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- Volume 7, Issue 1, 2014
South African Journal of Bioethics and Law - Volume 7, Issue 1, 2014
Volume 7, Issue 1, 2014
Author Gert SteynSource: South African Journal of Bioethics and Law 7 (2014)More Less
We wish to take this opportunity to thank you for your continued support through the completion of our online CPD questionnaires as well as to share some exciting news with you. HMPG's journal CPD questionnaires will be moving to the Medical Practice Consulting (MPC) CPD platform (www.mpconsulting.co.za) as part of a strategy to consolidate all South African Medical Association (SAMA) members' CPD certificates and history.
Author Ames DhaiSource: South African Journal of Bioethics and Law 7, pp 2 –3 (2014)More Less
In terms of the Regulations Relating to the Artificial Fertilisation of Persons (R.175) of the National Health Act, when gametes are removed or withdrawn from the body of a gamete donor, this is done for the purpose of artificial fertilisation. In the Regulations, artificial fertilisation is defined as '... the introduction by other than natural means of a male gamete or gametes into the internal reproductive organs of a female person for the purpose of human reproduction ...'. All information regarding the donated gametes is to be stored in an electronic central databank. No further gametes can be removed or withdrawn from the body of a donor once six children have been conceived through artificial fertilisation using the gametes of that donor. If a competent person involved in this aspect of reproductive medicine is informed or suspects that the maximum number of conceptions have occurred, s/he must make the donor aware of this and in addition must inform the donor that s/he may not make any further donation of gametes. This information must also be relayed to the central databank. A competent person is defined very broadly as a medical practitioner specialising in gynaecology with training in reproductive medicine, or a medical scientist, medical technologist or clinical technologist with training in reproductive biology and related laboratory procedures.
The ethics of claiming a 60% reduction in HIV acquisition from voluntary medical male circumcision : letterAuthor Gwinyai MasukumeSource: South African Journal of Bioethics and Law 7 (2014)More Less
To the Editor: Is telling people that voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition (female to male) by 60% ethically defensible? It is commonly stated that VMMC reduces the risk of HIV acquisition by (about) 60%, and this statement is even repeated during the process of obtaining consent for the circumcision procedure, often without the clarification that this statement applies to female-to-male HIV transmission.
Author D.R. WassenaarSource: South African Journal of Bioethics and Law 7, pp 5 –8 (2014)More Less
The Global Forum on Bioethics in Research (GFBR) served as a global platform for debate on ethical issues in international health research between 1999 and 2008, bringing together research ethics experts, researchers, policy makers and community members from developing and developed countries. In total, nine GFBR meetings were held on six continents. Work is currently underway to revive the GFBR. This paper describes the purpose and history of the GFBR and presents key elements for its reinstatement, future functioning and sustainability. Potential participants and sponsors are encouraged to contribute actively to the future of this unique international research ethics event.
Is there a foundation in South African legislation to require students to disclose their academic status to patients when involved in their care?Source: South African Journal of Bioethics and Law 7, pp 9 –13 (2014)More Less
Student involvement in patient care has been debated for many decades. There is an increasing body of literature calling for greater respect for patients' rights in a teaching environment. South African legislation already gives patients certain rights, including the right to non-medical information such as the costs of procedures. This paper analyses pertinent international guidelines and South African legislation to ascertain whether the existing rights of patients extend to the teaching environment. It is concluded that patients have a right to informed consent in every aspect of healthcare, including student involvement.
Language, cultural brokerage and informed consent - will technological terms impede telemedicine use?Source: South African Journal of Bioethics and Law 7, pp 14 –18 (2014)More Less
Background. Telemedicine provides a solution to treatment of economically and geographically compromised patients and enhances the level of care. However, a problem has arisen in safeguarding patients' rights to informed consent.
Objective. To determine the impact of language, translation and interpretation barriers on gaining legally valid informed consent in telemedicine.
Methods. Forty-one key words relevant to computer terminology and concepts required to gain informed consent for a telemedicine encounter were selected and sent for translation into isiZulu, the local indigenous language of KwaZulu-Natal, South Africa. A questionnaire with the list of words was developed with three domains covering information communication technology (ICT) use, ICT terms and ethics terms. This was administered to patients at four outpatient departments in rural KwaZulu-Natal hospitals.
Results. Of the 54 participants, 50 (92.6%) did not know or understand the term 'telemedicine', 49 (90.7%) the term 'video conference' and 49 (90.7%) the term 'electronic records'. Words such as 'consent' and 'autonomy' were understood by less than a third of the participants. Only 19 individuals (35.2%) understood the word 'consent', and only 4 (7.4%) understood both the words 'consent' and 'telemedicine'.
Conclusions. Obtaining informed consent for a telemedicine consultation is problematic. Alternative ways of doing so need to be investigated.
Current role of research ethics committees in health research in three geopolitical zones in Nigeria : a qualitative studySource: South African Journal of Bioethics and Law 7, pp 19 –22 (2014)More Less
Background. Ethics are rules or standards governing the conduct of a person or members of a profession. Medical research must be regulated to ensure that fundamental human rights are not breached in the quest for knowledge. Nigeria had no laws or specific guidelines to regulate health research until 2007, when a national regulatory body, the National Health Research Ethics Committee (NHREC), was established. Its function is to ensure ethical conduct in research and to accredit institutional and state health research ethics committees (HRECs).
Objective. To document the current role of HRECs in the ethical practice of health research in Nigeria, 4 years after the establishment of the NHREC.
Methods. Functioning of the HRECs was evaluated via interviews of 14 members of state and institutional HRECs chosen from selected geopolitical zones of the country.
Results. The HRECs surveyed had between nine and 15 members, with more males than females. Review meetings were held only occasionally owing to the competing interests of members, who receive no incentives for participation, and poor funding. Scientific and ethical reviews are conducted together by the same committee, but few members of the HRECs are trained in research ethics. Monitoring of research after approval is poor.
Conclusion. Nigeria now has about 30 institutional HRECs, but their functioning is hampered by a shortage of both money and qualified individuals to serve on them.
Author D.L. ClarkeSource: South African Journal of Bioethics and Law 7, pp 23 –25 (2014)More Less
Objective. This study audited the process of ethics approval for Master's research at the Nelson R Mandela School of Medicine, Durban, KwaZulu-Natal, South Africa.
Methods. After obtaining the appropriate ethical approval, all the correspondence surrounding each Master's proposal for the year 2010 was reviewed.
Results. A total of 53 proposals for Master's degrees were available for review. All the proposals were for low-risk studies, and all were subjected to expedited review. It took an average of 15 weeks (range 3 - 32) for the institutional ethics review board (the Biomedical Research Ethics Committee (BREC)) to respond to each of the 53 proposals. Twenty-three studies (43.4%) received provisional approval on the first response, 2 proposals (3.8%) were rejected, and 28 proposals (52.8%) were sent back with major queries. For the 28 proposals that required major revisions, 11 responses had been submitted by the time the data were collected. The average length of time to receive a response from the applicants to BREC queries was 4 weeks.
Conclusion. This study suggests that there is a potential cumulative delay of over 4 months before data collection for low-risk clinical audits can be commenced. Any system designed to improve this situation must ensure that high standards of vigilance are maintained, but must be flexible enough to allow for a faster review and approval process.
Reporting sexual offences involving child patients : what is the current law following the Constitutional Court judgment?Author P. MaherySource: South African Journal of Bioethics and Law 7, pp 26 –29 (2014)More Less
The Constitutional Court of South Africa has recently invalidated certain sexual offences involving adolescents and placed a moratorium on reporting adolescents who engage in 'lawful' sexual activity. In evaluating the constitutionality of the law that criminalises sexual activity between adolescents, the Court recognised how the reporting obligations could exacerbate the violation of children's constitutional rights. However, in light of the Court's narrow focus, its judgment only slightly amends the reporting obligations of healthcare providers in terms of adolescent patients, and for the most part the current law remains intact. Despite this judgment, adolescent patients can still be exposed to the negative effects of the reporting obligations placed on healthcare providers, and healthcare providers are still faced with the challenges created by their duty to report sexual offences involving young patients. This article explores the judgment in order to clarify the current law on reporting sexual conduct involving adolescents, and also provides some analysis to assess the implications of the judgment for healthcare providers.
Author J. GardnerSource: South African Journal of Bioethics and Law 7, pp 30 –33 (2014)More Less
Health promotion is a key element of public health practice. Among strategies aiming to deal with public health problems, health promotion purports to help people achieve better health. Health promotion can significantly alter people's lifestyles, and three main ethical issues relate to it: (i) what are the ultimate goals for public health practice, i.e. what 'good' should be achieved? (ii) how should this good be distributed in the population? and (iii) what means may we use to try to achieve and distribute this good? The last question is the subject of this article. Concerns raised about health promotion can be divided into two groups: (i) efficacy-based considerations - are they cost-effective or cost-ineffective? and (ii) autonomy-based concerns - (to what extent) do they interfere with free choice, i.e. do they attempt to direct social values and lifestyles? Ways in which an individual's autonomy may be compromised by means of influencing behaviour change are considered.
Author T. MetzSource: South African Journal of Bioethics and Law 7, pp 34 –39 (2014)More Less
South African law currently forbids those seeking to arrange a surrogate motherhood agreement from creating a child that will not be genetically related to at least one of them. For a surrogacy contract to be legally valid, there must be a 'genetic link' between the child created through a surrogate and the parents who will raise it. This law is currently being challenged in the High Court of South Africa, and in this article I critically explore salient ethical facets of the dispute. I argue that the law is unjust and should be revised.