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- Volume 3, Issue 1, 2010
South African Journal of Bioethics and Law - Volume 3, Issue 1, 2010
Volume 3, Issue 1, 2010
Source: South African Journal of Bioethics and Law 3, pp 2 –3 (2010)More Less
Carol Levine stated in 1988 that ethics in research was '... born in scandal and reared in protectionism'. To answer the question 'What is the function of RECs?', it would be necessary to understand the notion of ethics in research from the perspective of past tragedies. There are many examples of studies in the health context where vulnerabilities of research participants have been exploited. Violations of participants' rights and dignities have in many instances resulted in morbidity and mortality, costing them their health and even their lives.
Author Kelsey StuartSource: South African Journal of Bioethics and Law 3, pp 4 –8 (2010)More Less
Strike action is by no means an unfamiliar situation in the South African context. However, health care strikes are now emerging as a highly controversial topic. Current teaching of medical students does not adequately cover this unique ethical dilemma facing health care professionals. Only with a broader understanding of the subject can medical students' future decisions on the matter be informed and based on the ethical principles governing the medical profession. I attempt to explore the issues surrounding health care strikes and assess whether or not this is compatible with true medical professionalism in the 21st century.
Author Caterina NicolaouSource: South African Journal of Bioethics and Law 3, pp 9 –11 (2010)More Less
'Ethics Alive' is an annual initiative in the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg. The week aims at instilling an enthusiasm for bioethics among students and staff at the Faculty and further afield, and includes a Faculty Assembly where students and staff re-affirm their commitment to professionalism. At the Faculty Assembly this year, Caterina Nicolaou, then president of the Medical Students' Council, addressed the audience. It is interesting to see how she perceives professionalism among her teachers
Some consent and confidentiality issues regarding the application of the Choice on Termination of Pregnancy Act to girl-children : reviewAuthor David McQuoid-MasonSource: South African Journal of Bioethics and Law 3, pp 12 –15 (2010)More Less
The Choice on Termination of Pregnancy Act (Choice Act) allows a female of any age to consent to a termination of pregnancy, but other statutes such as the previous Child Care Act and the present Children's Act provide for different ages of consent for medical and surgical procedures. As a result doctors are not always certain whether girl-children are legally capable of giving informed consent for certain associated procedures when undergoing a termination of pregnancy. In addition the Criminal Law (Sexual Offences and Related Matters) Amendment Act (the Sexual Offences Act) imposes a duty to report sexual offences against children which may undermine the girl-patient's right to confidentiality. This article attempts to clarify the legal position regarding these grey areas for practitioners faced with girl-child patients requesting terminations of pregnancy.
Ethical dilemmas and financial burdens faced by clinical dental students in a 'quota-driven' curriculumSource: South African Journal of Bioethics and Law 3, pp 16 –19 (2010)More Less
Unprofessional behaviour, cheating or falsifying of information by undergraduate dental students is a serious problem, and may be a predictor of future professional board disciplinary actions against practitioners. In quota-driven curricula students have to complete a minimum number of procedures, many of which require laboratory services. In order to achieve this some students at the University of Limpopo had begun bribing technicians to complete their work preferentially, or to do part of it for them. A final-year dental student carried out an independent investigation to establish the extent of the problem so that school authorities could be alerted and requested to curb this practice. Anonymous questionnaires were given to all the clinical-year dental students, who were asked to answer as honestly as possible. Results showed that almost half of the 4th-year students (47%) and double that of 5th-years (86%) had paid technicians for special favours and services. Payment methods and amounts ranged from gifts to actual monetary reimbursement. Ninety-three per cent of students reported additional financial burdens owing to their having paid for patient treatment, transport costs, telephone calls or food, or for the actual prosthesis.
Ethics courses are part of most dental curricula, but have no standard, universally accepted outline or structure. Bribery was investigated by a student who had experienced it as a problem himself, highlighting the point that students will be more engaged in ethics education when it addresses issues directly relevant to them. Faculties should therefore design dental ethics curricula that are practical and relevant to students' experiences, and ensure these courses begin early in the dental education and span its entire duration. Faculties should also support and encourage consistent professional conduct in undergraduate students which they will hopefully continue to practise in their future professional lives as dentists.
Process error rates in general research applications to the Human Research Ethics Committee (Medical) at the University of the Witwatersrand : a secondary data analysisAuthor P. Cleaton-JonesSource: South African Journal of Bioethics and Law 3, pp 20 –24 (2010)More Less
Objective. To examine process error rates in applications for ethics clearance of health research.
Methods. Minutes of 586 general research applications made to a human health research ethics committee (HREC) from April 2008 to March 2009 were examined. Rates of approval were calculated and reasons for requiring revision or non-approval of the applications were grouped into eight categories.
Results. Of the applications, 37% were approved at first evaluation; minor revisions were required for 56% and major revisions for 3%, while 4% were not approved. Eventually 69% of the 586 applications were approved. Surprisingly, 28% were removed from the Committee agenda because of no response from the applicants. Of the 607 instances of process error in 369 applications requiring revision or that were not approved at first evaluation, difficulty with consent documents (55%) and missing information (43%) were the most frequent; the remaining 6 types ranged in frequency from 3% to 17%.
Conclusion. It is suggested that the process errors seen could be reduced in rate if applicants were to show a draft of their application to an HREC member or experienced researcher before submission.
Author Timothy Craig HardcastleSource: South African Journal of Bioethics and Law 3, pp 25 –27 (2010)More Less
Compulsory testing of alleged sexual offenders - implications for human rights and access to treatmentSource: South African Journal of Bioethics and Law 3, pp 28 –32 (2010)More Less
Rape is a major criminal and public health problem in South Africa. Not only does it inflict major trauma on the victim, but it also affects the integrity and dignity of the victim and puts him or her at risk of contracting various sexually transmitted diseases such as HIV and other sexually transmitted infections (STIs).
This paper proceeds with the current definition of rape, the provisions of the Criminal Law (Sexual Offences and Related Matters) Amendment Act 32 of 2007 and the arguments relating to compulsory HIV testing of perpetrators, and post-exposure prophylaxis for rape victims/survivors. It reviews the legal and ethical issues relating to compulsory HIV testing of perpetrators, as well as the access to antiretroviral treatment of rape victims and perpetrators if they are diagnosed with HIV infection.
It concludes that compulsory testing may provide a feeling of reassurance to victims/survivors but does not protect them from infection, since they have to take all the necessary precautions that they would otherwise have taken had they not demanded the HIV test of the perpetrator.
Source: South African Journal of Bioethics and Law 3, pp 33 –37 (2010)More Less
The practice of telemedicine is viewed as a possible solution to the human resources crisis in health care in South Africa and internationally. Reports on its successful implementation and combating of health-related problems are readily available from both developed and developing countries. Even though these reports indicate that telemedicine seems to have addressed the problem related to the shortage of health care personnel, it is still posing a challenge to regulatory authorities such as the Health Professions Council of South Africa. The regulatory authorities are there to ensure that quality health care service is delivered and that the patient will be protected from possible mismanagement by the health care practitioners involved. Misconduct can occur through improper clinical care or excessive billing.
Policies and guidelines from both developing and developed countries were reviewed to highlight how telemedicine is regulated elsewhere. The focus was on the ethical implications of telemedicine practice. Telemedicine has proved itself to be a possible solution to the human resources crisis, especially in developing countries or where there are vast rural communities. Success of telemedicine has been reported in a number of developed and developing countries as a way of alleviating the human resources crisis and providing quality health care to needy communities.
Author M.D.T.H.W. VanguSource: South African Journal of Bioethics and Law 3, pp 38 –43 (2010)More Less
Introduction. Truth telling forms part of the contemporary debate in clinical bioethics and centres around the right of the patient to receive honest information concerning his or her medical condition/illness and the duty of the doctor to give this information to the patient. Many patients complain that they are not being informed, but on the other hand there may be patients who do not want a truthful answer about their health problems.
Objectives. This study explores the preferences of patients at four Johannesburg General Hospital outpatient clinics regarding the practice of truth telling and their attitudes towards it.
Methods. Four hundred and sixty-five participants voluntarily completed and returned a questionnaire.
Results. The majority of the participants stated that the doctor had disclosed information about their condition (92.9%). Almost all were of the opinion that patients have the right to know about their condition (98.3%) and also that the doctor has the duty to inform them of their condition (98.0%). If they were suffering from a serious condition most participants (86.3%) would prefer to know about it, but a small but significant percentage (13.7%) would prefer not to know. Variables such as gender, age and level of education did not seem to impact significantly on the participants' opinions about the truth telling process, with the exception of gender, as more females than males had knowledge of their condition (p=0.0176), and education, where more participants with higher education supported the right to disclosure (p=0.0430).
Conclusion. The vast majority of participants supported the right of patients to disclosure, but the majority also considered that the level of information given to them was not satisfactory, even when they had asked for more. This implies a need to look at the way we give information to our patients and to seek ways in which this can be improved.
Inaugural lecture : African spirituality, ethics and traditional healing - implications for indigenous South African social work education and practiceAuthor Eleanor RossSource: South African Journal of Bioethics and Law 3, pp 44 –51 (2010)More Less
The over-reliance of South African social work on Euro-American and British theories, and the need to decolonise the profession, has long been recognised by many writers. This article endeavours to conceptualise a pluralistic, indigenous, Afro-centric model of social work education and practice that seeks to infuse the educational curriculum with African spirituality and ethics as well as traditional and Western approaches to helping and healing. However, the main thrust of the paper is that, while educational curricula need to be locally relevant, universities need to remain globally engaged.