3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
12 results
Search Results
Item Perceptions of participants and community members about research on gender-based violence(2014-02-11) Sikweyiya, Yandisa MsimeleloTITLE: Perceptions of participants and community members about research on gender-based violence The goal of this thesis was to explore ethical issues in conducting gender-based violence (GBV) research with human participants in South Africa. We study this question from the perspectives of both the researchers and the research participants. This thesis has two specific aims. First, to critically review the applicability and usefulness of the WHO 2001 guidelines in regulating community based research from the perspective of the researchers who do GBV work globally. Second, to explore peoples’ motivations for research participation, their perceptions of risks and benefits in participating in studies, the perceived psychological impact of answering sensitive questions, and adverse experiences of research participation. Three studies were conducted to meet the study aims, and were carried out using the combination of qualitative and quantitative methods and techniques. In the first study, 12 in-depth Interviews were conducted with GBV researchers from various countries and a desk review was also conducted. Study two had two components. First, 26 in-depth interviews (adult 19 women and 07 men) were conducted, and data were also collected using participant observation over a period spanning three months. Additionally, a real life incident was analysed as a case study of ethical dilemmas faced by researchers when unsolicitated incriminating disclosures by participants occur during the course of data collection. Thereafter, 22 in-depth interviews were conducted with men and women (over 18) who had recently participated in a survey on gender-based violence. In study 3, data were collected from 1085 women and 985 men (between ages 15-26) using a structured questionnaire. The results revealed no empirical evidence from published literature and from the accounts provided by researchers to support the view that GBV research is exceptionally risky when ethical guidelines are adhered to or that is has greater risks than other community based studies. From the perspective of the research participants, findings show that breach of confidentiality was viewed as a major concern in participating in studies. This was reported by both men and women, with, gender-differences. Women were more likely to fear violent reaction from their male partners for participating in the studies without man’s approval, and some women were threatened by their partners, but this was not GBV specific. No man reported this fear or any adverse reaction by intimate partners or others. Men rather feared other negative ramifications like being shamed, stigmatized, humiliated, and embarrassed in the community if breach of confidentiality could occur. Findings of this thesis reveal a complexity of people’s reasons for participating in community based studies. Participants reported multiple and various, sometimes conflicting, reasons for participating in the studies. Most were motivated by self-interest to enroll while others reported reasons that were viewed as altruistic. For example, the chance to be tested for HIV, financial incentive for research participation (R20), hope for immediate financial assistance with municipal debts, assistance with their ill-health and intervention in abusive relationships, were some of the reasons given. Also, the desire to help advance knowledge, to contribute to society, to provide information that would help others suffering from same illness or disease, or those in abusive relationships like them were also given as reasons by participants and in most cases, same individual participants gave reasons that overlapped or oscillated between altruistic and self-interest motives. Emotional distress as a result of being asked questions about interpersonal violence histories and other traumatic experiences is viewed as major risk in GBV studies, and data from interviews with researchers in this thesis confirm this. Data from interviews with participants revealed that being asked in research interviews about such histories made the participants to feel sad and some reported that reflecting on these experiences was painful. Yet, none described the impact as harmful, rather most stated that such emotions occurred for a very limited time and that they did not need professional support to deal with the emotions. Many, including those who had emotional reaction to some research questions or had regretted participating in the research, also viewed the experience of participating in research as beneficial. The findings in this thesis have implications for ethical and safety guidelines on GBV research and on future community based sensitive research in South Africa. Findings presented here provide support to the WHO 2001 guidelines that studies that are community based and researching sensitive issues with women, including partner violence, should keep secret the violence focus and other sensitive questions at community level, and such focus be divulged only to participating women. This thesis has shown that this recommendation may provide protection to a particularly vulnerable subgroup of women i.e. those in abusive or potentially abusive relationships from potential physical harm.Item Risk management in HIV/AIDS: ethical and economic issues concerning the restriction of HAART access only to adherent patients(2011-02-15) Chawana, RichardSouth Africa, like many other developing nations, is faced with the challenge of mobilising resources to fight the HIV/AIDS pandemic. There is a huge budget gap between the ideal and actual funding provided to achieve universal access to highly active antiretroviral therapy (HAART), which leads to the inevitable rationing of HAART. Although healthcare spending has been increasing in South Africa, new demands are being placed on the HAART roll out programmes. This is particularly due to the emergence of HIV drug resistance (HIVDR). Because non-adherence to HAART is strongly linked to drug resistance, this is a major threat to any successful HAART programme. In the face of restricted resources, this research report looks at some of the ethical and economic implications of non-adherence to HAART. I suggest that there is merit in considering that HAART be restricted only to adherent patients.Item Ubuntu, Zimbabwe and the ethics of intervention(2010-12-14) De Jager, PetaABSTRACT The profound and extensive nature of difficulties in Zimbabwean current affairs raises a moral dilemma for South Africa: should it intervene in some way, or respect Zimbabwean sovereignty? Is there a plausible ‘middle ground’ theory to resolves this dilemma? This paper argues that there may well be. It further argues that such a ‘middle ground’ account is consistent with at least one version of ubuntu, an indigenous sub-Saharan African philosophy. What does ubuntu have to say about the right (or perhaps even the obligation) of the South African government to have intervened in Zimbabwean affairs? Does it vindicate South Africa for its failure to intervene? This project, whilst not providing a decisive answer to the question of whether intervention in Zimbabwe by South Africa is legitimate on this African world-view, provides one possible approach to evaluating the dilemma from an ubuntu-informed perspective.Item Water utilization and population demography in South Africa: key ethical and human rights issues(2010-09-23) Mugabi, BrianAccess to sufficient water is a constitutionally recognized right in the Republic of South Africa as well as being a Universal Human Right. Despite this however, the world wide population numbers are ever growing and water is known to be finite. The Constitution’s Bill of Rights gives South African citizens the right to reproductive choices. South Africa is a water stressed country, with three forces feeding into availability of freshwater, namely; climate change, demographic factors, and policies. Currently, the problem of accessing safe freshwater is under question. This is presents a problem as the Constitution also addresses the right to a healthy environment. Uncontrolled population growth is detrimental to environmental integrity. It is arguable as to whether it is possible to conserve the environment, and at the same time realize human reproductive rights as envisioned in the Constitution. In this research report I reflect on the state of water and environmental resources in view of the right to procreate. I suggest that environmental education could play a major role in finding “the right balance”.Item Ethical and legal considerations concerning the acceptance by doctors of "incentives" offered from pharmaceutical companies: a South African survey(2010-04-14T06:54:13Z) Maholwana, Mandisa Joyce GwendolinePurpose There is limited literature available in South Africa concerning the interaction of doctors with the pharmaceutical industry. The purpose of this research report was to establish what South African doctors believe to be acceptable and appropriate incentives from the industry, highlight what they consider reasonable compensation for professional activities performed on behalf of the industry; and whether they perceive interaction with the industry’s marketing apparatus to be a significant influence on their prescribing habits. Methods A questionnaire was emailed to all active doctors in South Africa with email addresses from the Medpages® database. The survey was conducted in March 2009 - April 2009. The desired sample size was 500 General Practitioners (GPs) and Specialists in private practice. Results A final sample of 400 valid responses was analysed, representing 80% of desired sample. Majority of the respondents were male (74%) with an almost equal split between GPs (51.5%) and specialists (48.5%). The study revealed that 92% of the respondents accepted branding items whilst 60% of the respondents accepted personal gifts from the industry. The results revealed that 85% of the respondents felt that doctors should be paid for speaking at CMEs, and just over v half the sample (52%) felt they wanted to be paid their own rate as opposed to the industry rate. The investigation revealed that 77% of the respondents felt that their interaction with the industry influenced their prescribing habits and suggesting that such influence to be more pervasive with their colleagues, specifically 95% felt their colleagues are influenced by their interaction with industry (p< 0.001). About three quarters of the respondents (73%) believe patient management may be compromised if doctors’ prescribing habits are influenced by their interaction with the industry. Most respondents (72.5%) were either not aware or did not know of any regulations or guidelines with regards to acceptance of gifts by doctors from the industry. Conclusion This study demonstrated that perverse incentives continued to be given to doctors, and doctors have not shown a distinct aversion to accepting these perverse incentives and gifts. These perverse interactions have been shown in existing literature and in this research report to influence prescribing habits. Doctors do not seem to operate within their guidelines and legal framework, as stipulated by the HPCSA, when accepting these potentially harmful perquisites. What legal and ethical considerations are the doctors employing when accepting ‘incentives’ from industry is the question; and what is the doctor’s role in protecting his/her patients? Ignorance of the guidelines, as the study indicates to be the case, does not justify involvement in perverse relationships. Doctors have professional and personal moral responsibilities to ensure they familiarise vi themselves with guidelines regulating their professional conduct and ultimately protect the patients.Item Informed consent in research in developing countries: Is there some unfinished business?(2010-02-17T11:17:02Z) Tsotsi, Norma MabelThe application of informed consent in research in developing countries continues to be a topical and complex issue. The debate concerning informed consent has become even more relevant in light of the groundswell of international collaborative research that is conducted in developing countries. The discussion centres on the uncertainties of the application of informed consent in developing countries based on the normative criteria set out in international codes and regulations. Although the ethical and legal basis of obtaining valid informed consent is incontestable, contextual differences between developed and developing countries is a key problem. For example, it is debated if the tenets of ‘Western’ research ethics, mainly in the application of a written informed consent model can truly be applied in the African context. The question is whether the participants of research when conducted in developing countries actually are “informed” in the consent process. There are perceptions that the protective instruments that guide researchers on how to obtain informed consent from research participants are not robust and sensitive enough for developing countries needs. In literature, some have questioned the relevance of its purist application in the context of developing countries as ‘overly paternalistic’. Others have argued from the view point that the Eurocentric approach recommended in obtaining informed consent in developing countries has the potential to undermine cultural norms and traditions. In the latter argument, concerns are raised about the principle of respect for persons / ‘autonomy’ and its applicability in so-called communitarian societies. To overcome some unique hurdles, there are voices that call for tailor-made processes for obtaining informed consent to suit the prevailing context, suggesting therefore that there should be some variance in its application. The importance of the issue of informed consent becomes critical as much international collaborative research takes place in Africa where health services are often inadequate and research is perceived by participants as a means of ameliorating some of their suffering. Given the philosophical and the ‘universal’ ethical foundations at the heart of the international regulations and codes on the issue of informed consent, there is a need to further explore the foundation of these perceptions as they raise various ethical issues which need to be discussed. The question concerned in this research report is “is there unfinished business not addressed in the process of obtaining informed consent in developing countries?” In order to answer this question, it is necessary to look at some of the requisites for the application of informed consent principles. I will examine whether the content of the commonly cited ethical codes and regulations (originally initiated in developed countries) are sufficiently broad enough to explain the aims of obtaining informed consent, the steps to be taken in obtaining informed consent and the structures necessary for its facilitation. In addition I will examine whether the intent of the codes and regulations take cognizance of socio-cultural variations. In other words, is the environment sufficiently conducive to apply the concept and are the guidelines flexible enough to deal with “unusual circumstances”. In consideration of the latter, I consider the question of the adequacy of structures to ensure the essence of respect for persons is not lost in dealing with “unusual circumstances”. I contend that if the answer is in the affirmative it is only then can it be said that the principles of informed consent are being adequately addressed and meet the moral, ethical, and legal obligations of research activities.Item A review of the ethical and legal principles used in the decision making process for feticides at seven sites in South Africa(2009-11-12T07:18:18Z) Patel, BhavnaThis study set out to perform an ethical-legal analysis of the current practices across the seven public health centres in South Africa that perform feticide for congenital abnormalities. Ideally, such decisions need to be guided by multidisciplinary discussions with the parent(s) and the parties included in the team, e.g. Obstetricians, Neonatologists, Nursing, Genetics counsellors and Social Workers and following the ethical principles of beneficence and respect for autonomy. Prior to the study, it was unknown as to whether all seven centres were using multidisciplinary groups in the decision-making process and on what basis approvals were being granted for feticide. The objectives of the review were to assess the number of feticides performed, who made the decision to offer the feticide and for what ethical or clinical indications. The results showed that all public health facilities in South Africa differed in the criteria that were used in making the decision to offer feticide. The clinicians varied in terms of who was represented in the team that reviewed the cases of congenital abnormalities. An analysis of the literature, together with a review of the data received on the current practices, guided the development of an ethical guideline for this service as well as making recommendations as to how the law could be strengthened in order to protect both health workers and patients.Item The multiple formations of identity in selected texts by William Faulkner and Tennessee Williams(2009-09-18T11:56:26Z) Malan, MorneABSTRACT This project compares and contrasts the ways in which selected texts by William Faulkner and Tennessee Williams render their fictional figures as modern subjects engaged in the complex processes of identity-formation and transformation. These processes are deeply rooted within the context of the American South. The interrelatedness of identity and language is explored by investigating how these texts dramatize selfhood not as an essential or homogenous state, but as a perpetual process of self-fashioning and play amid multiple positionings. The central hypothesis is that identity manifests itself necessarily and continuously as a textual discourse in and through language, and that self-fashioning gives rise to ethical questions, because identity involves not only the subject’s relation to the self, but also his or her relationships with others in closely interwoven personal, familial and communal-cultural bonds. This ethical dimension underscores the relational aspects of selfhood, that is, the notion that the individual is always situated inextricably within the social, and that the fashioning of the self is thus inconceivable without a consideration of the other. The following pairs of texts are compared: As I Lay Dying and The Glass Menagerie; The Sound and the Fury and Cat On A Hot Tin Roof; Light in August and A Streetcar Named Desire.Item Ethical aspects of immunisation services in South Africa: implications for legislation and policy review(2009-09-16T10:47:40Z) Ngcobo, Ntombenhle JudithImmunisation is the most cost-effective public health intervention currently available. However, immunisation raises ethical conflicts as it may be considered a public good with little individual benefits. Considering the effectiveness of immunisation in controlling vaccine preventable infections and the constant threat of outbreaks from conditions like measles, refusal to participate in a universal immunisation programme is morally questionable. This research analyses the ethical issues brought up by universal immunisation in South Africa. It focuses on local practice and on selected risk benefit issues. The research method used is literature search with analysis in the form of critical thinking and moral reasoning. The findings are that universal immunisation is ethically defensible based on various ethical theories and principles. South Africa’s experience with the 2003 -2005 measles outbreak points to a social contract for individuals to immunise their children. The argument of taking personal risk for public good and the no additional benefit argument once herd immunity is reached (presented by Dawson), are refuted. Risk-benefit elements for each infectious condition and vaccine are continually changing. This demands an ongoing assessment of risk-benefit issues for each vaccine and targeted infections to ensure the use of vaccines with optimal safety levels that are appropriate in South Africa. Recommendations are made on immunisation policy and legislation aimed at improving ethical practices of the immunisation service. Implementation of the recommendations will help ensure an immunisation programme that is proactive in addressing associated risks and should help eliminate litigation. The main recommendation of a legislated Compensation System for those who suffer severe adverse events following immunisation is directed at just distribution of benefits and burdens.Item Chequebook journalism: a South African picture(2009-09-15T11:48:50Z) Stos, Susan LisabethChequebook journalism is the convention of paying for stories. It is considered antithetical to good journalism, yet is essentially ignored in many codes of conduct. This research report investigates television actuality programs Carte Blanche, Special Assignment and Third Degree in which the theory, as well as the practice of chequebook journalism was discussed with the journalists and executive producers. Discussion expanded into other contingent, morally suspect areas of payment, and the lines they felt should not be transgressed. Four focus groups of viewers then debated chequebook journalism and the quality of these programs. It was anticipated that the practice of journalism would be in line with audience views yet the standard of journalism as herein established surpassed viewer estimation. Whereas the topic has been written of extensively in many first world Englishspeaking countries, no research has been conducted in South Africa, thus adding valuable information to the study of journalism.