A 30-year-old Hollywood epic is being revisited for its rarely discussed portrayal of medical assisted dying, with experts asking whether the fictional case would meet South Africa’s proposed legal standards.
DignitySA chairperson Prof Willem Landman has written a detailed review of The English Patient to mark three decades since the film’s release, focusing on its closing scene where a nurse administers a lethal dose of morphine to her severely burned patient.
“Would the English patient have been eligible for MAiD as envisioned for South Africa by DignitySA’s constitutional challenge?” Landman asks in the organisation’s September newsletter.
The question goes beyond academic interest. DignitySA is currently challenging South African law to legalise voluntary medical assisted dying (MAiD) for people facing unbearable suffering.
Award-winning epic
The English Patient, based on Michael Ondaatje’s 1992 novel, won nine Academy Awards in 1997, including best picture, best director for Anthony Minghella, best supporting actress for Juliette Binoche, and best cinematography.
The novel itself shared the Booker Prize in 1992 and later won the Golden Man Booker 50 prize, competing against the best Booker winners of the preceding 50 years. It was translated into 38 languages.
Set against the backdrop of World War II, the film moves between two timeframes. The “present” takes place in October 1944 in an abandoned Italian monastery church, where Canadian Army nurse Hana cares for a severely burned, unrecognisable man known only as “the English patient” because of his accent.
The patient, later identified as Hungarian Count Ladislaus de Almásy, is bandaged, disfigured, and suffering from amnesia. His only possession is an ancient copy of Herodotus’s The Histories, with personal papers tucked inside.
A love story in wartime
Through morphine-induced memories, the film reveals Almásy’s past. Before the war, he worked as a cartographer in North Africa, piloting his own plane over the desert to draw maps.
He fell in love with Katharine Clifton, an Englishwoman who joined his desert exploration team with her husband Geoffrey. The two began an intense affair in Cairo, which Katharine ended out of guilt and concern for her husband.
After discovering the affair, Geoffrey deliberately crashed his plane into Almásy’s camp with Katharine on board, killing himself and critically injuring her. Almásy carried the wounded Katharine to the Cave of Swimmers and set out to find help.
British forces refused to believe his story or mount a rescue. By the time Almásy managed to return years later, Katharine had died. While attempting to fly her body out of the desert, his plane caught fire. He suffered severe burns and was rescued by Bedouin tribesmen, left unrecognisable.
The final act of mercy
Back in the “present”, the critically burned Almásy, suffering from failing organs and severe pain, signals to Hana that he wants to die. He deliberately pushes several vials of morphine towards her and says he has “had enough”.
Hana, deeply emotional but understanding his wish, grants it by administering a lethal dose of morphine into his intravenous drip. As Almásy drifts into permanent sleep, she reads aloud the final letter written by Katharine as she died alone in the cave.
Landman notes that film reviews rarely pick up on this portrayal of assisted dying, despite its relevance to current debates.
Would he qualify in South Africa?
Landman examines whether the English patient would meet the criteria proposed in DignitySA’s constitutional challenge.
The patient was injured rather than ill, though his organs were failing. It remains unclear whether he was in a terminal state, usually defined as likely to die within six months, though burn patients in the 1940s had poorer recovery rates than today.
His suffering stemmed from both physical pain and mental distress. There is no reason to believe he lacked mental competence to decide about his continued life. His request was voluntary, with no coercion, though war and limited medical care narrowed his options.
The morphine came from a field hospital, making it a case of medical assistance in dying. The patient likely could not self-administer due to his injuries, so Hana administered it.
“I believe so,” Landman writes. “The English patient was likely mentally competent, had severe injuries making any semblance of a normal life impossible, without ever higher dosages of morphine his suffering was unbearable and intractable, and his request was the outcome of a free choice.”
With proper safeguards in place, assistance like Hana’s would be both ethically justified and legal in a South Africa shaped by constitutional values, he argues.
Landman stresses that palliative care remains non-negotiable in any MAiD setting, particularly given the extreme suffering caused by burn wounds.
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He contrasts this with cases where nurses act without patient consent, believing they are acting in patients’ best interests. Such instances, including South Africa’s Smorenburg case in 1992, lead to criminal prosecutions.
DignitySA’s court challenge involves voluntary MAiD only, where patients themselves request assistance in dying.
The English Patient remains a timeless film that can be revisited like classical literature, Landman concludes. Above all, it tells a story of identification and solidarity with another, of caring and compassion to the point of honouring an ultimate request despite the personal emotional cost.
