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- Volume 1, Issue 2, 2008
South African Journal of Bioethics and Law - Volume 1, Issue 2, 2008
Volume 1, Issue 2, 2008
Author Ames DhaiSource: South African Journal of Bioethics and Law 1, pp 34 –35 (2008)More Less
Bioethics as we know it today began about a decade and half after the end of World War II as a loosely defined movement to 'humanise' medical education and practice, in which there was an over-emphasis on technological and scientific progress. The goal was to cushion the powerful leaning towards specialisation and science that had started to dominate the education of health practitioners and simultaneously maintain equilibrium between these developments and human values. The objective of bioethics at that time was the ideal of the scientifically competent yet humanistically responsive practitioner. The fervent application of scientific medicine and the specialisation it required was viewed, and correctly so, as deleterious to the human dimensions of medical education and care. What was required was an antidote - and in this way the infusion of human values and the humanities in health sciences education was conceived.
Author Graham HowarthSource: South African Journal of Bioethics and Law 1, pp 36 –37 (2008)More Less
Health care professionals face medicolegal threats from numerous quarters - complaints, inquests, litigation, and investigation with possible disciplinary action by their regulatory body. To the individual practitioner the regulatory body is the most personal, as not only do they run the risk of public criticism by the regulatory body but also the possibility of censure. Sanction may include the temporary or permanent loss of their ability to practise with concomitant loss of income.
Source: South African Journal of Bioethics and Law 1, pp 38 –43 (2008)More Less
A health research ethics committee (REC) to deal with medical research involving humans was established at the University of the Witwatersrand, Johannesburg (Wits), in October 1966, 4 months after publication of the seminal article on ethics and clinical research by Beecher. This committee, the first in South Africa, has functioned continuously ever since. From 1966 to 2002 it was known as the Committee for Research on Human Subjects (Medical) and subsequently as the Human Research Ethics Committee (Medical) (HREC(M)). The Committee has United States Federal Wide Assurance (FWA No. 00001223) and has applied for registration with the newly formed National Health Research Ethics Council in South Africa ; it is informally accepted by the South African Medical Research Council (MRC) and the Human Sciences Research Council (HSRC). There are two other RECs at the University, one dealing with research in the humanities (since 1988) and the other with research involving animals (since 1975).
Source: South African Journal of Bioethics and Law 1, pp 44 –46 (2008)More Less
The development of new therapies is a major undertaking with the potential for huge profits. Consequently a large industry associated with running of clinical trials has arisen. Many clinical trials are undertaken in the developing world. This creates some unique ethical dilemmas of which ethicists in developing countries need to take cognisance. Some of the regulations for research in developing countries are less stringent than in First-World countries and infrastructure to police such work is often lacking. Developing-world patients are often less informed about their rights and are less likely to have access to legal support in the event that they feel aggrieved. In many ways the situation in the world of knowledge reflects the situation as seen in that of trade, with the developing world being rich in natural resources but poor in infrastructure. Managing research in the developing world is a delicate balancing act in which the rights of vulnerable communities need to be protected while facilitating research that may provide meaningful knowledge and therapies. In South Africa ethics review boards need to be advocates of patient rights and not mere overseers of research.
Author Anthony EganSource: South African Journal of Bioethics and Law 1, pp 47 –52 (2008)More Less
Euthanasia and physician-assisted suicide (hereafter E/PAS) is a practice with a long history. It was a frequent occurrence in the Ancient World, despite the prohibitions of the Hippocratic Oath (which had no legal standing and was supported by a minority of Greco-Roman physicians). It was condemned as murder by the Christian community and prohibited in Christian Europe (though - like abortion - was no doubt practised secretly). Strong support and advocacy for E/PAS re-emerged in the 19th century in Europe and North America. The first attempts to legalise it, in a number of states in the USA, were defeated in the early 1900s, though voluntary euthanasia societies advocating for reform of existing laws proliferated there and throughout Europe. Although not legal, cases brought before the courts - particularly in the USA, Britain and The Netherlands - were treated with remarkable leniency.
'No one may be refused emergency medical treatment' - ethical dilemmas in South African emergency medicineAuthor Efraim KramerSource: South African Journal of Bioethics and Law 1, pp 53 –56 (2008)More Less
Enshrined in section 27(3) of the Constitution of South Africa is the right that 'no one may be refused emergency medical treatment'. While this universal human right is altruistic in its simplistic meaning and appears to be in tune with the requirement of freedom, equality and dignity for all in South Africa, in-depth analysis reveals ethical concerns. The definition of a medical emergency, although present on the statute books, recently seems to have been revised by the Constitutional Court, which may have practical ramifications for patients in life-threatening situations. Additionally, there is no definition of what constitutes basic emergency medical treatment, and the author has ventured to resolve this glaring deficiency. The Department of Health's introduction of a hierarchy of health services in South Africa to increase efficiency in the use of scarce health care resources nationally, with emergency medical treatment a notable exclusion, has presented ethical issues concerning patient redirection and transfer from health care establishments. Similarly, redirection and transfer of financially disadvantaged emergency medical patients from private health care establishments present major ethical concerns. It is incumbent upon all health care providers to render basic medical treatment without fear, favour or undue financial demand. The Constitutional Court needs to ensure that it does not excessively limit section 27(3) from an initial absolute provision to one dominated by progressive realisation that potentially may prohibit every individual in South Africa receiving basic emergency treatment when required.
Author Bhavna PatelSource: South African Journal of Bioethics and Law 1, pp 57 –60 (2008)More Less
The inter-relationship between Medicine and Law is most commonly brought to the fore by cases involving medical negligence. This relationship needs to protect all parties concerned based on the probability of reasonableness in terms of who performs the act as well as the patient affected by the act in question.
The res ipsa loquitur (the case speaks for itself) doctrine is currently not being used in the South African courts. This paper discusses what is considered medical negligence and the use of the res ipsa loquitur doctrine. A short overview of the international perspective is given, followed by a discussion on how negligence matters are dealt with by the South African courts.
Author Tuviah ZabowSource: South African Journal of Bioethics and Law 1, pp 61 –63 (2008)More Less
The interface between psychiatry and the law is often unclear and complicated. Ethics in psychiatry is a complex, controversial, often ambiguous topic. Conflicts arise about confidentiality, informed consent, involuntary hospitalisation, right to treatment and right to refuse treatment, among other daily clinical issues. There is an extended responsibility to others as well as to the mentally ill vulnerable person. An overarching departure point would be to address 'competence' with a view to understanding the above issues better. The making of decisions pertaining to health and personal issues is dependent on the ability of the patient to function in various areas. The concept of competence is viewed differently from the clinical as opposed to the legal viewpoint. Some jurisdictions have introduced into legislation more specific legal guidelines for recoding mental capacity.
This discussion takes a practical clinical standpoint and introduces an 'umbrella' concept via a general approach, while also specifically addressing individual ethical issues.