• Medical scooters procured by the Eastern Cape Health Department do not meet criteria to transport patients.
• Health Minister Zweli Mkhize said his department was not consulted on the specifications of the scooters.
• The Eastern Cape Health Department spent R10 million to procure 100 scooters.

Health Minister Zweli Mkhize has admitted medical scooters in the Eastern Cape – at a cost of R10 million – do not meet the basic criteria for “patient transport as an ambulance”.

Mkhize announced this in response to a written Parliamentary question from DA MP Siviwe Gwarube who wanted details on whether the scooters were suitable for patient transport.

Mkhize’s response read: “No, the Scooter Project that was launched by the Eastern Cape Department of Health (ECDOH) does not meet the basic criteria for patient transport as an ambulance. The purpose of this project by ECDOH is mainly for widening access to primary health care and delivering of chronic medicine for the most remote areas of the Eastern Cape province.”

Mkhize said the national Department of Health was not consulted on specifications before the procurement of the scooters.

“The province, (however), has been advised that none of these scooters will be used as ambulances because they do not meet the specific requirements as provided for in the EMS Regulations, such as, minimum patient compartment space and equipment requirements,” Mkhize said.

Tender

News24 reported last month that a R10 million tender awarded to a King William’s Town company to supply 100 ambulance scooters to the Eastern Cape Department of Health, was now also under investigation.

The department confirmed that the Bid Adjudication Committee (BAC) was reviewing the processes followed in the awarding of the contract.

On 12 June, Mkhize and Eastern Cape Health MEC Sindiswa Gomba unveiled six scooters fitted with a bed on one side, overhead gazebo with a first aid kit and oxygen on board.

Gomba told News24 at the time it was meant to ferry patients from far-flung, remote rural areas to clinics and hospitals.

In a statement, the DA’s Gwarube said this “scooter scandal” was yet another indication of the ineptitude of the Eastern Cape Department of Health leadership.

“The MEC has recently argued that the department is bankrupt, yet R10 million can be wasted on scooters which will gather dust in some warehouse. All the while, the province is failing to mount a decent response to the Covid-19 crisis. There is a critical shortage of staff, insufficient bed capacity, ambulances in some areas, underscored by the rising number of infections and deaths,” she said.

Gwarube said the DA would submit Mkhize’s response to the SAHRC as supplementary evidence in the investigation they have committed to.

“If the national Department of Health now backtracks from the initial purported function of the scooters which Minister Mkhize personally endorsed, it begs the question: why R10 million is being spent on a chronic medication distribution system? What is the point of the first aid equipment, drip stands and the stretcher attached to the scooter?” she asked.

The following initiatives have already been undertaken in Western Cape municipalities:

Ø Key services including technical services, water, sewerage, electricity and waste management continues.

Ø Water and electricity restrictions have been lifted in areas where it may have been implemented to date.

Ø Councils are working closely with SAPS and the SANDF to ensure the safety of all communities.

Ø Loud hailing pertaining to COVID-19 operations and information is done in rural areas and informal settlements.

A snapshot of some of the additional measures some councils have undertaken include but are not limited to:

Ø Stellenbosch Municipality will suspend all rate collections for three months. In addition all homeless residents in the Franschhoek, Stellenbosch and Klapmuts areas are being accommodated in temporary accommodation.

Ø In Overstrand Municipality, businesses who find themselves in financial stress, as a result of the lockdown and cannot pay their accounts due for March 2020 and/or April 2020, may enter into an extended term of payment agreement in order for their payments to be done over a period of 6 months. Residential customers, who find themselves in financial stress, as a result of the lockdown and cannot pay their accounts due for March 2020 and/or April 2020, may also enter into an extended payment agreement in order to pay these accounts, over a twelve month period. In addition, all tenants of the Municipality who cannot make use of the premises they lease, for the purpose it is leased for, such as business premises, stalls, etc. will be exempted from the payment of their rental for the months of April 2020 and May 2020.

Ø In Hessequa municipality all ward councillors have been provided with funding to provide food parcels to their constituencies where needed.

Ø Swartland Municipality is working with the private sector to develop feeding schemes for homeless people. The municipality is still considering a possible payment holiday for property rates as well as writing off interest on arrear accounts.

Ø In Witzenberg municipality, the council has decided not to implement strict credit control during the lockdown period. All prepaid electricity meters that may have been shut off due to non-payment has been reconnected. Shelter has been arranged for homeless people needing accommodation during this time.

Ø Saldanha-Bay: A temporary suspension of all credit control measures and procedures will be implemented until the end of April 2020, meaning that there will be no blocked electricity meters and no restriction measures. The Free basic water allocation for indigent residents will be increased from 6 to 10 kilolitres from April 2020 until the end of June 2020. The largest holiday resort has been made available for a containment area if needs be.

Ø Drakenstein municipality has lifted all water and electricity blocks. Temporary shelter for the homeless has been arranged.

Ø BreedeVallei municipality has rolled out additional water points and toilets in informal settlements which are also being serviced on a greater frequency.

Ø Mosselbay Municipality is providing financial assistance to all lessee’s of the municipality. When it comes to water all water that has been restricted (on drip) has been opened and all prepaid and conventional electricity meters that were blocked had their restrictions lifted.

Ø Oudtshoorn Municipality has undertaken various measures including exempting the billing of interest on all overdue consumers’ accounts for a period of four (4) months from March 2020 – June 2020.

Ø Theewaterskloof Municipality has also lifted restrictions on water and electricity. All critical services continue and communication in the affected areas is rolled out continuously. The council is working with NGOs in to distribute food parcels where needed.

Ø Drakenstein Municipality is providing shelter to the homeless in four different shelters across its municipal area. The homeless receive soap, water, blankets and daily meals.

Ø In Bergrivier Municipality, people who were placed on a controlled water management system, now have full access to water for the duration of the National State of Disaster. Credit control on outstanding accounts are also being relaxed.

Ø George Municipality will not charge any interest for April 2020 on service accounts. The council has unblocked all electrical meters from 24 March to allow purchase of pre-paid electricity for all consumers. Additional sanitation facilities and waterpoints are being provided in a number of informal settlements. Rosemore Sport Stadium has been set up as a homeless shelter. Loudhailing has been taking place in all areas as of 25 March – with areas being identified on a daily basis that need to be revisited.

“District municipalities in the Western Cape continue to render all essential services, including firefighting, road maintenance and environmental health services. Our disaster management centres are all in 24/7 activation and working hard to tackle the COVID-19 crisis,” says Bredell.

“Further measures continue to be investigated by all councils as the situation unfolds. I want to thank our councils in conjunction with the Western Cape Department of Local Government for doing what they can to assist their communities during this difficult time,” says Bredell.

Bredell has urged all citizens with questions regarding the ongoing lockdown and what it means for them, their families and their lives to visit the website: www.westerncape.gov.za/coronavirus

“In addition, if you have flu-like symptoms, and have come into contact with someone who has COVID-19, please contact the provincial hotline on 021 928 4102 for advice on what to do next.”

ENDS.

Media enquiries:

James-Brent Styan

Spokesperson for the Minister of Local Government, Environmental Affairs and Development Planning, Anton Bredell

South Africa’s embattled consumers are set to see a rise in taxes as the government scrambles to implement the much-touted National Health Insurance (NHI) scheme.

JOHANNESBURG – South Africa’s embattled consumers are set to see a rise in taxes as the government scrambles to implement the much-touted National Health Insurance (NHI) scheme.

The NHI Bill, which was tabled in Parliament last week, has drawn both praise and scorn.

The National Treasury had estimated that NHI will cost R256 billion, but has said that the department plans to release a revised paper with a revised costing.

Raymond Parsons, an economist at the North-West University Business School, said factors such as declining tax revenues, escalating debt ratios, an excessive public sector wage bill and extensive financial assistance to state-owned enterprises like Eskom leave little room at this stage for large-scale projects such as NHI.

“South Africa needs to know the financial implications of this massive health scheme before irrevocable decisions are taken, which could be economically damaging. There are no soft options available, especially for as long as the economy remains in a ‘low-growth trap’,” Parsons said.

“The forthcoming Medium Term Budget Policy Statement will therefore need to bring these hard fiscal decisions into sharp focus, and in particular indicate whether the costs of a NHI can indeed fit into the deteriorating overall fiscal picture.”

Data from Statistics South Africa released in May showed that more than 47 million South Africans did not have medical scheme cover, with just 9.4 million people enjoying the benefit.

The statistics agency said that between 2002 and 2018, the percentage of individuals covered by a medical scheme increased marginally from 15.9 to 16.4 percent.

The Free Market Foundation (FMF) said that taxes will have to rise to fund the NHI scheme.

“During these dire economic times, the NHI tax will be the final nail in the coffin for cash-strapped consumers struggling to make ends meet,” the FMF said.

“While supposed to help people access medical care, the NHI scheme will undermine any chance of economic success by either cutting wages or eliminating jobs altogether and will entrench South Africa’s terminal economic conditions.”

The bill states that NHI will be funded through payroll taxes for employees and employers, a surcharge on personal income tax, the reallocation of medical scheme tax credits to the fund and general taxes.

Cosatu’s parliamentary co-ordinator, Matthew Parks, said President Cyril Ramaphosa was providing leadership and stewardship on the NHI implementation process.

“Cosatu, together with like-minded organisations, has on an ongoing basis called for the speedy release of the NHI Bill as a step closer towards the realisation of quality health care for many vulnerable groups,” Parks said.

Article by KABELO KHUMALO and IOL

President Cyril Ramaphosa signed the Presidential Health Compact on Thursday, which will make the way for a new health care system in South Africa that doesn’t discriminate against whether a person is rich or poor.

“It has as its stated goal: one country, one health system. This means quality of care must be the same regardless of whether you have money or not, and regardless of where you live,” said Ramaphosa at a signing ceremony at the Dr George Mukhari Academic Hospital in Garankuwa, Tshwane.

The President pointed out: “It is fitting that we are signing this historic accord here at the Dr George Mukhari Hospital, where a groundbreaking and difficult operation to separate conjoined twins was performed in 2017…”

Accompanied by Health Minister Zweli Mkhize, Ramaphosa said the compact aims to standardise the quality of public healthcare by addressing nine key issues – including staff shortages, labour corruption, infrastructure and stock-outs of medicines, community engagement and supply chain management in the health department.

To ensure the healthcare system is effective he said “we will move from working in silos and we will seek to have a much more integrated approach”.

He said the post-Apartheid government has made progress with more than 40% of clinics that serve the population today built after 1994.

Ramaphosa confirmed Minister Mkhize’s emphasis on the need to regard healthcare as an investment rather than an expense.

“A healthy population is economically productive, is industrious and is the bedrock of any country’s economic development,” said the President. – SAnews.gov.za

 

THE DRAFT NATIONAL HEALTH AMENDMENT BILL 2018

The Draft Bill is long overdue. In the late 1990s, President Mandela instructed the South African Law [Reform] Commission (SALC) to investigate, and make law reform recommendations regarding, end-of-life decision-making in all its forms. Among others, the SALC’s second or final report (1999) proposed that advance directives (a living will and a durable power of attorney for healthcare) be legalised.

For almost 20 years, Parliament failed to follow these recommendations despite advance directives being a legal instrument in many other jurisdictions, and despite medical decisions regarding withholding and withdrawal of life-sustaining treatment having to be made in conditions of uncertainty regarding criminal and civil liability. (Life-sustaining treatment would include a range of treatments, such as antibiotics, IV-tube feeding, dialysis or surgery.)

Quite simply, in carefully prescribed circumstances, South Africans’ right to make decisions about their own continued life should be explicitly and unambiguously recognised in law by affirming the legal status and force of advance directives.

Advance directives are decision-guiding instruments that come into operation when contemporaneous decision-making is no longer possible due to incapacity brought on by an accident, trauma or disease.

First, a living will is an instrument that enables a patient to refuse unwanted life-sustaining treatment – by withholding or withdrawing it – when they are no longer able to do so contemporaneously due to irreversible decision-making incompetence.

Second, a durable power of attorney for healthcare is an instrument that enables a patient to transfer their healthcare (including medical) decision-making to another person – a proxy or substitute – when they are no longer competent to do so contemporaneously, including decision-making about continued life and thus withholding and withdrawal of life-sustaining treatment.

There are several persuasive considerations – ethical, legal and professional – why a living will and a durable power of attorney for healthcare should be explicitly recognised in our law.

These considerations demonstrate why the answer by the Minister of Health, in response to a question put to him in Parliament, is wrong – in ethics and law – when he said that “withholding or withdrawing life-sustaining treatment is a decision taken by the treating doctor and must only be based on his or her clinical evaluation and not on anybody’s request”.

On the contrary, a living will and durable power of attorney for healthcare:
1. Are instruments that give expression to widely-accepted, basic medical ethics principles, such as respect for autonomy (self-determination), beneficence (doing good), non-maleficence (refraining from doing harm) and justice (fair or even-handed treatment), as well as virtues such as compassion and solidarity;

2. Are expressions of constitutional rights in the Bill of Rights, such as the rights to dignity (incorporated in the right to life – former Constitutional Court Justice Kate O’Regan), to freedom of bodily integrity, and to privacy;

3. Were proposed by the SALC, in 1999, following a thorough investigation of international practice and after wide consultation with the South African public;

4. Are actually already embedded – without being named, and all too vaguely in respect of specifically life-sustaining treatment – in the National Health Act 2003

a. Section 7(1)(e) affirms informed consent as a prerequisite for providing healthcare services and recognises the right to refuse such services;

b. Section 7(1)(a) and (b) allow for the appointment of substitute or proxy healthcare decision-makers, explicitly or by way of natural succession by family members;

5. Were confirmed – albeit not directly or by name, but in respect of the underlying principles at stake – by the Supreme Court of Appeal (SCA) in its judgment of 6 December 2016 in the Stransham-Ford case, where a full bench of five SCA judges stated the following: “[31] A person may refuse treatment that would otherwise prolong life. This is an aspect of personal autonomy that is constitutionally protected and would not ordinarily be regarded as suicide. Medical treatment without the patient’s consent is regarded as an assault so that the patient is always entitled to refuse medical treatment. In refusing treatment the patient is allowing the natural processes of the disease to take their course” (my italics).

6. Would guide medical practice in an area of ignorance, uncertainty, and even unnecessary fear for adverse legal consequences, should practitioners act according to directives in a living will or durable power of attorney for healthcare.

We have a moral and constitutional right to life. But we do not have an obligation to live irrespective of the quality of our lives, or regardless of the circumstances.

Willem Landman
Professor Extraordinaire, Department of Philosophy, University of Stellenbosch
Executive Committee Member, Dignity SA
Founding CEO and Non-Executive Director, The Ethics Institute (TEI)

Stellenbosch
6 August 2018

Announcement
Dignity SA will be hosting the 22nd biennial conference of the World Federation of Right to Die Societies in September, with delegates from 23 countries attending and some of the world’s most distinguished thought leaders in the right to die movement – including ethicists, scientists, legal experts, and medical professionals – will grace the stage. The conference is open to the public (and the media) at the Cape Sun hotel on 7 and 8 September. The conference will end with what surely is to be a rigorous debate. For more information or to book (fewer than 30 seats left): www.assisteddying2018.com.

STATEMENT BY DEIDRE CARTER, MP

PRIVATE MEMBER’S BILL: DRAFT NATIONAL HEALTH AMENDMENT BILL

THE LEGAL RECOGNITION AND ENFORCEMENT OF ADVANCE DIRECTIVES

Dying is a natural and inevitable part of life.

Dying is a natural and inevitable part of life.

Unless we die an unnatural death, we will go through a natural dying process.

For some, it will be peaceful and dignified; for others it will be filled with pain, distress and suffering.

We do not know which it will be.

Coupled hereto advances made in medical science and especially in the application of medical technology have resulted in patients living longer.

For some patients this signifies a welcome prolongation of meaningful life, but for others the result is a poor quality of life which inevitably raises the question whether treatment is a benefit or a burden.

Worldwide, increased importance is being attached to patient autonomy.

Recent events in our own Country have put this question in the spotlight:   ·      In August 2014 Parliamentarian Mario Oriani-Ambrosini, terminally ill, in the last stages of lung cancer hastened his imminent death by shooting himself.   ·      Our revered Madiba lingered for months hooked up to machines after doctors declared him to be in “permanent vegetative state”.   ·      In July 2014 Archbishop Emeritus Desmond Tutu declared himself to be in favour of assisted dying should he ever find himself terminally ill and/or in a situation of intractable, unbearable suffering.

 

Advance HealthCare Directives

The need has therefore arisen to consider the protection of a mentally competent patient’s right to refuse medical treatment.

Furthermore, any competent person may foresee the possibility of becoming incompetent when they enter the terminal phase of the dying process, and may wish to control their healthcare decision- making as they are able to do when they are competent.

Advance health care directives are designed to enable competent persons to express their preferences and give instructions about such possible future situations – through a Living Will or a Durable Power of Attorney for Healthcare

The Objective of this Private Member’s Bill, the National Health Amendment Bill, is to ensure the ‘legalization’ – the recognition and enforcement of Advance Healthcare Directives – within the National Health Act.

This is not rocket science and neither is it that radical.

As matters stand:

• Chapter Two of the National Health Act provides for the ‘Rights and Duties of Users and Health Care Personnel;
• Section 6 of the Act provides for the right of a user to refuse health services; and
• Section 7 provides that a health service may not be provided to a user without the user’s informed consent.

(Note: An extract from Chapter Two of the National Health Act is attached)

Centenary of the Birth of Mandela

It was under Madiba’s tenure as President of the Republic of South Africa that the South African Law Reform Commission was appointed to look into issues pertaining to End of Life Decisions/ Dying with Dignity.

In 1999, the Commission, chaired by the late Justice Mahomed published its findings and recommendations.

Amongst the recommendations made by the Law Commission was the ‘legalisation’ of Advance Directives – the Commission even drafted a Bill – the End of Life Decisions Bill.

It is unfortunate that this important document and its recommendations were not perused by Government’s Executive or by Parliament (the legislature).

It thus seems appropriate, as we mark the centenary of the birth of the founding President of our Constitutional Democracy, Nelson Mandela, to re-initiate the ideals related to End of life Decisions (and Dying with Dignity) that were initiated during Nelson Mandela’s Presidency but never finalized.

(NOTE: Potions of the SALC report including the then draft End of Life Decisions Bill is included)

A Constitutional Imperative

In terms of our Constitutional Democracy the state has the obligation to respect, protect and promote its citizens’ fundamental human rights as enshrined in our Bill of Rights.

We believe that the recognition of Advance Directives gives effect to the following provisions of our Bill of Rights:

• The Right to Dignity– the right of patients to have their dignity respected and protected);
• The Right to Life– in respect of which death is an undeniable and ultimate part; and
• Freedom and Security of the Person– not be treated in a cruel, inhuman or degrading and to ensure bodily and psychological integrity and security and controlling of one’s own body (Section 12(2) and 12(2)(b) of the Bill of Rights)

The Bill – The National Health Amendment Bill

The National Health Act, 2003 in its current format does, to an extent, contain provisions regarding advance health care directives in that in one provision of the Act, a “living will” is inferred and in another, provision is made for the appointment of a substitute healthcare decision-maker.

However, it is argued that these provisions, while a step in the right direction, are inadequate for a number of reasons.

These reasons, inter alia, include:

• That a “living will” is not expressly recognised;
• That the purpose, scope and format of these advance health care directives are not explicitly set out;
• That it is not clear whether they may, in certain circumstances be overridden by family or medical practitioners; and
• Whether persons acting upon the directives (such as Doctors) are immune from civil and criminal prosecutions.

The National Health Amendment Bill, 2018, will therefore provide for the legal recognition, legal certainty and legal enforceability regarding advance health care directives such as the Living Will and the Durable Power of Attorney for Healthcare.

(Note: The notice of intention to introduce the Bill which includes an explanatory summary of the Bill as published in the Government Gazette is attached)

Public Participation/Representation

Interested parties and institutions are invited to submit written representations on the proposed content of the Draft Bill to the Speaker of the National Assembly.

Representations must be submitted by 22 AUGUST 2018

Representations can be delivered to the Speaker, New Assembly Building, Parliament Street, Cape Town; mailed to the Speaker, P O Box 15, Cape Town 8000 or e-mailed to speaker@parliament.gov.za and copied to dcarter@parliament.gov.za

Minster of Health

In preparing the Bill, the views and comments of the Minister of Health were sought.

Of particular concern was the Minister’s assertion in his written reply that:

“withholding and withdrawing life-sustaining treatment is a decision taken by the treating doctor and must only be based on his or her clinical evaluation and not on anybody’s request“.

The Minister’s reply is misguided, wrong and therefore unacceptable as public policy for the following reasons:

1. It contradicts the National Health Act 2003;
2. It fails to respect rights in the Bill of Rights;
3. It disrespects basic ethical principles, such as self-determination, respect and dignity;
4. It contradicts the judgment of a full bench of the Supreme Court of Appeal (SCA) of 6 December 2016;
5. It disregards the recommendations of the South African Law (Reform) Commission’s final report of 1999;

The Minister’s answer (if it represents official public policy) is not only wrong in law and ethics, but could cause great harm.

I have written to the Minister seeking a meeting with him to discuss his reply and the Bill.

The Draft Bill in course of preparation, on the contrary, is in line with 1-5 above.

(Note: A copy of the questions put to the minister and his reply is attached. Also attached is our letter seeking a meeting with him)

Dignity SA

The Congress of the People supports the work and advocacy of Dignity SA and this Bill represents a joint initiative between Dignity SA and COPE.

On a personal level, I wish to dedicate this Bill to Lee Last of Dignity SA – a ‘Joan of Arc’ in the struggle to ensure the right to die with dignity

Furthermore, COPE welcomes the fact that Dignity SA will be hosting the World Federation of Right to Die Societies Biennial Conference (2018) from 6 -9 September in Cape Town and call upon the media to cover this important international event.

Part of a Larger Debate

Without wishing to conflate matters – this Bill is restricted to the matter of Advance Directives – I hope that this Bill will open the debate around other issues affecting the right to die with dignity – including the matter of active euthanasia

Non-Partisan – The Progressive Realisation of our Human Rights

Finally, let me state that I view this Bill as being non-partisan and hope that it will not be viewed and contested party-politically.

I view it a part of the process of fully realising the content of our Bill of Rights, especially those pertaining to the Right to Dignity, Life, and Freedom and Security of the Person.

If anything, Government (the Executive and Parliament) should be supportive of this initiative.