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- Volume 2, Issue 1, 2009
South African Journal of Bioethics and Law - Volume 2, Issue 1, 2009
Volume 2, Issue 1, 2009
Author Ames DhaiSource: South African Journal of Bioethics and Law 2, pp 2 –3 (2009)More Less
The recent industrial action by health care professionals underscores the gloomy and progressively worsening state of affairs in the health care sector. The reaction of their employer (the Department of Health) has been one of scathing criticism of a professional group who have dared to go 'against their calling' and the Hippocratic Oath that they took at graduation, making health care professionals vulnerable by the very noble and righteous pledges that they have made. And of course, the Department, true to its machiavellian modus operandi, has chosen to exploit this vulnerability and hold these professionals ransom to the Oath. Moreover, they have tried to use the Labour Relations Act No. 66 of 1995 as a legal ploy to declare the actions by the health care professionals illegal.
Author Kyle WilsonSource: South African Journal of Bioethics and Law 2, pp 4 –7 (2009)More Less
All health professionals, no matter what their background, will experience problems of dual loyalty. As long as relationships between the health professional and parties other than the patient exist, there will be potential for problems of dual loyalty. Our challenge as health professionals is to place our patients first and negotiate the many ethical challenges this duty presents. How can we negotiate these challenges on the African continent?
Author Donrich W. JordaanSource: South African Journal of Bioethics and Law 2, pp 12 –19 (2009)More Less
This article discusses the classic conflict between freedom and propriety with reference to the use of human gametes (sperm and egg cells) in South African law. The core question addressed is whether it is legal to use one's own gametes, or others' with their consent, for non-medical, non-sexual-intercourse purposes. This question is answered divergently by the two possible interpretations of the relevant statutory law - section 56(1) of the National Health Act - which is ambivalent. Since these two possible interpretations are representative of the two poles of the freedom v. propriety dichotomy, this matter can be perceived as a test of the depth of the South African juristic commitment to the principle of freedom. Section 56(1) is analysed, using the applicable common law presumptions as well as human rights. To illustrate the practical implications of these analyses, a hypothetical case study of a boy who studies human spermatozoa under his microscope at home is outlined and used throughout the article. The analyses conclude that the interpretation must be followed that answers the core question in the affirmative (in favour of freedom), namely that it is indeed legal to use one's own gametes, or others' with their consent, for non-medical, non-sexual-intercourse purposes.
Author Mpho SelemogoSource: South African Journal of Bioethics and Law 2, pp 20 –22 (2009)More Less
The harm principle states that '[t]he only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others'. Despite its apparent simplicity, the harm principle is 'a mere convenient abbreviation for a complicated statement that includes, among other things, moral judgements and value weightings of a variety of kinds'.
Source: South African Journal of Bioethics and Law 2, pp 23 –27 (2009)More Less
Traditional Abrahamic religious teaching states that it is wrong to kill the innocent. However, advances in medical care have created new situations. The principle of double effect and the distinction between ordinary and extraordinary therapies have allowed religious ethicists a degree of latitude when it comes to thinking about euthanasia. Secular ethicists have also been challenged by these developments, and there are various opinions ranging from conservative to radical among these writers. In essence the principle of autonomy tends to trump all other issues, and this would mean that an autonomous decision to die by refusing treatment is to be respected. An autonomous request to be actively killed is more controversial, but there seems to be growing legal and ethical support for this under tightly controlled circumstances. Apart from theological objections, opponents of euthanasia raise practical concerns such as the slippery slope argument and the effect of active euthanasia on the doctor-patient relationship. When it comes to decision making in those patients who cannot function autonomously, such as neonates, patients in intensive care and patients in a persistent vegetative state, the issue is clouded. Health professionals must act in the patient's best interests, but what these are may be difficult to define. In many cases there is no pre-existing decision of the patient that can be used as a basis for end-of-life decision making. Health care providers have to make use of surrogates to help reach a decision, and this is controversial. This paper attempts to place the current discussions around euthanasia in context and to highlight both areas of agreement and of contention.
Author Harriet R. EtheredgeSource: South African Journal of Bioethics and Law 2, pp 28 –31 (2009)More Less
This article aims to establish whether processes around the consideration and execution of the living will help enhance the doctor-patient relationship. Studies indicate that the living will is not used frequently, and that the doctor-patient relationship is often deficient. The article explores the two primary topics - the living will, and the doctor-patient relationship - separately, and then presents a synthesis of these separate investigations. This synthesis concludes that the living will can help enhance the doctor-patient relationship. Following this analysis a brief practical model is offered.
Source: South African Journal of Bioethics and Law 2, pp 32 –34 (2009)More Less
Introduction. Guidelines for biomedical research involving human subjects require that research should be conducted in accordance with accepted ethical principles. The International Committee of Medical Journal Editors guidelines require authors to indicate that they have obtained ethical approval and informed consent. Sudanese scientific medical journals ask authors to declare informed consent and ethical approval by an ethics review committee (ERC) in published reports.
Methods. We reviewed 114 original research articles published in five peer-reviewed Sudanese medical and health journals to assess the extent to which ethical considerations had been reported.
Results. A subtitle indicating 'ethical considerations' was found in 5 (4.4%) articles, 35 (30.7%) stated that informed consent had been obtained from the study participants, and 13 (11.4%) stated that the study had been approved by an independent ERC. Although all five journals explicitly ask authors to document ethical approval and informed consent, 88.6% and 69.3% of the articles examined had failed to document ethical approval and informed consent, respectively.
Discussion. Failure to obtain or report ethical approval by an ERC and failure to obtain informed consent from study participants was the most prominent finding. Failure to report ethical approval or consent was seen to a similar extent in all study designs reported, so study design did not seem to influence the reporting of ethical considerations. However, failure to document ethical considerations, in particular ethics committee approval and obtaining of informed consent, does not necessarily mean that these were not done in the research reported.
Limitations. We reviewed only Sudanese journals, so do not know the practice of Sudanese authors in this regard when they publish in international scientific journals.