THE LIVING WILL
The Living Will ...
SAVES Suffering and pain
SAVES Anxiety for loved ones
SAVES Valuless prolongation of terminal illness
SAVES Existence without quality of life
SAVES Spending life savings unnecessarily
SAVES - The Living Will Society
SAVES -The Living Will Society was formed in Natal
in 1974 and now, with a membership of over 31 000
throughout the country, bases its operation on the
- That death is inevitable for every human being. It
is a natural consequence of life and ought to be
as dignified and humane as possible.
- That in the event of terminal illness, or where there
is no imminent and reasonable chance of recovery,
the employment of artificial means to sustain life is
pointless and only serves to prolong unnecessarily
the distress of all concerned.
- That in such cases a humane and acceptable
alternative should be sought, in the form of a
declaration setting forth one's wishes with regard
to the question of allowing death to occur naturally
through the withholding of artificial life support
systems which would otherwise sustain "Life" - but
one of little or no quality.
- That every effort should be made to relieve the patient
from any mental or physical pain and discomfort,
even if medication administered exclusively for this
purpose hastens the moment of death.
- That any life-support systems such as ventilators,
respirators or other sophisticated and possibly costly
medical techniques be used prudently to sustain life
where there is a reasonable chance of recovery;
not merely to postpone the moment of death and
thereby prolong the agony and anguish where no
reasonable chance of recovery exists.
- That a mentally competent adult patient has the legal
right to refuse medical treatment should he so wish,
and in such instance, the doctor is obliged in law,
to honour the patient's wishes.
The Living Will
To this end, a document called 'The Living Will' was
devised to stand as a testament to one's wishes,
particularly in the event of one being unable to
communicate at the time.
The Living Will states:-
"If the time comes when I can no longer take part in
decisions for my own future, let this declaration
stand as my directive.
"If there is no reasonable prospect of my recovery
from physical illness or impairment expected to
cause me severe distress or to render me incapable
of rational existence, I do not give my consent to be
kept alive by artificial means, and I request that I
receive whatever quantity of drugs and intravenous
fluids as may be required to keep me free from pain
or distress even if the moment of death is
An optional codicil which reads "I do not consent to
any form of tube feeding" is provided for signature and
Three copies of The Living Will should be signed when
of sound mind and after careful consideration, in the
presence of two witnesses. It is advisable to share this
decision with anyone who may have to implement The
Living Will - family, close friends and one's doctor.
We suggest that these documents be lodged in the
- Kept at home in a safe place for easy access in an
- Lodged with one's doctor, after full discussion of the
contents, so that in advance of the possible need, the
doctor understands the patient's wishes. Should there be
no private doctor, arrangements can be made to have
this copy filed in one's out-patient file at any hospital.
- Kept for inclusion in one's in-patient file should the need
for hospital, nursing home or hospice ever arise.
N.B.: An extra copy may be applied for should one
be residing where there is a matron or sister in-charge.
A Wallet Card incorporating the essentials of the Living
Will is supplied. This should be carried on one's person
at all times for use in an emergency.
How to Obtain The Living Will
Any person over the age of 18 years may join SAVES .
The Living Will Society, regardless of race, colour or creed.
A woman married in community of property does not need
her husband's authority when signing a Living Will.
Complete the enrolment form set out below.
You will then receive 3 copies of The Living Will, a Wallet
Card plus a Newsletter keeping you informed of the progress
of this and similar organisations throughout the world.
Donations are always very gratefully accepted and will be
Should you have any further queries the Director can be
contacted telephonically on telephone number
To: The Director
SAVES - The Living Will Society
P.O. Box 1460
Please enrol me as a life member of the Society. I enclose
my Membership Fee. See Fees
- per Person
- per Married Couple
- per Social Pensioner
(Please give OAP, DG or WV number) .................
Surname (Mr) :
First Names :
Surname (Mrs / Ms) :
First Names :
Cheques/Postal Orders to be made payable to
SAVES - The Living Will Society
SAVES - THE LIVING WILL SOCIETY
P.O. Box/Posbus WANDSBECK 3631 Telephone number
- DIE LEWENDE TESTAMENT VERENIGING
GUIDELINES FOR MEDICAL PRACTITIONERS ON LIVING
WILLS PREPARED BY THE MEDICAL ASSOCIATION OF
A "living will" is a declaration or an advance directive which
will represent a patient's wish to refuse any medical
treatment and attention in the form of being kept alive by
artificial means when the patient may no longer be able to
competently express a view.
Every person may refuse medical treatment even if such
refusal will result in death, unless such treatment is sanctioned
by law. To be able to make a declaration such as the
"living will", a person must be over the age of medical
consent and "compos mentis". The declaration will remain
valid even if the declarant later on becomes "non compos
The "living will" is not a will in the testamentary sense of the
word. There is in South Africa at present no law regarding
the validity of "Living Wills". These guidelines have therefore
been designed to assist doctors who are confronted
with a "living will". Doctors are, however, to approach
issues surrounding "living wills" with considerable consideration
and obtain advice from the Medical Association of
South Africa if appropriate.
- A doctor should offer to treat and to relieve suffering,
and should generally act in the best interests of his
patients. There shall be no exception to this principle
even in the case of incurable disease or malformation.
The World Medical Association's declaration on terminal
illness should be borne in mind. This declaration
"the doctor may relieve suffering of a terminally ill
patient by withholding treatment with the consent of the
patient or his immediate family if the patient is unable
to express his will. Withholding of treatment does not
free the doctor from his obligation to assist the dying
person and give him the necessary medication to
provide relief in the terminal phase of his illness and the
doctor shall refrain from employing any extraordinary
means which would prove of no benefit for the patient."
- All patients have aright to refuse treatment, which right
should be respected. This, however, does not imply or
justify abandonment of the patient. Doctors should
offer medical care in accordance with good medical
practice. The medical care should, however, be acceptable
to the patient and appropriate to the circumstances.
Doctors are encouraged to raise the subject
in a sensitive manner with patients who are anxious
about the possible administration of unwanted treatment
at a later stage.
- A written advance directive, in the absence of contrary
evidence, must be regarded as representing the
patient's expressed wish. The drafting of an advance
directive is the patient's responsibility. It is, however,
recommended that an advance directive should be
drafted in conjunction with medical advice and counseling.
It is further advisable that patients discuss the
specific terms of their advance directives on a continuing
basis with their general medical practitioners.
- Patients frequently believe that an advance directive to
refuse life-saving or sustaining treatment will be
honoured under all circumstances. The reality of medical
practice makes this impossible. If an advance
directive is specific to a particular set of circumstances
the directive will have no force when these circumstances
or ones essentially similar to them do not exist.
If an advance directive is so general that it applies to all
possible events that could arise, it is usually too vague
to give any usable direction to the doctor. In either case
doctors will have to rely on their professional judgement
to reach a decision.
- It is the responsibility of a patient to ensure that the
existence of an advance directive is known to his family
and to those who may be asked to comply with its
provisions. It is recommended that individuals who
made an advance directive, should consider wearing
on their person an indication as to the location of the
document. Doctors who are aware of the existence of
such an advance directive, should make all reasonable
efforts to acquaint themselves with its contents. In
cases of emergency, however, necessary treatment
should not be delayed in anticipation of a document
which is not readily available.
- It is strongly recommended that patients review their
advance directives at regular intervals. It is further
recommended that patients rather destroy than amend
the existing advance directive.
- Doctors with a conscientious objection to withhold
treatment in any circumstance are not obliged to comply
with an advance directive but should advise patient
of their views and offer to step aside, transferring
management of the patient's care to another practitioner.
- Late discovery of an advance directive after life
prolonging treatment has been initiated is not sufficient
grounds for ignoring it.
SAVES - THE LIVING WILL SOCIETY
This is an explanation of "Informed Consent" which is Common Law in South Africa
A patient has the right to the following: -
- You have the right to refuse specific medical treatments. A treatment given by a doctor or
nurse against your wish constitutes a common law assault. If a nurse overrules you send
for the sister in charge: if still overruled send for your doctor. If you receive no support
from your doctor send for your attorney.
- You have the right to countermand treatments which you have previously sanctioned. And
you can expect to be informed of the consequences.
- You have the right to expect treatment and care (within the limitations of any refusal of
treatment) which will keep you comfortable and mitigate pain.
- Your own wishes override those of your next of kin. Your next of kin cannot legally order
which you wish to be discontinued. A claim that your death would harm your next of kin
would need to be re-enforced by a court order before your wishes could be overridden.
No one has legal powers of guardianship over an adult person who is compose mantis.
- You have the right to full and current information from your physician on his diagnosis, suggested
treatment, and prognosis (forecast of course of disease). You have the right to information
on prescribed drugs and possible side effects. In other words, your doctor must obtain from
you "informed consent" before he undertakes any treatment whatever. You also have the
right to be informed as to fees for professional services of whatever kind, and for hospitalisation
(this letter must be obtained from the hospital or clinic to which you are to be admitted).
- When significant alternatives for treatment and/or care exist, or when you request information
on medical alternatives, you have the right to expect such information in language you can
- You have the right to a second opinion if you are not sure that the diagnosis of your illness,
or the suggested treatment, or the prognosis, is correct. Always bear in mind that correct
diagnosis may be extremely difficult, particularly in an older person who may be suffering
from several degenerative diseases.
- You have the right to change the doctor you employ in private if you are not satisfied with
any aspect of his professional service. The correct procedure is to ask for a referral letter.
You .are under no obligation to name the doctor to whom you intend to go. Although your
medical records are regarded as being the property of the doctor (or hospital) who has recorded
them, they are invariably made available when your new doctor asks for the.
- On discharge from hospital you have the right to expect adequate instructions in self care
to ensure maintenance of health and prevention of disability.
- You have the right to discharge yourself from a hospital or nursing home. The hospital or
nursing home may ask you to sign a release, stating that you are leaving against the medical
judgement of the medical staff, (There is no legal compulsion to sign a release.) Exceptions
to the right to discharge yourself will occur if you have an infectious disease or if you have
been declared mentally incompetent.
- You have the right to have your case history kept confidential except where you consent
to have such information divulged or where it is required by law to be divulged.
- A public patient has the same right to privacy as to his person as a private patient. You
have the right to privacy during medical examinations and you have the right to ask anyone
not involved in your care to leave during such examinations. Remember that your co-operation
may be valuable in a teaching hospital.
- As a patient you have the right to be informed before you are included in any medical research
programme. You have the right to refuse to take part in a research programme.
- As a public patient you have the right to know by name and consult with the medical officer
responsible for your medical programme. You possess the rights set out above except that
you do not have the right to choose or change the physician appointed to attend you while
Informed consent by a patient is required for any treatment
a doctor considers advisable, either for purposes of diagnosis
or treatment, except in exceptional cases, such as
unconscious accident cases. Patients who have executed
the Living Will have, in their right minds, given definite
instructions regarding the type of treatment to which they
will not consent, thereby exercising their legal prerogative
to lay down limits to what may be done to them. This is
binding in law, and a doctor who disregards this instruction
by a patient, is legally in the wrong.
No matter how sincerely he may believe himself to be acting
in the patient's best interests, or according to moral
principles, if a patient does not consent to treatment, then,
with certain exceptions of which the Living Will is not one,
the doctor's act is unlawful, and may render him liable to
damages. It should be noted that in South African law it
is the patient's informed consent, not the doctor's motive,
which makes the latter's act lawful.
Firstly, a doctor has no legal duty in general to accept a
patient. Secondly, normally the doctor's right to treat is based
on the patient's informed consent. Subjecting a patient to
medical treatment against his express will may indeed be
legally tantamount to assault.
Professor SA Strauss, professor of Criminal law at UNISA,
and author of the book, "Doctor, Patient and The Law",
"I have authorised my wife to apply to the Supreme Court
for an interdict (prohibitory court order) against medical
staff should they refuse to give effect to my own Living
Professor Strauss also advised SAVES - The Living Will
Society to place a footnote to the Living Will stating as
"Should they wish, any person has my concurrence to apply
for a court order to insure compliance with this directive
should any medical practitioner or health authority refuse
to give effect to it".
Professor David McQuoid-Mason, Dean of Natal University
Faculty of Law, outlined the patient's legal right and the
problem a doctor may face if he/ she disregards the Living
"It is the duty of medical personnel to obey a patient's
wishes if he does not want life-sustaining treatment and has
signed a Living Will ( which must obviously be brought to
the doctor's attention). If a doctor then does not obey the
patient's wishes he has in fact perpetrated an assault against
the patient and can be sued".
Professor McQuoid-Mason said the law recognized the
patient's right to decide whether he wanted to live or die,
accept treatment or deny it.
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