ETD Collection
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Item The sustainable development goals as a vehicle for achieving global health objectives: an ethical critique(2019) Muiruri, Esther MurugiThis is an ethical critique of the Sustainable Development Goals (SDGs); and specifically, their potential for achieving healthy lives and well-being for all human beings. Drawing from globalization as the context in which various interactions take place across the globe between persons, corporations, institutions, and states, an argument is made that the dominant narratives of globalization have focused on its macro environmental impact, but have under-explored globalization’s effects on individual health and well-being. The case is made that the negative effects of globalization which individuals experience emanate from exclusion, powerlessness, and physiological risks to health. A further claim is made that Agenda 2030 and the SDGs represent a global consensus that seeks to focus on individual health and well-being. Using a broader conception of health and well-being that is grounded in diverse philosophical approaches, a link between the determinants of health and individual health and well-being is made, with Agenda 2030 and the SDGs as a central component of this undertaking. An ethical critique of reason, motive, and intention is also carried out; justified by an argument that they are crucial to the sustainability of actions under Agenda 2030. A detailed epidemiological and ethical analysis of SDG3 is also carried out, and the links between SDG3 and other goals explored. Challenges identified by various authors as being impediments to progress towards the SDGs are analysed, and solutions proposed. A contribution to knowledge is made by proposing Herbert Simon’s related concepts of satisficing and bounded rationality as being relevant to guiding the decisions that states will make towards progress in Agenda 2030. The conclusion is reached that while the SDGs are unlikely to be achieved by 2030, they are congruent with several philosophical approaches and represent a robust impetus for action to improve health and well-being for all.Item Ethical issues associated with using human biological material in collaborative research with developed countries: a case study(2011) Sathar, Mahomed AslamAlthough Human Biological Materials (HBMs) are invaluable resources in biomedical research, they have not been without controversy in collaborative research between developed and developing countries. The normative arm of the study compared the key ethical issues in the laws, regulations and guideline documents of developed and developing countries with regard to the use, collection, storage, export and benefit-sharing of HBMs in collaborative research with developed countries. The empirical arm of the study examined how investigators and a Research Ethics Committee (REC) at a South African institution addressed these ethical issues, implemented national and international frameworks with regard to the use of HBMs. The majority of sponsors (59.6%, 90/151) in the study were from the USA compared to other developed countries (p=0.0001) with the bulk (65.84%) of the funds (R517.19 million) allocated for HIV research. HBMs for storage was obtained largely from adults (80.8%, 122/151) compared to children (12.6%, 19/151) [p <0.0001]. Whilst the principle investigators (PIs) of all 151 protocols informed the REC of their intent to store HBMs, only 87.4% (132/151) of PIs informed research participants (P <0.0001). In 47.7% (72/151) and 71.5 % (57/151) of protocols research participants were informed of the location and duration of storage, respectively, compared to 86% (130/151) and 19.25% (29/151) informing the REC (p < 0.0001), respectively. In 98% (149/151) of protocols informed consent (IC) was obtained from research participants with 76.8% (116/151) of protocols soliciting broad consent compared to specific consent (21.2%, 32/151) [p < 0.0001]. In the remaining 2% (3/151) of protocols IC for storage was not obtained. In 69.5% (105/151) of protocols confidentiality was maintained by a code and in 9.35% (14/151) of protocols HBMs was anonymised [p < 0.0001]. Significantly more protocols informed the REC (90/151, 59.6%) than the research participants (67/151, 44.4%) that HBMs will be exported (p= 0.011). Separate consent forms were not available for 60.9% (92/151) of protocols as per the requirement REC’s standard operating procedures (SOP). In 74% (51/69) of protocols the rationale for export was to access specialised laboratories (74%, 51/69) that were not available locally. Export permits were not available for 73.2% (109/151) of protocols. Where export permits were available, there were more exports to the USA (31/42, 73.8%) than to Europe (26.2%, 11/42) [p < 0.0001]. In the majority of protocols research participants were not informed of benefit sharing from any discoveries (129/151, 85.4%) or commercialisation (123/151, 81.5%) of products derived from their HBMs. Material Transfer Agreements (MTAs) were not available for 94.7% (143/151) protocols. Whilst 122/151(80.8%) protocols disclosed the amount of funds available from the sponsors for the research to the REC, not a single PI made such disclosures to the research participants (p < 0.0001). The varied definitions of what constitutes HBMs, the different terminologies used to describe identifiability, confidentiality, the different models of informed consent and different standards of ownership in the various national and international frameworks are characterised by a maze of definitions, laws, regulations and guidelines that are confusing, conflicting and defy generalisation. International and national laws, regulations and guidelines are fragmented and lack harmonisation. Most developing countries are in favour of severe restrictions on the use of their HBMs in collaborative research with developed countries. The protocols in the empirical study did not adequately address the inter-related ethical issues of export, storage, IC, commercialisation and benefit sharing derived from HBMs that are currently the subject of intense debate and controversy and central to the access to HBMs in collaborative research with developed countries. Because the empirical study is limited by the use of a convenient sample, the results cannot be generalised to other RECs in South Africa. Nevertheless, the data gives some credibility to the anecdotal evidence that HBMs are leaving the country unaccounted for without export permits and MTAs in place. Given the long delays in harmonizing and publishing new regulations and changes, outdated regulations and regulatory frameworks create opportunities for the proliferation of undesirable and unethical practices. Omissions in the RSA regulatory and ethical frameworks with regard to HBMs and Tissue Biobanking are concerning and require urgent action.Item Ethical and legal considerations in the relationship between medical scheme and member(2012-01-09) Snoyman, HowardSouth African medical schemes (health insurance or medical aid) companies offer insurance to the general public in the form of a multitude of different schemes. Each scheme has its own unique range of benefits, but certain exclusions apply across the board in respect of all schemes operated by a medical aid. In this research report, I investigate the rationale and necessity, as well as some of the ethical and legal implications of numerous notable exclusions. I further make relevant recommendations with respect to their application within the legal and ethical framework of the South Africa’s Consumer Protection Act, No. 68 of 2010.Item A reflection on the morality of ownership of genetic material(2011-11-23) De Carvalho, Candice LeeThe question of ownership of genetic material is highly relevant to medical ethics at this point in our history. What has become a major debate is how DNA can, and if it ought to be commoditised; and how and if individuals can keep their genetic information private, or whether it ought to be shared with all. In this research report I question whether genetic information is exceptional when compared with other medical or health-related information. The Kantian view of commoditisation of the body and human dignity is given along with some of the most prominent views on self-ownership. Patenting and genetic biobanking have received much attention in recent years, I focus on these issues and moral questions that surround these practices. The idea of genetic information as a common and natural 'resource' is discussed. If it is indeed a common heritage for all, how ought individuals, populations, researchers and funders to relate to genetic information? I briefly examine what some communities and cultures may have to say about genetic information and I attempt to tie all these varying perspectives together. I find that it is not ownership per se that is often the subject of dispute, but how those who happen to have control over that information share it. I present a possible maxim to guide the sharing of genetic information with others; that patenting does not necessarily amount to an affront to human dignity in the Kantian sense and that inter-cultural perspectives on genetic information may differ significantly. I conclude that how genetic material is shared, or not shared and why seems to depend more on the population in question at any given time and its social, political and economic structures than on the question of ownership per se.Item An ethical reflection on the DOTS programme in South Africa: adherence, vulnerable populations, benefits, and burdens(2011-11-10) Maboko, EmmanuelThe introduction of the Directly Observed Treatment Short course (DOTS) recommended by the World Health Organization (WHO) in 1991 was developed as the ideal public health measure for the treatment and management of tuberculoisis (TB) (Naidoo, Dick & Cooper 2008:1). However, despite attempts to cure and control tuberculosis, two million new cases are reported in the sub-Saharan region of Africa. The problem of TB in South Africa is made worse by the high incidence and prevalence of HIV/AIDS. There are many contributing factors that may play a part in South Africa’s low cure rate such as unequal national drug distribution, lack of healthcare personnel, patient superstitions and myths concerning tuberculosis. I have touched upon some of these issues. But in this research report I have mainly concentrated on the South African DOTS programme and some of the ethical issues involved in the problem of patient adherence as it concerns the fair societal distribution of burdens and benefits. I have used the ethical framework for public health ethics for my analysis as proposed by Nancy Kass, and also placed a special focus on adherence problems as they concern vulnerable populations. Quality of the DOTS programme in South Africa such as staff attitudes towards TB patients and poor communication skills, nursing care, broken equipment, dirty facilities, absenteeism may contribute towards non-adherence. Moreover, poor quality healthcare services may encourage TB patients to seek alternative treatment other than hospital care thereby increasing their vulnerability to infection and disease progression. Cultural differences in health care and practices may be a barrier to the effective distribution of quality healthcare.Item Eating in the dark – an ethical appraisal of genetically modified foods’(2011-11-10) Early, JanetScience can define what is practicable, what can be done, but it cannot determine which developments it is right to pursue- this is largely an ethical judgment attempting to answer ‘ought we to do it’? The most sensible approach to making an ethical assessment is to try and weigh up the benefits of a novel technology against its potential to do harm. Deciding whether GM technology is acceptable in ethical terms involves a judgment about both the plausibility and moral weight of competing sets of claims, beginning with an assessment of the possible benefits and risks. Using four main guiding principles as the basis of my discussion and point of evaluation, I focus firstly on the principle of general welfare to examine the debate what would amount to an adequate safety assessment of GM foods and its possible ecological risk. The right of consumers to freedom of choice is addressed by exploring both the arguments against and for labelling. The principle of justice then questions the claims whether food security can indeed be improved by using GM technology and how patents, bioprospecting and biopiracy can be judged ethically justifiable. Finally the ethical status of the natural world is raised by attempting to answer whether modern biotechnology could be considered blasphemous and whether it is ethically permissible to breach the natural integrity of the species. Using these guiding principles do not make such as assessment straightforward as they cannot be rigidly applied in an abstract way to reflect absolutes on what is right or wrong and their operation depends on context. My approach is normative and presented in a way to stimulate dialogue as an explorative ethical travel through the genetically modified zone with the recognition that the debate remains inconclusive and controversial. Keywords: GM; Genetically Modified Foods; GM Technology; Transgenic.