Masters Degrees (Centre for Medical Ethics and Law)

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Should South African healthcare workers be mandated to receive the covid-19 vaccine
(Stellenbosch : Stellenbosch University, 2023-12) Botman, Karl Peter Maurice; Van Niekerk, A. A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Medical Ethics and Law.
ENGLISH SUMMARY: The Covid 19 pandemic caused global multifaceted devastation. The world was thrown into unprecedented territory. Not since the Spanish Flu has a viral pandemic had such a remarkably negative impact on society and life in such a short period of time. This virus did not only cause destruction on a global scale, but also far-reaching harm at an individual level. The socioeconomic devastation and governments’ responses to mitigate the unknown, will be felt across the globe for many years. Even in many developed countries, healthcare infrastructure was unable to manage the large number of patients during the several waves of the pandemic. One can only speculate the impact that it has had on developing, under-resourced countries. Whether one lived in a developed or developing country, the impact was felt both directly and indirectly. The devastation caused could only be labelled a public health emergency. The life-saving role that healthcare workers played was unquestionably highlighted during this pandemic. Without these skilled and dedicated individuals, the health system and its resources would definitely not have survived the pandemic. The physical and mental well-being of not only patients were affected, but also that of the healthcare workers (HCW) managing these patients. Healthcare workers have played a crucial role specifically in the prevention, education and management relating to the disease process. These persons, whom many regard as the cornerstone of healthcare, have not been spared the wrath of this disease either. The infectious nature of this virus and its various presentations, especially the asymptomatic cases, made diagnoses difficult, unless persons subjected themselves to microbiological and immunological testing. The virus which caused this devastation was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) with its associated disease referred to as COVID-19. In many aspects, COVID-19 caused a public health crisis across the globe. COVID-19 brought the world to its knees. Governments, scientists and HCWs across the globe were forced to collaborate with each other regarding different healthcare-related fields, including public health, virology, immunology, epidemiology, and intensive care. The objective was to save lives by means of containment measures, finding a treatment for the infection and, ultimately, a vaccine to prevent the spread of the virus. The legal and ethical considerations in mandating COVID-19 vaccination in resource constrained countries like South Africa needed to be approached judiciously. On the one hand, there was the right to autonomy and thus, by implication, liberty, which the South African Constitution supports. Equally important were the legal and ethical implications in exposing innocent persons, whether it be patients or close contacts of the HCW, to a potential vector (the HCW) for the transmission of the virus. Governments and employers across the world, specifically during times of pandemics, have both ethical and legal obligations to protect their citizens and employees, which may give rise to ethical conflicts. Should South African healthcare workers be mandated to receive the COVID-19 vaccine? This question was approached from several perspectives: I discuss the science behind the effectiveness of a vaccine and the history of vaccination. This is followed by the relevant aspects of the Constitution of South Africa and the various legislated Acts applicable to the implementation of mandatory vaccination. Given this background, I focus on the ethics of mandatory vaccination applicable to HCWs. The familiar principles and general acceptance of bioethics as the protection of individual rights in the medical setting, however, must be considered together with public health ethics in the COVID-19 pandemic context. I argue that these two principles cannot be considered independently regarding HCWs. There is no doubt that a conflict exists between autonomy and the promotion and protection of public health through vaccination. This study highlights the importance of a balance between individual rights and the common good – not only during times of pandemics.
Defining “sufficient maturity”: providing clarity on Section 129 of the Children’s Act
(Stellenbosch : Stellenbosch University, 2018-03) Pieters, Christian Rudolph Dewet; Moodley, Keymanthri; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Medical Ethics and Law.
ENGLISH SUMMARY: It becomes increasingly clear that when one deals with a child that one is not only dealing with the child but the entities that are responsible for the child as well. One, however, becomes aware that the intention of these entities, be they bona or mala fide, may not always translate into an outcome that is inherently beneficial to the child who is the subject of medical intervention. This concern was noted by the Legislature and was addressed as best they deemed fit with the inclusion of additional rights for children in section 129 of the Children’s Act. These rights allowed the child a certain level of participation in their health care needs. However, these rights were attached to “sufficient maturity“, a phrase that finds no clarity in the Children’s Act and has been seemingly left to the discretion of the Health Care Provider that finds him/herself in the position of treating a minor. This thesis aims to provide some certainty as what the content of sufficient maturity is and perhaps more importantly how Health Care Providers can give effect to the rights of children. Furthermore, the thesis provides the psychological backdrop for evaluating children and for making certain positive assumptions as to the agency of the child in need of health care. These assumptions are developed and used in tempering the ethical, be they western or ubuntu in nature, and legal landscapes in which Health Care Providers and children find themselves. The product of this thesis is a framework that aims to assist Health Care Providers in their interactions with the child, their parents, caregivers, guardians, or community in circumstances where the nature of the interactions is almost as crucial as the help sought by the child.
A System in Crisis: Ethical Concerns about Zimbabwean Healthcare in the 21st Century.
(Stellenbosch : Stellenbosch University, 2017-12) Moyana, Farayi; Moodley, Keymanthri; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Medical Ethics and Law.
ENGLISH SUMMARY: Health care services in post-independent Zimbabwe have undergone turbulence with periods of seemingly significant improvements and other periods of definite decline. This thesis looks at health-care systems in general and in particular, the way in which they are reflected through the health-care system of Zimbabwean. Ethical issues and challenges in health care can take many forms ranging from debates and discussions on the fairness or the lack thereof in the health-care reform process, the ethics of inter-professional relationships, the ethical problems with doctorpatient relationships, the state of advocacy in health matters, and patient rights, ethical perspectives influencing discourses on health systems, the ethics of health-care funding, and debates on access to health care. This thesis reflects on the complexities of the challenges, needs and reform requirements of the Zimbabwean situation. A critical analysis of the ethical principles, their impact on the Zimbabwe health care system, using largely the principlist approach as enunciated by Beauchamp and Childress (2013), is conducted. Other moral theories such as the social contract theory is also discussed in some detail because of its important application to issues related to health care. A whole chapter is dedicated to the principle of distributive justice and its relevance and implications for the health care systems in general, but also with particular relevance to the situation in Zimbabwe. Lack of or inadequate insurance is the biggest economic hurdle in accessing health care in many low income countries. There are two main arguments, which appear to support some sort of moral right to a health care funded by the government – “the collective social protection” and the “fair opportunity arguments” (Beauchamp & Childress, 2013). Both of these arguments are discussed in detail. Right to health and right health care are two concepts which confuse a lot of readers because they are close but refer to different dimensions of the concept of health. They are discussed with a particular emphasis on the ethical issues involving allocation of health resources, rationing and setting of priorities. This thesis winds up by looking at the possible solutions to the health crisis in Zimbabwe. The much-flaunted National Health Insurance, amongst other possible remedies, is analyzed. A list of recommendations is outlined, in the last chapter.
The tyranny of a kilogram : should we untie rather than cut the Gordian knot?
(Stellenbosch : Stellenbosch University, 1999-12) Howarth, Graham Robert; Van Niekerk, Anton A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Medical Ethics and Law.
ENGLISH ABSTRACT: The number of babies requiring neonatal intensive care exceeds the facilities available. The assignment questions the perceived shortage of resources and investigates methods of resource allocation. The first chapter addresses the development of technology and reflects briefly on the romance between medicine and technology. The second chapter addresses the issue of prognosis of the small preterm neonate and reflects on how these data are derived and the assumptions that are often made based on prognostic data. Chapter three concentrates on how outcomes discussed in the second chapter may be quantified. Individual utility quantification plays a role in decision making for the individual neonate, while comparative utility quantification addresses some of the issues concerned with the macroallocation of resources. This leads into chapter four that addresses macroallocation and challenges some of the assumptions that resource allocation is based upon. Are resources scarce? Are there financial constraints? What is the role of medicine in health? Will redistribution of wealth necessarily improve the health of the population? Who should. make decisions for individual sick neonates regarding neonatal intensive care is addressed in the next chapter. The tension between sanctity-of-life and quality-of-life ideologies, created by life sustaining technology has been legally and ethically settled in favour of the patient's right to self-determination, based on the principle of respect for patient autonomy. It will however be argued that the traditional four principles cannot be utilised as the neonate is at best pre-autonomous. Moral obligations towards the neonate are dependent on the beneficence and non-maleficence obligations of the parents and the caregivers. Both these principles are prima facie and may have to be tempered by distributive justice. Plato's absolutist thinking and Descartes mathematician's perspective, have influenced medicine's romance with certainty. If knowledge and certainty are necessary for decision· making and it is shown that absolute certainty is elusive, should we be nihilistic about decision making in neonatal intensive care? Chapter 6 critically assesses three approaches to decision making in the presence of prognostic uncertainty. In contemporary medicine there is a constant tension between the traditional commitment to the patient on the one hand and the awareness that resources are finite on the other, this tension is an unfortunate reality of medicine. To constrain the growth of medical expenditure, doctors are now asked to serve simultaneously as society's agent of cost containment and as the patient's agent for maximum health. There is increasing pressure on doctors to serve two masters, society and the patient. Acting on behalf of society as a gatekeeper, while for the patient the doctor is expected to act as advocate. Chapter seven investigates both gate-keeping and advocacy and attempts to answer the question whether doctors can and indeed should try to serve two masters Simultaneously? The final chapter brings together the threads of the various extended arguments and attempts to give solutions to some of the conundrums.

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