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- Volume 8, Issue 2, 2015
South African Journal of Bioethics and Law - Volume 8, Issue 2, 2015
Volume 8, Issue 2, 2015
Source: South African Journal of Bioethics and Law 8, pp 2 –3 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.448More Less
The recent case of Stransham-Ford v. Minister of Justice and Correctional Services and Others, brought to the fore intense discussion, debate and reflection on end-of-life issues. While much has been said, and rightfully so, of the patient's right to dignity and the entwining of this right with the right to autonomy as entrenched in the Constitution of South Africa with regard to physician-assisted dying, other core matters like the need for advocating for quality palliative care and the importance of taking the social context in the country into account require equal consideration too, if we are to have an evenly balanced debate.
The 2015 Sexual Offences Amendment Act : laudable amendments in line with the Teddy Bear clinic caseAuthor P. MaherySource: South African Journal of Bioethics and Law 8, pp 4 –6 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.375More Less
Two years ago the Constitutional Court invalidated provisions in the Sexual Offences Act which outlawed sexual conduct between adolescents. Parliament was ordered to fix the relevant provisions and to decriminalise consensual sexual activity between adolescents. In July 2015 the Amendment Act came into operation with the aim of revising the current Sexual Offences Act in line with the Constitutional Court judgment. This article evaluates some of the changes contained in the Amendment Act to determine its alignment with the ruling of the Constitutional Court. It also considers how the changes will impact the reporting obligations of health providers.
Author V.F. StockSource: South African Journal of Bioethics and Law 8, pp 7 –10 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.438More Less
Regardless of which bioethical theory one consults - be it, for example, utilitarianism, which states that one must do the most good for the greatest number of people, 'An action is morally right if the consequences of that action are on balance more positive than negative for the greatest number'; or perhaps deontology, which is duty theory 'there are certain actions which we have a duty to perform or to refrain fromperforming' - one will likely come to the conclusion that universal healthcare is an ideal which, if at all possible, should be achieved by mankind. It is a question of human rights, and respect for one's fellow man, or perhaps, more fundamentally treating those around us with the care we would expect for ourselves, or family members. In this article, I shall attempt to unravel universal healthcare as an ideal. To bring it down to fundamentals and perhaps make suggestions towards how such an ideal may be realised. I will look at relevant healthcare systems, which have been implemented overseas, and compare them with what government hopes to implement in South Africa (SA) - a National Health Insurance. Most importantly, I will analyse universal healthcare in the context of SA, and establish whether this ideal is attainable. Universal healthcare is the gem of healthcare in the 21st century. It is what all healthcare professionals would love to achieve within their lifetimes, but to achieve a goal as immense as this, one needs to build from the foundations upwards. As such, I shall discuss and suggest ways in which healthcare students can contribute to this ultimate ideal.
Source: South African Journal of Bioethics and Law 8, pp 11 –16 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.433More Less
Background. Achieving the highest standards of ethics in military health research is a challenging but crucial undertaking. The military environment is complex and African military health professionals struggle to maintain a balance between ethics and military ethos. The objective of this paper is to explore research ethics guidelines by reviewing 10 examples for their application to the military context, and describe the need for guidance in military research ethics in sub-Saharan Africa.
Method. To achieve this, five prominent international research ethics guidelines and five African guidelines were selected. Thereafter, designed topics were used in analysing them for their strengths and weaknesses in providing protection for military research participants.
Results. Out of the five international guidelines reviewed, only the Council for International Organization of Medical Sciences (CIOMS) mentions the 'armed forces'. Similarly, the only African national guideline that specifically mentions the 'armed forces' is the Ugandan national guideline.
Conclusions. We concluded that national and international guidelines for human subject research may be too general and not suitable for research with military populations. There is a need for additional guidance in research ethics for military health research in sub-Saharan Africa.
Author L. HattinghSource: South African Journal of Bioethics and Law 8, pp 17 –20 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.431More Less
Managed healthcare in South Africa is faced with complex moral challenges, where different stakeholders appeal to different ethics principles to guide decision-making. The traditional bio-medical ethics principles of beneficence, non-maleficence and respect for autonomy are typically emphasised in clinical practice, while third-party funders appeal to the principle of justice to guide the allocation of limited, pooled resources. Healthcare professionals working in managed care are particularly exposed to these conflicts, vis-à-vis incongruence between the ethics guidelines from their professional bodies and the legislation pertaining to managed care. Common understanding of the claims and responsibilities of each of the stakeholders may promote a more coherent, sustainable healthcare system.
The mandatory reporting of consensual, underage sex : knowledge, practices and perspectives of social workers in KwaZulu-Natal : researchSource: South African Journal of Bioethics and Law 8, pp 21 –25 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.435More Less
Until recently, any sex or sexual activity with a person under the age of 16 was criminalised, regardless of consent. All such incidents were considered criminal offences and needed to be reported to the police. This paper explores the knowledge, practices and perspectives of seventeen social workers in KwaZulu-Natal in relation to their mandatory reporting responsibilities on consensual underage sex. All social workers were clear about their reporting responsibilities regarding child abuse and non-consensual underage sex. However, findings suggest that social workers were less clear on the exact circumstances in which they ought to report consensual underage sex. Most participants indicated that they would make individual assessments about when to report underage consensual sex and sexual activity. Such decisions would be influenced by structural factors, the personal circumstances of affected children and the availability of other interventions to address early sexual activity. This study has shown that social workers are struggling to comply with mandatory reporting responsibilities involving underage consensual sex. Most social workers approach reporting of consensual sex and sexual activity differently to other reporting responsibilities and use a case-by-case approach. Given these findings, it is argued that parliament should consider reforming mandatory reporting provisions so that there is a distinction between the obligation to report consensual and non-consensual sexual offences against children. The mandatory obligation to report non-consensual sexual offences against children should remain but the obligation to report consensual sex or sexual activity should be discretionary and depend on the facts of each case.
Source: South African Journal of Bioethics and Law 8, pp 26 –29 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.437More Less
The purpose of this article is to explore the concept and scope of public health and to argue that particularly in low-income contexts, where social injustice and poverty often impact significantly on the overall health of the population, the link between public health and social justice should be a very firm one. Furthermore, social justice in these contexts must be understood as not simply a matter for local communities and nation-states, but in so far as public health is concerned, as a matter of global concern and responsibility. The interpretation of the scope of public health by any particular nation is I believe contingent on the current socio-political context and the conception of social or distributive justice that underpins this context. Furthermore I will argue here that the link between public health and social justice ought to be founded on a conception of social justice that adequately addresses issues of social injustice, and patterns of systematic disadvantage, that contribute to ill health and that so commonly prevail in many low- and middle-income social contexts.
Source: South African Journal of Bioethics and Law 8, pp 30 –33 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.436More Less
This article proposes that, in line with moral-cosmopolitan theorists, affluent nations have an obligation, founded in justice and not merely altruism or beneficence, to share the responsibility of the burden of public health implementation in low-income contexts. The current Ebola epidemic highlights the fact that countries with under-developed health systems and limited resources cannot cope with a significant and sudden health threat. The link between burden of disease, adverse factors in the social environment and poverty is well established and confirmed by the 2008 World Health Organization (WHO)'s Social Determinants of Health Commission report. Well-resourced nations generally consider that they have some humanitarian obligation to assist where possible, but this obligation is limited. The following questions are considered: Is reliance on the principle of beneficence to address the global disparities in the social determinants of health and life expectancy at birth good enough? Do well-resourced nations have some obligation from justice, which is stronger than from beneficence, and which cannot be as easily cast aside or diminished, to address these issues? In a globalised world, shaped by centuries of historical injustice and where first-world economies are now so intertwined and reliant on third-world labour, beneficence is not a strong enough principle on which to base an obligation to achieve the WHO vision of 'health equity through action on the social determinants of health'.
Stransham-Ford v. Minister of Justice and Correctional Services and Others : can active voluntary euthanasia and doctor-assisted suicide be legally justified and are they consistent with the biomedical ethical principles? Some suggested guidelines for doctors to consider : researchAuthor D.J. McQuoid-MasonSource: South African Journal of Bioethics and Law 8, pp 34 –40 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.446More Less
The recent case of Stransham-Ford v. Minister of Justice and Correctional Services and Others held that voluntary active euthanasia and doctor-assisted suicide may be legally justified in certain circumstances. The court observed that the distinction between 'active' and 'passive' voluntary euthanasia is not legally tenable as, in both instances, the doctors concerned have the 'actual' or 'eventual' intention to terminate the patient's life and have caused or hastened the patient's death. It is argued that as the South African Constitution is the supreme law of the country, the fundamental rights of patients guaranteed in the Constitution cannot be undermined by ethical duties imposed on healthcare practitioners by international and national professional bodies. The court in the Stransham-Ford case did not use ethical theories and principles to decide the matter. It simply applied the values in the Constitution and the provisions of the Bill of Rights. However, in order to assist medical practitioners with practical guidelines with which many of them are familiar - rather than complicated unfamiliar philosophical arguments - the biomedical ethical principles of patient autonomy, beneficence, non-maleficence and justice or fairness are applied to active voluntary euthanasia and doctor-assisted suicide in the context of the Stransham-Ford case. Although the case has not set a precedent or opened the floodgates to doctor-assisted voluntary active euthanasia and it is open to Parliament, the Constitutional Court or other courts to develop the concept or outlaw it, some guidelines are offered for doctors to consider should they be authorised by a court to assist with voluntary active euthanasia.
Author R. RheederSource: South African Journal of Bioethics and Law 8, pp 41 –43 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.441More Less
In 2005, the world community and the United Nations Educational, Scientific and Cultural Organization (UNESCO), comprising 191 member nations, unanimously accepted the Universal Declaration on Bioethics and Human Rights (UDBHR). This declaration is the first and only bioethical text to which the entire world has committed itself and helps put bioethics on the agenda of states. However, it appears to have had little or no impact in South Africa (SA). This article aims to join UNESCO's mission and to form part of the social responsibility initiative of teaching the universal right and the ethical principle of proxy consent in the context of medical intervention to promote the UDBHR in SA. We compare the UDBHR and SA Children's Act No. 38 of 2005. It is clear that the world community sees surrogate consent as the right and duty of all communities.
Source: South African Journal of Bioethics and Law 8, pp 44 –47 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.444More Less
Modern medicine makes it possible to transplant not only kidneys but any solid organs from one human body to another. Although it is the ideal to harvest organs from a brain-dead person, a kidney or a part of the liver or lung can be transplanted from a living donor to a patient. The majority of countries where organ transplants are performed have a dire need for transplantable organs as the current systems of organ procurement are not obtaining a sufficient amount of transplantable organs. Today's cruel reality is that many patients are dying while waiting for a transplant. Few nations are able to meet the organ demand through their domestic transplant systems and there is a constant debate about ethical ways of procuring organs for transplantation purposes. This article will scrutinise the Israeli system of organ procurement and it will be compared with the current system of organ donation in South Africa (SA) in order to indicate whether SA could possibly, or should, follow the example of Israel to improve its acute donor organ shortage.
Source: South African Journal of Bioethics and Law 8, pp 48 –49 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.434More Less
In December 2013, a 52-year-old-man who is a practising Jehovah's Witness was admitted to Chris Hani Baragwanath Hospital (CHBAH), Soweto, Johannesburg. This, the third largest hospital in the world, provides medical services to more than one million local residents. It has the busiest internal medicine unit in South Africa (SA) with 833 beds and a staff comprised of 133 doctors.
Nanotechnology in medicine and healthcare : possibilities, progress and problems : education and trainingAuthor J. GardnerSource: South African Journal of Bioethics and Law 8, pp 50 –53 (2015) http://dx.doi.org/http://dx.doi.org/10.7196/SAJBL.432More Less
Nanotechnology or nanoscience covers the investigation, design, manipulation, precision placement, measurement, modelling or fabrication of matter, structures, devices and systems that exist at the nanoscale - essentially at the atomic and molecular size levels. Nanotechnology has the potential to change the way we address some of the world's most critical development problems. In 2005, the United Nations (UN) Millennium Project's Taskforce on Science, Technology and Innovation concluded that nanotechnology can contribute to the attainment of the Millennium Development Goals (MDGs), specifically, the goals to reduce child mortality, improve maternal mortality and combat HIV/AIDS, malaria and other diseases. Health, specifically improved primary healthcare, is one of six focus areas highlighted in South Africa's National Nanotechnology Strategy (NNS), where nanotechnology can offer the most significant benefits for the country. Nanotechnology can revolutionise the practice of medicine and the delivery and accessibility of healthcare. However, despite the significant benefits of nanotechnology, there are problems that could prevent it from being widely accepted. The qualities that make nanotechnology so appealing are also those that give rise for concern. In particular, there are uncertainties about its potential impact on human health, the environment and societies in general, along with the concern that nanotechnology, much like genetic engineering or modification, is 'messing' with the building blocks of nature and is therefore, 'unnatural' even unethical. This article considers these concerns and concludes that there is nothing intrinsically good or bad about nanotechnology, but that its acceptability will depend largely on how it is used and introduced into society.
Source: South African Journal of Bioethics and Law 8 (2015)More Less
The Steve Biko Centre for Bioethics, at the University of the Witwatersrand in Johannesburg, will be offering a Masters course in bioethics and health law next year.The aim of the course is to train bioethics and medical law experts who will display skill and proficiency in the fields of bioethics and health law. The course aims to develop capacity and excellence in the ethical and legal analysis of issues arising in healthcare and research. Graduates will be able to apply their knowledge to the evaluation and management of bioethical and medico-legal problems and to propose solutions that are ethically acceptable and within the constraints of the law.
Persons, Parts and Property. How Should We Regulate Human Tissue in the 21st Century?, Imogen Goold, Kate Greasly, Jonathan Herring and Loane Skene : book reviewSource: South African Journal of Bioethics and Law 8 (2015)More Less
With rapid strides made in scientific and technological advances, it is inevitable that questions as to whether human body parts possess property rights have surfaced, especially over the past four decades. This debate has been the subject matter of not only the courts (in particular, the Anglo-Australian courts), but also of academic literature, with interalia, legal academics, philosophers, ethicists, and sociologists contributing to the differing opinions on the issue. While court decisions and statutory regulation in some jurisdictions have resulted in some acceptance of limited property rights in some kinds of tissue, this has remained an extremely disputed subject on all sides of the body-ownership argument.