## Facts

- Thiagraj Soobramoney, a 41-year-old indigent man, suffered from irreversible chronic renal failure along with serious cardiac and vascular disease and required dialysis multiple times per week to survive.
- After private funding ended, he sought dialysis at Addington Hospital, a public hospital with limited dialysis machines, staff, and budget.
- The hospital used written criteria to allocate dialysis:
  - Acute renal failure cases were treated because short-term dialysis could reverse the condition.
  - Chronic renal failure patients were accepted only if eligible for kidney transplant, with dialysis used as interim treatment.
  - Transplant eligibility required absence of significant vascular or cardiac disease.
- Because Soobramoney’s comorbidities made him ineligible for transplant, the hospital denied him access to its chronic dialysis program.
- The provincial health system faced major budget shortfalls and could not meet demand for chronic dialysis.

## Issues

1. Whether refusal of ongoing dialysis violated the constitutional right not to be refused “emergency medical treatment.”
2. Whether refusal violated the right of access to health care services, given that the state’s duties are limited to reasonable measures within available resources and progressive realization.
3. Whether the right to life required the state to provide life-prolonging dialysis notwithstanding the resource-limited health care framework.

## Decision

- The Constitutional Court unanimously dismissed the appeal.
- Ongoing dialysis for irreversible chronic renal failure was not “emergency medical treatment” because it was not immediate remedial care for a sudden catastrophe.
- The claim fell under access to health care services subject to resource limits; the hospital’s rationing policy was reasonable and was applied consistently to Soobramoney.
- The right to life did not create an unqualified entitlement to life-prolonging medical treatment that would override the resource-conditional structure governing access to health care.

## Legal Principles

- “Emergency medical treatment” protects access to immediately necessary, available care for sudden events requiring urgent intervention, not indefinite treatment for chronic, incurable conditions.
- Rights to health care services are conditioned on reasonableness and “available resources,” and courts may uphold medically and administratively justified rationing where scarcity is genuine.
- A general right to life cannot be used to circumvent explicit constitutional limits that qualify health care obligations through resource availability and progressive realization.
- In assessing alleged violations of resource-dependent socio-economic rights, a key inquiry is whether allocation criteria are rational, medically grounded, and fairly applied under conditions of scarcity.

## Conclusion

The court held that denial of chronic dialysis to a terminal patient, based on a transplant-linked rationing policy adopted under severe resource constraints, did not breach constitutional rights to emergency medical treatment, access to health care, or life.


Soobramoney v. Minister of Health (KwaZulu-Natal), 1998 (1) S. Afr. L.R. 765 (S. Afr. Const. Ct. 1997)