JOHANNESBURG (AP) — Nelson Mandela is being kept alive by a breathing machine and faces “impending death,” court documents show.

The former president’s health is “perilous,” according to documents filed in the court case that resulted in the remains of his three deceased children being reburied Thursday in their original graves.

“The anticipation of his impending death is based on real and substantial grounds,” the court filing said.

Mandela, who was hospitalized on June 8, remains in critical but stable condition, according to the office of President Jacob Zuma, who visited the anti-apartheid leader on Thursday. The president’s office also said doctors denied reports that 94-year-old Mandela is in a “vegetative state.”

A younger person put on mechanical ventilation — life support — can be weaned off the machine and recover, but that it can be difficult or impossible for an older person. The longer a person is on ventilation the less the chance of recovery, said the chief executive of the Faculty of Consulting Physicians of South Africa.

“It indicates a very poor prognosis for recovery because it means that he’s either too weak or too sick to breathe on his own,” said Dr. Adri Kok, who has no connection to Mandela’s care. “Usually if a person does need that, any person, not keeping in mind his age at all, for any person it would be indicative of a grave illness.”

“When they say ‘perilous’ I think that would be a fair description,” she said.

In Mandela’s hometown, Qunu, on Thursday, the bodies of three of his children were returned to their original resting site following the court order.

Family members and community elders attended a ceremony on the Mandela property that included the singing of hymns. The reburial took place in Qunu, where Mandela grew up and where the former president has said he wants to be buried. Forensic tests earlier confirmed the remains were those of Mandela’s children.

Grandson Mandla Mandela moved the bodies to his village of Mvezo — Nelson Mandela’s birthplace — in 2011. The two towns are about 25 kilometers (15 miles) apart. Fifteen Mandela family members pursued court action last week to force the grandson to move the bodies back to their original burial site.

Mandla Mandela — the oldest male Mandela heir and a tribal chief — told a news conference on Thursday that his grandfather “would be highly disappointed in what is unraveling.”

Retired archbishop Desmond Tutu appealed to the family of Mandela, also known by his clan name Madiba, to overcome their differences.

“Please, please, please may we think not only of ourselves. It’s almost like spitting in Madiba’s face,” Tutu said in a statement released by a foundation he leads. “Your anguish, now, is the nation’s anguish — and the world’s. We want to embrace you, to support you, to shine our love for Madiba through you. Please may we not besmirch his name.”

Mlawu Tyatyeka, an expert on the Xhosa culture of Mandela’s family, said the court case over the graves was decided quickly because the family knows that Mandela will soon die.

“It’s not a case of wishing him to die. It’s a case of making sure that by the time he dies, his dying wish has been fulfilled,” he said. “We have a belief that should you ignore a dying wish, all bad will befall you.”

Meanwhile, Mandela’s wife said the former president is sometimes uncomfortable but seldom in pain while being treated in a hospital.

Graca Machel spoke about her husband’s condition at a fundraising drive for a children’s hospital that will be named after Mandela.

“Whatever is the outcome of his stay in hospital, that will remain the second time where he offered his nation an opportunity to be united under the banner of our flag, under the banner of our constitution,” she said.

Mandela was imprisoned for 27 years during white racist rule and was freed in 1990 before being elected president in all-race elections. He won the Nobel Peace Prize along with former President F.W. de Klerk.

(Photo: AP)

One thought on “Mandela on Life Support, Faces ‘Impending Death’

  1. Nelson Mandela is Dying: Three Lessons for You and Your Family

    By typical end-of-life definitions, Nelson Mandela is dying (he is in critical condition after a lengthy hospital stay, and has had multiple recent admissions). Those of us in the healthcare professions see this end-of-life equation all of the time: increasing severity of illness and frequency of hospitalizations plus advanced age almost always equals dying. Now, everyone likes to believe this equation may be altered by hopes, prayers, and modern medicine. But unfortunately, such yearnings usually fail to change the equation, no matter how powerful our offerings or how advanced our medicine.

    President Mandela is a case in point. A case followed closely by the world, but also foreshadowing what may happen with each of us at the end of our own lives. We can all learn the following three lessons from his end-of-life experience.

    Lesson One: Recognize the End-of-Life Equation
    On June 9, 2013, South Africa’s best-selling weekly newspaper, The Sunday Times, reported that Mandela’s long-time friend Andrew Mlangeni publicly stated: “You (Mandela) have been coming to the hospital too many times. Quite clearly you are not well and there is a possibility you might not be well again.” Mandela’s long-time comrade recognized and verbalized the end-of-life equation whether the rest of the world wants to hear it or not. I applaud him. Oftentimes, the only one who is willing to acknowledge what is really happening is the one who is approaching death himself. The rest of us: friends, family and even doctors, often choose to remain in a state of denial believing that more can be done to change the equation.

    Lesson Two: Understand Decision Motivations
    Lots of people want to keep Nelson Mandela alive at all costs, even if it inadvertently causes unnecessary suffering for him. You may read this and ask, “Are these people selfish?” I would say, generally, they are not…we are not. We all love him and recognize his iconic peace-promoting power in South Africa and abroad. However, our perspectives are underpinned by “our” desires for him rather than perhaps asking what he would desire for himself. Virtually the whole world is praying for his return to health. In contrast, Mr. Mlangeni, was also quoted in The Sunday Times article urging Mandela’s family to “release him” and “let him go.” This position is the most selfless and loving, but can also be the hardest to realize. Again, should we become involved in making end-of-life decisions for another, we must ask ourselves about the motivations for our choices. We should select care not based on what we desire or fear about our loved one, but should with great reflection select treatments which the dying would choose for themselves.

    Lesson Three: Give Permission to Die
    In South African culture, it is customary for the family to give final permission to die, to emotionally and spiritually release the one who is approaching death. At some point Nelson Mandela will receive the words, “We release you, Father.” I have given this same permission to my very own dying grandmother, and I have frequently stood at the patient bedside as families gave permission to their own. Rarely, in living, do we create occasions to bid such sweet offerings to those we love, but surely in the face of dying, we should utter the words, “Thank You,” “I Love You,” and “Good-bye…I release you.”

    So, Nelson Mandela is dying (either shortly or in the not so distant future), yet he remains iconic, not only for South Africans, but for the rest of us as well. Take these three lessons from the end of his life and apply them to yourself and your own family. Then take his words and apply them to your life: “What counts in life is not the mere fact that we have lived. It is what difference we have made in the lives of others that will determine the significance of the life we lead.” (“The Top 10 Nelson Mandela Quotes,” The South African)

    Monica Williams-Murphy, M.D.

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