Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate... more Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula.
There are both ethical and legal obligations for increasing the number of medical students that a... more There are both ethical and legal obligations for increasing the number of medical students that are trained in South Africa to allow for increased access to doctors for patients seeking out or requiring healthcare. The lack of resources earmarked for healthcare will always be a potential concern in all spheres but this reason should not be used to justify limiting the training of much needed medical doctors. The right to access basic healthcare is enshrined in Section 27 of South African Constitution 1 and therefore, a system needs to be put in place to allow for both quality healthcare coupled with a strong commitment, financial and otherwise, to training more medical doctors. This should improve healthcare services as a result. However, at the same time, it is argued that there are both ethical and legal obligations to protect the rights of patients. The presence of increasing numbers of medical students in the hospital setting is likely to erode the rights of patients. There is a need for local South African professional healthcare guidelines defining a reasonable level of patient-medical student interaction and an information handout available to patients that includes what a teaching hospital is, what a clinical encounter with medical students would entail and the importance of the training of medical students.
South African Journal of Bioethics and Law, Aug 16, 2021
Background The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering mo... more Background The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering momentum internationally. There is interest in it being included within the offering of Critical Care services in South African State Hospitals. Objectives Most discussions about ECMO's appropriateness in State hospitals have been focused on healthcare economics and cost: benefit. To date, the bioethical considerations of this topic have not been comprehensively addressed. This research aims to articulate some of the normative ethical considerations to be considered when making decisions about government funding of medical therapies in general and costly life-sustaining therapies, such as ECMO specifically, within a limited resource environment. Methods Using a standard normative/philosophical design and the application of the ethical theories of Responsive Communitarianism and Ubuntu (African Moral Theory), to interrogate whether it is morally justifiable for Intensive Care Units in South African State Hospitals to be implementing ECMO programmes, at present. Conclusions Both Responsive communitarianism and Ubuntu (African Moral theory) advocate that when considering expensive therapies that extend or save lives such as ECMO, it is essential to consider the collective effect of such therapies on the community large – both the benefits as well as burdens. Accordingly, considering the National Department of Health's current state, it is ethically unjustified for ECMO to be included in the current critical care service in State Hospitals at present.
Background: The National Health Insurance (NHI) is a proposed health policy in South Africa that ... more Background: The National Health Insurance (NHI) is a proposed health policy in South Africa that aims to change the structure of the current health system. Public involvement in policy making is important and it is a constitutional requirement in the legislation development process in South Africa. Patients are key stakeholders and should be engaged in NHI policy process. Before patients can be engaged, they need to be provided with sufficient information about the NHI. Therefore, the aim of this exploratory study was to examine the levels of patient awareness of the NHI, which is a requisite for meaningful engagement. Methods: This was a cross sectional study of 244 patients from the follow-up clinics at the Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital in the Gauteng Province, South Africa. The patients were interviewed using a structured interview process and a questionnaire. Descriptive statistics and logistic regression analyses were conducted. Results: The majority (79.51%) of the participants were not aware of the proposed National Health Insurance (NHI) in South Africa even though the NHI policy process commenced in 2011. Of the participants who were aware of the NHI, 86% responded that they had not been provided with an opportunity to be involved in the policy making process of the NHI. The odds of awareness were higher for male (OR: 2.08, 95% CI: 1.11-3.9, p value: 0.02) than female participants; White (OR: 2.36, 95% CI: 1.06-5.26, p value: 0.04) and Indian (OR: 2.76, 95% CI: 0.10-7.60, p value: 0.05) participants when compared to Black participants; and retired (OR: 3.13, 95% CI: 1.35-7.25, p value: 0.008) than unemployed participants. Conclusion: The levels of awareness of the NHI were low among the participants from Department of Internal Medicine, CMJAH. Without the awareness and information about the NHI, patients are not equipped to be involved in the NHI policy process in a meaningful way. Public patients are the intended beneficiaries of universal health coverage, therefore they should be prioritized in the NHI community engagement process to ensure that the NHI is community and patient centred.
South African Journal of Bioethics and Law, Oct 24, 2013
In clear, concise language, Gavin Mooney ably explains the reasons for global ill health and offe... more In clear, concise language, Gavin Mooney ably explains the reasons for global ill health and offers viable solutions. The book is sharp and crisp, highly informative and makes compelling reading from the very first page. In this slim-volume, 212-page book, Mooney deals with the global response
Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate... more Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula.
There are both ethical and legal obligations for increasing the number of medical students that a... more There are both ethical and legal obligations for increasing the number of medical students that are trained in South Africa to allow for increased access to doctors for patients seeking out or requiring healthcare. The lack of resources earmarked for healthcare will always be a potential concern in all spheres but this reason should not be used to justify limiting the training of much needed medical doctors. The right to access basic healthcare is enshrined in Section 27 of South African Constitution 1 and therefore, a system needs to be put in place to allow for both quality healthcare coupled with a strong commitment, financial and otherwise, to training more medical doctors. This should improve healthcare services as a result. However, at the same time, it is argued that there are both ethical and legal obligations to protect the rights of patients. The presence of increasing numbers of medical students in the hospital setting is likely to erode the rights of patients. There is a need for local South African professional healthcare guidelines defining a reasonable level of patient-medical student interaction and an information handout available to patients that includes what a teaching hospital is, what a clinical encounter with medical students would entail and the importance of the training of medical students.
South African Journal of Bioethics and Law, Aug 16, 2021
Background The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering mo... more Background The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering momentum internationally. There is interest in it being included within the offering of Critical Care services in South African State Hospitals. Objectives Most discussions about ECMO's appropriateness in State hospitals have been focused on healthcare economics and cost: benefit. To date, the bioethical considerations of this topic have not been comprehensively addressed. This research aims to articulate some of the normative ethical considerations to be considered when making decisions about government funding of medical therapies in general and costly life-sustaining therapies, such as ECMO specifically, within a limited resource environment. Methods Using a standard normative/philosophical design and the application of the ethical theories of Responsive Communitarianism and Ubuntu (African Moral Theory), to interrogate whether it is morally justifiable for Intensive Care Units in South African State Hospitals to be implementing ECMO programmes, at present. Conclusions Both Responsive communitarianism and Ubuntu (African Moral theory) advocate that when considering expensive therapies that extend or save lives such as ECMO, it is essential to consider the collective effect of such therapies on the community large – both the benefits as well as burdens. Accordingly, considering the National Department of Health's current state, it is ethically unjustified for ECMO to be included in the current critical care service in State Hospitals at present.
Background: The National Health Insurance (NHI) is a proposed health policy in South Africa that ... more Background: The National Health Insurance (NHI) is a proposed health policy in South Africa that aims to change the structure of the current health system. Public involvement in policy making is important and it is a constitutional requirement in the legislation development process in South Africa. Patients are key stakeholders and should be engaged in NHI policy process. Before patients can be engaged, they need to be provided with sufficient information about the NHI. Therefore, the aim of this exploratory study was to examine the levels of patient awareness of the NHI, which is a requisite for meaningful engagement. Methods: This was a cross sectional study of 244 patients from the follow-up clinics at the Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital in the Gauteng Province, South Africa. The patients were interviewed using a structured interview process and a questionnaire. Descriptive statistics and logistic regression analyses were conducted. Results: The majority (79.51%) of the participants were not aware of the proposed National Health Insurance (NHI) in South Africa even though the NHI policy process commenced in 2011. Of the participants who were aware of the NHI, 86% responded that they had not been provided with an opportunity to be involved in the policy making process of the NHI. The odds of awareness were higher for male (OR: 2.08, 95% CI: 1.11-3.9, p value: 0.02) than female participants; White (OR: 2.36, 95% CI: 1.06-5.26, p value: 0.04) and Indian (OR: 2.76, 95% CI: 0.10-7.60, p value: 0.05) participants when compared to Black participants; and retired (OR: 3.13, 95% CI: 1.35-7.25, p value: 0.008) than unemployed participants. Conclusion: The levels of awareness of the NHI were low among the participants from Department of Internal Medicine, CMJAH. Without the awareness and information about the NHI, patients are not equipped to be involved in the NHI policy process in a meaningful way. Public patients are the intended beneficiaries of universal health coverage, therefore they should be prioritized in the NHI community engagement process to ensure that the NHI is community and patient centred.
South African Journal of Bioethics and Law, Oct 24, 2013
In clear, concise language, Gavin Mooney ably explains the reasons for global ill health and offe... more In clear, concise language, Gavin Mooney ably explains the reasons for global ill health and offers viable solutions. The book is sharp and crisp, highly informative and makes compelling reading from the very first page. In this slim-volume, 212-page book, Mooney deals with the global response
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