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Medical Law and Ethics

Medical Law and Ethics Regarding Treatment Withdrawal for a Terminally Ill Patient in South Africa

Failure to get informed consent for a particular medical treatment according to the regulations of medical law in South Africa falls within the scope of medical practice if the failure to do so has caused harm to the patient. The National Health Act, no. 61 of 2003 details the obligations of the healthcare provider regarding informed consent.

Although the action of a healthcare professional may be within the boundaries of the law, when it comes to the health profession in South Africa, it is also about ethics. The Health Professions Council of South Africa (HPCSA) provides ethical guidelines for medical professions regarding every aspect of their relationships with their patients and the treatment of their patients. The health practitioner, therefore, has a duty to act within the boundaries of medical law and to uphold high standards of ethics.

The above also pertains to withholding and withdrawing of medical treatment to which end the HPCSA has published a booklet with full guidelines on ethics and upholding of the medical law in South Africa. To help you, as a patient or close relative of a terminally ill patient, understand when the health professional’s conduct is within the boundaries of medical law and ethics, we briefly look at part of the framework for procedures regarding treatment provision against which misconduct is measured.

Medical law in South Africa, under the National Health Act No.61 of 2003, makes provision for patients to allow another person to act on their behalf if they no longer have the ability to do so. The patients must provide such mandates in writing and it is recommended that terminally ill patients take the proactive step in mandating a person to act on their behalf if they cannot do so due to their medical condition.

The healthcare professional must take the mandated person as the substitute decision maker. It is also important to keep the patient(s) and their close families updated and informed about the treatment options, risks, possible outcomes, and alternatives. Also forming part of ethics is the recommendation of encouraging patients to put their directives, regarding future care in instances such as permanent coma, in writing in the form of a living will.

For the health professionals, the issue of what to do when there are no directives in writing regarding the patient’s medical treatment is also addressed by the HPCSA. Accordingly, where such directives are lacking, the health professional(s) must consult the close family of the patient regarding the best medical interest of the patient if the person is, for instance, in a permanent coma or has lost mental reasoning capacity to the level that the patient cannot make a decision on their own.

The healthcare professional or team should consult or obtain advice from other healthcare team workers and professionals, the immediate family, in addition to a professional regarding ethics. Should the family of the patient insist on on-going treatment against professional healthcare advice, where the treatment would not be in the best interest of the patient or would be futile, then the healthcare professional should provide the family with the option of transferring the patient to another institution where such treatment can be provided.

Only if the family refuses to do so and the professional healthcare team, after consultation and confirmation by an independent healthcare professional (competent and qualified), can the healthcare team withdraw or withhold further treatment. It is essential to document the decisions and keep a full record of the reasons for withholding or withdrawing further treatment. The procedures followed in deriving at the decision must also be documented to ensure compliance with medical law and ethics in South Africa.

Call Adele van der Walt Incorporated for legal advice regarding the correct procedures and valid reasons for a healthcare professional to withdraw or withhold medical treatment in South Africa.


Information in this article is not intended as legal advice and is only for informational purposes. Please seek legal guidance from Adele van der Walt Incorporated before relying on this information to make any legal decisions.

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