3. Electronic Theses and Dissertations (ETDs) - All submissions
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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 Does Steve Biko have more to offer medical ethics than his death?(2015) Poole, Samuel Cedric Herbert BazilSince his death at the hands of the South African security police on 12 September 1977, much has been written in medical, legal and other literature about Steve Biko. This dissertation explores the medical literature and finds that the vast majority of authors, when writing about Biko, refer primarily to his death, the role of the medical profession in the events leading up to his death, and the ethical issues regarding dual loyalties that arise from studying those issues. In my research question I ask: Does Steve Biko have more to offer medical ethics than his death? In exploring Steve Biko’s writings as collected together in I Write What I Like, I find an underlying thinking which guided Biko’s philosophy. I show that this underlying philosophy is nothing other than the philosophy which underlies ubuntu and I explore how ubuntu should influence our medical ethical thinking and suggest that this could be Biko’s real contribution to medical ethics, namely an ethic that takes seriously the contribution that African moral thinking has to make in the field of medical ethics, a contribution that does nothing less than give to medical ethics a more human face, a contribution which Biko himself believed was what Africa was still to give to the world, a more human face. I critically review the writings and philosophy of Steve Biko and identify key notions or conceptions that are of relevance to medical ethics and then explore the impact and relevance of these key notions and conceptions to the fundamental bioethical issues of autonomy, dignity and confidentiality. I defend the normative claim that integrating Biko’s and other salient African ethical conceptions into our predominantly Western bioethical thinking is a moral requirement.Item The birth of a "saviour sibling": an ethico-legal appraisal(2014) Muade, Elphus NdivhoniswaniIt is every normal parent’s wish to have a happy child free of ailments and suffering. However, not all children are born free of diseases and suffering. Some are born with severe disabilities and others are born with congenital genetic problems that have less chances of cure or no cure at all. These unfortunate circumstances make parents of such children with severe medical conditions desperate and devastated to the extent that they try anything possible in attempting to improve quality of life of their sick children. No parent wants to see his or her child suffering. However, a more pressing situation is when parents decide to have a second child whose purpose is to save the life of the sick first child by donating stem cells from cord blood or bone marrow. This second child is sometimes referred to as the “Saviour sibling” and is born for the purpose of saving the life of the sick older child of the family. ‘Saviour sibling is the media name for a child who is conceived, gestated, and delivered in order to provide umbilical cord blood, or, even more contentious, bone marrow desperately needed by the parents’ older child’ (Mills 2005:2).Because there is no matching donor for the ill older child, a donor is created in the form of a second sibling, whose match is genetically guaranteed by IVF, preimplantation genetic diagnosis (PGD), and tissue typing (Boyle and Savulescu 2001). Given that children are already being created in other Countries such as the United States of America, France and Britain for the above-mentioned purpose, this research report will attempt to engage in the debate surrounding saviour siblings, the use of preimplantation genetic diagnosis (PGD) in creating these children, and the possibility of this technology being abused and misused for gender selection. Taking this into consideration, this research report will attempt to highlight what the South African laws and policies say about saviour siblings. Should parents with pressing issues as mentioned-above demand to have a “saviour child” of their own for the purpose of using him or her to save the life of another of their children in South Africa, on which grounds would it be rejected or accepted?Item Adequacy of consenting patients for computed tomography (CT) scans in a developing country: a survey of two academic hospitals in Johannesburg, South Africa(2015-03-27) Shayingca, Thandaza MitchelINTRODUCTION South Africa presents a complex scenario with regard to patients consenting for medical procedures, because of the differing profiles of the population and the health care workers who perform the consenting procedures. AIM To evaluate consenting practice for CT scanning, within the South African tertiary referral setting and to determine if there are any associations between patient demographic profile and the level of understanding with the adequacy of consent. METHOD A prospective survey regarding consenting practices for CT scanning was performed in a form of an interview questionnaire in patients presenting to Chris Hani Baragwanath Academic and Charlotte Maxeke Johannesburg Academic hospitals. Determination of any associations between patient age, racial group, language and education was made with the level of understanding and adequacy of consent. RESULTS The survey was conducted on 117 patients; 86 from Charlotte Maxeke Johannesburg Academic Hospital and 31 from Chris Hani Baragwanath Academic Hospital. We found no significant association between gender and age category (p=0.11), racial group (p=0.17), education (p=0.26), home language (p=0.21) or residential area type (p=0.70). vi There was a significant, weak, association between age category and education (p=0.043; Cramer’s V=0.29). There was a significant, moderate association between the understanding of the language of consent and the home language of the patients (p=0.0013; phi coefficient=0.43). There was also some association between education and age. Just over 50% of patients felt that they had been given enough information and had had an opportunity to ask questions and only 33% had been offered an alternative to the CT scan. There was a significant difference in the mean adequacy of consent score with regards to racial group (p<0.0001), home language (p=0.0073), residential area type (p<0.0001) and level of education (p<0.0001). CONCLUSION Language differences between patients and personnel performing the consent procedure proved to be a major barrier in offering adequate consenting for CT Scans.Item The legal and ethical duty of the medical doctor to report police brutality(2014-09-09) Jacovides, Tracy CatherineItem Trust: a case study of the intersection of doctors' and journalists' ethics(2014-08-25) Sidley, Patricia RosemaryThis research report tells the story of a doctor and a journalist who, at the height of Apartheid’s State of Emergency, placed themselves at risk for the sake of practicing their professions ethically. They chose to defy the law, and bring to the attention of the public, the plight of many detainees who suffered at the hands of the State. In the report, I set out to give an account of the events and to ethically reflect on the actions of the two professionals involved. In particular, I consider the role played by professional codes of conduct in the actions of the two professionals and I reflect on the notion of trust as a centrally important ethical conception with respect to the events described.Item Human papillomavirus (HPV) vaccine immunisation as an intervention programme for the prevention of cervical cancer and other similar HPV genotype-related diseases in South Africa: Some ethical and legal matters for consideration(2014-08-22) Motopi, Lineo MamphiA new opportunity to reduce cervical cancer deaths as well as other HPV associated diseases arises from recently developed prophylactic vaccines. A large body of scientific literature concludes that the vaccines provide 100% protection against the oncogenic (high-risk) HPV types 16 and 18, which are responsible for about 70% of all cervical cancers in women. The vaccines also protect against infections with HPV 6 and 11, the cause of about 90% of genital warts (condylomataacuminata) in both males and females. South Africa is faced with uncertainties about how to implement a HPV vaccine immunisation programme aimed at the improvement of health in relation to the burden of disease caused by cervical cancer and related HPV-implicated diseases whilst struggling to provide the most basic of healthcare services in the midst of a HIV pandemic and a diminished base of key healthcare professionals. In such a context and relative to other priorities and the comparative benefits of different interventions, should, and if so why should South Africa invest in a HPV vaccine immunisation programme; likewise, if not, why not? In this research, report I will provide the main ethical and legal issues related to the implementation of a National HPV vaccine immunisation intervention programme. The research method used is a literature review of some ethical & legal issues in HPV vaccine immunisation analysing findings by way of critical thinking and moral reasoning. The outcomes of my research report suggest that South Africa is bound ethically and legally to provide HPV vaccine immunisation as an intervention to reduce the scourge of HPV infections, especially cervical cancer-based on the outcomes, I make recommendations concerning policy changes at the National level. These changes include interventions targeting the youth with an HPV vaccine immunisation programme included as one type of intervention.Item Some ethical and legal consideration concerning strike action by doctors in the South African public service(2012) Zeijlstra, Irene ElisabethDoctors in the South African public services went on strike in mid-2007, 2009 and 2010. The main issue related to salaries. In my research report I will present arguments concerning the justifiability or not of strike action by South African doctors Thus the laws, codes, and oaths subscribed to by medical practitioners in South Africa will be presented. Doctor's obligations stated in such declarations, and some ethical theories will be presented as they relate to the moral justifiability of doctor's strikes, and to the individual doctor-patient relationship. Arguably, the individual doctor-patient relationship is crucial for a flourishing population and social justice. In the context of this relationship, the potential harms and benefits of strike action for both parties will be discussed. I will suggest that whether justified or not, strikes may not be the right means to achieving the end of excellent healthcare. The aim of the research, ultimately, is optimal health for the South African population with retention of doctors in the public service.Item Parents perceptions of HIV counselling and testing in schools: ethical, legal and social implications(2014-02-19) Gwandure, RuthGiven the high prevalence of HIV and AIDS in South Africa, particularly among the 12-25 year age group, the study set out to understand the perceptions of parents regarding the proposed school-based HIV Counselling and Testing (HCT) campaign planned by the Department of Health in collaboration with the Department of Education. This campaign is aimed at encouraging teenagers to get tested and to know their HIV status in the hope that such knowledge will reduce the number of new infections. The target market of the HCT campaign includes high schools because they have a significant number of adolescents and young adults who could benefit from HCT campaign (SANAC, 2010:11). The research looked at the ethical, legal and social implications of the HCT campaign in schools as perceived by parents. Semi-structured interviews were conducted with a sample of 20 households. Among the main findings was that parents were generally in favour of the HCT campaign but believed that participation in the programme should be voluntary. They anticipated that the HCT programme could potentially affect children’s emotional well-being, particularly if ethico-legal issues of consent and confidentiality were violated and social issues of stigma and discrimination were not handled sensitively. They emphasised that the campaign needed to consider children’s vulnerability and should seek to protect them in the process. Findings are discussed in terms of their implications for promoting bioethical principles in implementing the HCT campaign.Item Whistle blowing in clinical research: some perspectives from good clinical practice and the role of research ethics committees(2011) Africa, Lorraine‘Whistle blowing’ means to blow a whistle calling attention to practices which an individual considers as immoral or illegal and harmful to the public. Some people think whistle blowing is a good or right act; others consider it wrong. There are numerous reports concerning blowing the whistle in scientific research. I place whistle blowing in the context of institutions, focusing on good clinical practice and Research Ethics Committees. Many research activities take place resulting in monetary and personal gain which may influence research conduct. I explore some issues in the development and organization of Research Ethics Committees, discuss the nature of whistle blowing and whistle blowers, and examine some whistle blowing incidents in scientific research. I conclude that although the function of Research Ethics Committees does not necessarily include mechanisms for whistle blowing, that this idea has merit and should be considered.