South African Journal of Bioethics and Law

Publisher:: Sabinet African Journals
Publication date:: 2021-07-20

ISBN:: 1999-7639

Description:

The South African Journal of Bioethics and Law is a bi-annual journal for health professionals dealing with bioethics, law, human rights and related topics.

Issue Number

No. 17-1, April 2024

Latest documents

Clarifying the legal requirement for cross-border sharing of health data in POPIA: Recommendations on the draft Code of Conduct for Research
The draft Code of Conduct for Research is an important initiative towards assisting the scientific community in complying with the provisions of the Protection of Personal Information Act 4 of 2013 (POPIA). However, its approach towards cross-border data sharing should be reconsidered to clarify the ambiguities inherent in the legal requirements for the cross-border sharing of health data in the POPIA. These ambiguities include the concept of ‘transfer of information’, the application of adequacy as a legal mechanism for transfer, the nature of consent for cross-border sharing and the scope of the recipient third party. We suggest that the draft Code of Conduct for Research can be improved by:rnrnrnExplaining or defining the concept of ‘transfer of information’ and when it applies to cross-border sharing in researchrnrnClarifying the application of adequacy as a legal mechanism for transfer vis-
Healthcare and genocide: BDS as an entry point to health justice
To the Editor: On 26 January 2024, the International Court of Justice (ICJ) found that there was a prima facie case for genocide by Israel in Gaza. Provisional measures were issued for Israel to ensure that its military does not commit and takes all measures within its power to prevent acts of genocide, as defined in the Convention on the Prevention and Punishment of the Crime of Genocide.[1] The Israeli government has denied accusations of genocide, claiming that it has the right to self-defence. South Africa’s (SA) case included numerous detailed reports of attacks on healthcare workers and hospitals. Such attacks have also occurred prior to the events of 7 October 2023.[2,3] The crippling of Gaza’s healthcare system has left it unable to cope with the sheer number of injured patients. This, along with the worsening man-made public health catastrophe which has paved the way for malnutrition and wide-spread infection, should be of particular concern to those in the healthcare sector.
Navigating ethical challenges of integrating genomic medicine into clinical practice: Maximising beneficence in precision oncology
The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research Council’s Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits.
Organ donation after circulatory death – legal in South Africa and in alignment with Chapter 8 of the National Health Act and Regulations relating to organ and tissue donation
Organ donation after a circulatory determination of death is possible in selected patients where consent is given to support donation and the patient has been legally declared dead by two doctors. The National Health Act (61 of 2003) and regulations provide strict controls for the certification of death and the donation of organs and tissues after death. Although the National Health Act expressly recognises that brain death is death, it does not prescribe the medical standards of testing for the determination of brain death (neurological determination of death), circulatory death (circulatory determination of death) or for determination of death based on somatic criteria. However, in all cases of organ donation, including after circulatory death, the National Health Act mandates that two doctors certify the death, with one doctor possessing more than 5 years of experience. Additionally, both doctors must be independent from the transplant team. The standard for such determination, as for brain death, aligns with accepted medical standards. The Critical Care Society of Southern Africa has published South African (SA) Guidelines on Death Determination that outline rigorous standards for death determination in hospital settings by either a neurological or circulatory method. Legislation and the Health Professions Council of SA’s (HPCSA) professional guidance direct clinicians on obtaining informed consent for donation either from the patient or in cases of incapacity from their surrogate decision maker. Collectively, the legislation, regulations and professional guidelines in SA provide a robust ethical framework that supports organ donation after circulatory death.
Israel’s systematic weaponisation of health in Gaza
The Israeli army has been relentless in its targeting of healthcare workers and infrastructure in Gaza. This strategy is not new for the Zionist state, and the use of health as a weapon against the occupied Palestinian population has been previously documented over the years.[1-4] While this is not a novel concept in modern day warfare, the scale at which it is being used to strangulate a population is unprecedented. Deliberate targeting of health infrastructure, manufactured scarcity of medical supplies and availability of fuel, and restricted access to basic necessities are all tactics employed to destroy healthcare as a weapon of war. Through these actions, Israel aims to amplify the scale of civilian losses in the Gaza strip and force survivors into exodus.
Examining the Mr Tsafendas enquiry trial: Current insights on forensic psychiatric assessment and ethics
On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis of schizophrenia; Consideration of cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis.
Scientific racism: Histories, legacies and ethics Steve Biko Bioethics Lecture, 12 September 2023
In 1936, Raymond Dart led the Wits University Expedition to the Kalahari where he used the tools of physical anthropology, including bodily measurements, face masks and comparative anatomy, to promote the ill-fated concept of race typology to understand human evolution. Dart’s successor at the Wits School of Anatomical Sciences, Phillip Tobias, and his colleagues continued these anthropological practices in numerous expeditions to the Kalahari and elsewhere in the 1950s, 60s and 70s, including an excavation of the grave of Cornelius Kok II in Campbell, Northern Cape in 1961. This paper reviews these practices and their contribution to scientific racism in South Africa. The paper also explores the impact that Steve Biko’s life and death had on medical ethics at Wits University in the 1970s, leading to Wits Medical School’s submission to the Truth and Reconciliation Commission and the decision to hold an Internal Reconciliation Commission (IRC). While the IRC was important, the absence of any review of pre-apartheid and apartheid-era anthropological practices at the Wits School of Anatomical Sciences meant that it was incomplete. This paper concludes by suggesting that there is a need to acknowledge and revisit this painful history of scientific racism to build a greater understanding of history, transparency and ethics for the future.
Futility, communicating bad news and burnout in doctors and other health practitioners
Futile medical interventions have virtually no chance of success. Doctors might perform such procedures because of pressure from families or patients. The doctor might also have an ulterior motive of gain or prefer to do it rather than take time to communicate with the patient about a poor prognosis. Established ways to communicate bad news to patients are not always used by managing physicians with time constraints. The SPIKES protocol method is outlined to assist in sensitive communication where further intervention is futile.rnThis review primarily explores various aspects of medical futility. It also explores strategies for effectively communicating with patients and their families regarding futility interventions. A side-effect of futile interventions is burnout in doctors and other health practitioners (HPs). The complex relationship between futility and burnout is described.
The noble cause of medicine – fact or fallacy?
The aim of the article is threefold: to argue and motivate that unnecessary surgery is a worldwide phenomenon, that it exposes patients to unwarranted risks and that patients should actively participate in decision-making and take a shared responsibility to protect their interests. There is a firm belief that the enterprise of medicine is something of value – both intrinsically because being healthy is good and instrumentally since being healthy allows us to do what we wish to, to attain happiness and to live valuable lives. However, this can only hold if treatment is justified in terms of accepted evidence-based criteria. Imperative for all forms of treatment, including costly and invasive investigations, this is particularly true for surgical interventions because no surgery is without risk. Surgery performed outside of the norms of accepted indications constitutes a grave form of assault. Medicine is a noble cause if we stick to the rules and help each other to do so. As professionals, our most fundamental regulation is by ourselves.
International humanitarian laws: Applicable to all or a privilege for some?
There is an intrinsic connection between genocide and colonialism where both concepts are in close proximity and are based on the logic of elimination. The fact that an active genocide of the Palestinian people continues in 2024 is extremely disturbing. A plethora of human rights laws and principles complement and reinforce the protections afforded under international humanitarian law. These laws were developed in order to prevent historical atrocities from repeating themselves. As history is re-written, it is submitted that these laws, while good on paper, are not being put into practice in the case of Palestine. This article reflects on the application of specific international humanitarian laws, namely protecting healthcare, preserving nutrition and safeguarding children during times of conflict, and analyses how these protections are being flouted in the case of Gaza.