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- Volume 4, Issue 2, 2011
South African Journal of Bioethics and Law - Volume 4, Issue 2, 2011
Volume 4, Issue 2, 2011
Source: South African Journal of Bioethics and Law 4, pp 48 –49 (2011)More Less
Over three decades ago, signatories to the Alma-Ata Declaration noted that Health for All would contribute not only to a better quality of life but also to global peace and security. They gave recognition to the fact that promoting and protecting health is essential not only for human welfare but also for sustained economic and social development. In 1996 the Constitution of the Republic of South Africa, in its preamble, established its constitutional imperative to improve the quality of life for all citizens and to free the potential of each person. Section 27 of the Bill of Rights of the Constitution affirms that everyone has the right to have access to health care services, including reproductive health care. Section 27 places an obligation on the state to take reasonable legislative and other measures within its available resources to achieve the progressive realisation of this right.
Source: South African Journal of Bioethics and Law 4, pp 50 –51 (2011)More Less
The United South African Neonatal Association (USANA) takes the opportunity to respond to the article by Vawda and Maqutu entitled 'Neonatal circumcision - violation of children's rights or public health necessity'. In their article the authors concluded that the rights of neonates to bodily integrity should not be tampered with lightly, and that only a severe public health hazard such as the HIV/AIDS pandemic may justify incursion into this constitutionally protected right. USANA is concerned by this last-mentioned conclusion and wishes to address it.
Source: South African Journal of Bioethics and Law 4, pp 52 –54 (2011)More Less
Although Fischer's premise seems perfectly reasonable, the alarming public perception that medical mistakes are commonplace suggests that even this 'one rule' is not being followed to the extent that patients are confident that their best interests will be preserved. This article aims to explore this concept from the perspective of a medical student. Rather than offer a comprehensive review of the topic, the focus will be on some rather unusual and possibly controversial views, which aim to highlight the unique constraints and difficulties of the medical profession.
Author Sandra SitholeSource: South African Journal of Bioethics and Law 4, pp 55 –57 (2011)More Less
The medical industry has, over the past couple of decades, seen remarkable development in the use of stem cells for therapeutic and research purposes. This is despite opposition from various radical groups, who argue, specifically in relation to the use of embryonic stem cells, that such use involves the creation, use and destruction of stem cells, which is unethical and tantamount to murder.
In South Africa, chapter 8 of the National Health Act, which deals with, among others, the use of stem cells, is not yet in operation. This means that we have to rely on the provisions of the Human Tissues Act which are for the most part outdated in so far as they do not take into account the development relating to stem cell research.
This paper discusses the current regulatory framework of stem cell research with specific reference to the provisions of the Human Tissues Act, 1983 and the National Health Act, 2003.
The public's attitude towards strike action by healthcare workers and health services in South AfricaSource: South African Journal of Bioethics and Law 4, pp 58 –62 (2011)More Less
Objectives. To evaluate a representative group of South Africans for their views about healthcare worker strikes and related matters.
Methods. A descriptive, cross-sectional, self-administered questionnaire-based study of 600 participants over the age of 18 years and able to read English, from two representative shopping malls (300 from each mall) in Greater Johannesburg. Data were analysed using SAS software version 9.1.3 for Windows. Tests for significant relationships were carried out using Pearson's χ2 test at the 0.05 confidence level. The strength of the associations was determined by Cramer's V.
Results. Results revealed strong opinions among the population regarding strikes, numerous misapprehensions when it comes to striking and rights, a poor awareness of other healthcare-related rights and the perception of poor treatment at public hospitals.
Conclusions. A majority of South Africans are aware of the healthcare worker strikes and are dissatisfied with the manner in which these take place, with strong objections to the perceived neglect of the critically ill during strikes, compounded by poor treatment at public hospitals. Many South Africans lack awareness of human rights issues, a situation which requires urgent remedy.
Psychometrics of the student version of the Jefferson Scale of Physician Empathy (JSPE-S) in final-year medical students in Johannesburg in 2008Author Kantilal VallabhSource: South African Journal of Bioethics and Law 4, pp 63 –68 (2011)More Less
Background. In selecting medical students for medical school, there is interest in predictors other than examination scores. This is motivated by the concern that the selection processes, mainly based on academic attainment, appear to disadvantage some applicants. There is increasing recognition that empathy and communicating skills are important for doctors.
Aims. To assess empathy levels in final-year medical students in Johannesburg and to examine the psychometrics of the student version of the Jefferson Scale of Physician Empathy (JSPE-S).
Methods. Empathy level was assessed in 158 final-year medical students using the JSPE-S at the University of the Witwatersrand Medical School in 2008. Gender, age and prior degree/s were used as confounders.
Results. The mean empathy score in final-year medical students was 107 (standard deviation (SD) 10.9). The mean empathy score was higher in 95 female students than in 63 male students (109 SD 9.8 v. 104 SD 12) (t=2.51; p<0.013). The inter-item score correlations were positive and statistically significant. Cronbach's coefficient alpha was 0.79. Factor analysis using principal component analysis identified three factors that are generally consistent with the grand conceptual aspects of the notion of empathy in the JSPE-S (viz. perspective taking, compassionate care and standing in the patient's shoes).
Conclusion. The results indicate that the mean empathy scores and psychometrics of the JSPE-S among final-year medical students in Johannesburg, South Africa are similar to studies published among students in America and Europe and that the scores are higher than those published in studies of students in Asia.
Using the concept of 'parental responsibilities and rights' to identify adults able to provide proxy consent to child research in South AfricaAuthor Ann Elaine StrodeSource: South African Journal of Bioethics and Law 4, pp 69 –73 (2011)More Less
There are circumstances where independent consent to research by children is appropriate (for example, where the participants are older adolescents and the research approximates minimal risk). However, in many instances an important safeguard will be a dual consenting process involving an appropriate adult alongside the potential child participant (according to their evolving capacities). But what adults are appropriate in what instances? We attempt to use principles set out in the Children's Act (2010) to address this question. This article differentiates between those adults who according to the Children's Act (2010) have full parental responsibilities and rights (i.e. parents/guardians) and those who have no parental responsibilities and rights (i.e. caregivers). We argue that some responsibilities accorded to caregivers are substantially similar to the authority to provide proxy consent to research in which the research risks approximate those risks present in the child's everyday life. In these instances, we argue that where parents and guardians are not available, caregivers should be considered by research ethics committees as a possible source of proxy consent for younger children. This approach might not be logically extended to caregiver consent for clinical trial enrolment, for which alternative arguments may need to be debated.
Mandatory reporting of sexual abuse under the Sexual Offences Act and the 'best interests of the child'Source: South African Journal of Bioethics and Law 4, pp 74 –78 (2011)More Less
It may not be necessary for doctors to report cases of consensual sexual penetration in terms of the Criminal Law (Sexual Offences Act and Related Matters) Amendment Act, where the children involved are under 16 years old and their age difference is not more than 2 years, if such a requirement is unconstitutional. The mandatory reporting provision regarding such conduct may be unconstitutional if it violates the constitutional 'best interests of the child' principle and unreasonably and unjustifiably limits the constitutional rights of children to bodily and psychological integrity and privacy. It may also undermine the provisions of the Choice on Termination of Pregnancy Act regarding terminations of pregnancy by girl children, the confidentiality provisions of the Children's Act regarding the distribution of condoms and contraceptives to sexually active children and their testing for HIV, and the efficacy of the Child Justice Act which aims to divert children away from the criminal justice system. It will also be unnecessary to report such conduct in terms of the Children's Act if the doctor concerned does not believe on reasonable grounds that child abuse has occurred and the doctor is acting in the 'best interests of the child' as required by the Constitution and the Children's Act.
Source: South African Journal of Bioethics and Law 4, pp 79 –84 (2011)More Less
Recent medical advances in the field of regenerative medicine and tissue transplantation have highlighted the importance of umbilical cord blood (UCB) as a valuable alternative source of haematopoietic stem cells, which are potentially life-saving in a vast array of clinical applications. Although less controversial than the use of embryonic stem cells obtained from fetal tissue, the practice of UCB biobanking presents several ethical and regulatory challenges surrounding its procurement and use, especially in developing countries like South Africa, where the majority of the population is vulnerable and prone to exploitation. Currently only private umbilical cord banking is practised in South Africa and the regulatory framework for human tissue use is still rudimentary with no clear guidelines. This environment raises ethical questions about consent and ownership of tissues, the cost-effectiveness of harvesting and storage of UCB, undue influence on donors, and issues of distributive justice such as the fact that UCB, which is potentially life-saving and could be easily obtained, may become a resource unfairly restricted only to the wealthy. In view of the fact that UCB has become a valuable, non-invasive source of stem cells for regenerative therapy, establishment of a public cord blood bank (CBB) in South Africa would vastly improve the availability of haematopoietic stem cells for research and therapeutic uses, and increase the tissue genetic diversity that currently impedes the South African bone marrow registry.
Source: South African Journal of Bioethics and Law 4, pp 85 –88 (2011)More Less
Because of changes in litigation frequency and estimated claims value, indemnity costs for South African obstetricians have increased sharply and may soon become virtually unaffordable. There is the real possibility of very serious public health consequences and it is important that the matter is addressed as a matter of urgency. Resolution is by no means limited to obstetric care, but it is important that obstetricians become actively involved in the debate. While the alternatives suggested may be considered unpalatable they are raised to open and stimulate debate - they are by no means prescriptive. Clearly the debate has to extend beyond the obstetric or indeed the medical community and urgent and serious consideration will have to be given to tort reform.
Author Calvin GwandureSource: South African Journal of Bioethics and Law 4, pp 89 –94 (2011)More Less
This position paper seeks to explore the ethical concerns surrounding the use of medical male circumcision as an effective method of preventing HIV infection in sub-Saharan Africa. The study explores research that looked at the effectiveness of medical male circumcision in clinical trials. While clinical trials reveal that medical male circumcision showed statistically significant results in HIV prevention, there is still a paucity of studies that take into consideration the ethical challenges posed by medical male circumcision in sub-Saharan Africa. This paper argues that rolling out medical male circumcision to the larger community without adequately addressing the ethical concerns could weaken programme initiation, implementation and evaluation in sub-Saharan Africa.
Source: South African Journal of Bioethics and Law 4, pp 95 –101 (2011)More Less
Chapter 5 of the Sexual Offences Amendment Act strives to achieve two objectives. It makes post-exposure prophylaxis (PEP) accessible to victims of sexual assault, whether a charge is laid or not. In addition, it allows for the victim or the investigating officer to make application for the forcible disclosure of the HIV status of the accused, within 90 days of the assault. It is argued that the provision of PEP to victims of sexual assault is required by section 27(1) of the Constitution, and is an obligation that the state should assume and discharge efficiently and ably. However, it is considered that the provisions compelling the accused to disclosure his HIV status to the victim and investigating officer serve no medical purpose, and seriously infringe a number of important constitutional rights. The authors go on to argue that a magistrate has to be satisfied that a prima facie case has been made that the accused sexually assaulted the victim before compelling disclosure. Given the seriousness of this finding, it is very likely to be robustly contested by the accused and consequently victims may have to testify twice, initially at these proceedings and subsequently at the criminal proceedings. They argue that the medical, legal and support services provided to the victim should be upgraded and improved. The authors identify some clinics that are operating with reasonable efficiency. They argue that the simplistic solution of compelling the accused to disclose his HIV status is aimed at making up for the inadequacies of policing and the inability to prosecute effectively. They also submit that the test results may bring false hope and result in poor choices being made regarding treatment. They submit that the testing provisions may not be in the medical best interests of the patient and the provisions are not reasonable and justifiable in an open and democratic society and consequently unconstitutional.
An innovative South African-based Master's Programme to train bioethics and medical law experts : education and trainingAuthor J. GardnerSource: South African Journal of Bioethics and Law 4, pp 102 –103 (2011)More Less
In modern society we regularly witness rapid progress in scientific research and its medical applications. Advances in science and technology, combined with restrictions on resource allocation, present many ethical challenges and issues that raise questions about these scientific endeavours and the impact that they will have on us as a society. For example, developments in life-sustaining interventions have compelled us to revisit our traditional understanding of when life ends, in other words when someone can be said to be dead. These sorts of questions are therefore not the exclusive domain of those involved in healthcare practice and research.
Source: South African Journal of Bioethics and Law 4, pp 104 –105 (2011)More Less
Southern Africa is a research-rich environment in which research ethics review is critical. The research ethics review system is well established but considerable variability in capacity and training exists among the various research ethics committees (RECs) in the region. The ARESA programme comprises a Postgraduate Diploma in Health Research Ethics, an annual seminar, a newsletter and an association of REC members. The programme has been developed to promote health in the region via capacity development in the field of research ethics.
Author L. LondonSource: South African Journal of Bioethics and Law 4 (2011)More Less
The Health and Human Rights Programme in the School of Public Health and Family Medicine at the University of Cape Town has run an annual short 'Train-the-Trainer' course in health and human rights since 1998. The course is aimed at staff who teach students in the health professions and is geared to enabling staff to incorporate human rights in their curricula and to share good practice in teaching human rights in a health setting.
Author Doug WassenaarSource: South African Journal of Bioethics and Law 4, pp 107 –108 (2011)More Less
The South African Research Ethics Training Initiative (SARETI) is the oldest Africa-based Master's programme in the field of health research ethics. The programme, initially a collaboration between the University of Pretoria's School of Health Systems and Public Health and the University of KwaZulu-Natal (UKZN)'s School of Psychology in association with Johns Hopkins University, equips African health professionals with the education and practical experiences needed to provide sound ethics review of the increasingly numerous and complex health studies taking place in Africa. SARETI started in 2003 and to date has graduated 1 PhD, 14 Masters (with several more close to completion), and 22 non-degree fellows, and is currently awaiting a funding decision for a third cycle of Fogarty/National Institutes of Health (NIH) funding for 2012 - 2016.
Source: South African Journal of Bioethics and Law 4 (2011)More Less
Health research, while a valued social activity, is fraught with complexities, especially where participant populations are convenient, easily accessible, and in the main, vulnerable. Researchers and research ethics committee (REC) members currently confront difficult moral, ethical and legal dilemmas when their work involves such populations. This is especially so in international research in developing regions where sponsors are from the developed world. Careful analysis and action has therefore become imperative regarding research conducted in this context.