An ethical and legal commentary on access to renal dialysis programmes in public hospitals in South Africa: reflections on Thiagraj Soobramoney versus the Minister of Health (Kwa-Zulu Natal) 1997
Date
2010-08-26
Authors
Billa, Manyangane Raymond
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Abstract
The current exclusion criteria for accessing renal dialysis in South African
public hospitals places great emphasis on the allocation of scarce
resources. The case of Soobramoney at the Constitutional Court
highlighted the ethical and legal implications of providing this scarce
resource. Mr. Soobramoney was denied access to renal dialysis on the
basis of scarce resources and he did not qualify for care due to not meeting
the criteria set for renal care.
The Soobramoney case was considered mainly on the basis of scarce
allocation of resources and offering treatment on an emergency basis. It
was argued by the appellant that the state had an obligation to provide him
with the treatment in terms of s 27(3) read with s 11 of the Constitution
(para 14). This report takes a different slant and looks at the quality of life
argument for increasing access to renal dialysis for those denied it based
on current South African protocols.
In exploring this concept one would venture to offer a definition of ‘quality of
life’ according to Brown as an overall sense of well-being. This includes an
individual’s satisfaction with their own lives (Brown, 2007: 72). A health
related quality of life extends the definition to include the way a person’s
v
health affects their ability to carry out normal social and physical activities
(ibid).
A case is made for increasing access by developing programmes to cater
for those in need of enhancing their quality of life. This is what is being
motivated for in cases similar to Soobramoney, especially those with comorbid
disease. The quality of life argument is based on the fact that there
are indications in literature that patients with end-stage renal disease rate
their own quality of life to be as important as the quality of life of the general
population.
Furthermore, there is no indication that the elderly live more miserable lives
when they are on dialysis. The idea of respect for persons is highlighted -
respect for the autonomous choices patients make concerning how they
live their lives and including respect for them towards the end of their lives.
Finally, I reflect on some legal issues concerned with the Soobramoney
versus the Minister of Health Kwa-Zulu Natal 1997.
Description
MSc(Med), Bioethics and Health Law, Faculty of Health Sciences, University of the Witwatersrand
Keywords
kidney dialysis, access, renal dialysis, medical futility