Patient's rights in South Africa's public health system : Moral-critical perspectives

Nevhutalu, Helen Khanyisa (2016-03)

Thesis (PhD)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: The aim of this dissertation is to critically investigate the nature, status and efficacy of the application of patients‟ rights in the South African context, with particular reference to the situation of healthcare in the public sector (particularly public hospitals in urban settings). The study focuses initially on the ethical and moral grounding of human rights. Justice theories or theoretical perspectives are themselves abstract; however, they serve as a useful philosophical background that shape worldwide thought on the concept of “human rights”. These philosophies lend a high degree of credibility to the notion of human dignity and therefore provide great wisdom in dealing with complex medico-ethical issues, such as patients‟ rights. From human rights to patients‟ rights, the notion of rights is mapped out by following the historical development of the human rights culture internationally, regionally and locally. Against this backdrop, an exposé of South Africa‟s record in dealing with socio-economic rights is given by presenting Constitutional Court cases in the country dealing with socio-economic rights. The issue of economic, social and cultural rights cannot be dealt with without engaging in a discussion of the very idea of human rights. Perspectives on patients‟ rights – the moral principles of autonomy, respect, informed consent and confidentiality and privacy, which form the core of patient‟s rights – are discussed in detail, focusing on their application to clinical settings. It is necessary to assess whether there is a correlation between theory (international, regional and local human rights instruments, including the Constitution of the Republic of South Africa and the National Patients‟ Rights Charter of 1999 (PRC) and practice (the realities at the patient‟s bedside). The only way in which one can assess the realisation and enforcement of patient‟s rights is to go to a public hospital and ascertain from patients (out-patients and in-patients) as well as staff (all categories, including hospital management) what their opinions are about the realisation or non-realisation of patients‟ rights at that particular hospital. A case study (an ethics audit) of the Chris Hani Baragwanath Hospital (CHBH) is presented in this dissertation. Firstly, the researcher analyses the case study and identifies evidence of infringements and violations of patients‟ rights; secondly, key problems hindering the realisation of patient‟s rights at CHBH are identified and discussed. Case studies and research projects subsequent to the CHBH case study that focus on the implementation of the PRC and respect for patients‟ rights are also given serious consideration in this dissertation. Based on the findings from the ethics audit, case studies, and empirical studies including media reports, a reassessment of patient‟s rights in the South African context is considered. Wide-ranging recommendations are made to various stakeholders, such as the national Department of Health, Provincial Health Departments, professional associations and regulatory bodies, community-based organisations and non-governmental organisations. The study proposes a consultative process based on mutual respect, a non-confrontational attitude and trust between healthcare authorities and/or providers and the receivers of care (in-patients and out-patients), with the aim of initiating robust discussions about patients‟ rights in South Africa‟s public hospitals, which, it is hoped, will culminate in a resilient patient care policy and/or a revised patients‟ rights charter (if needed) for South Africa.

AFRIKAANSE OPSOMMING: Die doel van hierdie proefskrif is ‟n kritiese ondersoek na die aard, stand en doelmatigheid van die toepassing van pasiënte se regte in Suid-Afrikaanse konteks, met besondere verwysing na die toestand van gesondheidsorg in die openbare sektor (veral staatshospitale in stedelike gebiede). Die proefskrif fokus eerstens op die etiese en morele gronde van menseregte. Regsteorieë of teoretiese perspektiewe is uit die aard van die saak abstrak, maar dien as ‟n waardevolle filosofiese agtergrond wat denke wêreldwyd rig oor die begrip van “menseregte”. Hierdie filosofieë verleen „n hoë mate van geloofwaardigheid aan die idee van menslike waardigheid en verskaf dus beduidende wysheid wanneer komplekse medies-etiese kwessies soos pasiënte se regte ter sprake is. Vanaf menseregte tot pasiënte se regte, word die idee van regte in kaart gebring deur die historiese ontwikkeling van die menseregtekultuur op internasionale en op streek- en plaaslike vlak te volg. Gesien teen hierdie agtergrond, word „n beskrywing gegee van Suid-Afrika se rekord in die hantering van sosio-ekonomiese regte, deur hofsake in die Konstitusionele Hof van die land in die hantering van sosio-ekonomiese regte te bespreek. Die hantering van die kwessie van ekonomiese, sosiale en kulturele regte kan nie vermag word sonder 'n bespreking van die spesifieke idee van menseregte nie. Perspektiewe op pasiënte se regte – die morele beginsels van outonomie,respek, ingeligte toestemmings, vetroulikheid en privaatheid, wat die kern van pasiёnte regte is, word in besonderhede bespreek, met die fokus op kliniese instellings. Dit is nodig om verder te bepaal of daar „n korrelasie is tussen die teorie (internasional, streeks en plaaslike mensregte-instrumente, insluitend die Grondwet van die Republiek van Suid Afrika en die National Patients‟ Rights Charter van 1999) en die praktyk (die werklikheid by die pasiënt se bed). Die enigste mannier om die verwesenliking en toepassing van pasiënteregte te evalueer is om „n publieke hospitaal te besoek om te bepaal direk van pasiënte (binne- en buitepasiënte) en personeel (alle kategorieë, insluitend hospitaal bestuur) wat hul opinies is met betrekking tot die verwesenliking en nie verwesenliking van pasiëntese regte by „n spesifieke hospitaal. ‟n Gevallestudie (‟n etiekoudit) van die Chris Hani Baragwanath Hospitaal (CHBH) word in hierdie verhandling weergegee. Die navorser analiseer eerstens die gevallestudie en lê getuienis voor van die skending van pasiënte se regte en tweedens word kernprobleme wat die handhawing van pasiënte se regte by CHBH verhinder, geïdentifiseer en bespreek. Verdere gevallestudies en navorsingsprojekte oor die CHBH en wat gefokus het op die implementering van die PRC ten opsigte van pasiënte se regte, word ook ernstig oorweeg in hierdie verhandeling. Gebasseer op die bevindinge van die etiekoudit, gevallestudies, en praktiese studies insluitende media verslae, word „n heroorweging van pasiënte se regte in die Suid-Afrikaanse konteks gedoen. Omvattende aanbevelings aan verskeie rolspelers soos die Nasionale Departement van Gesondheid, Provinsiale Departmente van Gesondheid, assosiasies en professionele organisasies (regulatoriese liggame), gemeenskapsgebaseerde organisasies en nie-regeringsorganisasies word gemaak. Gebasseer op die voorafgaande besprekings, stel die studie voor dat „n proses van konsultasie gevolg word wat gebasseer is op wedersydse respek, gebrek aan konfrontasie en vertroue tussen die gesondheidsorg owerhede en/of verskaffers en ontvangers van sorg (binne- en buitepasiënte), met die doel om ernstige gesprekvoering te inisieer rakende pasiënte se regte in Suid-Afrika se publieke hospitale, wat, so word gehoop, sal lei tot „n buigbare pasiëntesorgbeleid en/of „n kompak (hersien indien nodig) vir pasiënteregte in Suid-Afrika.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98591
This item appears in the following collections: