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- Volume 5, Issue 1, 2012
South African Journal of Bioethics and Law - Volume 5, Issue 1, 2012
Volume 5, Issue 1, 2012
Author Ames DhaiSource: South African Journal of Bioethics and Law 5, pp 2 –3 (2012)More Less
During the apartheid era, disproportionate resource allocation policies by the state at a systemic level resulted in poor-quality and inferior services being available to black people. Healthcare services were not spared the discriminatory constraints of apartheid rule. As a consequence, there were treatment delays, drug and bed shortages, and black South Africans in psychiatric hospitals were refused sheets, made to sleep on the floor, and given inferior foods. In many instances, black women were made to leave healthcare facilities immediately after giving birth. No doubt the state had the resources to provide better care, but because of apartheid racist policies did not.
Source: South African Journal of Bioethics and Law 5, pp 4 –10 (2012)More Less
The implementation of the National Health Insurance in South Africa is a noble attempt to address the inequities and scarcities of healthcare resources in the country. However, while South Africa's status as a developing country does not preclude the success of universal healthcare, as evidenced by certain international models, its success is threatened by corruption, mismanagement of resources, and poor-quality institutions. Rather than build a new system on poor foundations, existing facilities need to be overhauled. Increased transparency, as well as improvement in challenges such as cleanliness, personnel attitudes, and long waiting times may secure public 'buy-in'. Without these and other changes, public confidence will not be inspired - and, even more importantly, the system may fail in its goal of bringing about equitable resource allocation and improved healthcare.
Author David McQuoid-MasonSource: South African Journal of Bioethics and Law 5, pp 11 –14 (2012)More Less
Dr Conrad Murray was convicted of the involuntary manslaughter of Michael Jackson for negligently causing his death when complying with Jackson's request to give him the anaesthetic propofol at home. The case raises the issue of the relative nature of patient autonomy, because the other bioethical principles of beneficence, non-maleficence and justice or fairness must also be applied where appropriate. Doctors should not accede to requests from their patients to engage in unethical or illegal conduct, as such requests will be no defence to disciplinary or criminal charges. Such requests will also be no defence to civil actions if the harmful conduct by the doctor is the result of illegality, fraud or gross negligence. South African doctors faced with requests similar to those received by Dr Murray from Jackson will be judged by the standard of reasonably competent practitioners in the same situation. Doctors are well advised to refuse requests to circumvent good medical practice and instead to seek other remedies, even if it means limiting patient autonomy and losing their patients.
Author J. GardnerSource: South African Journal of Bioethics and Law 5, pp 15 –19 (2012)More Less
In April 2010, South Africa launched an HIV Counselling and Testing (HCT) campaign that, among other things, sought to massively increase the numbers of people who test, know their HIV status and receive treatment. This is in line with the goals laid out in the country's National Strategic Plan (NSP) for HIV, Sexually Transmitted Infections and Tuberculosis, which aims to significantly reduce the number of new infections and expand access to appropriate treatment, care and support to people diagnosed with HIV.
The realisation of the NSP goals requires strategies that lead to a greater number of individuals getting tested. This article has one simple objective - to stimulate discussion and debate on the topic of HIV home testing, which the author postulates may be preferable to some people, largely because it enables individuals to perform some or all aspects of the test in locations chosen by them. In this way home testing has the benefit of potentially increasing the number of people who test, know their HIV status and consequently present for treatment. The article considers whether some of the reasons that are usually offered against this approach to counselling and testing are sufficiently justified in the South African context, and suggests that these reasons are not sufficiently justified and that this system of HIV testing could contribute towards achieving the goals set out in the country's NSP.
Author Rekha A. KumarSource: South African Journal of Bioethics and Law 5, pp 20 –26 (2012)More Less
Objectives. To evaluate the conflicts between the rights of society and those of mothers-to-be and the unborn, which raise difficult ethical and legal questions regarding decision-making, respect for autonomy, confidentiality, public health and individual rights in an 'opt-out' approach to HIV testing in antenatal care, which Botswana introduced in 2004.
Methods. An empirical study with critical analysis of research studies since 2004, and documentary data/reports relating to opt-out HIV testing policy in prenatal cases in Botswana.
Conclusions. The Government of Botswana's capacity to deal effectively with HIV/AIDS is inherently connected with larger societal, legal, policy and contextual issues. These issues appear to be insufficiently appreciated in Botswana, even though their consideration is essential if the country is to align its practices with existing national laws, as well as international conventions to which it is a signatory.
Author M. Nothling SlabbertSource: South African Journal of Bioethics and Law 5, pp 27 –32 (2012)More Less
The statutory regulation of surrogate motherhood in the Children's Act 38 of 2005 is fraught with practical, legal and ethical problems. Healthcare professionals specialising in assisted conception are often confronted with practical scenarios for which the Children's Act does not provide clear answers. The purpose of this article is to briefly examine some of these questions against the background of the relevant legislation and recent case law.
Global health justice : a perspective from the global South on a Framework Convention on Global HealthSource: South African Journal of Bioethics and Law 5, pp 33 –37 (2012)More Less
A global coalition of civil society and academics recently launched the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI), which is developing a post-Millennium Development Goal (MDG) framework for global health. The Framework Convention proposes establishing fair terms of international co-operation, with agreed-upon mutually binding obligations to create enduring health system capacities, meet basic survival needs, and reduce unconscionable inequalities in global health. States that bear a disproportionate burden of disease have the least capacity to do anything about it. The richer states are deeply resistant to expending the political capital and economic resources. When they do act, it is often more out of narrow self-interest or humanitarian instinct than a full sense of ethical or legal obligation. The result is a spiralling deterioration of health in the poorest regions, with manifest global consequences and systemic effects on trade, international relations, and security.
Applications and secretariat workload at the University of the Witwatersrand Human Research Ethics Committee (Medical) 2002 - 2011 : a case studyAuthor P. Cleaton-JonesSource: South African Journal of Bioethics and Law 5, pp 38 –44 (2012)More Less
Objective. To examine trends in the numbers of new applications for ethics clearance of health research and associated research ethics committee secretariat activity.
Methods. Data were obtained from research ethics committee secretariat databases with ethics approval.
Results. General research applications increased from 440 in 2002 to 685 in 2011, all handled by one full-time staff member. This load is expected to increase by 250 per year for 2012, 2013 and 2014 before reaching a plateau. This new applications load per year is based on registered clinical postgraduates at the University of the Witwatersrand in a 4-year specialisation who must comply with the new Health Professions Council of South Africa requirement for completion of Master's level research in order to register as a clinical specialist. Sponsored clinical trials have remained and should remain at approximately 100 per year but require three staff members to attend to this workload.
Conclusion. The increased workload is a serious challenge and has to be tackled first by increasing the administrative staff number.
An audit of the informed consent process in postgraduate dissertation studies at the College of Health Sciences, University of Nairobi, KenyaSource: South African Journal of Bioethics and Law 5, pp 45 –50 (2012)More Less
Background. Informed consent ensures respect for individual autonomy and safeguards against abuses of human participants. However, the high prevalence of poverty, inaccessibility of healthcare services, diseases, social insecurity and low literacy in developing countries such as Kenya increases participants' vulnerability to research exploitation and abuse. Biomedical and behavioural studies conducted on the vulnerable population in Kenya raise concerns about voluntary participation.
Objective. The purpose of this study was to assess the process of obtaining informed consent by postgraduate students in the College of Health Sciences at the University of Nairobi, Kenya.
Method. The study was observational, descriptive and quantitative. A convenience sample of 20 postgraduate students at the data collection stage was selected to participate in the study. Each student was observed during four episodes of administering informed consent, totalling 80 episodes of observed student-subject interaction. Data were collected for a period of 6 weeks by means of an observation checklist and analysed using the SPSS version 14 computer package. Descriptive statistics were used to answer the research questions.
Results. The main finding was that performance scores were better on the items that had a positive influence on patient participation than on those that would negatively influence patient participation.
Conclusions. The consent form was mainly used for the students' legal protection and not for the patients' benefit.
Recommendation. A further study on a large sample drawn from all the schools of the college is needed to confirm the practice of obtaining informed consent and compare performance in all the schools.
Laws, regulations and guidelines of developed countries, developing countries in Africa, and BRICS regions pertaining to the use of human biological material (HBM) in researchSource: South African Journal of Bioethics and Law 5, pp 51 –54 (2012)More Less
Human biological material (HBM) is an invaluable resource in biomedical research. Although research ethics committees (RECs) are guided by international guidelines and frameworks, some RECs might not be fully informed about local ethical and regulatory requirements regarding the use, collection, storage, ownership, transfer and benefit-sharing of HBM in collaborative research.
Author K.S. SatyapalSource: South African Journal of Bioethics and Law 5, pp 55 –59 (2012)More Less
Concerns regarding treatment of the dead in scientific and public arenas, issues related to consent, respect for human dignity, scientific integrity, societal expectations, and why treatment of cadavers are ethically significant are highlighted.
The display of human remains claimed as 'edutainment' or 'anatomy art' in Body Worlds is discussed. In this regard, the issues of consent, legal controversy surrounding Body Worlds' innovator, copycat competitor exhibitions, human rights violations and the legal vacuum within which anatomical specimens are permitted to cross international boarders are explored.
The display of Saartjie Baartman, a Khoisan woman, as a popular novelty, curiosity and political caricature is examined. The role of anatomists, controversies and difficulties in repatriation, and the need for respect for indigenous cultural, religious and traditional values, are discussed.
The exhumation by the Truth and Reconciliation Commission (TRC) and final laying to rest of Phila Portia Ndwande are explored. The TRC report relating to the treatment of human remains, including cultural rights of the dead, sacred rituals and the demand that the 'amadlozi' (spirit of the dead) be officially brought home and inaugurated as an 'ancestor' are examined.
Boundaries will be pushed only as far as society condones it. Key recommendations include valuable lessons recommended by the TRC; the formation of a multi-stakeholder forum to consider definitive answers to complex issues in the use of unclaimed cadavers; policy relating to legacy collections; guidelines by healthcare and scientific associations; and revision of the National Health Act, 2003.
Source: South African Journal of Bioethics and Law 5 (2012)More Less
Legislation pertaining to human tissues is complex. In addition to an ever-changing landscape where advances in science and medicine need to be accommodated, a high degree of technical expertise is required to ensure that the legislation is accurate, appropriate and unambiguous. It is generally accepted that, where human tissue legislation is concerned, the law does not keep pace with advances in science and technology. In this regard, the National Health Act 61 of 2003 (hereafter NHA), assented to by the President on 18 July 2004, came into force on 2 May 2005. At that time, however, Chapter 8 of the NHA, entitled 'Control of use of Blood, Blood Products, Tissue and Gametes in Humans', was not enacted, and matters pertaining to human tissues were legislated under the Human Tissue Act 65 of 1983 (hereafter HTA).