EUTHANASIA, ASSISTED DYING AND THE RIGHT TO DIE IN GHANA: A SOCIO-LEGAL ANALYSIS

Ernest Owusu-Dapaa*

ABSTRACT

There is unanimity among states to protect the continuation of life the individual as a safeguard against their collective extinction. The right to life is accordingly guaranteed but its antithesis, the right to die is the subject of unending debate. The controversy over the right to die is deepened by rapid advances in medicine creating the capability for prolongation of life beyond the span which one’s natural strength can endure. Ghana’s supreme law explicitly guarantees the right to life but remains ambiguous on right to die particularly euthanasia and assisted dying. Thus, some of the other rights, such as right to dignity and not to be tortured, can creatively be exploited to justify some instances of euthanasia. The Ghana’s criminal code largely proscribes euthanasia. Notwithstanding, proscription of euthanasia and assisted dying by the law in Ghana empirical work undertaken in some of the communities in Ghana suggest that euthanasia is practised on the quiet in health facilities and private homes especially in the rural areas. Contrary, to the popular reasons assigned, in the literature in the Western world, for the practice or quest for legalization of euthanasia being a necessity for providing relief from pain or hopeless quality of life, empirical data from social and anthropological studies conducted in Ghana reveal that poverty is the motivation for informal euthanasia practice in Ghana rather than genuine desire on part of patients to die or their relatives to see to their accelerated death. Apart from poverty, traditional cultural values of African societies consider non-natural death as a taboo and ignominy to the victim and his family. Thus, any move by the government to legalize euthanasia will need to be informed by a widely held consultations and possibly referendum; otherwise the law may be just a mere transplant of Western models of legislation on euthanasia without reflecting ethos of the African people.  

KEY WORDS: Euthanasia; Right to die; Assisted Dying; Ghana; Sanctity of life; Criminal law; Bad death.

1. INTRODUCTION

‘Euthanasia is a hotly debated issue in almost every country, even those states with reasonably well settled constitutions find them tested by medico-legal decision at the end of life.'[1] The desire for life, to remain alive and keep living is deeply seated in the ethos of human society regardless of geography, race, gender religion or class. Indeed, life has been mentioned as the first irreducible condition for human flourishing. Indeed, John Finnis has noted that ‘a first basic value, corresponding to the drive for self-preservation, is the value of life.’[2] The consensus of the international community after the devastating and grueling World War II culminated in the legal protection of the right to life.[3] The sanctity of life principle in international human rights law has been one of the prominent bases for an advocacy for the abolition of death penalty.[4] Medical advances have unleashed both relief and challenges to human beings everywhere. Geography is no immunity to the radical and sweeping revolution in medical intervention technology. Thus, patients in Ghana can experience the life prolonging capacity of medical advances accomplished in the developed world.  In recent times respirators and artificial hydration among others are available to sustain life even beyond what the natural capacity of a human body can endure. Advances are so cumulative that the standard definition of biological death is being revised constantly within the medical research world, especially in the light of successes with the medical technology of organ transplantation. The concept of death is no longer cast in stone because it shifts with progress in medical capabilities to sustain life beyond a person’s natural ability to remain alive. For a long time it was thought that the vital functions of a human body were breathing, heartbeat and the capacity for consciousness or sentience; thus, death was understood as the absence of these vital functions.^[5]

However, the introduction of respirator and life support machines has meant that the generally accepted medical definition of death in the late 1950s has become obsolete. In 1976 the Royal Colleges of Medicine in England and Wales adopted brain-stem death as the new definition of death.^[6] The question of the definition of death has several ethical and legal implications. To begin with, the determination of when the dying process begins and ends has implication for euthanasia. In this paper, I explore the extent to which euthanasia assisted dying and the right to die exist under Ghanaian law; and the social and anthropological attitudes and ethos of Ghanaians towards the end of life issues. The segment after this general introduction is an exploration of the nature euthanasia and assisted dying.

2. UNPACKING EUTHANASIA, ASSISTED DYING AND THE RIGHT TO DIE

It is incontestable that euthanasia remains a phenomenon of universal concern.  But what exactly constitutes euthanasia. The term ‘euthanasia’ is succinctly defined in the Black’s Law Dictionary as ‘the act or practice of painlessly putting to death persons suffering from incurable and distressing disease as an act of mercy.’[7]  This definition is consistent with the etymology of the term. Etymologically, 'euthanasia' originates from the Greek words, eu (good) and thantos (death).[8] Physician assisted dying is the practice of a doctor or healthcare professional providing the means for a patient to end his own life. Based upon relationship between role of the doctor and the patient, we may have voluntary active euthanasia, passive euthanasia and involuntary euthanasia.[9] Voluntary active euthanasia refers to ‘hastening one’s own death by use of drugs or other means, with a doctor’s direct assistance.’[10] On the other hand passive euthanasia connotes’ hastening death by withdrawing life sustaining treatment and letting nature take its course.’ Involuntary euthanasia involves causing or accelerating the death of someone who has not asked for assistance with dying, such as a persistent vegetative patient. The right to die is the very antithesis of the right to life. It is clear that  all the various forms of euthanasia including assisted dying all fall within the ambit of right to die but it is possible for some other forms of death to be subsumed under the right to die. It is submitted that the right to die should be narrowly understood to encapsulate only those instances of death meant to alleviate pain and suffering in situation where there is no hope whatsoever of being restored to meaningful life. To that extent, right to life, euthanasia and assisted dying are not mutually exclusive stricto sensu. 

 There is no consensus as to the rightness or wrongness of helping someone to die.[11] A positive act leading to death as euthanasia was unequivocally denounced by Bingham, MR in the English case of Airedale NHS Trust v Bland, which deals with the issue of removal of life support from a patient in a persistent or permanent vegetative state. His Lordship considered that such practice,

is not about euthanasia, if by that is meant the taking of positive action to cause death. It is not about putting down the old and infirm, the mentally defective or the physically imperfect. It has nothing to do with the eugenic practices associated with fascist Germany.[12]

3. IS EUTHANASIA LEGALISED IN GHANA?

There is no direct legal framework for lawful euthanasia in Ghana. The default provision of the law as reflected in disparate statutory and customary law provisions is proscription of euthanasia. It is important to survey the laws of Ghana which are relevant to the subject in order to bolster this observation that Ghanaian law by default outlaws euthanasia.  

The search for the legal position on euthanasia in Ghana must begin from the 1992 Constitution (hereinafter ‘the Constitution’), which is the fundamental and supreme law of the land.[13] The right to life is guaranteed by the Constitution. Article 13 of the Constitution stipulates:

• No person shall be deprived of his life intentionally except in the exercise of the execution of a sentence of a court in respect of a criminal offence under the laws of Ghana of which he has been convicted.’
• A person shall not be held to have deprived another person of his life in contravention of clause (1) of this article if that other person dies as the result of a lawful act of war or if that other person dies as the result of the use of force to such an extent as is reasonably justifiable in the particular circumstances.- (a) for the defence of any person from violence or for the defence of property; or (b) in order to effect a lawful arrest or to prevent the escape of a person lawfully detained; or (c) for the purposes of suppressing a riot, insurrection or mutiny; or (d) in order to prevent the commission of a crime by that person.[14]

The wording of the provision suggests that it is deprivation or termination of a person’s life by another which is generally outlawed by the Constitution. Thus a doctor or any person who seeks to assist a suffering patient even in a persistent vegetative state in Ghana could be guilty of depriving another person’s life contrary to the provision in Article 13 of the Constitution.  In one leading English case[15], a health authority responsible for the treatment of a persistent vegetative state patient brought an application to the court for a declaration that it and the responsible physicians could lawfully discontinue all life-sustaining treatment and medical support measures designed to keep the patient alive in his existing PVS, including ventilation, nutrition and hydration by artificial means.^[16] The House of Lords granted the declaration but reiterated the need for doctors to seek the guidance of the courts before withholding treatment in such cases.^[17] The trial judge in Bland, Sir Stephen Brown P, noted that the term persistent vegetative state (PVS) was first coined in 1972 by some medical professors to ‘describe a syndrome that was being increasingly encountered as the life-saving and life-sustaining technologies of intensive care were securing the survival of some patients with brain damage of a severity that would previously have proved fatal.’^[18]  Commenting on article 3 of the European Convention on Human Rights (ECHR) which is substantially in pari material with article 13 of the Constitution, Suzanne Ost rightly contended that although euthanasia does not fall within the permitted derogations of the provision on right to life, the fact that ‘there are circumstances in which the deprivation of life does not amount to a breach of this Article provides indication that the right to life is not an absolute right.’[19] Indeed, if the right to life is not so sacrosanct or absolute, then it is apposite to explore other provisions of the Constitution for support or rejection of euthanasia, assisted dying or right to die.

         The right to personal dignity under the constitution is worth exploring to ascertain if it lends some support to the right to die or euthanasia in Ghana. Article 13 states that:

• No person shall, whether or not he is arrested, restricted or retained, be subjected to -(a) torture or other cruel, inhuman or degrading treatment or punishment; (b) any other condition that detracts or is likely to detract from his dignity and worth as a human being.[20]

This provision raises interesting possible interpretations which may provide some support for the antithesis of the right to life, that is, right to die or euthanasia and assisted dying. It may be contended that a refusal to terminate life of a suffering patient in irretrievably excruciating terminal condition may constitute violation of the right not to be subjected to torture or un-dignifying treatment. Reflecting on a similar provision in Article 3 of ECHR, Ost noted that it may be theoretically possible to construe omission by doctors to end a suffering patient’s life as cruel treatment.[21] She opines that such possibility may exist where a suffering patient who feels humiliated by his condition voluntarily request for assistance to die from the doctor. Notwithstanding, the persuasiveness of Ost’s argument, the derivative right to die based upon right to personal dignity has not yet been tested in health care related litigation in Ghana.  

Apart from the constitutional provisions, it is apposite to explore the extent to which the practice of euthanasia is prohibited or permitted by other statutes of Ghana. The Criminal Code of Ghana, 1960 (Act 29) is the most relevant piece of legislation which needs to be analysed here. Sections 42,[22] 47, 52 and 57 are the material provisions of Act 29 with respect to exploration of euthanasia and assisted suicide. The infliction of harm may be justified by consent under Act 29 but section 42 expressly excludes consent as a justification for killing another person. Thus, euthanasia and assisted dying may not be justified by merely pleading consent. Also, a patient who does not succeed in terminating his life shall be guilty of attempted suicide punishable as misdemeanour under section 47(2) of Act 29. However, any person who abets the commission of attempted suicide, that is assisted dying in medical law taxonomy, is guilty of first degree felony punishable by life imprisonment.[23] According to section 20 of Act 29, ‘every person who, directly or indirectly, instigates, commands, counsels, procures, solicits, or in any manner purposely aids, facilitates, encourages, or promotes, whether by his act or presence or otherwise, and every person who does any act for the purpose of aiding, facilitating, encouraging or promoting the commission of a crime by any other person, whether known or unknown, certain or uncertain, is guilty of abetting that crime, and of abetting the other person in respect of that crime.’ The import of this provision in the context of end of life discourse is that it is not only the doctor or health care professional that may be liable for the offence of attempted suicide but relatives of the patients who aided or facilitated or anyway encouraged the provision of assistance towards the termination of the patient’s life are equally culpable as accessories. What remains unclear from statutory law in Ghana is the extent to which the use of force (such as painless in relation to insensate patients) can be used to bring an end to suffering.

There appears to be an ambiguity in the law which can be exploited to justify a limited version of euthanasia in Ghana. Section 42 of Act 30 stipulates:

 The use of force against a person may be justified on the ground of his consent, but—
(e) if a person is intoxicated or insensible, or is from any cause unable to give or withhold consent, any force is justifiable which is used, in good faith and without negligence, for the purposes of medical or surgical treatment or otherwise for his benefit, unless some person authorised by him or by law to give or refuse consent on his behalf dissents from the use of that force.

A close analysis of the above provision reveals a certain degree of ambiguity which can be interpreted liberally to encapsulate some forms of euthanasia in Ghana particularly in relation to persistent or permanent vegetative state patients as was noted above in relation to Bland.  It is striking that the law does not limit application of force to only medical or surgical treatment but also ‘otherwise for his benefit’. It is submitted that the provisions tacitly recognises that it is not all the time that medical or surgical therapy may achieve the traditional purpose for restoration of health. Indeed, in the case of medical futility where therapeutic intervention does not in any way prolongs life or relief pain it may be beneficial to the patient in some situations to be exit.  Thus, the phrase ‘otherwise for his benefit’ is quite elastic as it stands until a court of law has competently interpreted it.  A number of questions arise from the potential import of that phrase. Can termination of life in a severe and excruciating pain with no hope of recovery be considered as benefiting that patient? Can a patient who does not have means to afford palliative care be assisted to die for his benefit? The answers to these questions cannot be known until the provisions have been tested in a court of law. A search conducted in all the law reports in Ghana as at January, 2013 did not reveal any decided case in relation to this provision. An equally important test for operationalization of the justification in section 42 of Act 29 is whether the doctor or healthcare professional acted in good faith. The determination of good faith in this context may impinge on issues of medical ethics and in particular the Hippocratic Oath which doctors in Ghana subscribe before being enrolled.  I submit that the doctrine of double effect established in 1957 by the English case, R v Bokin Adams[24] may properly be invoked under Section 42(e) of Act 29 to exculpate liability for physician assisted death in appropriate situations.[25] The doctrine is basically that a doctor is not culpable where in discharging his primary obligation in treating terminally ill patient; he administers a form of treatment for his patient’s benefit with the awareness that it has secondary effect of accelerating or likely to accelerate the patient’s death.[26] In 1957 Dr John Bodkin Adams was tried for the murder of an eighty-four year old woman in his care, who had named him as beneficiary in her will. The patient was terminally ill and succumbed following the administration of large doses of narcotics prescribed by Dr Adams. Other, similar cases were also suspected in his practice. Devlin J advised the jury that, regardless of the health of the victim and the motive of the accused, the law would treat as murder any action which intended to kill and did in fact kill. Despite this he also ruled that

if the first purpose of medicine, the restoration of health, can no longer be achieved there is still much for a doctor to do, and he is entitled to do all that is proper and necessary to relieve pain and suffering, even if the measures he takes may incidentally shorten human life.[27]

Regardless of the interpretive window of opportunity lending support for a certain degree of euthanasia and assisted dying in Ghana, it remains a mere conjecture or phantom of legal speculation until a court of competent jurisdiction has pronounced upon the matter. Consequently, the current position is that Ghanaian law by default proscribes euthanasia and assisted dying in all its forms.

The rational of the default position of the law in Ghana in preventing euthanasia is not clearly discernible. However, we can situate the legal position in the moral context.  Two competing moral arguments may be explored. The sanctity of life theory holds that life must be protected and sustained under all conditions possible.[28] It trumps even the right of the individual to self-determination or autonomy. The sanctity of life argument postulates further that human being is a relational being such that there is an important sense in which a person’s life is not just her own but also belongs to the group of which he is part of.[29] The countervailing argument to sanctity of life is the libertarian notions of autonomy. It has been argued that autonomy of a person should find expression in the exercise of his or her self-determination to life or die especially having regard to irretrievably diminished quality of life.[30] Thus, a person can exercise his or her autonomy and choose one’s own death in terms of time and place.  In this way, a person is able to have good death which underscores the etymology of euthanasia, that is eu (good) and thantos (death). 

4. THE VIEWS OF GHANAIANS ON EUTHANASIA AND ASSISTED DYING FROM SOCIO-ANTHROPOLOGICAL   STUDIES

Euthanasia occurs in Ghana in various forms. Geest has noted that certain family members continue to request for physicians to withhold care for their relatives because of lack of funds to sustain such treatment.[31] Whereas in the developed countries euthanasia is undertaken predominantly to end suffering of a patient in irretrievably difficult medical condition,[32] the motivation for instances of euthanasia in Africa and in particular Ghana is probably more of poverty,  inability to meet medical bills and inadequacy of health care facilities than the need to release patient from suffering.[33]

There is a divided sociological and anthropological opinion on the phenomenon of euthanasia in Ghana according to empirical research undertaken by other scholars. A properly contextualised understanding of the debate on euthanasia in Ghana ought to begin from understanding the perceptions of Ghanaians on death and dying due to the inextricable linkage between the two stages of the same phenomena.[34] The inevitability of death is beyond realm of disputation due to the ultimate immortality of humankind.[35] In his empirical studies conducted in 2002 Van der Geest identified two kinds of deaths in the Kwahu-Tafo region of Ghana, namely ‘good death’ and ‘bad death.’[36] An individuals who lived a descent life and died naturally is said to have has a good death.[37] On the contrary, an individual is considered to have had a bad death  if he or she died through  an unnatural cause such as  accidents, suicide or  a woman who dies during childbirth.[38] It is a widely held view in Ghana that euthanasia is a form of suicide and is therefore considered a ‘bad death.’[39]

Euthanasia which is generally categorised by people in Ghana as bad death has unpleasant consequences for the deceased and his or her relatives. Agyemang has noted that it attracts incalculable shame and social stigma upon existing family.[40] Due to weak law enforcement coupled with the predominantly rural areas where euthanasia often takes place in Ghana, it is the adverse social consequences rather than the deterrence potential of law which discourage rampant resort to euthanasia even in the face of poverty and lack of adequate health care facilities.  Moreover, the heavily religious and traditional nature of Ghanaian society even in modern times suggest that practice of euthanasia is against what the people consider to be the wishes of the Almighty God. Indeed, an empirical survey in the rural town of Kwahu-Tafo in Southern Ghana confirmed that euthanasia was not accepted as a possible means of death because both the young and old held the view that life and death are and should remain in God’s hands.[41] This finding is further corroborated by the philosophical reflection on the impact of new medical technology by Kwasi Agyeman:

The absolute sanctity and dignity of life, as well as reverence for life, and the analytic claim that every event has a cause, are among the everyday truisms which go unquestioned even when state-of-the-art medical wonders appear to challenge the given realities of the natural world. Such convictions concerning nkrabea or destiny run contrary to approving of euthanasia.[42]

5. CONCLUSION

It is undoubted that society is readily jealous to protect the continuation of human life as a safeguard against its collective extinction. The right to life is accordingly guaranteed but its antithesis, the right to die is the subject of unending debate. The controversy over the right to die is deepened by rapid advances in medicine creating the capability for prolongation of life beyond the span one’s natural strength can endure. Ghana’s supreme law, the constitution, explicitly guarantees the right to life but remains ambiguous on right to die particularly euthanasia and assisted dying. Thus, some of the other rights, such as right to dignity and not to be tortured, can creatively be exploited to justify some instances of euthanasia. But no court has yet taken that stance. The statute law, particularly Ghana’s criminal code, largely proscribes euthanasia. Notwithstanding, proscription of euthanasia and assisted dying by the law in Ghana empirical work undertaken in some of the communities in Ghana suggest that euthanasia is practised on the quiet in health facilities and private homes especially in the rural areas. Due to weak law enforcement generally in Ghana, there is no decided case on euthanasia or assisted dying in Ghana. Contrary, to the popular reasons assigned in the literature in the Western world for the practice or quest for euthanasia being a relief from pain or hopeless quality of life, empirical data from social and anthropological studies conducted in Ghana reveal that poverty is the motivation for informal euthanasia practice in Ghana rather than genuine desire on part of patients to die or their relatives to see to their accelerated death. Apart from poverty, traditional cultural values of African societies consider non-natural death as a taboo and ignominy to the victim and his family. Thus, any move by the government to legalize euthanasia will need to be informed by a widely held consultations and possibly referendum otherwise; the law may be just a mere transplant of Western models of legislation on euthanasia without reflecting ethos of the people.   

* Barrister at Law, Lecturer, Faculty of Law, Kwame Nkrumah University of Science and Technology, Ghana and PhD Candidate, Lancaster University School of Law, UK. Email:  eodapaa@yahoo.com.

I wish to express my appreciation to Rodrigo Cespedes of Lancaster University School of Law, for his helpful comments and criticism. I remain solely responsible for all limitations.

[1] M. Davies, Textbook on Medical Law, 2^nd edn (Oxford: Oxford University Press, 1998), p.342.

[2] J. Finnis, Natural Law and Natural Rights, 2^nd edn, (Oxford: Oxford University Press, 2011), p.86.

[3]  See Article 3 of UN Universal Declaration on Human Rights http://www.un.org/en/documents/udhr/index.shtml (last visited: 3/4/2013); Article 6 of the International Covenant on Civil and Political Rights http://www.unhcr.org/refworld/docid/3ae6b3aa0.html (last visited: 3/4/2013).

[4] http://www.amnesty.org/en/death-penalty (last visited: 3/4/2013).

[5] I. Kennedy, The Unmasking of Medicine (England: St Albans, 1983), pp.162-164

[6] Ibid.

[7] H. C. Black, Black’s Law Dictionary, 16th edn, (St Paul Minn-West Publishing Co, (1991)), p. 554.

[8] S. Ost, An Analytical Study of the Legal, Moral, and Ethical Aspects of the Living Phenomenon of Euthanasia, (Lampter: Edwin Mellen Press, 2003), p.15.

[9] J.K. Mason, G.T. Laurie, Mason and McCall Smith’s Law and Medical Ethics, 6^th edn (Oxford: Oxford University Press, 2006), p.566.

[10] S. C. Chima, A Primer on Medical Law, Bioethics & Human Rights for African Scholars (Durban- SA: Chimason Educational Books, 2011), 324.

[11] A. Norrie, ‘Legal Form and Moral Judgment: The Problem of Euthanasia’ March 23, 2010). Warwick School of Law Research Paper No. 2010-05. Available at SSRN: http://ssrn.com/abstract=1577163 or http://dx.doi.org/10.2139/ssrn.157716 (last visited 1/4/2013).

[12] [1993] 1 All ER 821.

[13] 1992 Constitution of the Republic of Ghana (Accra, Assembly Press, 1992), Art.2.

[14] 1992 Constitution.

[15] By virtue of colonial connection, Ghana’s legal system is based upon the common law tradition. English decisions are of persuasive authority.

[16] Airedale NHS Trust v Bland [1993] 1 All ER 821.

[17]  Airedale NHS Trust v Bland [1993] 1 All ER 821 at 874 per Lord Goff of Chieveley; at 880 per Lord Brown-Wilkinson.

[18] Airedale NHS Trust v Bland [1993] 1 All ER 821 at 827

[19] S. Ost, ‘Conceptions of the Euthanasia Phenomenon: A Comparative Discussion of the Law, Individual Rights and Morality within Three Jurisdictions,’ (2000) 5 Journal of Civil Liberties 155, 158; Also see generally, B. Brody, ‘Life and Death Decision Making,' (Oxford: Oxford University Press, 1988).

[20] 1992 Constitution.

[21] Ost, n.24 above, p. 159.

[22] Section 42- ‘The use of force against a person may be justified on the ground of his consent, but—
(a) the killing of a person cannot be justified on the ground of consent;
(b) a wound or grievous harm cannot be justified on the ground of consent, unless the consent is given, and the wound or harm is caused, in good faith, for the purposes or in the course of medical or surgical treatment.
(c) consent to the use of force for the purposes of medical or surgical treatment does not extend to any improper or negligent treatment.
(e) if a person is intoxicated or insensible, or is from any cause unable to give or withhold consent, any force is justifiable which is used, in good faith and without negligence, for the purposes of medical or surgical treatment or otherwise for his benefit, unless some person authorised by him or by law to give or refuse consent on his behalf dissents from the use of that force;’

[23] Criminal Code, 1960 (Act 29), s. 47 (1).

[24] [1957] Crim. L R. 365.

[25] This decision can be a persuasive authority in Ghanaian court since Ghana’s Criminal Code was passed in 1960 barely three years after the Bodkin Adams case.

[26] I. Kennedy, ‘The Law Relating to the Treatment of the Terminally ill’ in I. Kennedy, Treat Me Right – Essays in Medical Law and Ethics (Oxford: Oxford University Press, 1988), ch.16, p.325.

[27] [1957] Crim. L R. 365.

[28] A. O. Nwafor, ‘Comparative Perspective on Euthanasia in Nigeria and Ethiopia,’ (2010) 18 Africa Journal of Comparative and International Law, 170, 173.

[29] A. Norrie, n.15 above, p.3.

[30] Mason, Laurie, n.9 above, ch.18.

[31] S. Van der Geest ‘I want to go: How elderly people in Ghana look forward to death’ (2002) 22(1) Ageing and Society, 7-28.

[32]Ost, n. 8 above.

[33] K. Agyemang, ‘The Impact of new medical technology  upon attitudes towards euthanasia among Akans, Cultural Heritage and Contemporary Change,  http://www.crvp.org/book/Series02/II-5/chapter_ix.htm (last visited: 6/4/2013)

[34] M. Luguterah, The Experiences and Perceptions of Ghanaian Medical Professionals towards the Practice of Passive Euthanasia in Ghana (Cappella University, PhD Dissertation: 2012), p.32-33.

[35] F. Brennan, ‘Palliative Care as an International Human Right’ (2007) 33(5) Journal of Pain and Symptom Management, 494-499.

[36] Van der Geest, n.31 above, p.20.

[37] Ibid.

[38] Ibid.

[39] Agyemang, n.33 above.

[40] Ibid.

[41] Van der Geest, n.31.

[42] Agyemang, n.33 above.