Life Esidimeni

When we got our independence, we did not ask ourselves what kind of ethics this new country needed. South Africa’s health ombud reflects on his first big case

In September 2016, Health Minister Aaron Motsoaledi asked me to investigate the deaths of, at that time, 36 mental health patients as part of the Life Esidimeni tragedy. The deaths came after the Gauteng health department removed about 1 700 long-term psychiatric patients from state-sponsored care at Life Esidimeni facilities in 2016 and placed them into the custody of mostly unlicenced non-governmental organisations.

Since I released my 2017 report, the number of people who died as part of what became known as the Gauteng Mental Health Marathon Project, has gone up four times and now stands at 144.

People have asked me what I learned from the Life Esidimeni saga. I learned many things but three, in particular, stand out for me. They tell us how our history informs our present and what we need to fix to change our future.

My first lesson was that democracy might have dawned for South Africa, but we can’t say the same for bioethics — or the tenets that guide the way we practise medicine and care for our people.

In fact, some of the central ethics that govern our health professionals have not been reviewed for 50 years.

We continue to live under what I call “colonial and apartheid” bioethics that allow for the kind of political co-option that we saw in police cells under apartheid and in the halls of