Introduction

International humanitarian laws: Applicable to all or a privilege for some?

There is no denying the brutality raining down on Gaza. As death, destruction, starvation, disease and a catastrophic man-made humanitarian crisis are unconvincingly sold to society as norms of war, a lingering question that recurrently surfaces is whether international humanitarian laws are applicable to all or a privilege for some. The Global North, which prides itself on developing international benchmarks for human rights, has undeniably shown the world that its moral compass requires prompt scrutiny at the very least. It is the proverbial underdogs in the Global South who have positioned themselves firmly behind the very principles claimed to have been developed by players in the Global North, who are now holding them to account. This article outlines the current devastation occurring in Gaza, considering South Africa (SA)’s case at the International Court of Justice (ICJ) that resulted in a provisional measures order against Israel. It reflects on the application of specific international humanitarian laws, namely protecting healthcare, preserving nutrition and safeguarding children during times of conflict.

Navigating ethical challenges of integrating genomic medicine into clinical practice: Maximising beneficence in precision oncology

The era of genomic medicine has witnessed major developments over the last decade, especially in the field of cancer genetics. With the implementation of a new precision oncology scale for clinical actionability of molecular targets as proposed by the European Society of Medical Oncology in 2018, the utilisation of next-generation sequencing (NGS) technologies has become an integral part of cancer risk management. The clinical utility of therapy targeted to genomic alterations stretches beyond immunohistochemistry (IHC)-based personalised medicine, as demonstrated by significantly improved survival outcomes. Although all malignancies are currently treated according to tumour type and/or stage, the gene expression information obtained from IHC can be enriched by NGS to increase the precision of the therapeutic approach. The genetic basis for differences in patients’ response to therapy involves diverse signalling pathways, deficiency in the DNA double-strand break repair pathway, microsatellite instability and hypermutated tumour status. Maximising beneficence in this context is challenging as every situation is unique.

Examining the Mr Tsafendas enquiry trial: Current insights on forensic psychiatric assessment and ethics

Diagnosis of schizophrenia

Making a psychiatric diagnosis in a forensic setting has many challenges. One of these is an assessment of the mental state of the accused at the time of the offence, which is usually a retrospective assessment. This has a bearing on the criminal responsibility of the accused, including the retrospective nature of the mental state of the alleged offender at the time of the offence in question. Psychotic conditions are the mental disorders most often leading to a verdict of legal insanity.[5] To make a diagnosis of schizophrenia, the psychiatrist will use standardised diagnostic criteria, such as the criteria from the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases.

Organ donation after circulatory death – legal in South Africa and in alignment with Chapter 8 of the National Health Act and Regulations relating to organ and tissue donation.

Death is a medical occurrence that has social, legal, religious and cultural consequences requiring common clinical standards for its diagnosis and legal regulation. In cases of organ donation, it is legally and ethically required that the determination of death is independent of organ transplant teams who are considered to have a conflict of interest. Donation after circulatory death (DCD) refers to the recovery of organs for transplantation that occurs after the certification of death by circulatory criteria and not neurological criteria. In cases of circulatory death, the loss of neurological function is secondary to the complete loss of circulatory output. Given the time pressures of organ recovery in DCD, institutional and professional processes that guide DCD must be ethically and legally appropriate.

Clarifying the legal requirement for cross-border sharing of health data in POPIA: Recommendations on the draft Code of Conduct for Research

The transnational nature of health research and patient care makes cross-border data sharing inevitable. African researchers are increasingly realising the need to collaborate and are doing so among themselves, sharing resources including data. Intra-Africa collaborations and data exchange have increased, especially with the COVID-19 pandemic. The cross-border sharing of health data (and associated resources) for research purposes raises peculiar legal concerns, making it subject to specific regulations in various legal frameworks. Under the Protection of Personal Information Act 4 of 2013 (POPIA), there is an outright restriction on data transfer outside of South Africa (SA). Extra limitations are applicable if such data includes health data considered to be special personal information. Indeed, these restrictions are not intended to stifle scientific research or cross-border data sharing but rather, to ensure that personal data protection is not undermined when data is transferred to third countries with little or no protection.

Futility, communicating bad news and burnout in doctors and other health practitioners

Medical futility occurs when an intervention is performed that has little or no chance of success. Doctors might do this because of family and patient pressure, financial gain or other perceived benefits such as teaching new procedures to train doctors. Performing futile interventions is not only considered unethical and introduces unjustified risk to patients but also indicates burnout in healthcare workers. Futile interventions may also induce stress and depression in doctors who may withdraw from their colleagues, patients and families. It may seem easier to do something, however pointless, rather than dealing with admitting treatment has failed and taking the time to convince families of futility.  Ethically, the situation requires the balancing of several complex interactions that underlie the decision-making process preceding medical interventions. Essentially doctors are not required to provide futile treatment.

Accreditation

Health Professions Council of South Africa

MDB015/MPDP/038/208

3 Ethics

Certification

Attempts allowed: 2

70% pass rate





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South African Journal of Bioethics and Law - April 2024 Vol 17 No 1