Advance DirectivesCampaign
A multi-stakeholder campaign in South Africa to provide a sound legal basis for advance directives such as living wills and the durable power of attorney for healthcare - enabling natural deaths.
Legal Uncertainty
Current gaps in legislation
Advance Care Planning
Facilitated conversations about care goals
Palliative Care
Compassionate care addressing physical and emotional needs
Why This Campaign Matters
The Draft National Health Amendment Bill is long overdue. It would provide much-needed legal clarity for advance directives in South Africa, empowering individuals to maintain agency over their illness trajectories when they anticipate losing capacity to make their own medical decisions. This enables individuals to prioritise palliative care when aggressive, curative treatment no longer matches their goals, while ensuring loved ones and health professionals can confidently support and respect their wishes.
Legal Uncertainty
Medical professionals face perceived risk of criminal or civil liability when allowing natural deaths by respecting advance directives, creating unnecessary uncertainty.
Advance Care Planning
Advance care planning enables meaningful discussions between patients, families, and healthcare providers about treatment preferences, values, and goals for care during serious illness.
Palliative Care
Palliative care provides specialised medical support that focuses on relieving symptoms and improving quality of life, allowing natural death when aggressive treatments no longer align with patient goals.
The Draft National Health Amendment Bill
The bill proposes two types of advance directives that can be freely made by competent individuals.
Living Will
A signed and attested document that enables a competent person to refuse unwanted life-sustaining treatment, allowing a natural death should they irreversibly lose their capacity to make such decisions. Palliative care and symptom management continue to ensure comfort and dignity.
- Specifies treatment preferences
- Addresses life-sustaining treatments
- Legally binding when executed
Durable Power of Attorney
A signed and attested document that enables a competent person to transfer their healthcare decision-making to a trusted proxy or substitute. Palliative care remains available to maintain quality of life throughout the process.
- Appoints healthcare decision-maker
- Remains valid upon loss of competence
- Covers unspecified decisions
Constitutional, Legal and Ethical Foundation
The Draft Bill is anchored in existing constitutional rights, legal principles, and strong professional ethical guidance.
Constitutional Rights
Human Dignity (Section 10)
The right to have one's inherent dignity respected, which is diminished when life loses meaning through futile treatment.
Bodily & Psychological Integrity (Section 12)
The right to security in and control over one's body, including the right to refuse unwanted medical intervention.
Freedom from Cruel Treatment (Section 12)
Protection from treatment that is cruel, inhuman, or degrading, which can include forced medical procedures.
Personal Autonomy
The foundational right to self-determination, which informs all other rights related to end-of-life decisions.
Legal Precedents
SA Law Commission (1998)
Following public input, recommended legislation for both living wills and durable powers of attorney for healthcare.
Download Project 86 ReportNational Health Act (2003)
Section 7 establishes the right to informed consent and refusal of treatment, and provides for appointing a healthcare proxy.
Supreme Court of Appeal (2016)
Unambiguously affirmed the right to refuse life-prolonging treatment, allowing natural processes to take their course.
Common Law Recognition
Long-standing recognition of bodily integrity and that medical treatment without consent constitutes an assault.
Professional Ethics
HPCSA Guidelines (2008, 2023)
Explicitly require practitioners to respect patient autonomy in refusing treatment and support the use of advance directives.
Download GuidelinesSAMA Medical Ethics
Recognises that living wills reflect a patient's wishes and should be respected, advising medical guidance in their drafting.
PALPRAC Advance Care Planning
The Association of Palliative Care Practitioners provides toolkits for patients and doctors to facilitate compassionate end-of-life conversations.
Visit PALPRAC WebsiteStandard of Care
A professional consensus that withholding or withdrawing futile life-sustaining treatment is not only permissible but mandatory.
Supported By
Leading organisations backing advance directive legislation in South Africa
Natural Death, Not Assisted Dying
It's crucial to understand that advance directives enable natural deaths by allowing nature to take its course, not assisted dying which involves administering means that cause death.
Advance Directives
Natural Death Process
Withdrawing or withholding life-sustaining treatment to allow the natural disease process to continue
No Active Intervention
No administration of substances or means that directly cause death
Letting Nature Take Course
Allowing natural biological processes and disease progression without artificial prolongation
“A competent person's right to refuse medical treatment, even if it results in death, is a well-established principle in our law.”
Assisted Dying
Active Intervention
Administering a lethal substance or means to intentionally and prematurely end life
Intentional Act
The explicit purpose is to cause death, rather than allowing natural processes to unfold
Distinct from Palliative Care
Palliative care aims to manage symptoms and improve quality of life, not hasten death
“This campaign does not support assisted dying or euthanasia, which are separate issues with their own distinct legal and ethical considerations.”
Support the Campaign
Add your organisation to our list of supporters, or send us a message to find out how you can get involved.