Thesis (MPhil)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: While most people acknowledge the dignity of fellow humans, atrocities that deny the dignity of people are rampant in our world. The ongoing ignorance and aberrations of the dignity of human beings in the world might mean that there is still not clarity on what respect for the dignity of others really mean, how it should be practiced and whether human dignity is an entitlement or a responsibility. Human dignity was not always bestowed to every individual. In ancient times dignity was reserved for the strongest individual in and later was extended to certain classes, groups and nations like the monarchy and clergy, the Egyptians and Romans. The Renaissance brought a new consciousness of the worth of man. But despite this awareness, and the advent of a human rights culture as is found in the writings of modem philosophers like John Locke, Jean-Jacques Rousseau and Immanuel Kant, who all support the notion of human dignity, liberty and human rights, gross human rights violations still took place during the twentieth century. Stalin used the Russian people to create a successful socialistic state; Hitler exterminated all those who obstructed his ideal of creating a pure Aryan race, while Verwoerd legalized racial discrimination in South Africa and Namibia. As a result of the atrocities in Europe, especially during World War II, The United Nations was established with the aim to oversee and address human rights violations in the world. Human rights and respect for human dignity are included in the Bill of rights of the Constitutions of America, South Africa and Namibia. Health care providers acknowledge the rights of patients by respect for the autonomy of patients. Patients are autonomous persons and health care providers enable patients to take autonomous action. Autonomous action means that a patient will act with understanding, intention and without coercion. Paternalism is only justified when it serves to protect the patient or protect the rights of others. Health care providers practice autonomy by facilitating informed consent, by providing truthful information, by upholding confidentiality, to protect privacy of patients and to treat patients with respect. There is little uncertainty that people can claim the right to human dignity because persons have intrinsic worth as unique beings that are irreplaceable and exist as an end in themselves. Holy Scripture confirms that humans are created in the image of God. International human rights instruments and national constitutions provide people with the statutory right to human dignity and enable people to legally claim this right. But human dignity is also a responsibility because claiming a right has a reciprocal obligation on others not to violate the claimed right, but also requires from persons to value their own lives. Over reliance on science and rational thinking may negate human dignity because scientists do not always consider the needs of persons. The examples of world leaders like Gandhi, King and Mandela have also shown that one can earn human dignity through respectful conduct towards others. Protagoras of Abdera was aware of human worthiness as right and responsibility as long back as the fifth century Be, and this awareness still exists today. / AFRIKAANSE OPSOMMING: Ten spyte daarvan dat meeste mense die menswaardigheid van ander erken, misken gruweldade in die wereld steeds die waardigheid van baie mense. Die miskenning van menswaardigheid mag beteken dat daar steeds onduidelikheid is oor wat respek vir die menswaardigheid van ander werklik beteken, hoe dit gepraktiseer moet word en of menswaardigheid 'n reg of 'n verantwoordelikheid is. Menswaardigheid was nie altyd aan alle persone verleen nie. In die antieke beskawing was menswaardigheid grootliks gereserveer vir die sterker persone, en later vir sekere klasse, groepe en nasies, soos die monargie en geestelikes, die Egiptenare en Romeine. Die Renaissance het 'n nuwe bewuswording van menswaardigheid gebring. Maar ten spyte van hierdie bewuswording en die koms van die menseregtekultuur is die werk van moderne filosowe soos John Locke, Jean-Jacques Rousseau en Immanuel Kant, wat almal die gedagte van menswaardigheid, vryheid en menseragte ondersteun, het gruwellike menseregte skendings steeds plaasgevind gedurende die twintigste eeu. Stalin het die Russiese volk gebruik om 'n suksesvolle sosialistiese staat te skep, Hitler het probeer om almal wat sy ideaal bedreig het om 'n egte nie-Joodse Kaukasiese nasie te skep, te vermoor, terwyl Verwoerd rassediskriminasie gewettig het in Suid-Afrika en Namibië. As gevolg van die gruweldade in Europa, veral gedurende die Tweede Wereldoorlog, het die Verenigde Nasies tot stand gekom om die menseregteskendings in die wereld te monitor en aan te spreek. Die Konstitusies van Amerika, Suid-Afrika en Namibië, erken menseregte en die respek vir menswaardigheid. Ook in gesondheidsorg word die regte van die pasiënt beskerm deur die beginsel van respek vir die outonomie van pasiënte. Pasiënte is outonome persone en gesondheidsorg werkers maak dit moontlik vir pasiënte om outonome handelinge uit te voer. Outonome handelinge beteken dat die pasiënt sal handel met intensie en sonder dwang en dat die handeling ten volle verstaan word. Paternalisme is alleen geregverdig wanneer dit die regte van die pasiënt of ander persone beskerm. Gesondheidsorg werkers fasiliteer outonomie van pasiënte deur ingeligte toestemming te verkry, pasiënte nie te mislei nie, vertroulikheid te handhaaf, privaatheid van die pasiënt te verseker en deur pasiënte te respekteer. Daar is min onsekerheid dat persone op die reg tot menswaardigheid kan aanspraak maak want mense het inherente waarde as mense wat nie vervang kan word nie en wat in hulself 'n bestaansdoel het. Die Skrif bevestig dat die mens na die beeld van God geskape is. Internasionale menseregte instrumente en nasionale konstitusies maak voorsiening vir die wettige reg tot menswaardigheid en maak dit vir mense moontlik om wettiglik op hierdie reg aanspraak te maak. Mense het egter nie net 'n reg tot menswaardigheid nie maar ook 'n verantwoordelikheid. Aanspraak op 'n reg tot menswaardigheid impliseer 'n wedersydse verantwoordelikheid dat ander die reg nie mag skend nie, maar vereis ook die verantwoordelikheid dat persone waarde aan hul eie lewens sal heg. Oorwaardering van die wetenskap en rasionaliteit mag ook menswaardigheid ontken, omdat menslike behoeftes nie altyd in ag geneem word deur wetenskaplikes nie. Voorbeelde van wêreldleiers soos Gandhi, King en Mandela bewys dat menswaardigheid ook verwerf kan word deur ander respekvol te behandel. Protagoras of Abdera was reeds in die vyfde eeu voor Christus bewus van menswaardigheid as reg en verantwoordelikheid, en hierdie bewussyn is steeds geldig vandag.

Thesis (MPhil)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: This thesis looks at poverty in the Third World and tries per implication to understand how the economy functions. Finally it suggests solutions for the poverty problem. The first chapter looks at the definition of poverty and why this subject is important to study. It also mentions that there are two ways to look at the poverty problem. The first is the structural thesis and the second the modernisation thesis. The second chapter looks at what the economy is and how it functions. It is emphasised that the economy should be considered to be a complex ecosystem and not a mechanical machine. The third chapter points out that there was a change in focus in the passed 50 years. Now education and information have become much more important. This change is known as postmodernism or globalisation and resulted in the decline of the power of the state. The economic success of countries like the USA, Britain, Japan and Germany is considered in the fourth chapter. The following factors are considered: • The geographic location of a region includes phenomena like the rainfall, natural disasters and mineral wealth. • Historical factors like colonial oppression and the self image of groups. • Diseases and nutrition which makes individuals less productive. • Cultural factors like self-discipline, diligence and an over emphasis of the supernatural • Property rights • Communalism and social capital • State intervention • Technology which makes it possible to produce more with less This chapter also looks at how these different factors interact together and makes the functioning of the complex economic system possible. In the fifth chapter we look at possible solutions for the poverty problem. It is pointed out that the “annexation of the means of production” is no solution. The ignoring of the problem is also rejected as no solution. The renewal of people’s mind is put forward as the solution. The last chapter has a look at the conclusions of the thesis. / AFRIKAANSE OPSOMMING: Hierdie verhandeling poog om na die armoede in Derde Wêreld lande te kyk en dan per implikasie te verstaan hoe die ekonomie funksioneer en dan oplossings voor te stel. Die eerste hoofstuk kyk na wat die definisie van armoede is en hoekom dit belangrik is om na hierdie probleem te kyk. Dit wys ook daarop dat daar twee maniere is om na die armoede vraagstuk te kyk, naamlik die strukturele tesis en die modernisasie tesis. Die tweede hoofstuk kyk na wat die ekonomie is en hoe die ekonomie funksioneer. Daar word daarop gewys dat die ekonomie as ’n komplekse ekostelsel beskou moet word en nie as ’n meganistiese masjien nie. Die derde hoofstuk wys daarop dat daar die afgelope 50 jaar ’n klemverskuiwing in die wêreld plaasgevind het waar onderwys en inligting baie belangriker geword het. Hierdie tendens word postmodernisme of globalisering genoem en het onder andere daartoe gelei dat die staat se mag ingeperk is. In die vierde hoofstuk word na die ekonomiese sukses van lande soos die VSA, Brittanje, Japan en Duitsland gekyk. Daar word na die volgende faktore gekyk: • Die geografiese ligging van ’n gebied omsluit verskynsels soos reënval, natuurlike rampe en minerale rykdomme • Historiesefaktore soos koloniale onderdrukking en groepe se selfbeeld • Siektes en voeding wat mense minder produktief maak • Kultuurfaktore soos selfdissipline, hardwerkendheid en oorbeklemtoning van die bonatuurlike • Eiendomsreg • Kommunialisme en sosiale kapitaal • Staatsinmenging • Tegnologie wat dit moontlik maak om met minder meer te produseer Daar word ook in hierdie hoofstuk gekyk hoe hierdie verskillende faktore op mekaar inwerk om saam te werk om die komplekse ekonomiese stelsel te laat funksioneer. Ons kyk in die vyfde hoofstuk na moontlike oplossings vir die armoede vraagstuk. Daar word uitgewys dat “die anneksasie van die produksiemiddele en die herverdeling van rykdom” nie die oplossing is nie. Die ignorering van die probleem word ook afgewys. Die oplossing word voorgehou as die hernuwing van die denke van mense. In die laaste hoofstuk word die gevolgtrekking van hierdie verhandeling voorgehou.

Thesis (MPhil (Philosophy))--University of Stellenbosch, 1999. / The hunters and anti-hunting have been arguing for years over whether or not trophy hunting should be allowed. While attempts have been made to resolve the issue, no widely acceptable solution has yet been found. Hunters have put forward various arguments including: religion, instinct, sustainable utilization, money, excessive populations and the wildlife management support argument. These have usually been criticized for being management orientate and not addressing the focal question of the anti-hunters: 'What gives man the right to hunt'. Anti-hunters have countered these arguments and presented new ones. These include: cruelty, animal rights, animal liberation, special and rare species as well as religion and wildlife management support arguments. The anti-hunters have used sympathy and emotion to gain support for their movement while making effective use of the media. Hunters on the other hand have been slow to make use of this communication tool. In presenting their arguments, a fundamental difference has been identified between the use of the various terms. The seemingly simple word 'ethics' has been used by the hunters to mean a code of conduct while the anti-hunters have used this word in indicate the morality of man's actions. The inherent value of an animal has also been debated. Does an animal have value in and of itself or does it only have value in that it is useful to man? Furthermore, is it the individual animal, the species or the population which has value? The value of wildlife as a natural resource and the right to use this resource is also discussed. Do developed countries have the right to determine the use that a developing country may make of its resources? Leopold's land ethics is discussed an it is shown how hunting preserves the integrity, stability and beauty of the biotic community. In order to address the issues raised by the debate, it is necessary for the hunters and the anti-hunters to be willing to work towards common goals. It is unlikely that either side would ever be willing to give up their position but if they can agree to work towards some common goals, the long on-going debate would have achieved something. For this reason, four solution to this debate are looked at and analyzed. Their weakness and failures are discussed as well as their strong points. Taylor's Priority Principles are then analyzed to identify the first steps that need to be taken in draWing up guidelines for hunting. While this assignment does not attempt to identify these guidelines it does point out the need to have such guidelines and establishes that there can be common ground. Also, that it is desirable to achieve this aim. The assignment highlights the need for groups to work towards common goals without having to give up their beliefs and standpoints. There will be time later to determine whether or not man should hunt. In the meantime, man should be focussing on hunting ethically - both in the moral sense and within the framework of a good code of conduct.

Assignment (MPhil)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: This study was undertaken to evaluate whether a mentally competent mature human being, who is suffering an intolerable, irremediable existence resulting from an incurable agonising or devastating paralysing disease; has a moral, personal and civic right to end that life or have it ended by requesting assistance in meeting death in a humane, compassionate and dignified manner. ~ The righteousness of such assistance can only be gauged if it follows the repeated and voluntary request of someone who is presently not suffering from any psychiatric disorder, is presently mentally competent or had made such a written or verbal witnessed advance directive while mentally competent to do so. ~ This study will not deal with assistance in dying either active or passive which is performed on severely mentally and physically handicapped new-born babies with scant prospect of survival; nor with euthanasia for the relief of malignant or paralysing disease in those with life-long [anoxic, congenital, inflammatory or traumatic] mental incompetencies who have never had decision-making capacity. ~ This study will not address issues of aid-in-dying for mentally incompetent persons suffering from senile dementia, Alzheimer's disease, or permanent vegetative states due to brain pathology following anoxic, circulatory, infective, malignant or traumatic events, who have not made advance directives and who had never stated preferences concerning assisted euthanasia. The aim of this study is to outline the moral case advanced by those in favour of legalising Voluntary Assisted Euthanasia [VAE] also called Assisted Euthanasia [AE] and to develop ethically sound and practical proposals for policy and actions contributing towards the resolution of the moral dilemma faced daily by doctors when asked by mentally competent patients suffering from irremediable malignant or paralysing diseases or the agonising symptoms of end-stage Acquired Immune Deficiency Syndrome (AIDS) for assistance to end their lives. }ii> This study will cover and discuss the more important objections of those opposed to the legalising of assisted suicide for mentally-competent terminal patients who are irremediably suffering in their bodies or from dehumanising incurable endstage paralysing diseases and are near to an inevitable death. }ii> The insights of philosophers, theologians, physicians and sociologists on the subject of suicide and aid-in-dying, have been researched in the extensive literature that exists (both in print and in cyberspace) on these subjects and are presented with the study. }ii> The study tries to show that a competent adult in certain grim circumstances should have an inalienable human right, if not a constitutional one, to request assisted euthanasia or aid-in-dying or assistance in ending their lives. }ii> Such assistance must be subject to peer review, after careful assessment by a multidisciplinary team in the healing [both physical and spiritual] professions This paper will try to determine whether the actionalisation of voluntary assisted suicide or assisted euthanasia is murder or an act of compassion and empathy performed out of respect for a fellow human being's autonomy and in deference to their right to self-determination and self-realisation. ~ The relevance of this situation is that aid-in-dying is becoming one of the major, moral, religious, philosophical and bio-medical dilemmas at this time. ~ The author's position is that it is neither just nor ethical to prevent a mentallycompetent human being, who is tormented by agonising, incurable terminal physical or irremediable paralysing disease, from deciding to chose to die when he/she can no longer bear the torment and asking for professional assistance to effect this. This relief should be given not only to those who are able to make an enduring, informed contemporaneous decision, but also to those who [when they still had decision-making capacity] had previously made a considered informed advance directive about the use of ordinary and extraordinary medical methods of sustaining a life that had become merely an existence. / AFRIKAANSE OPSOMMING: Die studie is onderneem om te evalueer of 'n bevoegde, volwasse mens wat 'n onverduurbare en ongeneesbare bestaan het a.g.v. 'n ongeneesbare, folterende of vernietigende siekte, 'n morele, persoonlike of burgerlike reg het om daardie lewe te beeïndig of hulp te vra om dit te laat beeïndig, ten einde die dood op 'n menswaardige wyse tegemoet te gaan. ~ Die regverdigbaarheid van bogenoemde hulp kan slegs bepaal word as dit volg op die herhaalde en vrywillige versoeke van iemand wat nie, wanneer hy/sy dit versoek, ly aan 'n geestessiekte nie, wat bevoeg is of wat so 'n geskrewe of mondelinge versoek, met getuies, gemaak het terwyl die persoon kompetent was. ~ Die studie handel nie oor bystand-in-sterfte, aktief of passief, waar dit uitgevoer word op fisies of psigies ernstig gestremde pasgebore babas met 'n skrale kans op oorlewing nie; ook nie oor genadedood ter verligting van kwaadaardige of verlammende siekte in diegene met lewenslange [anoksiese, kongenitale, inflammatoriese of traumatiese] geestelike ongesteldhede, wat nog nooit besluitnemende kapasiteit gehad het nie. ~ Die studie ondersoek nie gevalle van bystand-met-sterfte waar inkompetente persone wat ly aan seniliteit, Alzheimer se siekte, of permanente vegetatiewe toestande a.g.v. brein patologie n.a.v. anoksiese, sirkulatoriese, infektiewe, kwaadaardige of traumatiese gebeure, nie direk gevra het vir genadedood of nooit die voorkeur vir geassisteerde genadedood uitgespreek het nie. Die doel van hierdie studie is om die morele saak van diegene ten gunste van die wettiging van Vrywillige Geassisteerde Genadedood, ook bekend as Geassisteerde Genadedood, te stel en om praktiese sowel as eties verantwoordbare voorstelle te maak vir beleid en optrede wat kan bydra tot die oplos van die morele dilemma wat dokters daagliks in die gesig staar wanneer hulle deur geestelik bevoegde pasiënte wat ly aan ongeneesbare, kwaadaardige of verlammende siektes, of die folterende simptome van die finale stadium van Verworwe Immuniteits Gebrek Sindroom [VIGS], gevra word vir bystand in die beeïndiging van hulle lewens. ~ Die studie sal die belangriker besware van diegene aanspreek wat teen die wettiging is van geassisteerde genadedood vir geestelik bevoegde terminale pasiënte wat ongeneesbaar ly of van dehumaniserende ongeneesbare finale stadium siektes en wat naby is aan 'n onafwendbare dood. ~ Die insigte van filosowe, teoloë, dokters en sosioloë oor bystand-met-sterfte en selfmoord, is nagevors in die wye literatuur beskikbaar is (beide in druk en kuberruimte) oor hierdie onderwerpe en word saam met die studie angebied. ~ Die studie probeer aantoon dat 'n bevoegde volwassene in sekere erge omstandighede 'n onvervreembare mensereg, indien nie 'n konstitusionele reg nie, behoort te hê om bystand tydens genadedood te versoek. ~ Sulke bystand moet onderworpe wees aan groepsevaluasie, na versigtige ondersoek deur 'n multi-dissiplinêre span in die gesondheidsprofessies [beide fisies en psigies]. Die studie sal probeer bepaal of die uitvoering van vrywillige geassisteerde selfmoord of geassisteerde genadedood moord is, of 'n aksie van empatie, uitgevoer uit respek vir 'n medemens se outonomie, sy/haar reg tot selfdeterminasie en self-realisasie. )lo- Die relevansie van hierdie situasie lê daarin dat bystand-met-sterfte besig is om een van die belangrikste morele, religieuse, filosofiese en biomediese dilemmas van ons tyd te word. )lo- Die outeur se posisie is dat dit nie regverdig of eties is om te verhoed dat 'n geestelik bevoegde mens, wat ly aan folterende, ongeneesbare terminale fisiese of ongeneesbare verlammende siekte, self kies om te sterf wanneer hy/sy nie meer die lyding kan verdra nie en vir professionele bystand vra om dit uit te voer. Die verligting behoort gegee te word, nie net aan diegene wat in staat is om 'n bindende en ingeligte besluit te maak nie, maar ook aan -diegene wat [toe hulle nog besluitnemende kapasitiet gehad het] vroeër 'n oorweegde, ingeligte vroegtydige versoek gemaak het aangaande die gebruik van gewone en buitengewone mediese metodes vir die verlenging van 'n lewe wat bloot 'n bestaan geword het.

Thesis (M.A.)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: This paper examines aspects of power within the physicianpatient relationship. The historical development of the physician-patient relationship is briefly reviewed and some of the complexities of the relationship highlighted. It is shown that, historically, there is no imperative for the physician to consider only the interests of the patient and it has always been acceptable to consider the interests of a third party, such as the State or an employer - essentially the interests of whoever is paying the physician. The classical sources of power are then considered. These sources include legitimate power, coercive power, information power, reward power, expert power, referent power, economic power, indirect power, associative power, group power, resource power and gender power. Other approaches to power are also considered such as principle-centred power as described by Covey, power relationships as explained by Foucault, the power experience as described by McClelland and an analysis of power as expounded by Morriss. The various sources of power are then considered specifically within the physician-patient relationship to determine: if this particular type of power is operative in the physicianpatient relationship, and if so if it operates primarily to the advantage of the physician or the advantage of the patient. A simple method of quantifying power is proposed. Each form of power operative in the physician-patient relationship is then considered and graphically depicted in the form of a bar chart. Each form of power is shown as a bar and bars are added to the chart to 'build up' an argument which demonstrates the extent of the power disparity between physician and patient. It is clearly demonstrated that all forms of power operate to the advantage of the physician and in those rare circumstances where the patient is able to mobilize power to his/her advantage, the physician quickly calls on other sources of power to re-establish the usual, comfortable, power distance. Forms of abuse of power are mentioned. Finally, the ethical consequences of the power disparity are briefly considered. Concern is expressed that the power disparity exists at all but this is offset by the apparent need for society to empower physicians. Conversely, consideration is given to various societal developments which are intended to disempower physicians, particularly at the level of the general practitioner. Various suggestions are made as to how the power relationships will develop in future with or without conscious effort by the profession to change the relationship. / AFRIKAANSE OPSOMMING: Hierdie voordrag ondersoek aspekte van mag in die verwantskap tussen pasiënt en geneesheer. Die historiese ontwikkeling van die verwantskap word kortliks hersien en 'n kort beskrywing van die ingewikkeldheid van die verwantskap word uitgelig. Vanuit 'n historiese oogpunt, word 'n geneesheer nie verplig om alleenlik na die belange van die pasiënt om te sien nie en was dit nog altyd aanvaarbaar om die belange van 'n derde party soos die Staat of 'n werkgewer se belange to oorweeg - hoofsaaklik die belange van wie ookal die geneesheer moet betaal. Die tradisionele bronne van mag word oorweeg. Hierdie bronne sluit in: wetlike mag of 'gesag', die mag om te kan dwing, inligtingsmag, vergoedingsmag, deskundigheidsmag, verwysingsmag, ekonomiesemag, indirektemag, vereeningingsmag, groepsmag, bronnemag en gelslagsmag. Alternatiewe benaderings word ook voorgelê, naamlik die beginsel van etiese mag soos deur Covey beskryf, krag in menslike verhoudings soos deur Foucault, die ondervinding van krag soos beskryf deur McClelland en 'n ontleding van krag soos deur Morriss verduidelik. Hierdie verskillende mag/gesagsbronne word spesifiek met betrekking tot die geneesheer-pasiënt verhouding uiteengesit om te besluit: of hierdie tipe mag aktief is tussen geneesheer en pasiënt, en indien wel, werk dit tot die voordeel van die geneesheer of die pasiënt. 'n Eenvoudige sisteem vir die meting van mag/gesag word voorgestel. Die bronne word individueeloorweeg en gemeet en die resultaat in 'n grafiese voorstelling voorgelê op so 'n wyse dat 'n argument daardeur 'opgebou' word om die verskille van van mag/gesag tussen geneesheer en pasiënt uit te wys. Dit word duidelik uiteengesit dat alle vorms van mag/gesag ten gunste van die geneesheer werk. Kommer is getoon dat hierdie magsverskil werklik bestaan, asook die snaakse teenstelling dat die gemeenskap wil eintlik die geneesheer in "n magsposiesie plaas. Die etiese gevolge van hierdie ongebalanseerde verwantskap, asook die moontlikheid van wangebruik van hierdie mag word ook genoem. Verskillende gemeenskaplike ontwikkelinge wat die mag van die geneesheer wil wegneem word geidentifiseer, meestalop die vlak van die algmene praktisyn. Verskeie voorstelle vir toekomstige ontwikkeling van die verwantskap word voorgelê, met of sonder spesifieke pogings van die professie om die verwantskap te verbeter.

Thesis (MPhil)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: We live in a complex world. We have questions and face problems that defy conventional reductionist approaches to finding answers and solutions. This is because we find ourselves dealing with complex systems that are dynamic, self-organizing and adaptive, while maintaining a balance between static order and chaotic change. The Earth, or Gaia, is such a system. So is the biosphere, and so is an ecosystem, an economy, a business and any living organism, including homo sapiens. By concentrating on the connections and interactions between entities, and not things in themselves, complexity research is enabling us to grasp a better understanding of the spontaneous, self-organizing dynamics of our world. Complexity studies can have an enormous impact on the conduct of economics, business and politics. This thesis describes the characteristics of complex systems, analyzes the Earth and its evolutionary story as a complex adaptive system, discusses how we can harness complexity, and how through cooperating and caring we can survive and even prosper in the world of today. A pluralistic moral 'world vision' is argued for, founded on an ethics of universal compassion for all living things, that can lead to responsible and pragmatic action. As human beings, if 'He are to uplift the poor and restore and preserve the ecology of the Earth, what will be required is a major transformation of our environmentally destructive world economy into one that can sustain progress and human flourishing. This will entail a change of mind and heart, a sense of global interdependence and universal responsibility. The challenges we face are immense. However, there are encouraging signs that worldwide people are becoming increasingly aware of what is called for. More and more people are showing their willingness to rise to the occasion. It is a time of transition. It is complex, daunting, yet exciting. / AFRIKAANSE OPSOMMING: Ons leef in 'n komplekse wêreld waarin ons gekonfronteer word met vrae en probleme wat nie beantwoord of opgelos kan word deur middel van die gebruiklike reduksionistiese benaderings nie. Die rede hiervoor is dat ons te make het met komplekse sisteme wat dinamies, selforganiserend en selfaanpassend is, terwyl dit tegelykertyd 'n balans handhaaf tussen statiese orde en chaotiese verandering. Die aarde, of Gaia, is so 'n sisteem. Ook die biosfeer, 'n ekosisteem, 'n ekonomie, 'n besigheid en enige lewende organisme, insluitend homo sapiens, konstitueer komplekse sisteme. Daarom kan kompleksiteitsnavorsing, wat klem lê op die verbande en interaksies tussen entiteite, eerder as op die entiteite self, dit vir ons moontlik maak om die spontane en selforganiserende dinamiek van ons wêreld beter te begryp. Kompleksiteitstudies kan dan ook 'n enorme impak hê op die manier waarop ekonomie, besigheid en politiek beoefen word. Hierdie tesis beskryf die eienskappe van komplekse sisteme, en analiseer die Aarde en haar evolusionêre verhaal as 'n komplekse, selfaanpassende sisteem. Verder bespreek dit ook hoe kompleksiteit ontgin kan word, en hoe ons deur samewerking en sorg kan oorleef en selfs floreer in die wêreld van vandag. Op grond van 'n etiek van universele medelye met alle lewende dinge word 'n pleidooi gelewer vir 'n pluralistiese morele "wêreldvisie" wat kan lei tot verantwoordelike en pragmatiese optrede. Wat egter vereis word indien ons, as mense, armoede wilophef en die ekologie van die aarde wil herstel en handhaaf, is 'n daadwerklike transformasie van ons omgewingsvernietigende wêreldekonomie in die rigting van 'n ekonomie wat vooruitgang en menslike florering kan onderhou. So 'n transformasie sal 'n verandering van denke en ingesteldheid vereis, asook 'n sin vir globale interafhanklikheid en universele verantwoordelikheid. Dit is duidelik dat die uitdagings wat ons moet trotseer kolossaal is. Daar is egter bemoedigende tekens wêreldwyd wat aandui dat mense toenemend begin bewus raak van wat vereis word. Meer en meer mense toon hul bereidwilligheid om die situasie die hoof te bied. Dit is 'n tyd van verandering. Dit is 'n komplekse en angswekkende tyd, maar uiteindelik tog ook 'n opwindende tyd.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The dehumanising of human beings which often underpins western medicine lead to this study. Moreover a predominant mechanistic and reductionist view of a human being necessitated a philosophical investigation to revisit the stance. It is argued that western medicine is based upon uncritical assumptions about humans as a result of the dualism and mechanistic views of Descartes. The philosophy of Merleau-Ponty transcended dualism by his emphasis on the bodylines of a human being situated in his life world. Complexity thinking concurs with the above-mentioned view, however, takes the argument further by focusing on the importance of continuous interactions and relations between the whole and the parts. Interdependent aspects of our being in the world constitute our humanness, such as our human relations between family members, friends, that which we experience, ponder, feel, and believe. Our unique experience of disease often goes hand in hand with a deep-seated sub-conscious longing for meaning. According to complexity theory being ill is not a static condition, but rather an imbalance as a result of various dynamic interactions between many spheres of human life. Multiple causality due to various dynamic interactions and self-organisation should replace simplistic views of mechanical cause and effect in this regard. Medical training models should not employ reductionism as if humans are machines comprising of separate body parts. An organic view of the uniqueness of each evolving human being should replace obsolete reductionist and mechanistic views of healing.The essence of being human is embedded in a tapestry of dynamic relations. / AFRIKAANSE OPSOMMING: Die dehumanisering van die mens in hedendaagse westerse geneeskunde het aanleiding gegee tot hierdie studie. Verder het die meganistiese, reduksionistiese mensbeeld ‘n filosofiese herbesinning genoodsaak. Daar word geargumenteer dat westerse geneeskunde gebaseer is op onkritiese aannames afkomstig van onder andere Descartes se dualistiese antropologie en die meganistiese siening van die mens. Merleau-Ponty se wysgerige antropologie het die dualisme getransendeer deur sy filosofie van die mens as liggaamlikheid gesitueerd in sy leefwêreld. Kompleksiteitsdenke stem hiermee ooreen, maar voer die argument verder in die opsig dat dit die belangrikheid van relasies en voortdurende wisselwerking tussen die geheel en dele beklemtoon. Interafhanklike aspekte van dit wat ons mens maak, ontstaan as gevolg van relasies tussen ons leefwêreld, ons familie, vriende, tussen dit waaraan ons dink, wat ons voel, ervaar en glo. Ons siekte ervaring gaan meestal gepaard met ‘n diepgewortelde voorbewustelike soeke na sin en betekenis. Die kompleksiteitsperspektief beskou siekwees nie as ‘n statiese toestand wat teenoor gesondwees staan nie, maar eerder ‘n wanbalans in dinamiese interaksies van verskeie sfere van menswees. Enkelvoudige kousaal-meganiese oorsaak en gevolg moet plek maak vir veelvuldige kousaliteit wat geleë is in talle dinamiese interaksies en selforganisering. Mediese opleidingsmodelle behoort die mens nie te objektiveer tot aparte organe, soos die van ‘n masjien nie. Die verontmensliking van die masjien gedrewe model van genesing behoort plek te maak vir ‘n meer organiese siening van die mens wat rekening hou met die unieke menslikheid van die mens. Menslikheid impliseer ‘n tapisserie van relasies.

Thesis (MPhil)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: On entry to medical school, students are confronted with a worldview that can be typified as materialistic monism. The student progressively becomes a materialistic monist, not only because of the teaching, but also because medical schools fail to address the question of suffering. One would expect the biopsychosocial model to surmount the limitations of the biomedical model, but it in itself has to deal with both suffering and materialistic monism. Suffering cements the collapse into materialistic monism in the way the student practises medicine. What life strategies would transcend this materialistic monism? This thesis examines potential educational interventions that might help the student to analyse the philosophy of medical school and find ways of dealing with the question of suffering. / AFRIKAANSE OPSOMMING: Met toelating tot mediese skool word studente gekonfronteer met ’n wêreldsiening wat as materialistiese monisme beskryf kan word. Die student verander progressief in ’n materialistiese monis, nie slegs as gevolg van die onderrig nie, maar ook omdat mediese skole nie daarin slaag om die kwessie van lyding aan te spreek nie. ’n Mens sou verwag dat die biopsigies-sosiale model die beperkinge van die biomediese model sou oorkom, maar instede moet dit self beide lyding en materialistiese monisme aanspreek. Lyding moedig die verval in materialistiese monisme in die wyse waarop die student geneeskunde beoefen aan. Watter soort lewensstrategieë is nodig om hierdie materialistiese monisme te transendeer? Hierdie tesis ondersoek die opvoedkundige intervensies wat die student kan help om die mediese skool se filosofie te analiseer en wyses te vind om die kwessie van lyding te hanteer.

Thesis (MPhil (Philosophy))--University of Stellenbosch, 2009. / ABSTRACT: The European Enlightenment secured man’s freedom from doctrinal thought. Scientific progress and technological innovation flourished in the 18th Century, radically changing the lives of all. Man’s mastery and transformation of his environment was matched by revolutionary political reform, resulting in the dissolution of empire and the transfer of power into the hands of the people. Social transformation saw the city-states of pre-modern man supplanted by a globalized community whose existence grew from time and space distantiation facilitated by the new technologies and the development of symbolic forms. These sweeping social, political and ideological changes of the 18th Century fostered the belief that man’s transformative authority was indeed his to command. Man believed he had a right to self-governance and to autonomous decision-making. Kant described moral autonomy as the freedom men have to show rational accountability for their actions and he saw in men a dignity beyond all price because of this moral autonomy. Personal autonomy is seen as the expression of the free will of individuals and is justifiably constrained by the need to respect the interests and agency of others. The principle of autonomy, in the context of medical practice, was not clearly articulated until the early 20th century. Prior to this, the ethical practice of medicine relied upon the beneficent intentions of the practitioners. The limits to patient autonomy have been delineated largely by issues of social justice based upon the need to share scarce resources fairly among members of society. However, autonomy remains a dominant principle and is most clearly exemplified by the process of informed consent obtained prior to any medical intervention. This thesis provides a conceptual analysis of autonomy in the context of informed consent. Following this, several different clinical scenarios are examined for evidence of justifiable limitations to patient autonomy. Each scenario is examined in the light of different moral theories including deontology, utilitarianism, communitarianism and principlist ethical reasoning. Kantian ethical reasoning is found to be resilient in rejecting any limitation to the autonomy principle whereas each of the other theories allow greater scope for morally-justified curtailment of individual autonomy. The thesis concludes with reflection on post-modern society in which the radicalization of what began with the European Enlightenment sees the transformation of pre-modern society into a global community in which epistemological certainty is no longer available. In this environment, the emerging emphasis on global responsibility requires ethical accountability, not only when individuals secure transactions between one another but also between individuals and unknown communities of men and women of current and future generations. The thesis concludes that patient autonomy is justifiably limited in South African medical practice because of issues related to social justice but that the impact of the new genetic technologies and post-modernity itself may in future set new limits to individual patient autonomy. / OPSOMMING: Die Europese Verligting het die mensdom bevry van verstarde, dogmatiese denke. Wetenskaplike en tegnologiese ontwikkelinge het tydens the 18de Eeu die lewens van almal radikaal verander. Die mens se bemeestering en transformasie van sy omgewing het gepaard gegaan met revolusionêre politieke hervormings wat gelei het tot die ontbinding van tradisionele politieke ryke en die oordrag van mag aan die mens. Sosiale transformasie het veroorsaak dat die politieke ordeninge van voor-moderne mense deur ‘n globale gemeenskap vervang is wat ontstaan het as gevolg van onder meer die ontkoppeling van tyd en plek (Giddens), en wat deur nuwe tegnologiese ontwikkelings en die ontstaan van simboliese vorms moontlik gemaak is. Hierdie uitgebreide ontwikkelinge het die idee laat ontstaan dat niks vir die 18de Eeuse mens onmoontlik is nie. Die mens het geglo dat hy ‘n reg het op self-bestuur en outonome besluite. Kant het die morele outonomie van die mens beskou as sy vryheid om verantwoordlikheid te neem vir sy eie rasioneel-begronde handelinge en verder het hy ‘n besondere waardigheid in die mens geïdentifiseer vanweë sy morele outonomie. Omdat ‘n mens hierdie eienskap besit, beskik hy oor ‘n hoër waardigheid as alle alle ander lewensvorme. Persoonlike outonomie is die uitoefenimg van die vrye wil van die individu en word om geregverdigde redes beperk deur die regte van ander mense. Die beginsel van outonomie met verwysing na mediese etiek het nie voor die begin van die 20ste eeu prominent geword nie. Voor hierdie tyd het mediese etiek staatgemaak op die goeie voorneme van die praktisyn. Die grense van individuele outonomie word nou bepaal deur die noodsaak van sosiale geregtigheid. Al is dit die geval, bly die beginsel van outonomie die belangrikste beginsel in die etiese debat en word meestal gesien as ‘n deel van die proses van ingeligte toestemming. Hierdie tesis verskaf ‘n omvattende ontleding van outonomie met betrekking tot ingeligte toestemming. Daarna word verskillende kliniese gevalle beskryf en ontleed, en verskeie etiese teorieë gebruik om die wyse waarop pasiënt outonomie reverdigbaar ingekort behoort te word, te bespreek. Die teorie van Kant is in staat om enige inkorting van outonomie in alle gevalle the weerstaan. Elkeen van die ander teorieë verskaf redes waarom die outonomie van individuele pasiënte legitiem ingekort mag word. Hierdie werk sluit af met besinning oor die post-moderne gemeenskap wat ‘n globale samelewing moet aanvaar sowel as die ontoereikenheid van enige kenteoretiese sekerheid. Die ontwikkelende verantwoordelikheid vir die totale mensdom in hierdie wêreld veroorsaak dat individue nie meer slegs moet besluit oor die morele verhouding met sy medemens nie, maar ook oor sy verhouding met mense van gemeenskappe wat geskei is in tyd en ruimte, insluitend sy verhouding met die mense van toekomstige generasies. Hierdie werk sluit af met die gevolgtrekking dat pasiënt outonomie regverdigbaar beperk word in die Suid Afrikaanse mediese praktyk deur die noodsaaklikheid van sosiale geregtigheid. Die verwagte impak van nuwe genetiese tegnologieë en die ontwikkeling van ‘n post-moderne gemeenskap mag nuwe beperkings bring vir pasiënt outonomie.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: In efforts to combat the global HIV/AIDS pandemic, the WHO/UNAIDS published the Joint Strategic Action Framework to Accelerate the Scale-up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa which outlines the aim of a VMMC (voluntary medical male circumcision) prevalence of 80% among males 15-49 year old in 14 countries by 2016 (WHO/UNAIDS, 2011). In line with this directive, South Africa has launched a national VMMC campaign. However, a lot of ethical issues remain unaddressed surrounding VMMC. These can be categorised as individual considerations (autonomy and informed consent; non-maleficence and unintentional, unforeseen harm; risk compensation in circumcised men; risk of undermining current HIV prevention strategies; age of circumcision), community considerations (cultural considerations; justice: the gender divide and female subjugation; distributive justice; social stigmatisation as a result of VMMC), national considerations (adverse events and complications on a macro level; cost saving and unforeseen expenditure of VMMC; the implications of international funding for VMMC; the public health ethics of VMMC; risks of “de-medicalisation” of a surgical procedure; the ever present danger of corruption), global considerations (female genital mutilation; non-sexual HIV transmission; a dangerous shift in focus) and other considerations (a statistical perspective on VMMC; circumcision technique; lack of ethical awareness; dealing with medical uncertainty). Finally, I shall consider neonatal circumcision, which is in itself a contentious issue, and has no role to play in VMMC. The unresolved issues raised by these ethical considerations cast doubt on the moral status of VMMC and I conclude that the VMMC campaign as it stands in South Africa currently is morally indefensible. There is, undeniably, a pressing need for HIV/AIDS prevention strategies in South Africa and other developing countries but the role of circumcision has been overemphasised to the detriment of more holistic approaches. While there are no easy answers to any of the ethical dilemmas presented in this thesis, it is imperative to raise ethical awareness surrounding VMMC. / AFRIKAANSE OPSOMMING: In ‘n poging om die globale MIV/VIGS-pandemie te bekamp, het die WHO/UNAIDS in 2007 die Joint Strategic Action Framework to Accelerate the Scale-up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa gepubliseer wat ‘n aksie-plan is wat poog om ‘n voorkoms van VMMC (vrywillige mediese manlike besnyding) van 80% in 14 lande onder 15-49 jaar oue mans in 2016 (WHO/UNAIDS, 2011) te bewekstellig. In ooreenstemming met dié riglyn, het Suid-Afrika 'n nasionale VMMC veldtog geinnisiëer. Maar baie van die etiese kwessies verbonde aan VMMC is nie bevredigend aangespreek nie. Hierdie kwessies kan geklassifiseer word onder individuele oorwegings (outonomie en ingeligte toestemming; nie-kwaadwilligheid en onbedoelde, onvoorsiene skade; risiko vergoeding in mans wat besny is; VMMC ondermyn die huidige MIV-voorkoming strategieë; ouderdom van besnyding), gemeenskap oorwegings (kulturele oorwegings; geregtigheid: die oorweging van die geslag verdeel en vroulike onderdanigheid; distributiewe geregtigheid; sosiale stigmatisering as gevolg van VMMC), nasionale oorwegings (newe-effekte en komplikasies op 'n makro-vlak; kostebesparing en onvoorsiene uitgawes van VMMC; die implikasies van internasionale befondsing vir VMMC; die openbare gesondheid etiek van VMMC; risiko's van "de-medikalisering" van 'n chirurgiese procedure; die alomteenwoordige gevaar van korrupsie), globale oorwegings (vroulike genitale verminking; nie-seksuele oordrag van MIV; 'n gevaarlike verskuiwing in fokus) en ander oorwegings ('n statistiese perspektief op VMMC; besnyding tegniek; die gebrek aan bewustheid van hierdie etiese kwessies; die hantering van mediese onsekerheid) bespreek. Ten slotte, sal ek neonatale besnyding ondersoek, wat op sigself 'n omstrede kwessie is, en geen rol behoort te speel in VMMC nie. Die onopgeloste kwessies wat deur hierdie etiese oorwegings aan die lig gebring word veroorsaak twyfel oor die morele status van VMMC. Ek lei dus af dat die VMMC veldtog soos dit tans bestaan in Suid-Afrika moreel onverdedigbaar is. Daar is ongetwyfeld 'n dringende behoefte vir MIV/VIGS- voorkoming strategieë in Suid-Afrika en ander ontwikkelende lande, maar die rol van besnydenis word oorbeklemtoon ten koste van ‘n meer holistiese benadering. Hoewel daar geen maklike antwoorde op enige van die etiese dilemmas wat in hierdie skripsie verken is nie, is dit noodsaaklik dat etiese bewustheid rondom VMMC verhoog word.