Department of Philosophy

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Browsing Department of Philosophy by browse.metadata.advisor "De Roubaix, Malcolm"

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    Authenticity of informed consent in anaesthesia : ethical reflection on the dilemma of informed consent in anaesthesia
    (Stellenbosch : Stellenbosch University., 2020-03) Potgieter, Helet Elizabeth; De Roubaix, Malcolm; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy.
    ENGLISH ABSTRACT: Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment (Appelbaum 2007: 1834). Health Care Professionals should obtain informed consent from the patient before proceeding with the proposed treatment. Therefore, the anaesthesiologist should obtain informed consent from the patient before proceeding with the anaesthetic. The requirement of informed consent implies that certain pre-requisites should be met. The patient should be competent to understand the information given to him/her. The patient should be adequately informed and thereby be able to decide, without being influenced, and should also have the right to refuse the treatment. These requirements of obtaining informed consent prompted this investigation into the authenticity of informed consent in anaesthesia and the ethical dilemma faced by the anaesthesiologist. In order to examine this dilemma in anaesthesia the thesis firstly investigates the origin and establishment of informed consent, both in biomedical ethics and in the law. It starts by investigating the concept of autonomy and the development of respect for autonomy as the basic premise for the development of the informed consent process and elucidates the move away from the paternalistic approach in medicine to the current patient centred approach. To expound the unique nature of informed consent consultation in the peri-operative environment, anaesthesia as a speciality is examined. This investigation into the history and origin of anaesthesia leads to an acknowledgment of the unique moral status of the anaesthetised patient. The patient transits from the patient-as-person to the-patient-as-body while undergoing anaesthesia, as was alluded to by the first users of anaesthesia who experienced this transition firsthand. This unique moral status questions the validity of consent in this exceptional environment. The unique ethical dilemma the anaesthetists faces in the peri-operative setting is further investigated, keeping in mind the requirements for informed consent as stipulated in bioethical literature as well as in legal and regulatory guidelines. The guidance of current thought leaders in informed consent, as well as bioethical principles as published in bioethical literature are used as tools to examine the dilemma of informed consent in anaesthesia. In an attempt to find ethical solutions to this dilemma, ethical alternatives to informed consent in anaesthesiology are investigated. Phronesis and the ethics of responsibility, virtue ethics as well as medical professionalism offers some solutions to the ethical dilemma, and if promulgated could alter the construct of informed consent in anaesthesiology as it currently exists. The unique moral status that being anaesthetised infers upon a patient also has interesting potential implications for altering the construct of anaesthetic informed consent. Lastly practical solutions to satisfy the responsibilities that current legal, regulatory and bioethical guidelines place on the anaesthesiologist are investigated. Ultimately the reality of the difficulties in obtaining authentic informed consent in anaesthesia remains a dilemma in its current form and one looks forward to future development in the bioethical and legal fields to be able to develop an authentic anaesthetic informed consent consultation.
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    Evidence, truth, reality and power: A Foucauldian analysis of the ethics of testing and using novel medical devices
    (Stellenbosch : Stellenbosch University, 2018-12) Abdool, Zeelha; De Roubaix, Malcolm; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy.
    ENGLISH ABSTRACT: From the onset of time, human beings have used substances in all forms and shapes to promote health. Prior to the nineteenth century, traditional folk medicine, religious ceremonies, magical practices, herbs and the balancing of the ‘humors’ were popular methods of healing amongst others practiced by the Greeks. The various earlier Egyptian papyri detail the ancient Egyptian concepts of disease and cures, various ailments and anatomical observations. Informed consent was simplistically manifested by patient trust and cooperation. The nineteenth and twentieth centuries witnessed significant medical advancement is all spheres of medicine i.e. opening of hospitals, training of doctors, era of antibiotics, development of universities and research centres. Since the quest for science and health was a priority, doctors earned a high social standing and began to enjoy the privileged status in society. This resulted in the birth of a heavily professionalized discipline. Developing Michel Foucault’s ideas, we may regard that discipline is a specific technique of power, which aims to objectify human beings using three main practices i.e. dividing practices (e.g. birth of hospitals and asylums), scientific classification (medicine regarded as a discipline) and subjectification of human beings (humans considered as subjects). Using Foucauldian ethics, this thesis aims to deconstruct the power versus knowledge relationship between physicians and the healthcare industry in context of adopting novel medical devices. The last century has been challenged by the invention of medical devices by the healthcare industry. Some of these medical devices have raised both scientific and ethical issues because patients suffered harm. The use of transvaginal mesh for pelvic organ prolapse is currently a global topic questioning how harm came to women. The rationale for mesh development, regulatory clearance and dissemination to society, and conflict with the four ethical principles is discussed. Three other gynaecological devices will also be the focus of this thesis. The power of regulatory authorities to clear medical devices using a substandard clearance mechanism, and the power of the healthcare industry to employ vicious marketing strategies to physicians is critically analysed. Physicians as bodies of knowledge adopt these procedures with noble intentions. The implications of using novel medical devices are significant as physicians represent the final point of care for patients during which informed consent is finalized. The interplay between physicians and the healthcare industry illustrates the clash between the urge to ‘develop’ and market new technology (medical devices in this case) and the ethics of responsibility espoused by physicians to protect against harm, notwithstanding the role of regulatory authorities. Medical device innovation will continue to expand. Physicians aided by sound science and ethical principles have the responsibility to implement safe and efficacious treatment. As this may be not sufficient to prevent harm, the addition of virtue ethics and shifting of the power balance toward physicians is proposed.