South African Journal of Bioethics and Law - latest Issue
Volume 9, Issue 1, 2016
Source: South African Journal of Bioethics and Law 9, pp 2 –3 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.474More Less
The price paid by society because of unreasonable medical negligence claims cannot be ignored. While medical malpractice systems in the country are exorbitantly costly, they are also inefficient. This impacts directly on access to healthcare, a basic human right in the country as enshrined in section 27 of the Bill of Rights of the Constitution of South Africa (SA). Practising defensive medicine, irrespective of the sector in which healthcare is delivered, has now become the norm, with the focus being not just patient health and best interests, but also that of safeguarding against possible medical malpractice liability, thereby increasing unnecessary clinical and diagnostic procedures. The unequivocal situation is that currently the fear of lawsuits holds hostage practitioners' options and preferences for delivery of ethically exercised care to their patients, leading to frustration and dissatisfaction both to practitioners and patients. Moreover, a culture of blame is also now pervasive.
May doctors refuse to treat rape survivors in order to avoid having to give evidence in court? : forumAuthor D. McQuoid-MasonSource: South African Journal of Bioethics and Law 9, pp 4 –6 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.461More Less
It has been reported recently that private doctors often refuse to treat rape survivors because they do not want to give evidence in court. Private doctors and hospitals must treat patients in emergency situations, but may otherwise refuse to treat patients provided such refusal is not unconstitutional. Rape survivors require emergency medical treatment and should not be refused treatment by private doctors and hospitals because practitioners do not wish to give evidence in court. Such refusal is unconstitutional. Sexual assault evidence kits may be used by both private doctors and hospitals. Given the high rate of sexual violence in South Africa it is recommended that both private and state doctors should have stocks of sexual assault kits, and the National Police Commissioner's national instruction for providing assistance to survivors of sexual offences. District surgeons 'on call' must treat rape survivors as requiring emergency medical treatment. They may not defer seeing them until the next day as this violates their constitutional right to dignity and exposes them to secondary victimisation.
Author N. ClaassenSource: South African Journal of Bioethics and Law 9, pp 7 –10 (2016) http://dx.doi.org/http://dx.doi.org/10.7196.SAJBL.469More Less
Is there a crisis in the healthcare industry? Most certainly there is. Dr Motsoaledi, Minister of Health, publicly acknowledged the existence of such a crisis at a Medico-Legal Summit held at his initiative in Pretoria on 9 and 10 March 2015 at St Georges Hotel. Currently, as recently confirmed by the MEC for Health, Ms Mahlangu, there are about 2 000 pending court cases against the Gauteng Provincial Health Department, the total quantum being claimed amounting to approximately ZAR 3.5 billion. During 2013/2014 this department spent about ZAR 256 million on legal costs payable to claimants' attorneys. No budget for these expenses exists, resulting in payment being made from funds designated for the acquisition of medical equipment and other purposes. This undermines the department's ability to renew old equipment and upgrade to more modern equipment, resulting in even further claims. More claims are therefore to be expected. The Medical Protection Society also confirmed an increase in medical malpractice claims against their members of nearly 550% compared to 10 years ago. The quantum of claims that exceeded ZAR 5 million per claim, also increased by 900%. The ripple effect of these increases in medico-legal claims causes insurance premiums for healthcare professionals to become exorbitantly expensive, resulting in some practitioners leaving the medical profession. Practitioners also act more defensively in applying their trade, resulting in additional and sometimes unnecessary tests that increase the costs of medical care and often cause further grounds for the institution of claims.
Constitutional, legal and regulatory imperatives for the renewed care and prevention of congenital disorders in South AfricaSource: South African Journal of Bioethics and Law 9, pp 11 –17 (2016) http://dx.doi.org/http://dx.doi.org/7196/SAJBL.429More Less
Medical genetic services for the care and prevention of congenital disorders have declined significantly in recent years due to competing health priorities, with previously developed services becoming compromised. With an infant mortality rate of 28/1 000 live births, South Africa (SA) has passed the threshold of 40/1 000 when such services should be implemented. This article outlines the international background and SA legislative framework for medical genetic services and their implementation. International, regional and national conventions, legislation, and policy were studied for relevance to genetic services and their implementation was evaluated, including a comparison of sector capacity between 2001 and 2015. A comprehensive legislative and regulatory framework exists in SA for the provision of medical genetic services, but implementation has been fragmented and unsustained. Congenital disorders and genetic services are not prominent in national strategies and excluded from interventions aimed at combating child mortality and non-communicable diseases. Capacity today is at a lower level than in 2001. The failure to recognise the burden of disease represented by congenital disorders is the underlying reason for the implementation and service shortfall. Child mortality rates have stagnated since 2011 and can be significantly further reduced by prioritising healthcare issues other than HIV/AIDS, including congenital disorders. It is now an imperative that SA responds to World Health Assembly Resolution 63.17 and prioritises congenital disorders as a healthcare issue, providing services to uphold the dignity and human rights of the most vulnerable members of society.
Respect for vulnerability is a human right : Article 8 of the UNESCO Declaration on Bioethics and Human Rights, and senior citizens in South AfricaAuthor R. RheederSource: South African Journal of Bioethics and Law 9, pp 18 –21 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.456More Less
It is untrue that the elderly in South Africa (SA) are probably discriminated against in healthcare as the result of inadequate legislation that does not conform to international standards. The National Health Act recognises vulnerability and gives expression to it. Respect for vulnerability has not yet been introduced to fundamental political and bioethical frames of reference in SA and that is probably the reason why the concept and right have not become part of the ethical awareness in healthcare. The appeal of this article is that respect for vulnerability must be brought to conform to the Universal Declaration on Bioethics and Human Rights by declaring the ethical principle as an independent human right.
Source: South African Journal of Bioethics and Law 9, pp 22 –25 (2016) http://dx.doi.org/http://dx.doi.org/7196/SAJBL.464More Less
The popularity of social media has grown rapidly and healthcare practitioners and students commonly use sites such as Facebook. The ethical and professional implications and their benefits and hazards must be considered. Concerns include blurring of boundaries between an individual's public and professional lives, maintaining privacy and confidentiality of patient information, damaging the public image of the profession and inter-professional relationships. The same laws that apply to conduct in the real world also apply in cyberspace. Harmful or derogatory posts may result in a defamation lawsuit. The internet may also provide opportunities for patient education through peer-reviewed websites and to build professional networks. Institutions should have policies on the uses of social media. Emerging technology will continue to change the landscape of social media and social networking and the way patients and practitioners use websites will continue to evolve. Practitioners should proactively manage digital identity by reviewing publicly available material and maintaining strict privacy settings about their information.
Author J.B. GardnerSource: South African Journal of Bioethics and Law 9, pp 26 –30 (2016) http://dx.doi.org/http://dx.doi.org/10.7196.SAJBL.468More Less
The harmful effects of alcohol use during pregnancy have been well documented. Fetal alcohol spectrum disorder (FASD) is the collective term encompassing the various clinical diagnoses that can occur in a child who was exposed to alcohol prenatally. The affected child suffers a range of lifelong primary and secondary disabilities. There is no cure for FASD, but it is preventable if women do not drink during pregnancy. Should women be banned from, and/or punished for drinking during pregnancy for the sake of preventing fetal harm? This article considers the appropriateness of criminalising drinking during pregnancy as a means of preventing fetal harm and consequently FASD in children, and concludes that criminal approaches are unjustified, potentially discriminatory and likely to be ineffective.
Source: South African Journal of Bioethics and Law 9, pp 31 –34 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.460More Less
Background. Confidentiality is an important ethical principle for all health professionals and also has a legal bearing on duty. One of the most difficult issues health professionals face in their daily fieldwork practice is a conflict between their professional duties, as illustrated in keeping a patient's medical information confidential, and having empathy with a family member's need to know. This moral dilemma is difficult for students to circumvent and therefore this paper presents healthcare students' perspectives of confidentiality.
Methods. We aimed to explore healthcare students' views and experiences of confidentiality as an ethical principle by adopting a qualitative explorative approach. Purposeful sampling was undertaken where specific individuals with specific experiences were identified. Data were collected by means of written responses from two open-ended questions and analysed thematically. Two themes emerged.
Conclusion. Confidentiality, as with other ethical principles, is an important obligation of a good client-therapist relationship as identified by students. However, the students' responses illustrate that it cannot be absolute, and cognisance must be taken as to when it is acceptable, and even desirable, to override confidentiality because of conflicting, greater duties.
But is this really the 'parent' or 'guardian'? Practical strategies for consent to child research in South AfricaSource: South African Journal of Bioethics and Law 9, pp 35 –38 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.457More Less
Research ethics committees (RECs) in South Africa may require consent from a parent or legal guardian for child research. In instances where an REC determines that parental or guardianship consent is required, how far should researchers go to establish if the accompanying adult is in fact the parent or guardian? Should researchers accept disclosures at face value, probe assertions that are made, or even call for supporting documentation? In this article we set out the facts research staff should possess, propose key questions they could ask, and recommend practical steps for uncertain cases. We recognise that a parental/guardianship consent strategy may not be appropriate in all instances, but do not debate that issue in this article. This article is confined to practical advice for researchers wishing to implement a parental or guardianship consent approach.
Ethical considerations in implementing a biometric co-enrolment prevention system in clinical trials in South AfricaSource: South African Journal of Bioethics and Law 9, pp 39 –41 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.405More Less
Preventing co-enrolment in clinical trials ensures participant safety and data integrity. To facilitate co-enrolment checks, a novel biometric coenrolment prevention system (BCEPS) was developed and implemented in 2010 by the HIV Prevention Research Unit (HPRU) in collaboration with the South African Medical Research Council's (SAMRC) Information Technology Services Division. The use of this web-based system to capture participant's identification details in real time was approved by the SAMRC Ethics Committee. BCEPS was implemented at 13 other research organisations conducting clinical trials in South Africa (SA). Participants who screened at the clinical research sites (CRSs) had their names, SA identity or passport number and fingerprints captured onto BCEPS after comprehensive education and discussion. This information was verified at all study visits. If a participant attempted to screen or co-enrol at multiple CRSs, the system flagged this as a potential coenrolment. By addressing the ethical concerns around participant consent and rights, participant confidentiality and privacy, data security and access, and data management and storage, we were able to successfully implement BCEPS within the clinical trials conducted at HPRU, while adhering to the principles of good clinical practice (GCP), including respect for persons, beneficence and justice.
Author S. SinghSource: South African Journal of Bioethics and Law 9, pp 42 –46 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.465More Less
Accessing research participants within some social institutions for research purposes may involve a simple single administrative event. However, accessing some institutions to conduct research on their data, personnel, clients or service users can be quite complex. Research ethics committee chairpersons frequently field questions from researchers wanting to know when and why gatekeeper permission should be sought. This article examines the role and influence of gatekeepers in formal and organisational settings and explores pragmatic methods to improve understanding and facilitation of this process. Conscientious and well-informed negotiations with gatekeepers are required in order to honour the ethical obligations to conduct appropriate stakeholder engagement before and during research, along with respect for the autonomy of institutions and their employees/clients/service recipients. Provision must be made to identify explicit and implicit gatekeepers to initiate and build collaborative networks that could best support the research process. Careful mutually respectful access agreements which consider the needs and vulnerabilities of both the gatekeeper and the researcher can improve the quality of the scientific data collected. Strategic planning in the research process must take these sometimes complex processes of gatekeeper permission into careful account.
Medical Ethics Today. The BMA's Handbook of Ethics and Law, British Medical Association, Ethics Department : book reviewSource: South African Journal of Bioethics and Law 9 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.475More Less
With rapid advances in science and technology modern healthcare gives rise to complex multidimensional dilemmas that the physician is not fully equipped to handle. Furthermore, in many countries, physician autonomy has been restrained by governments and other authorities enforcing controls on medical practitioners, adding to the many issues they are confronted with. Physicians are challenged with questions on behavior and decision-making as frequently as scientific and technical ones on an almost daily basis in current medical practice. It is therefore not surprising that the BMA's Handbook of Ethics and Law goes beyond a simple guidebook or manual and is a voluminous comprehensive sourcebook of around 1 000 pages covering almost every eventuality that physicians could face in the practice of healthcare.