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- Volume 8, Issue 1, 2015
South African Journal of Bioethics and Law - Volume 8, Issue 1, 2015
Volume 8, Issue 1, 2015
Author Ames DhaiSource: South African Journal of Bioethics and Law 8, pp 2 –3 (2015) http://dx.doi.org/10.7196/SAJBL.407More Less
A Medico Legal Summit was convened by the National Minister of Health, Dr Aaron Motsoaledi, on 9 and 10 March this year. In his keynote address (published in full on page 4), Dr Motsoaledi stated that the summit was long overdue. He expressed concerns, and rightfully so, that medico-legal litigation had reached a crisis of epic proportions in the country. It became clear as the summit unfolded over the two days that the triggers to litigation in the healthcare context are primarily two-fold: medical malpractice and/or professional negligence and patient safety reasons. While the private sector grapples largely with the former, the state sector healthcare facilities deal with a combination of both causes. This editorial discusses some of the causes and impact of increasing medical litigation, and considers possible interventions in this regard.
Author Aaron MotsoalediSource: South African Journal of Bioethics and Law 8, pp 4 –6 (2015) http://dx.doi.org/10.7196/SAJBL.409More Less
Let me welcome you heartily to this very important Summit, which needless to say, has been long overdue. There is definitely a lot of anxiety within both the medical and the legal professions on the expected outcome of this Summit, albeit for totally different and opposing reasons.
Author Gwinyai MasukumeSource: South African Journal of Bioethics and Law 8 (2015) http://dx.doi.org/10.7196/SAJBL.367More Less
To the Editor: I thank Professor Millard for his interest in my article on some ethical aspects surrounding voluntary medical male circumcision (VMMC). He presents Table 1 (study data), which has a range for the Kenyan relative risk reduction (RRR) and the number needed to prevent HIV infection (NNT) but he presents no range of values for South Africa and Uganda. In addition, he does not present the point estimate and 95% confidence intervals for the RRR and NNT. Finally, he does not show how the RRR and NNT were calculated. By him presenting Table 1 in this way, one cannot readily make like for like comparisons.
Does withdrawing treatment from a pregnant persistent vegetative state patient resulting in her death constitute a termination of pregnancy? : forumAuthor D. McQuoid-MasonSource: South African Journal of Bioethics and Law 8, pp 8 –10 (2015) http://dx.doi.org/10.7196/SAJBL.336More Less
A recent article on the Texas case of Munoz v. John Peter Smith Hospital, begs the question of whether if the pregnant woman had been in a persistent vegetative state (PVS) the courts in South Africa would have ordered the withdrawal of life-support treatment because she had expressed her wish not to be treated under such conditions in an advance directive, and that keeping her alive against her wishes would violate her constitutional rights to equality, dignity, privacy and bodily integrity. The answer seems to be yes in both instances. This applies even if the withdrawal of such support is opposed by the persons legally capable of consenting on her behalf in terms of the National Health Act. Where there is no advance directive - provided the treating clinicians conclude that any further treatment will be futile or that the benefits of further treatment are outweighed by the burdens and risks involved - life-support treatment may be withdrawn even against the wishes of persons entitled to consent on her behalf in terms of the National Health Act. Such legally competent persons may, however, apply to court to prevent the implementation of the decision of the clinicians.
Author K.P. MaheshSource: South African Journal of Bioethics and Law 8, pp 11 –18 (2015) http://dx.doi.org/10.7196/SAJBL.354More Less
Ownership with regard to human biological material (HBM) is addressed to some extent within South African law, specifically in chapter eight of the National Health Act (NHA) and its associated regulations. However, members of the legal fraternity struggle to conceptualise ownership of such materials without objectifying a person or people and risking reducing such individuals to a state of property. This then infers a reduction in human dignity by rendering one-self or parts of that same self as a commodity. The complexity of the issue raises much debate both legally as well as ethically.
Things may not be as expected : surprising findings when updating workload at the Wits Human Research Ethics Committee (Medical)Author P. Cleaton-JonesSource: South African Journal of Bioethics and Law 8, pp 14 –21 (2015) http://dx.doi.org/10.7196/SAJBL.339More Less
Objectives. To compare numbers of applications to the University of the Witwatersrand Human Research Ethics Committee (Medical) for clearance by the full committee during 2011 - 2013; to see the proportion of clinical Master's applications in 2013 and to look for the influence of eight variables in applications reviewed from January to June 2013.
Methods. A retrospective extraction of data from committee minutes (2011-2013) and application forms (January - June 2013) was done. Statistical analysis was completed using SAS for Windows (version 9.4). Variables examined were committee decision, choice of research method, supervision or not, supervisors' research degree, supervisors' publication group, university administrative entity, registered degree and month of approval after first review.
Results. Total numbers were 685 (2011), 845 (2012, a 23.4% increase from 2011) and 769 (2013, a 9.0% decrease on the previous year). In 2013, 22% of applications were for clinical Master's degrees required by the Health Professions Council of South Africa (HPCSA) for specialist registration. A number of cross-tabulations of variables are presented. Logistic regression analysis (Proc Catmod) showed that three variables significantly influenced the committee's initial review decision, namely school (p=0.03), applicants' registered degree (p=0.01) and the research method chosen (p=0.03). The month of committee approval was also significantly affected by school (p=0.002). Preferred research methodologies for supervised and independent research applications differed within and between schools.
Conclusion. A predicted continuous increase in number of applications from 2011 to 2013 did not happen for unknown reasons. Research method, school, and registered degree significantly influenced the committee's decision at the initial review of applications. For clinical Masters, and other Masters, a supervisor's degree had no effect on the committee's decision at the initial review of applications; however undergraduate and honours applicants having supervisors without a research degree had more than double the approval rate at first review than when supervisors had either a Doctorate or a Master's (p=0.008). Supervisors' possession of a research degree did not increase approval rate of applications nor did a supervisor's publication grouping.
Source: South African Journal of Bioethics and Law 8, pp 22 –25 (2015) http://dx.doi.org/10.7196/SAJBL.346More Less
Consent is required for almost all health research. In order for consent to be valid a number of requirements must be met including that the consent cannot be contra bonos mores or contrary to public policy. This principle has its roots in the common law and it is used to ensure that the consent to harm, or the risk of harm, is permitted or ought to be permitted by the legal order. Recently, it has also become a statutory requirement embedded in the consent obligations relating to non-therapeutic health research with minors. Section 71 of the National Health Act provides that the Minister of Health (or potentially his or her delegated authority) must provide consent to non-therapeutic research with minors. However, such consent may not be granted if 'the reasons for the consent to the research or experimentation are contrary to public policy'. Limited work has been done on how to determine when consent to health research with children would be contrary to public policy.This article attempts to begin the debate by describing the boni mores principle, setting out some of the general factors that could be used to assess whether consent is consistent with it and suggesting how they could be applied to health research. The article concludes by stating that simply requiring proxy consent for non-therapeutic health research with children is insufficient as it cannot always be assumed that proxy consenters will act in the best interests of the child. Thus the boni mores principle acts as a limit on autonomy in order to protect the child participant. It is further submitted that establishing when consent to health research is consistent with public policy requires an assessment of whether the research is consistent with constitutional values, prevailing legal norms regarding children, and an assessment of the legal convictions of the community.
Source: South African Journal of Bioethics and Law 8, pp 26 –29 (2015) http://dx.doi.org/10.7196/SAJBL.372More Less
Background: The professional standards expected of individuals who commit to the practice of medicine require that they possess character traits that are consistent with and reflect the core values, principles and competencies of the medical profession.
Objective: The aim was to evaluate final year Bachelor of Clinical Medical Practice (BCMP) students' experiences of professionalism during clinical rotations.
Method: Hatem's definition of professionalism was the stimulus that guided 25 final year BCMP students' reflections on their experiences of professionalism during clinical rotations. The students' responses documented as portfolio entries were distilled into quantitative core values and subjected to an ethical analysis according to the guidelines as provided by the Health Professions Council of South Africa.
Results: There was a positive association between frequency of reflections and the positive nature of the experiences of professionalism for the majority of the contextual attributes (53.8%). Negative experiences of professionalism (46.2%) were context-specific and perceived by students as denying them an opportunity to attain professionally required skills.
Conclusion: BCMP students reflected on their professional development as a process that was influenced by individuals and a competency that was determined by the extent to which the team pulled together for the benefit of the patients and the students. The study has highlighted some of the ethical dilemmas related to context.
Source: South African Journal of Bioethics and Law 8, pp 30 –34 (2015) http://dx.doi.org/10.7196/SAJBL.358More Less
Background. Seclusion in the psychiatric context is the involuntary confinement of an agitated, unstable person alone in a contained, controlled environment. Differing views on seclusion presents clinicians with an ethical dilemma. Significant morbidity and mortality have been associated with seclusion. No data exist in South Africa on rates of seclusion for psychiatric purposes. Consequently neither the need for seclusion nor alternatives to seclusion have been explored.
Objective. To determine the number of patients secluded over six months, provide a profile of patients that were secluded, and to ascertain the reasons for seclusion.
Methods. A retrospective record review of patients secluded at Sterkfontein Hospital, over a six-month period.Results. A total of 112 patients were secluded over the six-month period. Users were secluded for a total of 59 415.5 hours and on 4 814 separate occasions. A total of 84.8% of the users secluded were male. The mean age of users secluded was 29 years. Just under half the users (49.1%) were secluded for their own safety and 40% of users were secluded for aggression (either physical or verbal). The most common diagnosis was schizophrenia (31.4%) followed by cognitive impairment (20.6%) and bipolar mood disorder (13.7%). The most commonly used medication was sodium valproate (17%), followed by haloperidol (11%) and risperidone (11%).
Conclusion. Younger male patients with psychosis were most likely to be secluded. More research should be conducted locally to compare seclusion rates and patient profiles so that we may improve seclusion practices.
Author C.S. WarehamSource: South African Journal of Bioethics and Law 8, pp 37 –39 (2015) http://dx.doi.org/10.7196/SAJBL.374More Less
In South Africa and abroad the elderly are systematically discriminated against at all levels of healthcare allocation decision-making. Such discrimination is perhaps surprising in light of the National Health Act and the Older Persons Act, which explicitly recognise the elderly as a vulnerable group whose equal rights require special protection. However, ethical theory and public opinion offer some reasons to think that discrimination against the elderly may be justified. This paper examines possible ethical grounds for age discrimination. I claim that there are very few cases in which the aged may be discriminated against, and that age alone is never sufficient grounds for discrimination.