3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Keeping the flame of hope alight: refugees and right to access to healthcare services in South Africa(2011-03-30) Githaiga, Catherine Lucy WambuiDuring my interaction with various healthcare professionals while pursuing my post graduate degree, it was evident that a number of them were uninformed about refugees‘ rights.1 There was a predominant misconception that refugees are a burden to South Africa‘s already-constrained health care resources. Some of the healthcare professionals that I spoke to pointed out that they would care for all patients regardless of whether they were refugees or not, because they felt that they had a moral obligation to do so and because professional ethics required them to do so. This was the motivation behind my research.2 As observed by Bilchitz (2005: 5), the term „right to health‟ is a shorthand expression for two elements; the right to health care and the right to a healthy environment. This research report focuses on the right to health which includes access to healthcare services as one of the components of the right to health. It is not oblivious of other related and interdependent rights and it is not in any way intended to undermine the importance of other rights to health. For the most part, I centre my research report in the context of South Africa. In line with the above, the research report recognises the fact that the obligation of the states under international law extends to non-state actors. However, this 1 A refugee is defined by the Department of Home Affairs South Africa (2009) as ―Anyone fleeing from individual persecution, human rights violations or armed conflict in the land of their origin‖. 2 In my further studies, I hope to compliment this research report with empirical research. 7 research is limited to the state‘s obligations within the public healthcare sector. The research report takes an entitlement approach because entitlement empowers refugees by: 1. It gives them a base on which to stand up for themselves and for all persons past and present who, in the face of persecution, have become refugees; and 2. It allows refugees to draw attention to and demand the satisfaction of their rights (Liebenberg 2006: 20; Williams 2005: 446);and 3. It uses the legal process in order to obtain the fulfilment of their needs (ibid: 33-34);and 4. It aids in the pursuit of social justice as Pieterse (2006: 447) puts it: ... by demanding the acceleration of structural reforms that would put an end to prevailing hardship and by creating a space for collective mobilisation around such structural reforms. Although in some instances the research report refers to provisions and studies conducted on foreigners,3 this study is mainly focused on refugees and asylum seekers. However some of issues affecting foreigners in general inadvertently affect refugees as well. Overall, my research looks at the general rights of refugees. It acknowledges that there are specific rights that apply to specific classes of refugees.4 Lastly, the use of 3 A ‗foreigner means an individual who is neither a citizen nor a resident.‘ ( see Yacoob J.‘s ruling in Lawyers for Human Rights v Minister of Home Affairs & Another CCT 18/03 4 These include women and children amongst others. See Convention on the Elimination of all forms of Discrimination Against Women (CEDAW 1979); Convention on the Rights of the Child (CRC, 1989), in article 24 and related regional treaties. Also see s 28 of the RSA Constitution. 8 the term refugee in the study is intended for convenience and includes asylum seekers. The main thesis of the study is that states, as promoters and protectors of refugees‘ right to health, have an obligation to put in place all necessary measures that will aid refugees to full realisation of their right to access healthcare services.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 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(2010-08-26) Billa, Manyangane Raymond;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.