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A discussion on the ethical complexities of micro-level decision making in the South African private health insurance industry.Cazes, Aerelle Liëtte January 2017 (has links)
A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts in Applied Ethics For Professionals, July 2017 / Health and, by extension, healthcare is accepted to be a valuable and important social good that is both a good
in and of itself, as well as necessary to achieve life’s goals. Its fair distribution is therefore properly the subject
of ethical concern and in the era of modern medicine where costs and potentially limitless treatments exceed
available resources, rationing healthcare has become an unavoidable necessity. Since such rationing implies
that not everyone’s needs or preferences can be met, a fair and just way of rationing healthcare is a widely
debated and controversial topic that, to date, remains unresolved. Where third-party private funding
organisations are tasked with these rationing responsibilities, the ethical complexities are compounded by
perceived conflicts between the ethical frameworks that govern corporate organisations versus those that
govern healthcare. Given the apparent inability of normative theories to resolve the problem of how to ration
healthcare fairly, there has been a shift in thinking to considerations of procedural justice and a dominant
model, Accountability for Reasonableness (AFR), has emerged as the favoured procedure for healthcare
decision-making. The report shows why health is an important social value and examines the key models and
principles that dominate the rationing debate as well as why the conflict between healthcare ethics and
organisational ethics create additional complexities that must be considered when making these funding
decisions. Furthermore it explores the rationales for resorting to procedural accounts with specific emphasis on
the parameters and validity of AFR. The report concludes that even though the AFR framework may be a
legitimate and just process that can effectively frame decision-making and provide a platform to drive
transparency and consistency, like most procedural accounts, it does not guarantee that the outcomes it
produces are necessarily fair or just. Therefore a straightforward application of AFR cannot resolve the
healthcare rationing debate which should, given its ethical complexity, continue to appeal to the important
ethical principles that currently govern the field. / XL2018
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The medical profession in a transforming South Africa society : ideals, values and roleMahlati, Malixole Percival 04 1900 (has links)
Thesis (MPhil)--Stellenbosch University, 2000. / Some digitised pages may appear illegible due to the condition of the original hard copy. / ENGLISH ABSTRACT: Medicine in our country is under severe stress, brought about by internal and external
forces that need a response from the medical profession. The profession's attempts and
response will fall short unless the profession itself is aligned with the new social ethos and
the responses are based on the profession's inherent values.
Problem Statement:
Medical doctors have always been highly valued in society because of the duty they have
when illness and disease set in. As individuals, doctors have fulfilled other important roles
in the communities where they work. These include giving advice to young people on
career choices, counseling on various matters and provision of material help where there is
need. This profession has for a long time been shrouded in mystery, being a trade learnt by
a few. All these factors contributed to their social standing increasing phenomenally.
There is a view that this has also led to public perceptions that doctors are the rich
untouchable elite who have no interest or are unconcerned about problems faced by
society. The medical profession faces a challenge that is more significant because of the
value placed on it by society. The numerous submissions by the victims of human rights
abuses to the Truth and Reconciliation Commission have cast a shadow of doubt on the
medical profession for its complicity in these acts. The present government has declared
transformation of health care as one of its top priorities. The response of the medical
profession to this initiative has so far not led to any significant changes of public
perception that the profession is unwilling to participate in the transformation of our
society.
The challenge and subject of discussion in this thesis therefore is:
"What is the ideal role of the medical profession in a transforming South African
society?"
The medical profession, being the nerve centre of health care, has a big responsibility in
social transformation. Doctors stand accused as a collective for failing to protect the
human rights of patients and not living up to the standards of ethics required of them when patients' rights were violated. The Truth and Reconciliation Commission record of the
hearings into the role of the professional organisations in health is used in this thesis to
illustrate how serious society views the medical profession's role in the human rights
abuses of the past.
Based on the T. R. C's report and the assumption that society traditionally places high
value on the medical profession, I conducted a survey among South African doctors to test
their attitudes towards a range of policy and transformational issues. The unit of analysis
was the medical doctors who are in active practice in South Africa in whatever mode of
practice. The survey sought to explore the awareness of the respondents about a range of
transformation policy changes and invite their comments on the role that they envisage for
the medical profession in the process of transformation of society. There is unfortunately
scarcity or a lack of applicable South African literature on this topic thus limiting local
material for referencing. The search of international literature only yielded the subject of
the study of professional values and not necessarily the role of a medical profession in a
transforming society.
The medical profession has to re-visit its foundations, analyse its history and map out its
future in the context of the South African realities. It must find a way of aligning itself
with the new ethos and diverse cultures South Africa possesses. Medicine has its own
traditional goals and values derived and adapted from society's diverse cultural value
systems. With its national and international networks, the inherent knowledge and skills
that it possesses, guided by an ethical code, the Hippocratic Oath that serves as a public
promise, it influences policy on the country's health care system - a mechanism that
government uses to provide a basic human need.
The medical profession therefore has to be responsive to the needs of society as much as
society needs to support the profession. This thesis explores the role that the profession
should play in a transforming South African society. The argument is that this can only be
done through the profession examining its values and aligning itself with broader societal
value systems, the moral and social norms. It is further argued that visible realistic
commitment by the profession to public health will lead to an improvement in its public
image. It is the actions or non-actions of the majority that the public notices. The majority
of respondents to the survey have indicated that they approve of the transformation
policies in health but that they may differ in the way they were introduced. / AFRIKAANSE OPSOMMING: Die geneeskunde in ons land is onder geweldige druk as gevolg van interne en eksterne
faktore en dit is nodig dat die mediese beroep reageer. Dit sal die beroep egter nie help
om te reageer indien sy lede hulle nie met die nuwe maatskaplike etos vereenselwig nie en
die reaksie op die inherente waardes van die mediese beroep geskoei word nie.
Probleemstelling
Mediese dokters is nog altyd baie hoog geag deur die gemeenskap as gevolg van die
verpligting wat hulle het om na mense om te sien wanneer hulle siek word. In hulle
individuele hoedanigheid het dokters ook ander belangrike bydraes tot hulle
gemeenskappe gelewer. Dit sluit in: advies aan jong mense oor loopbaankeuses, berading
en die verskaffing van finansiele hulp waar nodig. Die beroep as sulks was egter vir baie
lank ietwat van 'n misterie omdat dit 'n vakrigting is waarin baie min mense hulle kon
bekwaam. Al hierdie faktore het die maatskaplike aansien/waarde van dokters geweldig
verhoog. Daar is ook diegene wat van mening is dat hierdie faktore aanleiding gegee het
tot die openbare mening dat dokters 'n ryk en onaantasbare elite is en glad nie in die
probleme van die gemeenskap belangstel nie. Die etlike voorleggings deur die slagoffers
van menseregtevergrype aan die Waarheids- en Versoeningskommissie het ook vrae
rondom die beroep se betrokkenheid by sodanige gevalle laat ontstaan. Die huidige
regering het die transformasie van gesondheidsorg as een van sy grootste prioriteite
verklaar. Die reaksie van die beroep hierop het tot dusver nie tot enige noemenswaardige
veranderinge in die openbare mening dat dokters nie bereid is om aan die transformasie
van ons gemeenskap deel te neem gelei nie.
Wat is die ideale rol van die mediese beroep in die transformasie van die Suid-
Afrikaanse gemeenskap?
As die senusentrum van gesondheidsorg het die mediese beroep 'n groot
verantwoordelikheid in maatskaplike transformasie. Dokters word kollektief beskuldig
dat hulle nagelaat het om die menseregte van pasiente te beskerm en nie voldoen het aan
die nodige etiese standaarde wat van hulle verwag word in die tyd toe pasienteregte
geskend is nie. Die rekord van die verhore van die Waarheids- en Versoeningskommissie
oor die rol van professionele gesondheidsorganisasies is vir die doeleindes van hierdie
tesis gebruik om te illustreer hoe ernstig die gemeenskap voeloor die mediese beroep se
rol in die menseregte vergrype van die verlede.
Gegrond op die WVK-verslag en die aanname dat die gemeenskap die mediese beroep
hoog ag, het ek 'n meningsopname onder 300 Suid-Afrikaanse dokters gedoen om hulle
houding jeens 'n aantal beleids- en transformasiekwessies te toets. Die eenheid van
analise was mediese dokters wat in die aktiewe praktyk staan, ongeag hulle praktykgebied.
Die opname het gepoog om te bepaal wat die vlak van bewustheid by die respondente oor
'n aantal beleidsveranderinge gerig op transformasie is, en hulle uit te nooi om
kommentaar te lewer op die rol wat hulle meen die mediese beroep behoort in die proses
te speel. Ongelukkig is daar nie toepaslike Suid-Afrikaanse literatuur oor die onderwerp
beskikbaar me. 'n Internasionale literatuursoektog het net studies rondom waardes
opgelewer, en nie oor die rol van 'n mediese beroep in die transformasie van 'n
gemeenskap nie.
Die mediese beroep moet die grondslag van sy wese in oenskou neem, die geskiedenis
analiseer en sy toekoms in die konteks van die Suid-Afrikaanse realiteite uitstippel. Die
beroep moet 'n manier vind om homself met die nuwe etos en uiteenlopende kulture van
Suid-Afrika te vereenselwig. Die geneeskunde het sy eie tradisionele doelwitte en waardes
gekry en aangepas vanuit die uiteenlopende kulturele waardestelsels van die gemeenskap.
Deur middel van sy nasionale en internasionale netwerke, inherente kennis en
vaardighede, die leiding van 'n etiese kode, die Eed van Hippokrates wat as 'n belofte aan
die publiek dien, beinvloed die mediese beroep die land se gesondheidsorgstelsel - 'n
meganisme van die regering om in 'n basiese menslike behoefte te voorsien.
Die mediese beroep moet daarom ingestel wees op die behoeftes van die gemeenskap in
dieselfde mate as wat die gemeenskap die beroep behoort te ondersteun. Hierdie tesis
ondersoek die rol wat die mediese beroep behoort te vervul in 'n Suid-Afrikaanse
gemeenskap waar transformasie besig is om plaas te vind. Daar word geargumenteer dat
dit net gedoen kan word indien die beroep sy waardes ondersoek en hom met die breer
maatskaplike waardestelsels vereenselwig. Daar word verder geargumenteer dat 'n
sigbare realistiese verbintenis van die mediese beroep tot openbare gesondheid tot die
verbetering van sy openbare beeld sal lei. Dit is die optrede of nie-optrede van die
meerderheid wat die publiek raaksien. Die meerderheid respondente in die
meningsopname het aangedui dat hulle die transformasiebeleid vir gesondheid ondersteun,
maar dat hulle verskil van die wyse waarop dit in werking gestel is.
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The parameters of medical-therapeutic privilegeWelz, Dieter Walter 06 1900 (has links)
Law / LL.M.
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The parameters of medical-therapeutic privilegeWelz, Dieter Walter 06 1900 (has links)
Law / LL.M.
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Medical therapeutic privilegeCoetzee, Lodewicus Charl 01 January 2002 (has links)
The therapeutic privilege is a defence in terms of which a doctor may withhold information from
a patient if disclosure of such information could harm the patient. This study explores the defence
of therapeutic privilege and provides a critical evaluation. A comparative investigation is
undertaken, while arguments springing from a variety of disciplines are also incorporated.
A number of submissions are made for limiting the ambit of the defence. The main submission
is that the therapeutic privilege should comply with all the requirements of the defence of
necessity. In addition, it should contain some of the safeguards afforded to the patient by the
requirements of the defence of negotiorum gestio so that therapeutic privilege is out of the
question if medical treatment is administered against the patient's will, or the doctor has reason
to believe (or knows) that the patient will refuse to undergo an intended intervention once
properly informed. / Jurisprudence / L.L.M. (Jurisprudence)
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The effectiveness of the referral system in primary health care in the West Rand region : a normative-ethical study with special emphasis on traditional healersMolepo, Edward R. 12 1900 (has links)
Thesis (M.Phil.)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: The aim of this research is to identify the various levels of health care units, their
relationships and the problems hindering an effective referral system. To achieve
this goal, use is made of a case study of the West Rand area in Gauteng. The
standpoint is that, to achieve Primary Health for all South Africans referral
systems within health care units and levels must be reciprocal. It is argued that
for Primary Health Care to be successful, it must satisfy the goal of affordability
appropriateness and accessibility. Results from the research revealed that four
health care levels, namely traditional healers, health NGOs, Clinics, and
Hospitals. Though there is some degree of referral in the study area, it was
observed that referrals in the study area were not reciprocal. Amongst the major
problems identified as hindering an effective referral system in the study area,
include lack of cooperation between health institutions, poor health infrastructure
and communication network as well as lack of other health paraphernalia. The
research also found that government policy towards some of the health
institutions (Traditional healers) contributes to the inefficiency of proper referrals
in the study area. / AFRIKAANSE OPSOMMING: Die oogmerk van hierdie ondersoek is om die verskillende vlakke van
gesondheidsorgeenhede, hulonderlinge verbande en die probleme wat
doeltreffende verwysings in die wiele ry, te identifiseer. Dit word gedoen
aan die hand van 'n gevallestudie van die Wes-Randarea in Gauteng. Die
uitgangspunt is dat doeltreffende Primêre Gesondheid vir alle Suid-
Afrikaners afhang van resiprokale verwysingsisteme tussen
gesondheidsorgeenhede en -vlakke. Suksesvolle Primêre Gesondheidsorg
vereis bekostigbaarheid, toepaslikheid en toeganklikheid. Die ondersoek
het vier gesondheidsorgvlakke aan die lig gebring: tradisionele genesers,
gesondheids-nie-regerings-organisasies, klinieke en hospitale. Hoewel
daar 'n mate van onderfinge verwysing in die studie-area bestaan, was dit
nie wederkerig nie. Onder die vernaamste struikelblokke vir 'n doeltreffende
verwysingsisteem tel swak samewerking tussen gesondheidsinstellings,
gebrekkige gesondheidsinfrastruktuur en kommunikasienetwerk, en
'n skaarste aan ander gesondheidsmiddelle. Die ondersoek het ook bevind
dat regeringsbeleid aangaande sommige van die gesondheidsinstellings
(tradisionele genesers) bydra tot die ondoeltreffendheid van verwysings in
die studie-area.
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Medical therapeutic privilegeCoetzee, Lodewicus Charl 01 January 2002 (has links)
The therapeutic privilege is a defence in terms of which a doctor may withhold information from
a patient if disclosure of such information could harm the patient. This study explores the defence
of therapeutic privilege and provides a critical evaluation. A comparative investigation is
undertaken, while arguments springing from a variety of disciplines are also incorporated.
A number of submissions are made for limiting the ambit of the defence. The main submission
is that the therapeutic privilege should comply with all the requirements of the defence of
necessity. In addition, it should contain some of the safeguards afforded to the patient by the
requirements of the defence of negotiorum gestio so that therapeutic privilege is out of the
question if medical treatment is administered against the patient's will, or the doctor has reason
to believe (or knows) that the patient will refuse to undergo an intended intervention once
properly informed. / Jurisprudence / L.L.M. (Jurisprudence)
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An assessment of African traditional medicines in pregnancy and on birth outcomes: pharmacists' perceptions of complementary medicines in pregnancyMupfumira, Rudo January 2012 (has links)
Increasing numbers of medicines are being used by pregnant South African women in the public sector during pregnancy, for the treatment of different biomedical and supernatural disease states and conditions. The motivation for the research is to support the development of more local pregnancy registries in order to strengthen evidence for the safety and efficacy of medicines used in pregnancy. A mixed methods approach was used. Women in their ninth month of pregnancy in a public sector setting, and four community pharmacists were identified. The women who met the inclusion criteria were recruited. One in-depth semi-structured interview was conducted with each woman before giving birth and data on their pregnancy outcomes were collected after labour. Coincidentally, the mother of one of the participants was found to be a traditional healer. She was also interviewed on the topic. A structured questionnaire was administered to the pharmacists. Ten pregnant women between the ages of 19 to 39 who had used or were using a traditional medicine during the pregnancy were recruited. All the participants had had at least one antenatal check up during their pregnancy with one having attended five times. No abnormal results were reported from any of the check ups or tests done during the visits. All of them had been to school and had at least Standard 8/Grade 10 education. Ten babies were seen between one and four days postpartum and no birth defects were obvious or were reported for any of them. The traditional healer did not provide additional information to what the women had said and confirmed that some of the practices the women reported were known to her as traditional medicine practices. All four pharmacists indicated that they considered complementary and alternative medicines (CAMs) to be “somewhat effective” and sold them at their pharmacies although none of them were aware of whether or not they were registered with the MCC. None of the pharmacists appeared to have an in-depth knowledge of traditional, complementary and alternative medicines (TCAMs). All four pharmacists said that it is important to have a basic understanding of TCAMs before using them, although they did not agree on the reasons for this. All of them felt that pharmacists have a professional responsibility to provide information on TCAMs (especially herbal preparations) and two felt that providing this information is part of a medical doctors’ responsibility. No harm from taking TCAMs could be shown. However herbal medicines have numerous ingredients some of which are unknown and taking these medicines is risky. The pharmacists in this sample were unsure whether they were accessing unreliable CAM information. Reliable sources of information and reference materials on CAMs to assist pharmacists and other healthcare professionals are needed. The apparent widespread use of TCAM in pregnancy indicates a need for documentation about its efficacy and safety. The establishing of TCAM pregnancy registries should seriously be considered. Due to the increase in CAM use, CAM education during pharmacists’ training as well as continuing professional development (CPD) in CAM for pharmacists in practice should be encouraged.
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Regsvrae rondom die geneeskundige behandeling van ernstig gestremde pasgeborenesNel, Johannes Petrus 03 1900 (has links)
Law / LL.M.
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Inconsistency in judicial decisions : the right to life in perspectiveMoabelo, Kgorohlo Micro 02 1900 (has links)
The dissertation critically examines and compares the decisions of the
Constitutional Court and the High Courts in cases dealing with the right to life, as
contained in section 11 of the Constitution of South Africa Act 108 of 1996. The
dissertation analysis the issues of adjudication and the concept of justice in
perspective. The main question is as follows: Are the Constitutional Court
decisions objective, based on the interpretation of the constitutional text, or do they
rather reflect the individual judge(s) personal perspective(s) or preference(s).
The purpose of this dissertation is to undertake a comparative study and analysis
of the Constitutional Court decisions on the right to life, same aspect from different
perspective, and show that the right to life is not given proper effect to on account
of the subjective approach to its interpretation undertaken by the judges.
It examines and scrutinises the Constitutional Court’s adjudication process. It found
that the law is indeterminable, because the court’s decisions are not based on the
interpretation of the law, but on the individual judges’ background and personal
preferences. This is so because the court uses the majority rule principle in its
decisions: The perception of the majority of the judges becomes a decision of the
court. It is argued that when taking a decision a judge does not apply the law but
instead uses the law to justify his predetermined decision on the matter. The
conclusion supports the critical legal scholars’ theory relating to the indeterminacy
of the law. It tests the objectivity of the judges using their own previous decisions. / Criminal & Procedural Law / LLM
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