Research Articles (Philosophy)

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Browsing Research Articles (Philosophy) by Author "De Roubaix, Malcolm"

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    Certificate of need : dead and buried, or hibernating?
    (Health & Medical Publishing Group, 2006) De Roubaix, Malcolm
    On 2 May 2005, ten of the twelve chapters of the National Health Act (Act No. 61 of 2003) came into effect, generally with favourable reviews. I restrict myself to the motivation and ideology fundamental to Chapter 6 of the Draft Bill which (together with Chapter 8) was omitted in the Act, or rather, as the official government communiqué ominously asserted, ‘not yet proclaimed’. Chapter 6 deals among other things with the classification of health establishments as a precursor to the notorious Certificate of Need.
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    Complexity, postmodernism and the bioethical dilemma
    (SUN MeDIA Bloemfontein, 2008) De Roubaix, Malcolm; Cilliers, Paul
    ENGLISH ABSTRACT: This article examines the implications of a postmodern ethics for bioethical problems. Traditional approaches to bioethics, with specific reference to “principlism”, depend on a modernist strategy which attempts to produce generalised solutions. Making use of complexity theory, it is shown that the factors specific to each instance cannot be reduced in an objective way. The contingency of each individual case has to be considered. This leads to an ethics which cannot be the result of following universal rules, but one that has to accept the responsibility for the outcome of our decisions, even if these outcomes are not fully predictable. The responsibility for our choices cannot be shifted onto some a priori principle.
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    Dare we rethink informed consent?
    (Health and Medical Publishing Group, 2017) De Roubaix, Malcolm
    Current informed consent practices conform to the informed consent paradigm (ICP). Our intention is finally to promote patient autonomy through the provision of information intended to remove the information (i.e. power) differential between doctor and patient. ICP is fundamentally flawed, since it is impossible to comprehensively and explicitly inform. A fundamental problem is our reliance on the container-conduit metaphor of informing. As a linguistic act, this metaphor conceptualises the process of informing as passive, when in reality informing and consequent sense-making are parts of an individualised, personal and active process. The difficulties of the ICP are discussed, as are possible alternative strategies (reverting to paternalism, retaining the illusion of autonomy, and de-linking informing/consent, or the moral and legal aspects of consent). Alternative models are also discussed (e.g. Manson and O’Neill’s notion of informed consent as a transaction). Concluding suggestions include drawing on an ethics of responsibility, incorporating the notion of informed consent as a transaction, debating the issues raised here and promoting the ethical empowerment of practising doctors.
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    Impliseer die wettiging van beeindiging van swangerskap op aanvraag dat voorgeboortelike menslike lewe geen waarde het nie?
    (LitNet, 2022) De Roubaix, Malcolm
    Die Roe teen Wade-uitspraak van 1973 het vroeë beëindiging van swangerskap (BVS) in die VSA grondwetlik geregverdig. Ewe omstrede was die onlangse omkeer daarvan, met ingrypende sosiaalpolitieke gevolge vir Amerikaanse vroue. Teen hierdie agtergrond, in ’n styl van Sokratiese herondersoek, dink ek na oor die morele implikasies van min of meer vrye toegang tot (vroeë) BVS, soos deur die Suid-Afrikaanse Wet 92 van 1996, Wet op Keuse oor die Beëindiging van Swangerskap, gewettig. Wet 92 impliseer dat die morele status van die fetus wat vernietig word negeerbaar is, lynreg in botsing met diep intuïsies wat die meerderheid Suid-Afrikaners hieroor hou. Hoe moet ’n verantwoordelike persoon dié inherente teenstrydighede vereenselwig? Daar is twee onverenigbare kampe in hierdie ewig-omstrede morele dilemma: pro-keuse teen pro-lewe. Ek neem, gegewe die komplekse eise van die tydvak waarin ons lewe, hul argumente teen en vir BVS opnuut in oënskou. Die belang van menslikheid en intrinsieke potensialiteit tot verdere ontwikkeling versus kontekstuele potensialiteit en geregtigheid in voortplanting word teen die agtergrond van die Suid-Afrikaanse situasie ondersoek: onder andere, die wenslikheid en bekostigbaarheid van swangerskap, die haglike omstandighede waarin baie Suid-Afrikaanse kinders grootword, die probleem van tienerswangerskap en die uitwerking van BVS op verpleegpersoneel wat dit behartig. Ek argumenteer dat voorgeboortelike morele status ten beste as toenemend parallel aan fetale ontwikkeling beskou kan word. Hierdie waarde is egter nie absoluut nie, en impliseer nie noodwendig ’n reg op voortgesette lewe nie. Ek stel voor dat die intrinsieke menslikheid en potensialiteit van elke fetus beoordeel word in wat ek ’n persoonlike “morele balansstaat” noem. Die enigste redelike afsnypunt waarna BVS gewoonlik onaanvaarbaar sou wees, is die bereiking van oorleefbaarheid (indien dan gebore), iewers verby die halfpadmerk van swangerskap. Selfs dan is BVS in uitsonderlike gevalle moreel aanvaarbaar. Hierdie gevolgtrekking laat ’n mate van ongemak, kenmerkend van die afsluiting van ’n morele dilemma.