Browsing by Author "De Roubaix, Malcolm"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Professionalism in anaesthesiology practice : ethical reflection on the nature of professionalism in anaesthesiology
    (Informa UK Limited, trading as Taylor & Francis Group, 2017) De Roubaix, Malcolm
    Anaesthesiologists are well trained and equipped to practise a high standard of care and contribute significantly to positive perioperative outcomes. Professionalism is characterised first by expertise in the clinical skills, capabilities, knowledge and experience internal to the practice of anaesthesiology (or a sub-specialty), and the knowledge, understanding and practice of the professional duties associated with anaesthesiology. Relatively recently it has been realised that more than good training and clinical expertise are required if anaesthesiologists want to practise as true professionals. This requirement relates to personal behaviour and attitudes that can loosely be labelled as moral attributes. The article argues that these moral attributes may best be understood with reference to Aristotle’s notion of virtue ethics—the idea that character and virtue are important in ethics. Though this is the central theme of the article, a more comprehensive picture is provided of what it means to be a professional.
  • Thumbnail Image
    Item
    The psychology of “cure” - unique challenges to consent processes in HIV cure research in South Africa
    (BMC (part of Springer Nature), 2019-01-24) Moodley, Keymanthri; Staunton, Ciara; Rossouw, Theresa; De Roubaix, Malcolm; Duby, Zoe; Skinner, Donald
    Background: Consent processes for clinical trials involving HIV prevention research have generated considerable debate globally over the past three decades. HIV cure/eradication research is scientifically more complex and consequently, consent processes for clinical trials in this field are likely to pose a significant challenge. Given that research efforts are now moving toward HIV eradication, stakeholder engagement to inform appropriate ethics oversight of such research is timely. This study sought to establish the perspectives of a wide range of stakeholders in HIV treatment and research to inform consent processes for cure research. Methods: In total, 68 South African stakeholders participated in two qualitative research modalities. In-depth interviews (IDIs) were conducted with a purposive sample of 42 individuals - audiotaped with consent. Twenty-six stakeholders participated in three focus group discussions (FGDs). Thematic analysis of transcribed IDIs and FGDs was conducted. Results: The majority of respondents indicated that there could be unique challenges in HIV cure research requiring special attention. In particular, given the complexity of cure science, translation of concepts into lay language would be critical for potential participants to adequately appreciate risks and benefits in early phase research with experimental interventions. Furthermore, to aid understanding of risks and benefits against a background of desperation for a cure, specially trained facilitators would be required to assist with a psychological assessment prior to consent to avoid curative misconceptions. Long-term participant engagement to assess durability of a cure would mean that the consent process would be prolonged, necessitating annual re-consent. Building trust to maintain such long-term relationships would be critical to retain study participants. Conclusion: Unique consent requirements for cure research in South Africa would include significant efforts to maximise understanding of trial procedures, risks and the need for long-term follow-up. However, the psychological dimension of cure must not be underestimated. Beyond an understanding of cure science, the emotional impact of HIV cure advances the discourse from cure to healing. Consequently, the consent process for cure research would need to be enhanced to include psychological support and counselling. This has several important implications for research ethics review requirements for consent in HIV cure research.