Medical affidavit (by Dr Allan Donkin)

Response to Mr Stransham-Fordfs affidavit on the subject of physician assisted suicide:
Medical affidavit to the April 2015 hearing of the Stransham-Ford case by Dr Allan Donkin

Though I would like time to provide a more comprehensive submission there are a few
points I would like to make initially.
I would like to challenge Mr Stransham-Ford’s affidavit in terms o f his idea of “dignity”.
In his Affidavit he states:
34. There is no dignity in:
34.1 having severe pain all over one’s body;
34.2 being dulled with opiate medication rendering:
34.2.1 you being unaware o f your surroundings and loved ones;
34.2.2 being confused and dissociative;
34.3 being unable to take care of your own hygiene;
34.4 dying in a hospital or hospice away from the familiarity of your
own home;
34.5 dying, at any moment, in a dissociative state unaware of your loved
ones being there to say goodbye.
He states that there is no dignity in these situations. Bv this he is stating (perhaps
unawares) that he considers people who are in pain, on medication, confused, unaware,
unable to care for their own hygiene, people who die in a hospital or hospice away from
the familiarity of their own home, to be without dignity and therefore undignified.
Would such people be an offence to his sensibilities?
Who is he to declare that such people are undignified?

The South African constitution states that everyone has a right to dignity.
Dignity is not dependent on ones function, but rather an innate part of being a human
being no matter what state one is in. Our drive in society should be to afford everyone
dignity by refusing to snuff them out when we feel our sensibilities are offended by
them.

Dignity is something given by the community around an individual. If we love someone
and say that they have great worth as a human and we consider them dignified, then they
have dignity, no matter what state they are in. Because of the dignity we as a community
afford them we will then care for them without resentment.
Were the court to grant Mr Stransham-Ford’s request they would in fact be taking away
peoples right to dignity by declaring that some people in some circumstances are not
worthy of dignity and are undignified and therefore can be snuffed out.
Mr Stransham-Ford is not so much making a statement about his own dignity, but rather
is revealing that he believes that not all South African’s deserve dignity, particularly if
they are in a state of dying.

He is asking in fact for the opposite of dignity.

Surely the right to dignity in the Constitution should not be interpreted as the right to
feel dignified. We have no control over the feelings o f individuals. But we should insist
that people have dignity and treat them with dignity even if they feel undignified.
Treating people with dignity in spite of their feeling undignified would mean refusing to
snuff them out. It would mean insisting on treating them as precious and people who
have inherent value as human beings and not treating them as we do animals. We
euthanase animals precisely because they are not human beings with unique human
value and dignity protected in the Constitution. To euthanase humans like we do animals
would be to remove their human uniqueness, value and dignity. It would be to degrade
human dignity.

As a General Practitioner I have personal experience in treating many patients in their
stages of dying and weakness. I believe that if the court were to affirm Mr Stransham-
Ford’s interpretation of dignity this would in fact undermine the dignity o f many people
who are dying and weak.

Furthermore I would like to point out what I believe to be some errors in medical fact in
Mr Stransham-Ford’s Affidavit

He states in point 47.5 “there is a risk that my symptoms might not be adequately
addressed due to poor renal function”. I note that Dr Bruce also states this in his report
(Point 8 o f Dr Bruce’s report on page 59 o f the Affidavit). However no reason for this
statement is given by Dr Bruce. Dr Bruce should be required to prove this statement as
he provides no evidence for it.

Just before this in point 47.4 o f Mr Stransham-Ford1 s Affidavit he reports the
foil owing,” as a result o f my poor kidney function, many o f the pain medications are
contraindicated and not as effective as my kidneys are unable to properly metabolise
medication;”

This statement by Mr Stransham-Ford is at the core of his argument for medical
urgency; However this information is not stated in Dr Bruce’s report. The onus is on Mr
Stransham-Ford to prove this as he has not produced any evidence to substantiate it. It
may be a result of his misunderstanding of what he was verbally told by Dr Bruce.
There are sufficient medicines to treat pain in renal failure safely, and what is more, in
palliative care we are no longer concerned about possible toxic effects of medicines
when a person is in their final stages o f dying as symptom control becomes of
paramount importance in the last few days.

Please see the following attachment for evidence:
Opiate toxicity in patients with renal failure
BM J 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7537.345 (Published 09 February
2O06)Cite this as: i?M/2006;332:345

He states in point 24 “If any other treatment other than Morphine is required, I’ll have to
receive same at hospital away from home”. This is not stated in Dr Bruce’s report. The
onus is on Mr Stransham-Ford to prove this as he has not produced any evidence to
substantiate it.

In my experience working with hospice, patients are able to receive all manner of
treatments from hospice nurses and doctors in their homes including palliative sedation
with a variety o f medications.

He states in point 29 “I am bed ridden and have injections and drips.” As a medical
doctor I know that he already has a right to decline any medical intervention he wishes
and physician assisted suicide will have no impact on this.

He states in point 30 “I will be confused and scared… until I breathe my last, which may
even he with a machine.” As a medical doctor I know that he already has the right to
make his wishes known to his doctors if he would not like to be put on a machine to help
him breathe. Physician assisted suicide will have no impact on this. In fact doctors
would be very unlikely to put him on a ventilator even if he wished it as he is known to
have a terminal illness.

These comments of Mr Stransham-Ford reveal that he does not have a good
understanding of the process that lies ahead of him, and that his doctors have not yet
adequately explained what he can choose about what he will go through. He request for
physician assisted suicide is unnecessary as there are already solutions to many o f his
fears. His lack of accurate information makes his request for physician assisted suicide
to be without credibility.

Lastly, Mr Stransham-Ford’s request for physician assisted suicide would add nothing to
his situation. He is already capable of committing suicide if he so wishes, and it would
be an easy task for him to overdose on the pain medication that he would be taking. As
physician assisted suicide would not change anything about his ability to commit
suicide, I must conclude that the reason he is making this request is not that he would
like a change in his circumstances, but rather that he would like the Court and the
Medical Profession to agree with his world view that human beings are undignified and
lack no inherent dignity when they are in certain states of being, and so can be snuffed
out. I believe by disagreeing with him we as a community will be continuing to afford
dignity to all who are weak and dying (in accordance with the Constitution), including to
Mr Stransham-Ford.

Signed
Dr Allan John Donkin