A pastoral approach to euthanasia in geriatric palliative care in a South African context

Abstract

Pastoral counsellors have a significant role to fulfil in end-of-life care, especially when faced with a patient’s request for euthanasia. South Africa has limited palliative care services due to insufficient funding. That complicates the integration of palliative care into the public healthcare system. Older terminal patients find themselves in a tenuous position if their healthcare needs cannot be fully addressed. As they face the end of their lives, they encounter physical, social, identity, and developmental challenges. Understanding these challenges is important if adequate holistic end-of-life care is to be provided for them. However, conventional palliative care approaches prove to be rather limited, especially when it comes to alleviating suffering. This situation can prompt a desire for euthanasia. In South Africa, euthanasia is illegal, which creates obstacles to obtaining life-ending interventions. One of the prevalent factors is the country's strong religious foundation. Traditional Christian teachings generally oppose euthanasia on the grounds of the ‘sanctity of life’ and trust in divine providence. There are, however, Christians believers who regard euthanasia as a last resort to alleviating unbearable suffering when all other avenues have been exhausted. When a decision about euthanasia must be made, a comprehensive assessment of the patient's understanding, reasoning, and abilities has to be made. Mental health issues and interpersonal problems contribute to a person’s desire to die. When such factors are not addressed, euthanasia can be used as a way to remove suffering at all costs. Ethical and theological concerns about the use of euthanasia include whether the older person has given informed consent. If depression and relationship problems have been adequately addressed, it can reduce a person's desire for death. This study develops a pastoral approach to euthanasia requested by an older person in an end-of-life-situation. It integrates insights from narrative and cognitive-behavioural therapy with insights from pastoral narrative counselling and spiritual guidance. The aim is to provide effective pastoral support in an end-of-life situation to people who struggle with feelings of depression. The aim is further to provide comfort and facilitate constructive social relationships. The study focuses specifically on addressing a request for euthanasia by a geriatric palliative care patient in the South African context from a pastoral perspective.