Pacemakers and end-of-life decisions.

It is accepted in South African law that patients have the right to refuse medical treatment even if it may cause them to die, if they have the legal capacity to make such a decision. In English law the principle ‘extends to situations where the person, in anticipation of his ... entering into a condition such as PVS [persistent vegetative state], gives clear instructions that in such event he is not to be given medical treatment ... designed to keep him alive’. It is submitted that similar principles apply in our law where patients have made a ‘living will’ that reflects their current wishes. It is no different from patients issuing an advance directive that they do not wish to undergo a blood transfusion should the need arise even if it may result in death.