecosystemic paradigm, as it is informed by Maturana's second-order cybernetic approach was discussed. The effect of such an approach on therapy with suicidal individuals was pointed out. It became clear that perceived methodological problems experienced when researching suicidal behaviour from a Newtonian/realist paradigm can be side-stepped when viewed from an Ecosystemic paradigm. It was finally proposed that an ethic of participation, as informed by a second-order cybernetic approach, be adopted when viewing the suicide situation. In the process ethics was reconceptualized as an awareness of the therapist's participation in whatever is created, and not in finding the ''right" way when working with suicidal individuals. / Psychology / M.A. (Clinical Psychology)