Sapiens are not just nerve endings
A personal reply to: “Why we, as palliative care practitioners, cannot support the drive to legalise assisted dying” An open letter to The Daily Maverick by 8 medical practitioners in response to Leigh Meinert of DignitySA’s opinion piece “Beyond the false choice — why SA needs both palliative care and assisted dying” published in The Daily Maverick of 16 June 2025.
https://www.dailymaverick.co.za/.../2025-06-16-beyond.../
https://www.dailymaverick.co.za/.../2025-06-30-why-we.../
Dear Dr Meiring and esteemed colleagues,
Thank you for your open letter and for your unwavering commitment to providing compassionate, expert palliative care for so many South Africans. Your voice reminds us that every dying person deserves comfort, relief, and dignity, principles that no one in this discussion disputes.
However, your letter also reveals where this vital conversation must widen to match the complexity of what it means to be human, and to die as a human, not only as a patient.
Sapiens is not just nerve endings:
Your open letter rightly names physical pain and symptom control as critical duties of medicine. Yet what emerges so clearly in the stories collected from all around the world, from “John’s” slow, starvation-forced dying, to “Brittany’s” decision to go to Switzerland, to “Mary’s” fight to speak while she still could, is that humans are more than a bundle of nerves.
Sapiens are sentient, relational beings. We feel, we imagine, we fear, we hope, and we deeply care how we are seen when our bodies fail us. Loss of physical function may be inevitable; loss of agency and the forced endurance of meaningless suffering need not be. It is an unbelievably self-serving view that terminal humans should be thankful for suffering up to the point where their organs are failing “naturally” to create an opportunity to teach humanity lessons in grief, humility, and gratitude.
Research cited in your letter (Chochinov’s work) makes this plain: the wish to die often flows from a perceived loss of dignity, but this perception is not only about how others see the patient. It is about whether the patient feels their will and choices are still respected when medicine’s power to heal has ended.
Palliative care is necessary, but not always enough:
You write, movingly, that “we do all we can” to help people die peacefully. No one doubts your intention or your skill. But every patient’s body and mind respond differently. Even best-practice palliative care cannot guarantee freedom from unbearable physical, existential, or spiritual suffering.
Many patients do not choose Medical Aid in Dying (MAID) because of unmanaged pain alone. They choose it because they face a prolonged decline that erodes their sense of self beyond what they can bear. For them, sedation or forced starvation is not dignity. It is a last resort when the law denies a more peaceful, conscious, and dignified goodbye.
Dignity is inherent and self-defined:
You argue that “dignity” is inherent and that ending life violates this. Many agree and many do not. From the perspective echoed by patients like “John” or “Brittany”, maintaining dignity means preserving some measure of agency over the most intimate fact of our existence - our death. Dignity cannot be defined solely by those who care for us; it must be defined by the one who lives and dies in that body.
Do no harm:
You invoke “do no harm.” But harm is not just a physician’s abstraction; it is felt by the person enduring it. When all that remains is irreversible decline and the stripping away of all quality of life, and the essence of what made you you. Preventing the dying from accessing MAID can itself become harmful, prolonging agony out of moral abstraction.
Humans are complex, and our laws must be, too:
Your open letter warns of slippery slopes and the tragic possibility of coercion or misuse. These are real concerns and must not be brushed aside. But real evidence from participating jurisdictions around the world shows that robust safeguards, capacity checks, and mental health reviews do work, and can coexist with strong palliative care.
I agree: the South African context demands caution. But caution must not mean that a universal human right to self-determination at the end of life is off-limits forever. Inequality must be addressed, palliative care must be strengthened, and when suffering truly cannot be relieved, an inclusive end-of-life option must be there for those who want it.
Ubuntu includes the dying person’s will:
You cite Ubuntu to argue that mutual care forbids assisted dying. But mutual care also means acknowledging each other’s wishes. When a person says, “Enough, I wish to go peacefully, not slowly,” ignoring that voice can be just as un-African, for it denies the dying their own agency within the community.
A path forward… both, not either/or:
Palliative care and MAID are not enemies. The stories from around the world show that they must work together. A just society does not force people to endure what they themselves define as unbearable suffering when there is no cure, no hope, and no relief.
Sapiens are not only biological. We are meaning-seeking beings. An inclusive law would respect this:
• High-standard palliative care as the default,
• MAID as a safeguarded choice,
• Strong mental health and consent checks,
• Equal access for rich and poor alike,
• Conscientious objection protections for practitioners.
In closing:
You remind us that “You matter because you are you.” This is exactly why some people, at the end of all medicine’s power, ask for MAID: because they wish to remain themselves to the very last breath, not to be reduced to a prolonged decline they never wanted.
It is not about forcing a choice. It is about allowing one. And that is why a more inclusive approach to end-of-life care, which protects every person’s dignity as they define it, is not only humane, it's a human right.
Even as a deeply divided nation at the time, together, we wrote one of the best constitutions in the world, guaranteeing all South Africans human dignity under the protection of the law. We can do it again…
With gratitude for your devotion, and a shared hope that no South African must ever face dying in despair, unspoken and unheard.
Sincerely,
Dawid van der Merwe
Living with Parkinson’s since 2010
On behalf of all who believe dignity includes the right to choose