Featured in this issue:
from the chairperson’s desk
Instruments enabling a natural death
- Willem Landman
Throughout our lives we decide for ourselves. We own the choices we make.
But because we live in networks of social relationships our decisions are quite naturally influenced and shaped by others in a myriad of indirect and direct ways.
So, unless we are forced or coerced to make decisions that are deep down against our will, we are responsible for our own decisions, and we are held accountable for them.
Provided, of course that we have the mental wherewithal to do so.
For all of us life is finite. But for some of us there will come a time that our bodies – compromised by injury or disease – live on even though we have lost the mental capacity to decide for ourselves.
Into this void step advance directives.
They are instruments that enable us to extend the decisions we make for ourselves beyond possible future decisional incapacity. They empower us to reach beyond mental “death” and before physical death sets in. They extend the ownership of our bodies past the point of mental incompetence.
While modern medical science enables us to live longer and better it may come at a cost, namely, a more difficult death. But advance directives help us towards dying naturally – a natural death – free from medical interventions that extend our lives artificially at the expense of our preferences and with loss of dignity.
In our Expert Input section in this, our second newsletter, Rhiannon Thomas shares more about the forms that advance directives take and their current legal status in South Africa. Once again we share with you our signature Exit Interview, a humorous and poignant take on death through a personal lens, this time with comedian Shimmy Isaacs.
And in the spirit of sharing personal stories, we are proud to be launching our new podcast series A Way To Go next month. Given that DignitySA's vision is all about availing choice at the end of life, our podcast aims to showcase a wide range of ways in which humans are choosing to live and to die. Our first episode will feature a young cancer survivor who came very close to dying and then found hope to live, once he had been able to access a way of dying with some assistance. Please look out for our new podcast, which will arrive in your inboxes next week.
Perhaps the contents of this newsletter will motivate you to prepare an advance directive for yourself if you have not already, and to encourage your loved ones to do so too. You can find resources to help you at https://www.dignitysouthafrica.org/legalisation-of-living-wills
Advance directives enable us to let go and to die as we live – in control and with dignity – and it is never to soon to prepare one. Indeed, the premise of our new A Way To Go podcast, is that thinking and talking about death is good for life. We trust you find this to be true.
the Exit interview
Dignity Matters poses some questions to:
Shimmy Isaacs is a South African comedian, actor, writer, and MC known for her bold humour and authentic storytelling. Her acclaimed one-woman shows including ‘Dens Wit Me’ and ‘Allie Pad Funny Worcester’ blend sharp wit with cultural insight, and have earned her national recognition. With a passion for uplifting communities, she continues to shape South Africa’s entertainment landscape through laughter and truth.
If calories and indigestion were no object, what culinary indulgence would be your last?
I am a big red meat eater! So it would definitely be slow-roasted lamb shank with cheesy mashed potatoes, even though I'm lactose intolerant - don't care! Cheesy mashed potatoes and… ooh! Creamed spinach! Yum, my favourite meal!
Ideally, how would you like to go?
If it's something accidental then it has to be quick, like a chop off the head, fine, don’t have time to feel pain, or if I get really old and grey then I want to go with a joint in my mouth – even though I’m in recovery please don’t cancel me!
In what publication would your obituary appear, and what would its glorious and slightly exaggerated but still somewhat truthful headline be?
Listen, it will be a splash, in like, Vogue. Like, she was that one Coloured girl who made it all the way from Worcester to Vogue.
Imagine your memorial service. What kind of music would be playing? What band or artist would be grateful for the opportunity to perform?
I have totally fallen in love with a band called Black Puma, my gosh, they have a song called Moon Rising, they’ll be there for sure, and Lenny Kravitz will be there too, no doubt.
Burial or cremation? And where would you like to be buried or have your ashes scattered?
Cremation, I’m cheap as hell, just please don’t scatter them on the ocean I’m scared what’s underneath. Maybe from a mountain top, because I’m such an aspirational gal.
If you could choose one object to be buried or cremated with (it doesn’t even have to belong to you, but could have sentimental value or be useful for the afterlife perhaps), what would it be and why?
I would have it be my Ex! No. OK. But a person. Maybe my best friend Melissa, I’d need her to have some fun with in the afterlife. I’d have to tell her she has to die ‘though.
If you were to haunt somewhere after your demise, where would it be and why?
All those executives that turn down my scripts! If I don’t get my breakthroughs in this life I’ll get them in the next.
Who’s in your will? And is there anything you’re leaving that might cause a fight?
This is a good question… but I confess I do not have a will and that’s bad on my part. I need to get onto that. But once I’ve done it, my niece and nephew will get my stuff, and if there’s any incredible writing it will go to my mom and sisters. We’re a small family so the fights will be tiny….
What do you still need to do before you kick the bucket?
I still need to run my own network company, where I’m able to generate produce and create work for people, so that we can really grow this industry, South African storytelling.
Finally, is there anything about death that you’ve always secretly wondered about, but have been too polite to ask?
Is there really an afterlife? I had an operation about a year ago and remember when I came out form aneasthesia and all that, I had this groggy feeling and remember the last thing just before I clocked out… was this nothingness, and if you’re out like that, you’re not really sleeping, isn’t your soul travelling somewhere? But I’m open to there being nothing on the other side, but I hope not. I hope there’s something beautiful.
EXPERT input
Advance Directives
- Rhiannon Thomas
“Death is not waiting for us at the end of a long road. Death is always with us, in the marrow of every passing moment. She is the secret teacher hiding in plain sight. She helps us to discover what matters most.”
(Frank Ostaseski – Founder of the Zen Hospice Project).
The Ostaseski quote is one of my favourites. Both of my parents died before I reached my mid-twenties and so death has been my companion now for over 30 years. Rather than seeing their deaths as being a terrible thing that happened to me, I see it as the opportunity to live a better, fuller and more purposeful life.
Neither of my parents had drawn up any form of advance directive and so when they were dying and unable to speak for themselves, medical decisions had to be made on their behalf. I made my best guess as to what they would have wanted. This left me always wondering if I’d made the right choices.
Advance directives come in two forms
First, a living will is a document intended to speak for you when you cannot about how you wish to be treated. It can cover your wishes about medical treatment and care. They usually include wishes about the refusal of life-sustaining treatments when there is no likely prospect of recovery. But you can describe your wishes about health care and medical treatment more generally.
Second, a durable power of attorney for healthcare is a signed and witnessed document, by means of which you can give another person, such a family member or trusted friend, the right to make all your healthcare decisions, including your preferences for refusal of life-sustaining treatment. That person then acts as your agent (proxy; surrogate decision-maker) when you are no longer competent to express or act on your preferences.
Any consent that is given must, in terms of the National Health Act, 61 of 2003, be informed consent, which gives effect to our right to autonomy. By extension, a living will is an expression of an advance decision about possible future health scenarios should one lack decisional capacity. However, the Act does not refer to an advance directive, living will or durable power of attorney for health care by name.
Consequently, the current legal status of these documents is unclear since there is no dedicated law governing them nor has their enforceability been tested in a court of law. However, our constitutional rights, the ethical guidelines of the medical profession, norms and provisions of the National Health Act, 2003 and foreign law support the recognition of advance directives in the form of living wills and durable powers of attorney for health care. Such evidence needs to be taken seriously since a blanket dismissal of someone’s clearly expressed choices could expose a medical professional to legal liability for assault on account of unwanted medical treatment.
The National Health Act does already confer on all of us the statutory right to choose to appoint someone as our health care proxy in terms of section 7. This is a broad right which allows you to mandate your chosen person as your substitute for giving informed consent when you cannot. Because it is a legal mandate this means that healthcare providers must follow the proxy's instructions. One must think very carefully when choosing a proxy because this person can make all the decisions about your healthcare on your behalf when you cannot – giving consent and refusal. Section 7 also provides for a proxy, drawn from a stipulated list of family members, in situations where no mandate has been appointed.
As a lawyer, I encourage my clients to draw up a document approximating a living will in addition to mandating a proxy so that the proxy can know clearly and be reminded of what you want the proxy to do or not to do. This means that you should think carefully about who you appoint and what you would or wouldn’t want to happen when you are unable to speak for yourself.
In 2018, a private member’s Bill was gazetted following an initiative by an MP for Cope. DignitySA’s current chairperson, Prof Willem Landman, worked with a team of parliamentary lawyers to formulate a draft National Health Amendment Bill, 8 of 2018. The Bill proposes specific recognition of durable powers of attorney for health care and living wills and offers templates for these documents. However, since 2018, nothing more has happened with the Amendment Bill. Dignity SA is currently working with others to reinvigorate the Bill (https://advancedirectives.org.za/), as well as working on bringing the case for assisted dying before the Constitutional Court. Assisted dying allows a person with a terminal illness or incurable condition to have help to take their own life, by means of lethal drugs provided by a doctor.
Every day countless South Africans are dying without having appointed a health proxy or having written down their wishes to guide the proxy when the time comes to literally make life and death decisions on their behalf. None of us escapes death; most of us have wishes about how we do and do not wish to be treated at the end of our life. So, it makes sense to prepare and save our loved ones a lot of guesswork and anxiety by acknowledging that death is with us ‘in the marrow of every passing moment’ by using the steps that are legally available to us all.
With over two decades of legal experience, Rhiannon Thomas is not your typical lawyer. She’s a specialist in the areas of law that impact meaningful life transitions, like marriage, divorce, and death. She is a pioneer in the global Integrative Law movement. Her approach to law is deeply human — rooted in values, collaboration, and conscious practice. Her goal is to help people navigate these transitions with meaning and integrity. For more please visit https://www.milkwoodlaw.co.za/
POPCORN TIME
REVIEW: Blackbird
Reviewed by: Dawid van der Merwe
Rating: ★★★★½
Blackbird – A Poignant Look at Dignified Choices
In the realm of cinema that dares to explore the deeply personal and often challenging topic of end-of-life choices, Blackbird, starring the incomparable Susan Sarandon, stands out as a tender and thought-provoking film. For our "Dignity Matters" readers, this movie offers a compelling lens through which to consider the complexities surrounding a chosen, dignified farewell.
The film centres on Lily (Susan Sarandon), a matriarch who, facing a terminal illness, has made the decision to end her life on her own terms. She gathers her family – her husband, daughters, and their partners and children – for one last weekend together at their beautiful beach house. What unfolds is not a morbid affair, but a rich tapestry of family dynamics, unspoken resentments, profound love, and the raw emotions that surface when faced with such a monumental decision.
Blackbird excels in its sensitive portrayal of a family navigating an intensely emotional period. It doesn't shy away from the difficult conversations, the tears, or even the moments of levity that punctuate such a gathering. Sarandon delivers a powerful and nuanced performance as Lily, embodying both strength and vulnerability as she prepares for her final act of autonomy. The ensemble cast beautifully captures the varied reactions and struggles of those left behind, highlighting how each individual processes grief and acceptance differently.
For those interested in the principles of dying with dignity, Blackbird serves as a poignant exploration of what it means to have agency over one's own death. It prompts viewers to consider the importance of respecting individual choices, the role of compassion in supporting loved ones through this journey, and the enduring power of family bonds, even in the face of profound loss.
Without revealing specific plot points, we can say that Blackbird is a film that encourages dialogue about a subject many find uncomfortable. It reminds us that while death is inevitable, the manner of our dying can be imbued with dignity, love, and personal choice. It’s a film that will resonate deeply and spark important conversations within our community.
Recommendation: Highly recommended for its sensitive handling of end-of-life choices and its powerful performances.
good reads
Review: “Being mortal”
by Atul Gawande
Reviewed by: Dawid van der Merwe
Rating: ★★★★½
Being Mortal – Medicine and What Matters in the End
For the "Dignity Matters" newsletter, we often seek resources that illuminate the complex journey of aging, illness, and dying, always with an eye towards preserving individual autonomy and quality of life. Atul Gawande's profound and deeply empathetic book, Being Mortal: Medicine and What Matters in the End, is precisely such a resource – an essential read that challenges conventional approaches to end-of-life care and champions the very dignity we advocate for.
Dr. Gawande, a practising surgeon, brings a unique perspective to this topic. He doesn't just critique the medical system; he delves into the personal stories of patients, families, and medical professionals, including his own, to illustrate how modern medicine, despite its incredible advancements in prolonging life, often falls short in ensuring a good life, especially as we approach our final chapters. He argues that our societal inclination to fight death at all costs can inadvertently lead to prolonged suffering and a diminished quality of life, rather than a dignified end.
The core of Gawande's message resonates powerfully with the mission of DignitySA. He champions the idea that the goal should not simply be a longer life, but a better life – one that prioritises what truly matters to the individual. This includes:
Valuing Quality of Life over Quantity: Gawande eloquently shows how aggressive, often futile, medical interventions can strip individuals of their independence, comfort, and joy in their final days. He advocates for care that focuses on alleviating suffering and enabling people to live as fully as possible for as long as possible, rather than merely existing.
The Importance of Conversation: A recurring theme is the critical need for open, honest, and early conversations between patients, families, and doctors about end-of-life wishes. These discussions, often avoided due to discomfort or fear, are crucial for ensuring that individuals' values and priorities are respected when difficult decisions must be made.
Embracing Palliative Care and Hospice: The book highlights how these approaches, often misunderstood, are not about giving up, but about enhancing comfort and quality of life for those facing serious illness. They are about living well until the very end, with dignity and support.
Assisted Dying as a Choice: When these interventions are no longer appropriate in maintaining a level of dignity and comfort acceptable to some terminally ill patients.
Gawande's writing is remarkable for its clarity, compassion, and intellectual honesty. He weaves together medical history, personal anecdotes, and compelling research to create a narrative that is both informative and deeply moving. He doesn't offer easy answers but encourages a fundamental rethinking of how we approach mortality, urging us to embrace our finitude not as a medical failure, but as an inherent part of the human experience.
For anyone grappling with their own mortality, caring for an aging loved one, or simply seeking a deeper understanding of what it means to live and die with dignity, Being Mortal is an invaluable guide. It empowers us to advocate for choices that honour our values and to redefine what a "good death" truly means. It's a book that will undoubtedly spark meaningful conversations and strengthen our collective commitment to dignified living and dying.
South African Update
There have been encouraging developments as DignitySA has ramped up efforts to promote access to a range of choices at the end of life and foster collaboration with diverse special interest groups in South Africa.
Dignity has gathered robust and compelling evidence from 19 international experts in preparation for the case of assisted dying that we are currently preparing. Respected local medical experts are in the process of providing inputs too and then we will be ready to take the case to court, hopefully before the end of 2025.
Public interest in the relationship between assisted dying and palliative care was ignited with the publication of an article by Leigh Meinert, Operations Manager at DignitySA, in the Daily Maverick in June.
Some doctors responded in the same publication and were interviewed by MIke Wills on Cape Talk about the matter.
Leigh Meinert's subsequent interview with John Maytham on Cape Talk is available here.
To watch the seminar that we held in May that sparked these engagements please visit https://www.youtube.com/@DignitySouthAfrica
DignitySA attended the national Palliative Care Conference that was held in Durban from 18- 21 June and supported the Durban Declaration that was signed at the conference.
Vuya Kabanyane, an Advisory Trustee to DignitySA, was interviewed in a wide-ranging and fascinating for the podasct Still Uncaptured on Advocating for Dignity and Choice. To watch video shorts from this highly engaging interaction, please visit https://www.youtube.com/@DignitySouthAfrica/shorts
Joseph Ramondo, DignitySA's Secretary, was interviewed on PowerFM in June alongside a traditional healer.
Global News Round-Up
In recent months, campaigns to legalize assisted dying have seen significant developments, particularly in the UK and France.
France: In May 2025, the French National Assembly passed a bill allowing some people in the last stages of a terminal illness to access assisted dying. This bill will now move to the Senate before a second reading in the lower house. In parallel, another bill on palliative care was adopted unanimously on the same day.
Scotland: A bill on assisted dying is also being considered in Scotland. It passed an initial vote in May and is awaiting further parliamentary scrutiny.
UK: On June 20 lawmakers approved the bill to allow terminally ill adults in England and Wales to choose to end their lives. This marked a significant step towards legalization, with a vote of 314-291 in the House of Commons. The bill now proceeds to the unelected House of Lords for further scrutiny, amendments, or delays, though it cannot be overruled by the lower chamber.
New Zealand: The New Zealand Ministry of Health published its annual report on Assisted Dying in July 2025. Under section 27(7) of the country's End of Life Choice Act, which became effective in 2021, the Registrar (assisted dying) must report on the assisted dying service under section 27(7) of the Act.
Italy: Several recent cases have directed attention and significant debate around physician-assisted suicide in Italy, where currently no effective legislation exists.
More articles from our website
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Poetry Apothecary
Words can be a powerful balm for body and soul. This month, we share “Die Doodsengel” (The Death Angel), a poem in Afrikaans by Aneta Shaw.
Die doodsengel -Aneta Shaw
Mei 2025
Sy klop nie aan die deur nie.
Sy ruk die handvatsel uit
Skop die deur in
En bars die huis binne
Soos ‘n eenman S.W.A.T squad
Met ‘n bodybag oor die skouer
Sy land op jou bors
En vat jou asem met haar heen.
Die doodsengel is vernuftig
Soms swaai sy haar saber of scimitar
In die lug
En met een stroke
kloof sy haar slagoffer middeldeur
Van kop tot tone
Sodat net ‘n halwe person oorbly
sy los sy asem vireers.
Die doodsengel is geduldig
Sy kom soos ‘n dief in die nag
Bekyk jou slapende lyf
En wonder wat kan sy nog vat
Sy het reeds al die nie-essensiele organe uitgepluk
Sy tik jou voorkop met ‘n tevrede grynslaggie
Sy hou van ontsteekte sinusse
Druk teen jou maag met haar lang benerige vingers
En is eweneens tevrede
As ‘n windjie ontsnap
Die een weet nog nie hoe om reg te eet nie
Dan skroef sy jou mooi hande af
En prop ‘n paar gehawende hande in hul plek
Die een sal nie weer ‘n mooi ring kan dra nie
Sy het reeds een knie uitgepluk
En wag vir die volgende
Haar boodskap op die nagtafel lees
“ek kom weer”
Sy doen ‘n vinnige skandering van die brein
Alle liggies brand deurmekaar en paniekerig
in die sentrum wat verlore goedere moet opspoor
maar die geheuesentrum toon min aktiwiteit.
Die doodsengel het Lene saggies weggeneem
Daar waar sy in haar hospitaalbed gele het
Was sy reeds tussen hier en daar
Het sy moeisaam teruggekom
Om diep in my oe te kyk
En my te groet
“Ek dink my tyd het gekom”
Ja, knik ek.
“Ek dink ek moet dit aanvaar”
Ja, knik ek weer.
En skielik moet sy dringend toilet toe gaan.
Die laaste keer.
Ek het heelnag saam met haar gewag,
In my bed en
Net voor sonop het ‘n skare engele
Haar kom haal.
En Johann bel my uit die Karoo
met die nuus
Maar ek het reeds geweet
Ek hoor nog haar laggie
Haar lakoniese opmerkings
Wat alles in plek laat val
Maar ek is bly haar lyding is verby.
𝐁𝐢𝐨𝐥𝐨𝐠𝐲 𝐢𝐬 𝐧𝐨𝐭 𝐭𝐡𝐞 𝐨𝐧𝐥𝐲 𝐰𝐨𝐮𝐧𝐝
For many of us with degenerative illnesses like Parkinson’s, MND, ALS, or advanced cancer, the worst suffering isn’t always physical pain. Medicine can dull pain. It cannot dull the terror of watching yourself disappear piece by piece.