South African Journal of Bioethics and Law - December 2023 Vol 16 No 3

Introduction

When sanctuaries of humanity turn into corridors of horror: The destruction of healthcare in Gaza

Nelson Mandela said, ‘The histories of our two peoples, Palestinian and South  African, correspond  in  such  painful  and  poignant  ways.’  In  South  Africa (SA), Apartheid  was  enforced  through  laws mandating ‘separateness’, based on race. This extended to limiting the movement of people of colour, prohibiting interracial marriage, restricting social and residential integration between racial groups, and  divisions  within educational facilities and healthcare systems. That Israel’s practices in occupied Palestinian territories mirror the gross discriminatory practices of the past apartheid regime in SA is no hidden secret. South Africans who have researched, reflected on and experienced issues in occupied Palestine draw a close comparison between the two regimes.

Gaza and international law: The global obligation to protect life and health

International humanitarian law can be described as the mother of human rights in conflict situations. It applies to both combatants in the conflict and civilians who are not participating, but bear the gravest consequences and loss in these conflicts. Much of international humanitarian law is contained in the four Geneva Conventions (1949) and their Additional Protocols adopted by nations worldwide.

The war on Gaza. A test of our humanity

The occupation of Palestine has been ongoing since the founding of the Zionist State of Israel in 1948. What followed over seven decades, is a carefully planned manifest of extermination, ethnic-cleansing and the displacement of the occupied indigenous populations of Palestine. There has been a series of major wars fought between 1948 – 2009. In the 2014 war, the death toll among Palestinians from the massive Israeli bombardments of the Gaza Strip created a humanitarian crisis. 

Is there a legal and ethical duty on doctors to inform patients of the likely co-payment costs should they be treated by practitioners who have contracted out of medical scheme rates?

Consider the following hypothetical situation: A female patient is admitted to a private hospital to undergo a mastectomy and breast reconstruction. The hospital informs her that the medical scheme will cover the admission – excluding a co-payment because the hospital is not on its approved list. It informs her of the amount of the hospital co-payment. The surgeons and anaesthetists  conducting  the  different  procedures  charge  three  times the medical aid rates. When the patient asks what the likely co-payments will be, she is informed by the doctors’ accounts section that they can only determine that after the procedures have been completed.  The  patient’s  medical  scheme  sends  the  patient  an  assessment form to complete and informs her that it cannot tell her the co-payments unless she completes the assessment form. The form requires her to fill in the costs of various ICD10 codes listed, which is impossible because the doctors’ accounts section did not provide the cost of each procedure. Further, she also does not know what the ICD 10 codes stand for.

Pragmatic ethical approaches to evangelising in the medical encounter

Since antiquity the practice of medicine has almost always been interwoven with religion. This relationship continued throughout the Middle Ages where treatises on the roles of religion and medicine were further explored. The physician, Sir William Moore, writing in 1642 in his treatise Religio Medici (the Religion of the Doctor), recorded that ‘there are infirmities, not only of the body but of the soule, which doe require the merciful hand of our abilities’. There is now a substantial body of literature reflecting positively on the association of faith with our patients’ abilities to cope with and recover from physical and mental illnesses.

A golden opportunity for South Africa to legislate on human heritable genome editing

With the Third International Summit on Human Genome Editing having  taken  place  in  March  2023,  it  is  time  to  take  stock  of  progress made with legislative efforts regarding this technology. One challenge is to develop legislation that is aligned with public opinion, but also fits within the boundaries of established legal rights in a given polity. Another challenge is political agenda-setting – human heritable genome editing (HHGE) must make it onto the legislative agenda. South Africa (SA) may currently be in an ideal position to successfully face both these challenges. Firstly, a deliberative public engagement on the governance of HHGE was conducted among South Africans, and the results were published recently.

Three to one – an ethicolegal outline of mitochondrial donation in the South African context

In 2015, the UK Parliament approved the clinical application of novel in vitro fertilisation (IVF) procedures, namely, ‘maternal spindle transfer’ and ‘pro-nuclear transfer’, otherwise known as mitochondrial donation or mitochondrial transfer.[1] These techniques require three gametes to produce a healthy embryo: two gametes from the intending parents and one gamete from a female donor. In May 2023, it was reported that the first UK baby had been born using mitochondrial donation treatment (MDT). However, the UK is not the only country to use this technique.

Collective responsibility during a cholera outbreak: The case of Hammanskraal

Cholera is a rapidly developing gastrointestinal infection primarily transmitted through the ingestion of contaminated food or water containing the bacterium Vibrio cholerae. This bacterium is responsible for causing acute diarrhoeal  symptoms  in  infected  individuals. Despite efforts to control its spread, cholera remains a significant global public health problem, often associated with social inequality and underdevelopment. Cholera affects approximately 3 - 5 million individuals globally each year, resulting in approximately 100 000 fatalities.