D Knapp van Bogaert

Post-birth Rituals: Ethics and the Law

Abstract Placental rituals and other birth-by rituals are common in various societies. These rituals often include culturally determined behavioural sequences which operate as anxiety-releasing mechanisms and they serve to offer a spiritual means of ‘control’ over the future health and welfare of mother, child, and even the community. As long as such rituals do not cause harm, they should be respected for the role that they play and be left alone. This article discusses ethical and legal considerations regarding post-birth rituals and its relevance to South Africa with special reference to the South African Human Tissue Act.

Voluntary active euthanasia: Is there a place for it in modern day medicine?

Abstract This article discusses various ethical and legal concepts regarding euthanasia and includes concepts like physician assisted suicide, assisted suicide, voluntary active euthanasia, killing vs. letting die, indirect euthanasia and terminal sedation. Is there a difference if death is only foreseen but not intended? This article opens up the debate and addresses pertinent issues for the family practitioner.

Is there a place for voluntary active euthanasia in modern-day medicine?

Abstract This article discusses various ethical and legal concepts regarding euthanasia and includes notions such as physician-assisted suicide, assisted suicide, voluntary active euthanasia, killing versus letting die, indirect euthanasia and terminal sedation. Is there a difference if death is foreseen, but not intended? This article opens up the debate and addresses pertinent issues for the family practitioner.

Ethics and the law relating to post-birth rituals

Abstract Placental rituals and other birth-by rituals are common in various societies. They often include culturally determined behavioural sequences which operate as anxiety-releasing mechanisms. They also serve to offer a spiritual means of “control” over the future health and welfare of mother, child, and even the community. As long as such rituals do not cause harm, they should be respected for the role that they play and be left alone. This article discusses the ethical and legal considerations regarding post-birth rituals and their relevance to South Africa, with special reference to the South African Human Tissue Act.

Common ethical issues related to HIV/AIDS

South Africa is the epicentre of the human immunodeficiency virus (HIV) pandemic. 1 Based on a wide range of data, including household and antenatal studies, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that HIV prevalence was 17.8% among 15-49 year-olds at the end of 2009. Their high and low estimates were 17.2% and 18.3% respectively. According to their own total population estimation, this implies that at the end of 2009, around 5.6 million South Africans were living with HIV, including 300 000 children under 15 years old. 2 The national prevalence of HIV is around 11%. In 2008, an estimated 5.2 million people were living with HIV and acquired immune deficiency syndrome (AIDS) in South Africa, and it is believed that over 250 000 people died of AIDS. AIDS is a major factor in the overall rising number of deaths. Around 70 000 babies are born with HIV every year. 3 Statistics South Africa (SSA) reveals that the annual number of deaths rose by 93% between 1997-2006. Among those aged 25-49 years, the rise was 173% in the same nine-year period. The overall increase in the number of deaths, as reported by SSA, is attributed to population growth. However, as they point out, these figures do not clarify the disparity in the rise in deaths among people aged 25-49 years. 4 It is believed that AIDS-related deaths are underestimated because many doctors avoid mentioning the cause of death on the death certificates.

Concepts Concerning 'Disease' Causation, Control, and the current Cholera Outbreak in Zimbabwe

Abstract There is an ethical necessity that doctors understand the complex social, political, environmental and economic dynamics involved in infectious disease outbreaks. This article discusses some important concepts concerning ‘disease’ causation and control with specific reference to the current cholera outbreak in Zimbabwe and its effects on the Limpopo Province in South Africa.

Cosmetic Surgery and the Practice of Medicine

Abstract In this post-modern world, there is a recognisable bent in the media to promote the idea of youth (read as synonymous with beauty and power) to the fullest. The result is that public perceptions of the normal bodily processes of aging are viewed as detrimental or unattractive. Since we are “social creatures”, as Aristotle put it, the mediasation, for example, in magazines, TV, film, fashion, music, etc. of youth as ideal is bound to impact upon our individual ideas of ‘what-is-good-for-me’. Since youth is viewed by society as a good, it is possible to understand an individuals desire to take advantage, when it is possible, of the cosmetic procedures that fortify this ideal. Moreover, since medical practitioners are part of the public, and no more or less swayed by such ideologies, it is also reasonable to assume that some will advantage themselves and take up the gauntlet of promoting youth, although perhaps in the more medical guise of ‘remedying the ills of aging’ in other words, enter the practice of cosmetic surgery.

Human immunodeficiency virus: confidentiality and disclosure of information to third parties

Social concerns relating to human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) can be understood in two ways. Firstly, social concerns can refer to the health determinants of the pandemic. The second disquiet relates to the way in which the HIV/AIDS pandemic has impacted upon society socially. One of the most vexing ethical dilemmas faced by doctors in this regard, concerns confidentiality. This pertains to whether or not their patient’s HIV-positive status should be kept confidential, or disclosed it to a third party. In this article, we will examine the meaning of “confidentiality” as it relates to the doctor-patient relationship. We will then discuss the two oppositional positions: keeping a patient’s confidentiality, or breaching it.

The Human Genome and Gene “Therapy”: Some Ethical Issues

Abstract The major scientific achievement of the Twentieth Century was the discovery of the double helix, and the mapping of the human genome in 2003. Contemporary medical and scientific knowledge in the field of gene therapy has the potential to inform us about many of the known inherited genetic conditions. In addition, medicine now has the ability to identify a significant number of diseases which may be inherited from us by our children. When we discuss the ethics of gene therapy, a distinction should be made between somatic (non-reproductive) and germ (reproductive) cell therapies. In this article, we focus on the ethical issues related to prenatal screening for genetic disorders which include autonomy, cost and maternal anxiety.