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- Volume 6, Issue 2, 2013
South African Journal of Bioethics and Law - Volume 6, Issue 2, 2013
Volume 6, Issue 2, 2013
Establishing national biobanks in South Africa : the urgent need for an ethico-regulatory framework : from the editorSource: South African Journal of Bioethics and Law 6, pp 38 –39 (2013)More Less
In 2012, the National Health Laboratory Service (NHLS) set up a biobank in Braamfontein, South Africa, which has a storage capacity of 120 000 samples. Recently, the H3Africa Initiative was launched with the aim of endowing several research projects across Africa, funding a bioinformatics network and establishing five biobanks, two of which are housed in Cape Town and Johannesburg respectively. The expectation is that, in a few years, the three sites in South Africa will evolve into full-scale central biobanks capable of storing over 100 000 samples harvested from African research each year. In addition, the Aids Malignancy Consortium sub-Saharan Africa biobank project has also received funding, and the plan is that this biobank will be located in Cape Town next to H3Africa's biobank.
Do prisoners in South Africa have a constitutional right to a holistic approach to antiretroviral treatment? : forumAuthor D. McQuoid-MasonSource: South African Journal of Bioethics and Law 6, pp 40 –44 (2013)More Less
The prevalence of AIDS in prisons is believed to be higher than in the broader community. While the courts have used their powers to enforce prisoners' rights in terms of the Constitution, specifically their right to medical treatment, the state needs to adopt a holistic approach when providing antiretroviral therapy (ART) for prisoners. Failing to provide support for ART, beyond its mere provision, would offend the values of the Constitution. This support includes comprehensive HIV and AIDS care and prevention, treatment of opportunistic infections, access to nutritional supplements, access to palliative care and compassionate release. Counteracting challenges to the implementation of effective treatment, care and support strategies will require committed endeavours by the Department of Correctional Services.
Source: South African Journal of Bioethics and Law 6, pp 45 –47 (2013)More Less
Doctors and researchers face a complex dilemma regarding the mandatory reporting of consensual underage sex, because of contradictions between the Children's Act and the Sexual Offences Act. When providing underage children with sexual and reproductive health services, they have had to decide whether to provide these confidentially, in terms of the Children's Act, or thereafter report the consensual but illegal sexual behaviour to the police, in terms of the Sexual Offences Act. The recent Teddy Bear Clinic for Abused Children, and Resources Aimed at the Prevention of Child Abuse and Neglect (RAPCAN) v. Minister of Justice and Constitutional Development case addressed whether consensual underage sex ought to be a criminal offence and thus reported. The court held that aspects of sections 15 and 16 of the Sexual Offences Act infringed on the constitutional rights of adolescents (aged 12 - 15 years) by proscribing many consensual sexual activities. McQuoid-Mason has described this case in detail. He submits that following the judgement, doctors are no longer under a reporting obligation in relation to consensual underage sex. We respectfully disagree. This article critiques McQuoid-Mason's approach, sets out our views on the mandatory reporting obligations after the Teddy Bear case and concludes with some comments on the judgement's implications for researchers and medical practitioners.
Beyond the hidden curriculum : the challenging search for authentic values in medical ethics education : researchAuthor G.M. SsebunnyaSource: South African Journal of Bioethics and Law 6, pp 48 –51 (2013)More Less
Since the practice of medicine is a moral enterprise, medical ethics education aims to produce 'good' doctors who are capable of self-reflective discernment of the many values at play in the clinical encounter, and of re-affirming the patient's human dignity. However, the caring and compassionate physician envisaged as the end-product of medical ethics curricula evidently remains elusive. I argue that this apparent failure of medical ethics education is traceable to a systematic de-emphasis of humanistic values since the pioneering stages of formal medical ethics curricula. The idea of 'the hidden curriculum' connotes a distinctive value-laden medical morality that is transmissible through socialisation and role-modelling in the medical school moral ecosystem. Further, the hidden curriculum is hampered by the challenging medical school workload, bad role models, and lack of appropriate evaluation and assessment methods, as well as the lack of consensus in bioethics on the key concept of human dignity. Properly conceived, the dignity of the human person is the ultimate source of human values. Optimising the hidden curriculum, therefore, demands an authentic and comprehensive enquiry into the concept of human dignity, as well as the nature of the human person, the true human good and what constitutes the unitary good of the patient.
No one 'owns' the genome : the United States Supreme Court rules that human DNA cannot be patented : researchAuthor E. HurterSource: South African Journal of Bioethics and Law 6, pp 52 –54 (2013)More Less
Modern biotechnological innovation has been fertile ground for profound and critical debate - and policy consideration - regarding its associated legal, social, ethical and moral issues. Patent laws exist to encourage the progress of science, innovation and discovery, but battle to provide a clear and stable regulatory framework. In a decision that looks set to shape the future, the United States Supreme Court recently ruled that isolated human DNA cannot be patented. It is argued that this decision will have a potentially serious negative impact on future biotechnological innovation and discovery, and that the more expansive European approach to 'gene patenting' is sounder and enables progress.
Informed consent for telemedicine in South Africa : a survey of consent practices among healthcare professionals in Durban, KwaZulu-Natal : researchSource: South African Journal of Bioethics and Law 6, pp 55 –59 (2013)More Less
Background. The Health Professions Council of South Africa is drafting guidelines to regulate the practice of telemedicine. These emphasise the need for signed informed consent for all aspects of the consultation process, including data transmission and storage.
Objective. To survey current practices relating to gaining informed consent both in routine clinical practice and when using information communication technologies (ICT).
Methods. A cross-sectional descriptive study was undertaken using a self-administered questionnaire. It surveyed healthcare professionals' habits and practices of obtaining informed consent in clinical practice scenarios and when using the telephone, fax and email for communication and healthcare provision.
Results. A total of 193 doctors and 207 nurses completed the questionnaire. Fewer doctors took written consent than nurses, with a range of 2.6% when examining a patient to 8.3% when ordering a special examination. A significant difference was observed for all activities. Of the 67.4% doctors and 50.7% nurses who faxed patient information, only 35.3% of doctors and 42.9% of nurses obtained informed consent to do so and less than half of those obtained written consent. Few used email to send patient information, with specialists being most likely to do so among doctors (p<0.0001). Of all healthcare professionals who used email, 40.7% obtained informed consent to do so.
Conclusions. Written informed consent is not routinely obtained from patients during clinical examination or when using ICT for the transfer of patient information. The issue of informed consent for telemedicine remains unresolved in South Africa.
Source: South African Journal of Bioethics and Law 6, pp 60 –63 (2013)More Less
In South Africa, increases in both the size and amount of medical malpractice claims have resulted in a move towards so-called defensive medicine, and have had devastating emotional effects on healthcare professionals. Among several recommendations for addressing these consequences, the first author's recent doctoral study critically analysed evidence-based patient choice as a partnership model in clinical decision making. This study indicated that none of the key skills of this approach are completely adequate in honouring the principle of respect for autonomy in clinical decision making. Instead, the study proposed the concept of medical information therapy - an expanded conception of the generic concept of information therapy - as an adequate approach to reconciling the opposing perspectives of patients and healthcare professionals in a therapeutic alliance. Recent case law, as well as relevant provisions of the National Health Act, emphasise patient autonomy, as well as the notion of shared decision making in the context of informed consent. The South African healthcare context is characterised by specific challenges affecting the process of obtaining informed consent. The article submits that the concept of medical information therapy will help address the significant increase in litigation against healthcare practitioners based on a lack of informed consent, in both the public and private healthcare sectors.
'Single' v. 'panel' appointed forensic mental observations : is the referral process ethically justifiable? : researchAuthor T. SchutteSource: South African Journal of Bioethics and Law 6, pp 64 –68 (2013)More Less
Objective. To compare the outcome and psychiatric morbidity of the forensic mental observation referrals, in the two legally created groups of detainees awaiting trial - the 'singles', representing the minor violent and non-violent offenders evaluated by a single-state appointed psychiatrist, v. the 'panels', representing the seriously violent offenders evaluated by two or more psychiatrists.
Methods. A retrospective record review covered 200 cases, comprising all individuals admitted to the forensic unit of Sterkfontein Hospital for 30 days psychiatric observation from January to August 2010. Pearson's χ22 test for categorical data were used to determine statistical significance.
Results. Of 110 singles, 49 (44.55%) were found fit for trial and 40 (40.4%) were found criminally responsible. Of the 90 'panel' cases 60 (66.67%) were found fit for trial and 57 (64.77%) were found criminally responsible (p=0.002 and p=0.001, respectively).
Conclusion. Those charged with seriously violent offences appear more likely to be found both fit and responsible, compared with those charged with less serious offences.
The parameters of the current legal framework for health research : forms of health research which are regulated and obligations imposed on researchers : researchAuthor A.E. StrodeSource: South African Journal of Bioethics and Law 6, pp 69 –71 (2013)More Less
On 1 March 2012, the South African Minister of Health operationalised section 71 of the National Health Act (NHA), ushering in a new phase of research regulation. When read with sections 1, 11 and 16 of the NHA, section 71 describes the legal norms for undertaking various forms of health research in South Africa. Three key terms used in the NHA now set the parameters of the legal framework for regulating health research: 'health research' (section 1), 'research or experimentation on a living person' (section 71), and the provision of a 'health service for research or experimental purposes' (section 11). Importantly, these three concepts delineate (i) what forms of health research are regulated by the legal framework, and (ii) the nature of the obligations placed on health researchers and others. Researchers and members of research ethics committees need to be aware that the NHA assigns different legal obligations to different forms of health research. This article describes the parameters of the new legal framework and the obligations that flow from each of the three categories of health research. It shows how the restrictions the framework imposes are not evenly spread across all forms of research, and concludes by identifying some of its strengths, weaknesses and anomalies. It further suggests that more conceptual elaboration is required to ascertain whether the differences are coherent and justified.
Source: South African Journal of Bioethics and Law 6 (2013)More Less
The Health of Nations: Towards a New Political Economy is highly critical of the structurally unjust world we live in and its failure to address the global burden of disease. In clear, concise language, Gavin Mooney ably explains the reasons for global ill health and offers viable solutions. The book is sharp and crisp, highly informative and makes compelling reading from the very first page.
Source: South African Journal of Bioethics and Law 6 (2013)More Less
In this strictly academic book, David Kirchhoffer processes the complex issues surrounding the concept of human dignity through a clearly defined ethical method. At the outset, he questions whether it is possible to use human dignity as a normative criterion, when empirical research has shown there is no evidence that an inherent and inviolable dignity of the person exists. Yet from there, he artfully demonstrates a multidimensional understanding of human dignity which could be used to refute recent calls for the concept's dismissal. He explains how, when viewed as a multidimensional concept, human dignity serves not only as a valuable descriptive function in ethics, but also as a way in which to understand moral behaviour.