People sang in tribute to Nelson Mandela outside Mediclinic Heart Hospital in Pretoria on Thursday.
JOHANNESBURG — The family of Nelson Mandela, who has been lying at the edge of death in a South African hospital for more than a month, may in the days or weeks to come face the same awful decision that has confronted myriad other families in an age of life-sustaining miracle machines — when it is time to say ‘enough.’
Medical experts in and outside South Africa who are not involved in his care have taken the government’s cryptic diagnosis — that Mr. Mandela is in critical but stable condition — to mean that he is being sustained by equipment, which given his advanced age could present his relatives, doctors and the country with a wrenching choice about how long to keep the 94-year-old alive.
Any decision would be made in the glare of an international spotlight and would involve an extended family that has shown itself to be fractious about decisions regarding inheritance, his eventual burial location and his legacy. And they would do so under a set of South African laws and court precedents that leave some unnerving gray areas over who might make the ultimate decision.
In cases where the patient has left a living will or has appointed a surrogate to act on his behalf, the path is clear. But in the absence of a living will, or if no surrogate has been chosen or there is more than one surrogate — like siblings or an entire extended family – South Africa’s law is not entirely clear, legal experts here say.
Conflicts are possible, especially in families that cannot agree about how to proceed. And finding such consensus may prove difficult in the case of the Mandela clan, which has been in the news and in the courts as recently as this month in the latest in a series of disputes.
“It is not easy when you are confronted with the internal wrangling within the family that has spilled into the public domain,” said Nomboniso Gasa, a political analyst in Johannesburg. “Still, despite all the contention and all the fights the Mandelas seem to be having, I think they are quite aware that an end-of-life decision may need to be taken. But the high profile makes it so very difficult.”
This, too, is an age when ventilators and feeding tubes and other high-tech machines can keep people — even those in a permanent vegetative state — alive for months and even years, as in the case of Ariel Sharon, the 84-year-old former Israeli prime minister who has been in a coma since he suffered a devastating stroke in 2006.
Not enough is known about Mr. Mandela’s true medical condition to know how his case might fall under South African law, experts in medical legal issues say. The government will say only that he remains in “critical but stable” condition. A court affidavit filed in June in a dispute within the Mandela family over where the former president might be buried claimed he was in a permanent vegetative state, but both family and medical team members have since denied this.
Indeed, family members and friends who have visited him in recent days say that Mr. Mandela is sometimes awake, smiling, communicating with his eyes, even attempting to talk. President Jacob Zuma, who visited Mr. Mandela as recently as Wednesday, said he was now responding to treatment.
Still, the anti-apartheid leader’s condition is undeniably grave, and there is a great deal of skepticism about what the government and the family is saying about his condition.
“I believe, personally, that there is a lack of honesty in this matter,” said Cheryl Webb, a counselor for the Family Law Clinic in Cape Town who has worked with families in similar situations. “You just get the feeling that the truth is not being told. We have elections coming up soon. There is talk of absolute chaos in the country after Mandela passes away. There are so many factors.”
Such sentiments are not unusual.
“Not long ago, I was told authoritatively, hands on heart, that Mandela had died by people who knew people,” said Bonita Meyersfeld, director of the Center for Applied Legal Studies at the University of the Witwatersrand in Johannesburg. “There is a great deal of misinformation. Nelson Mandela is an icon, but this time he is an icon for misinformation and not being told things.”
Also contributing reporting was Sheelagh McNeill in New York.
