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- Volume 7, Issue 2, 2014
South African Journal of Bioethics and Law - Volume 7, Issue 2, 2014
Volume 7, Issue 2, 2014
Source: South African Journal of Bioethics and Law 7, pp 42 –43 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.359More Less
The current outbreak of Ebola virus disease (EVD) in West Africa is proving particularly challenging to contain. At the time of preparing this editorial, over 2 500 lives have already been lost since the index case, which involved a 2-year-old child who died in December 2013. This outbreak was officially reported by the World Health Organization (WHO) towards the end of March this year. The Ebola virus is a filovirus that is believed to be harboured by specific bat species in the affected regions. Transmission is from bat to bat and spill-over occurs into other animal species, in particular antelope and primates. Spill-over to humans is through contact with infected animals or direct contact with infected bats. Once a person is infected, mortality is reported to be between 60% and 90%, and the disease spreads quickly through contact with infected tissues and body fluids of affected persons. It is therefore not surprising that EVD is now one of the most feared diseases of the globalised world.
Terminating the pregnancy of a brain-dead mother : does a fetus have a right to life? The law in South AfricaAuthor D. McQuoid-MasonSource: South African Journal of Bioethics and Law 7, pp 44 –46 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.317More Less
In the recent Texas case of Munoz v. John Peter Smith Hospital, the court granted a husband an order for the removal of life support from his brain-dead pregnant wife whose body was decaying, after a hospital had tried to keep her on 'life support' until the fetus was born. In South Africa the court would have issued a similar order but for different reasons, viz. because in this country: (i) a fetus has no legal rights until it is born; and (ii) unlawfully subjecting a dead pregnant women to 'life-support' measures to keep a fetus alive, where the deceased has not made a will to that effect, and against the wishes of the family, could result in a criminal charge of violating a corpse.
Author A. NienaberSource: South African Journal of Bioethics and Law 7, pp 47 –50 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.330More Less
Advances made by medical science are able to extend human life, sometimes by highly technical means such as life-support systems. Often these procedures prove life-saving, and the patient recovers fully; at other times, however, life-extending treatment is futile, such as when the patient is declared brain dead. Advances in reproductive technologies, similarly, have been able bring hope by treating and curing infertility. This article responds to an article by Professor McQuoid-Mason entitled 'Terminating the pregnancy of a brain-dead mother: Does a fetus have a right to life?' He examines the law in South Africa and the legal implications of the Munoz case, which concerned an application for a court order to have a brain-dead pregnant woman removed from a ventilator. Departing from Prof. McQuoid-Mason's discussion, this article highlights a few of the ethical and legal implications of new technologies that enable pregnancy to be extended beyond the pregnant woman's life. This article questions the ethical and legal appropriateness of the use of new technologies, especially in situations where such use is contrary to the pregnant woman's express wishes. In this context, the article deliberates on whether the dead may be considered to be the bearers of rights that must be respected.
Article 6 of the UNESCO Universal Declaration of Bioethics and Human Rights : a moral force in South AfricaAuthor R. RheederSource: South African Journal of Bioethics and Law 7, pp 51 –54 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.310More Less
The United Nations Educational, Scientific and Cultural Organization (UNESCO)'s Universal Declaration on Bioethics and Human Rights (UDBHR) was accepted unanimously in 2005 by the world community, consisting of 191 member nations. This means that the declaration is currently the first and only bioethical text to which the entire world, including South Africa (SA), has committed itself. Despite this, little or no attention is paid to this declaration in SA. According to UNESCO, the declaration should be brought to the attention of the community because knowledge will promote more effective application of its principles. In an attempt to answer the call of UNESCO, article 6 of the declaration is discussed briefly in this article. It is clear that the principle outlined in article 6, as a human right, comprises two important components, namely giving information and giving consent. These two ethical values must always be applied during medical intervention and research. Where these principles are applied, human autonomy is confirmed and human dignity is expressed. Although the UDBHR is not judicially enforceable in SA, its universal nature offers a clear moral force in the bioethical debate in SA.
Author A.A. Van NiekerkSource: South African Journal of Bioethics and Law 7, pp 55 –58 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.320More Less
The term 'covert research' refers to research on human subjects for which informed consent is not, and allegedly cannot, be solicited - not because of wilful negligence or the deliberate transgression of research ethics guidelines on the part of the researcher(s), but because the revelation of the nature of the research to the involved research participants would necessarily invalidate the research results. While covert research is deemed necessary in a number of sciences, such as ethnography, such research nevertheless elicits major ethical concern due to the fact that it seemingly violates the values of respect for autonomy and the protection of research subjects - values that have, since the first formulations of the Nuremberg Code, the Belmont Declaration and the series of Helsinki accords, become almost axiomatic in our understanding of the basic tenets of responsible and ethical research on human subjects. In this article, I contend that while subject autonomy is a pivotal value in morally legitimate research generally, there is more to morally legitimate research than informed consent. I conclude by formulating a few guidelines for the identification of circumstances under which covert research might and might not be morally in order.
Enhancing capacity of research ethics review committees in developing countries : the Kenyan exampleSource: South African Journal of Bioethics and Law 7, pp 59 –63 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.308More Less
Background. The increased number of clinical trials taking place in developing countries and the complexity of trial protocols mandate that local ethics review committees (ERCs) reviewing them have the capacity to ensure that they are conducted to the highest ethical standards.
Methods. The Kenya AIDS Vaccine Initiative (KAVI) Institute of Clinical Research (ICR) (KAVI-ICR) and the Kenyan National Council for Science and Technology (NCST) embarked on an exercise to enhance the capacity of ERCs in Kenya to review such protocols. This process involved conducting an audit of all ERCs in the country, and performing training needs assessments to identify knowledge and capacity gaps. Information obtained was used to develop training materials for ERC members at workshops conducted in different parts of the country.
Results. Five accredited and 13 non-accredited ERCs were identified. Four of the accredited ERCs were located in the capital city of Kenya, Nairobi. The most common challenges cited by participants during the needs assessments were excess workload, and a lack of co-ordination and/or communication between the ERCs. Subsequently, 140 ERC members from 17 institutions across the country were trained as follows: 36 from institutions in the western part of Kenya, 38 from institutions in the south-eastern coastal region, 38 from the eastern region and 44 from Nairobi.
Conclusion. The KAVI-ICR and the NCST have developed training modules for training ERC members in Kenya and are in the process of developing a manual to train members. The Kenyan experience may be used to enhance the capacity of ERCs in the East African region.
An analysis of the validity of medical legal documentation in cases where the patient refuses treatment and/or transportSource: South African Journal of Bioethics and Law 7, pp 64 –68 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.311More Less
Objectives. We investigated whether patient record forms (PRFs), as currently completed, meet minimum legal standards and provide medico-legal protection to prehospital healthcare providers, and if their qualification levels influence the level of detail recorded in the patient records.
Methods. We retrospectively reviewed consecutive case reports at a single centre over a 1-month period for cases in which ambulance crews attended a patient and the patient later refused to accept transportation to a medical facility. Scores were calculated for each case report, based on the number of data fields completed. The scores were compared for variation between qualifications.
Results. A total of 5 873 ambulance cases were dispatched during this period. Case reports for refusal of transport (n=229) were reviewed. No case report achieved 100% compliance with legal requirements. There was no statistically significant variation between levels of qualification with regard to improved detail being recorded. Young adults were the most likely to refuse transport. Most of the refusals occurred in the late evening.
Conclusion. Refusal of transport and its documentation are poorly understood and practised by prehospital healthcare providers. The implication is that some patients' rights could potentially be infringed. This could lead to possible grounds for litigation, for which the defence would also hinge on the adequacy of the documentation.
Source: South African Journal of Bioethics and Law 7, pp 69 –73 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.319More Less
This article examines the question of whether private obstetric care in South Africa (SA) can be saved in view of the escalation in medical and legal costs brought about by a dramatic increase in medical negligence litigation. This question is assessed with reference to applicable medical and legal approaches. The crux of the matter is essentially a question of affordability. From a medical perspective, it seems that the English system (as articulated by the Royal College of Obstetricians and Gynaecologists) as well as American perspectives may be well suited to the SA situation. Legal approaches are assessed in the context of the applicable medico-legal framework in SA, the present nature of damages and compensation with reference to obstetric negligence liability, as well as alternative options (no-fault and capping of damages) to the present system based on fault. It is argued, depending on constitutional considerations, that a system of damages caps for non-economic damages seems to be the most appropriate and legally less invasive system in conjunction with the establishment of a state excess insurance fund.
The battle against stem cell hype : are we doing enough? Can the medical and scientific community do more to support regulatory boards in advocating ethical evidence-based medicine? : opinionAuthor R.J. BurmanSource: South African Journal of Bioethics and Law 7, pp 74 –75 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.318More Less
This article highlights the current controversies around stem cell research and its application in clinical medicine. It aims to discuss the ethical concerns around how corporate involvement is corrupting the ethical progression in this field of research. The author appeals to medical and scientific communities to take cognisance of current practices and to facilitate the regulation of new stem cell therapies being advertised to the public.
Author M.A. SatharSource: South African Journal of Bioethics and Law 7, pp 76 –77 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.356More Less
Justice, sovereignty and self-determination for all human beings are fundamental foundations for healthcare and human rights. In any civilised society, the balance between medical ethics and human rights is critical for the delivery of healthcare. War is a deeply ethical issue. Combatants, whose violations of international conventions, laws and codes of ethics during war and political conflict are detrimental to civilian non-combatants, including healthcare workers, commit crimes against humanity. The war in Gaza is a humanitarian crisis.
The ethics of claiming a 60% reduction in HIV acquisition from voluntary medical male circumcision : letterAuthor Peter S. MillardSource: South African Journal of Bioethics and Law 7 (2014)More Less
To the Editor: Dr Masukume recommends that we avoid using the relative risk reduction (RRR) statistic in counselling men on the benefits of voluntary medical male circumcision (VMMC). He makes the following important points that epidemiologists frequently emphasise: RRR is a measure of association that is difficult for patients to understand and a different statistic, i.e. number needed to treat (NNT) (or in this case, number needed to prevent HIV infection), is often a preferable statistic to use when counselling patients about any medical intervention.
Source: South African Journal of Bioethics and Law 7 (2014)More Less
To the Editor: We are responding to the article 'Ethical issues in public health promotion', which misrepresents health promotion. Debate about health promotion ethics is important, as some practices may be coercive, e.g. using financial incentives to change behaviour. However, the article does not sufficiently address the balance between individual and collective rights, nor does it differentiate between evidence- and profit-driven communications. These two points are essential for any exploration of health promotion.
Author N.P. MoyakheSource: South African Journal of Bioethics and Law 7, pp 80 –83 (2014) http://dx.doi.org/http://dx.doi.org/107196/SAJBL.355More Less
Our national Minister of Health, Dr Aaron Motsoaledi, described publicly the challenges facing our healthcare system and discussed the national and provincial measures that are being implemented to allow all South Africans to obtain quality healthcare. One would then certainly argue that the issue of quality healthcare has been debated to its ultimate exhaustion, but at what point do we begin to be silent about pertinent issues, especially those affecting the livelihood of a whole nation? This paper addresses many of the issues highlighted above; it attempts to define what quality healthcare is, in the South African context, and its relationship to the branch of bioethics. It cites current views on ethics and rights in healthcare and the role of individuals and healthcare professionals in improving the provision of healthcare in our country.
Source: South African Journal of Bioethics and Law 7 (2014)More Less
This book provides an excellent systematic account of global health law by: defining the field of global health law within the broader currents of global governance for health; systematically describing and analysing the major sources of law together with their institutional frameworks; and developing critical themes to guide global health in this century. Gostin sets the backdrop to this by starting off with personal stories from the daily lives of young people living in poverty. The book is then divided into four parts.