Scielo RSS <![CDATA[South African Journal of Bioethics and Law]]> vol. 16 num. 2 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Revisions to the World Medical Association's Declaration of Helsinki: Africa Region Consultation</b>]]> <![CDATA[<b>Bridging the regulatory gaps created by smart and connected technologies in South Africa</b>]]> The prevalence of technology-embedded products, services, and cities, described colloquially as 'smart' technologies and 'smart' cities, has seen a spate of unprecedented growth in recent years. South Africa (SA) has not been left behind, with smartphones, smart watches, and smart voice-controlled virtual personal assistants such as Amazon's Alexa now frequently used. But while these technologies hold great promise to revolutionise homes, offices and cities, their adoption poses challenges to individual and collective interests and wellbeing. After demonstrating the legal and ethical difficulties brought about by the introduction of these technologies, this article explores whether SA legislation is sufficiently robust to address these challenges. While the current legislative landscape addresses certain crucial difficulties -such as the safeguarding of personal data by the Protection of Personal Information Act No. 4 of 2013 ('POPIA') - it is suggested that the position regulating other aspects of smart technology adoption is, in large part, fragmented and ill-equipped to deal with some of the more pressing legal and ethical questions. Our contention is that, not dissimilar to the issues arising from artificial intelligence-based technological adoption, the extant legislative and regulatory frameworks do not go far enough in addressing the many concerns emerging from recent novel technological design, development, and deployment. Not only do smart technologies give rise to unique challenges, so does their deployment within the Global South and in South Africa, in particular. We suggest that appropriate and effective regulatory reform measures be undertaken in SA to provide better ethical guidance and policy prescriptions buttressed by rigorous regulatory oversight. <![CDATA[<b>Turning the moral compass towards transformative research ethics: An inflection point for humanised pedagogy in higher education</b>]]> Ethical guidance in research is underpinned by the need to show respect for study participants by upholding autonomy in participant decision-making, and confidentiality and protection of individual rights, privacy and interests, yet decision-making could also be influenced by the participant's sociocultural and belief systems. This calls for a more Africanised approach to research ethics where these values and beliefs are upheld. While national and international ethics guidelines do exist, there is little evidence that such a paradigm shift in research ethics is adequately interrogated in the teaching and learning curricula in higher education, where research skills are developed and nurtured. Critical reflection is used to highlight opportunities to stimulate learning and debates underpinned by humanised pedagogy in higher education. <![CDATA[<b>Changes in the empathy levels of a group of undergraduate medical students: A longitudinal study</b>]]> BACKGROUND: The concept of empathy in students has gained significant attention in medical education. Whether implementing formal educational interventions to promote long-term and effective empathy levels leads to sustained increased empathy levels in students, is however less clear OBJECTIVES: The study aimed to evaluate the trajectory of medical students' self-perceived empathy levels during their 6-year MB ChB degree METHODS: A longitudinal, prospective study was conducted over 4 years. A cohort of 292 medical students was invited to participate. Participants completed the Jefferson Scale of Empathy for Students (JSE-S) at three intervals during their studies. The students attended two workshops related to empathic patient interactions during this time. The JSE-S mean score by age and gender was compared, making use of a linear regression model RESULTS: A total of 119 students completed the study. Students' total empathy levels were similar during the first and the last measuring point (110), but there was a significant rise in the intermediate measuring point (113.3). When the male and female cohorts' scores were interpreted separately, both genders demonstrated a similar pattern to the total score, although females' JSE-S scores were higher than the males CONCLUSION: The results of the study confirm that educational interventions can increase students' self-perceived empathy levels; however, we suggest that students require reinforcement and multiple opportunities to practise and observe empathic communication with patients to sustain high levels of empathy. Follow-up sessions to specifically target the promotion of empathy should be implemented; otherwise the long-term effect of educational interventions might be limited <![CDATA[<b>Human dignity and researcher conduct in emergency care research with incapacitated adults</b>]]> Emergency care research sometimes involves incapacitated adults as research participants. The ethical principle of respect for autonomy may not necessarily apply to an incapacitated person unable to act in an autonomous manner, although it can be argued that researchers still have a duty of respect towards such people because they have moral status despite being incapacitated. Sharing some common ground with theories of moral status based on 'humanness' and the ability for rational thought is the notion of human dignity, which features in arguments regarding researcher conduct with incapacitated patients. However, human dignity premised upon the unique ability of humans for rational thought and moral self-regulation is contingent upon these capabilities - a limitation that possibly makes dignity a less useful framework for research conduct in emergency care research. In this article, I will discuss the different conceptions of human dignity - as equality, status and virtue - and then draw on more recent literature that explains human dignity as a social constraint and as a factor influencing the conduct of healthcare professionals and researchers. I will address questions of whether dignity as a principle ought to apply only to those who have the ability to think rationally, or to all humans regardless of their condition or mental status. I will argue that, in relation to offering protection to research participants in emergency conditions, it is immaterial which view is taken. <![CDATA[<b>Unpacking the legality of termination of pregnancy based on 'social grounds' under South African law</b>]]> The topic of abortion was in the limelight again in Dobbs v Jackson, where the US Supreme Court overturned the decision of Roe v Wade, 'which guaranteed women and pregnant people a constitutional right to abortion'. While not bound by the judgment, this gives us an opportunity to reflect on the current law in South Africa which regulates the termination of pregnancy. The primary piece of legislation which governs abortion is the Choice on Termination of Pregnancy Act. Section 2 of the Act lists the grounds under which one may lawfully terminate a pregnancy. One of those grounds relates to the period of the 13th up until the 20th week of the gestation period, and states that if a medical practitioner, after consultation with the pregnant woman, is of the opinion that the continued pregnancy would significantly affect the social or economic circumstances of the woman, then the pregnancy may be lawfully terminated. The question is: What exactly is meant by 'social grounds'? This article considers this aspect from a legal perspective and attempts to provide clarity on the issue, in the hope that this will be of assistance to medical practitioners who are concerned about the outcome of their actions, when assisting persons in this position. <![CDATA[<b>Inserting microethics into paediatric clinical care: A consideration of the models of the doctor-patient relationship</b>]]> Microethics is about the ethics of everyday clinical practice. The subtle nuances in communication between doctor and patient (the doctor's choice of words, tone, body language, gestures, etc.) can influence the exercise of the patient's autonomy. The four models of the doctor-patient/physician-patient relationship (paternalistic, informative, interpretive, deliberative) weigh respect for autonomy and beneficence in varying proportions. Each model may be appropriate in certain circumstances. This article considers these models from the perspective of microethics and the unique dimensions created by the doctor-child-parent relationship. In particular, the article considers the nuances to the autonomy principle created by the child's developing maturity and the parent's role as a co-fiduciary of the child's interests. Ultimately, the deliberative model seems most appropriate to the paediatric setting, since it accommodates the child's developing maturity in making healthcare-related decisions. This model infuses care into the doctor's communication with the child and parent. <![CDATA[<b>Catch-22: A patient's right to informational determination and the rendering of accounts by medical schemes</b>]]> Many people who have reached the age of majority still qualify as financial dependents of their parents, and may be registered as dependents on their parents' medical schemes. This poses a practical conundrum, because major persons enjoy complete autonomy over their bodies to choose healthcare services as they please, including informational determination. However, their sensitive health information may end up being disclosed in the accounts rendered to their parents, as main members of medical schemes, thereby breaching their informational privacy, medical confidentiality and possibly also damaging personal relationships. On the other hand, medical schemes must ensure that they strictly manage the business of their hospitalisation to ensure that they can adhere to their contractual and legal medical insurance obligations. Both major but financially dependent patients and medical schemes have good legal grounds to defend their respective positions. In this article, we will analyse and clarify the applicable legal and ethical grounds by considering medical confidentiality, the Protection of Personal Information Act, the Consumer Protection Act and the Medical Schemes Act and rules. We shall conclude with recommendations to accommodate the interests of both parties. <![CDATA[<b>Using the right to enjoy the benefits of scientific progress to address the needs of adolescent mothers living with HIV</b>]]> Various human rights issues arise from the intersection of adolescent motherhood and HIV. While health rights may be the most obvious means by which to address such issues through policy development and legislative means, the right to health is not the only human right that may provide recourse or relief in this regard. This article considers an unexplored avenue of approaching such issues through reliance on the right to enjoy the benefits of scientific progress. The International Covenant on Economic, Social and Cultural Rights provides for the 'right to science' in article 15(1)(b) and more recently, as elaborated on in General Comment no. 25 of 2020. This article considers how this right can be relied upon to address issues pertaining to adolescent motherhood and HIV. Precedent from a Venezuelan Supreme Court decision is considered, as well as the normative content of the right to enjoy the benefits of scientific progress. This may be another legal means by which to hold states accountable for the health of young mothers and their children, especially as new practices, medicines and treatments emerge regarding HIV.