This response to the recent opinion piece by Leigh Meinert is published with the understanding that it is ehospice policy to publish articles on all sides of the debate on controversial topics and these are not indicative of the views or opinions of ehospice nor its management. This response was published in the Daily Maverick on 30 June.  Edited by Dr Michelle Meiring, this is an open letter to Leigh Meinert in response to her opinion piece, ‘Beyond the false choice – why SA needs both palliative care and assisted dying’. Dear Leigh, Thank you for opening this important conversation. We are grateful that Dignity SA is placing high-quality palliative care higher on their agenda but would like to present a more balanced argument as to why South Africa is not ready for assisted dying. We do also need to challenge some of the arguments put forward in your article. The reality that some people experience – what happened to Di First, our deepest sympathies go out to Yvette Andrews on the death of her friend Di. It was a brave account told with humour (the orange uniform), bravery and honesty. We acknowledge that our deliberations will not take away the pain of that moment, with Di asking Yvette to kill her. We only wish that she could have received the pain relief she needed at 3am that day. There definitely needs to be greater access to 24-hour prescriber (palliative care doctor) helplines so nurses like Yvette and patients like Di can receive the help they need at any time of day or night, especially if they want to remain at home. It is not uncommon for pain to escalate suddenly in the last week of life and often the dose and the way pain relief is given (such as by injection under the skin or into a vein) needs to change, so that pain relief can be brought about more quickly. Euthanasia isn’t something that should be added in an emergency, especially if proper pain relief and/or sedation could have provided comfort without having to kill the patient. It is, however, understandable that Di wanted her life to be ended in that moment. We do not seek to undermine the severity of Di and Yvette’s suffering. Reality behind the rhetoric You are right, Leigh, that we live in one of the most unequal countries in the world and appreciate your concern that only the well-resourced can fly to Switzerland to end their lives. Carol de Swart was one of South Africa’s recent patients to travel to Switzerland (in early 2024) for assisted suicide. She might not have been able to go had she not been awarded R4-million in a legal malpractice suit against a Pietermaritzburg hospital for radiation damage to her leg necessitating an amputation. She would also not have been able to do it without the assistance of Sean Davison of Dignity SA who was her witness in Switzerland. According to quotes from journalists who interviewed her, Carol’s main reason for wanting to end her life was that she felt she had lost her will to live when she lost her leg. She felt her quality of life was diminished because she was no longer able to lead the active life she had before (fishing and gardening). She was assisted to die because of a disability and not because she had a terminal illness. Although she says in an article that she does not see the value in holding grudges against the doctors who made a mistake, she does say she was upset by the fact that they lied. She fought this malpractice case for eight years, which must have made it difficult for her to move away from the feeling of being a victim. One wonders if things wouldn’t have been better for her if she had had better pain control, rehabilitation and mental health support while adjusting to life as an amputee so that she could have continued enjoying some of the things she did before her leg was amputated. A palliative care approach could have made this possible. Friends, not foes I do hope, Leigh, that after these exchanges that we can carry on being friends as you have been “one of us”. Sometimes, however, friends need to agree to disagree. While we are working towards the common goal of helping people to have dignified deaths, our approach to achieving this is fundamentally different. Palliative care and assisted suicide are not compatible. Palliative care is built on a foundation that views the person as being indescribably valuable as a person and is committed to doing everything possible to uphold the person’s dignity and relieve their distress. To relieve suffering by mercifully killing the person, even if motivated by compassion, doesn’t, in our view, speak to restoring their dignity if you’re doing this by eliminating the person. Dignity, by definition, is the state or quality of being worthy of honour or respect, it is something that is inherent and shouldn’t change if we regard all human life as sacred. Harvey Chochinov is a palliative psychiatrist and arguably the world leader in research around dignity in palliative care. Chochinov’s research has pointed out that a “wish to die” is usually motivated not by uncontrolled pain, but rather by a loss of a sense of dignity – and that foremost in what determines a person’s sense of dignity is their perception of how they are seen by others: In a sense, “dignity is in the eye of the beholder”. Agreeing with someone that they should die, answers a question that they are asking, and confirms what they were suspecting of themselves – that their life is no longer worthwhile. The South African context Our South African context does indeed make these discussions even more urgent. Our public healthcare system is falling apart, and our private healthcare sector is uncontrolled and driven by consumerism and silo-working, with insufficient access to psychosocial and spiritual care professionals. To ensure that safeguards are