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Prohibited substance regulation and compliance testing: A principalism approach 禁用物质法规和合规测试:一个原则的方法
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-12-15 DOI: 10.7196/SAJBL.2020.V13I2.00711
J. Laurens, P. Carstens
Abstract: Background : Prohibited substance regulation and compliance testing programmes are required to minimise risks to health and safety in the workplace due to inappropriate use of legal (alcohol, cannabis) and illegal substances. A compliance drug test is in principle an invasive biomedical intervention which infringes on the autonomy and other rights of the individual giving rise to ethical dilemmas.  Objectives: The principalism approach by Beauchamp and Childress was employed to reason and motivate for the minimum ethical requirements for this type of biomedical intervention. Methods: The ethical aspects relevant to the mandatory guidelines of the Substance Abuse and Mental Health Services Administration of the United States of America (SAMHSA) protocols and procedures were extracted and interpreted with reference to the principalism approach. Results : The principalism approach was found to be highly applicable to the ethical requirements of a prohibited substance regulation and testing programme. Conclusion: Ethical dilemmas could be explained and motivated by using the four principles of respect for autonomy, beneficence, non-maleficence and justice as a starting point.
摘要:背景:为了最大限度地减少因不适当使用合法(酒精、大麻)和非法物质而对工作场所健康和安全造成的风险,需要禁用物质法规和合规测试方案。依从性药物测试原则上是一种侵入性生物医学干预,侵犯了个人的自主权和其他权利,造成道德困境。目的:采用Beauchamp和Childress的原则方法来推理和激励这类生物医学干预的最低伦理要求。方法:对美国药物滥用和精神卫生服务管理局(SAMHSA)协议和程序的强制性指导原则中涉及的伦理问题进行提取,并参照原则主义方法进行解释。结果:发现原则方法高度适用于禁用物质监管和测试计划的伦理要求。结论:以尊重自主、仁慈、无害和正义四项原则为出发点,可以解释和激发伦理困境。
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引用次数: 0
Managed healthcare: Treatment protocols and fiduciary duties of funders 管理医疗保健:治疗方案和资助者的受托责任
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-12-15 DOI: 10.7196/SAJBL.2020.V13I2.00731
D. Masege, A. Dhai
Managed healthcare has become the cornerstone of health service delivery in the private sector in South Africa  and the world over. As a result, managed care organizations and medical aid schemes have had to draw up recommended treatment protocols in accordance with the rules and regulations of the Council for Medical Schemes (CMS). T he protocols are rigid, do not always consider each case on its own merit and do not always benefit the members of the respective schemes .  The purpose of the  protocols is  to determine which treatment options constitute essential medical care, costeffective treatment and which ones do not. The article examines the fiduciary duties of the medical aids and the existing relationship between the managed healthcare company and the members in a trustee-beneficiary duty of loyalty.
在南非和世界各地,管理医疗已成为私营部门提供医疗服务的基石。因此,有管理的护理组织和医疗援助计划必须根据医疗计划委员会的规则和条例制定推荐的治疗方案。协议是严格的,并不总是根据每个案例的优点来考虑,也不总是有利于各自计划的成员。协议的目的是确定哪些治疗方案构成基本医疗保健、成本效益高的治疗,哪些不构成。本文考察了医疗救助的信托义务以及托管医疗保健公司与受托人-受益人忠诚义务中成员之间的现有关系。
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引用次数: 0
The HPCSA’s telemedicine guidance during COVID-19: A review HPCSA在COVID-19期间的远程医疗指导:综述
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-10-19 DOI: 10.7196/SAJBL.2020.V13I2.00725
B. Townsend, M. Mars, R. Scott
The coronavirus disease 2019 (COVID-19) pandemic has raised interest in the application of e-health or d-health (digital health) innovations throughout the world. Many countries have rapidly developed, refined or retooled e-health solutions and existing legislation and guidelines to permit their swift implementation. It is anticipated that these events will stimulate sustained change in the interest in and use of e-health (e.g. telehealth, telemedicine, m-health (mobile health), e-learning and health informatics). The stance of the Health Professions Council of South Africa (HPCSA) has hampered this response, initially even in the face of the pandemic. This article reviews recent events in SA, relevant World Medical Association statements and international COVID-19-related responses. It concludes that the HPCSA must acknowledge global experience, and provide SA with clear, evidence-based and clinically practicable guidelines that promote and sustain the use of telemedicine broadly, now and post COVID-19.
2019年冠状病毒病(COVID-19)大流行引起了全世界对应用电子保健或d-保健(数字保健)创新的兴趣。许多国家迅速制定、完善或调整了电子卫生解决方案以及现有立法和准则,以便迅速实施这些解决方案。预计这些活动将刺激人们对电子保健(例如远程保健、远程医疗、移动保健、电子学习和保健信息学)的兴趣和使用方面的持续变化。南非卫生专业委员会(HPCSA)的立场阻碍了这一应对措施,最初甚至在面对大流行时也是如此。本文回顾了南非最近发生的事件、世界医学协会的相关声明以及国际上与covid -19相关的应对措施。报告的结论是,HPCSA必须认识到全球经验,并向SA提供明确、循证和临床可行的指南,以促进和维持远程医疗的广泛使用,无论是现在还是之后。
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引用次数: 4
A critical review of the ethical and legal issues in human germline gene editing: Considering human rights and a call for an African perspective 对人类生殖系基因编辑中的伦理和法律问题的批判性审查:考虑人权和呼吁非洲的观点
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-07-07 DOI: 10.7196/SAJBL.2020.V13I1.00709
B. Shozi
In the wake of the advent of genome editing technology CRISPR-Cas9, there has been a global debate around the implications of manipulating the human genome. While CRISPR-based germline gene editing is new, the debate about the ethics of gene editing is not – for several decades now, scholars have debated the ethics of making heritable changes to the human genome. The arguments that have been raised both for and against the use of genetic technologies in human reproduction reiterate much of the arguments made in the pre-CRISPR debate. As such, it is instructive for South Africa to reflect on these arguments now, in considering our position on the regulation of the use of this novel biotechnology. There are two dominant schools of thought in this area, bioliberalism and bioconservatism. Bioconservatives raise concerns about the risks of genetic manipulation and argue that it ought to be limited or prohibited to avert these risks to human health and human nature. Bioliberal scholars are more open to the prospect of genetic manipulation because of its potential utility. In this paper, I conclude that in liberal democracies like our own, bioliberal arguments ought to be seriously considered when formulating policy on human genome editing because of the extent to which they resonate with our Constitutional values and human rights. I further suggest that there is a need for an enquiry into the relevance of African perspectives on the ethical questions that arise concerning germline genome editing.
随着基因组编辑技术CRISPR-Cas9的出现,全球围绕操纵人类基因组的影响展开了辩论。虽然基于crispr的生殖系基因编辑是新的,但关于基因编辑伦理的争论却不是——几十年来,学者们一直在争论对人类基因组进行可遗传改变的伦理问题。支持和反对在人类生殖中使用基因技术的争论重申了在前crispr辩论中提出的许多论点。因此,南非现在在考虑我们对这种新型生物技术的使用进行监管的立场时,反思这些论点是有益的。在这一领域有两个主要的思想流派,生物自由主义和生物保守主义。生物保守主义者提出了对基因操纵风险的担忧,并认为应该限制或禁止这种行为,以避免这些对人类健康和人性的风险。生物自由主义学者对基因操纵的前景持更开放的态度,因为它具有潜在的效用。在本文中,我的结论是,在像我们这样的自由民主国家,在制定人类基因组编辑政策时,应该认真考虑生物自由主义的论点,因为它们在多大程度上与我们的宪法价值观和人权产生共鸣。我进一步建议,有必要调查非洲对有关生殖系基因组编辑的伦理问题的看法的相关性。
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引用次数: 3
Non-consensual disclosure of infectious drug resistant tuberculosis status in the occupational context: Health workers stuck between a rock and a hard place 非自愿披露职业背景下的传染性耐药结核病状况:卫生工作者进退两难
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-07-07 DOI: 10.7196/SAJBL.2020.V13I1.00686
C. Nnaji, S. Adams, L. London
Background The burden of drug-resistant tuberculosis (DR-TB) remains high in South Africa despite ongoing control efforts. DR-TB patients who are infectious and continue to work pose a substantial risk of spreading the disease at the workplace. When such patients refuse or interrupt treatment and are also unwilling to disclose their status at work they pose an infectious risk in the workplace, creating a conflict between public health good and individual human rights. Should health-workers breach confidentiality and disclose patients’ DR-TB status, or take no action while patients pose transmission risks in occupational settings? Objectives To provide professional and ethical guidance for health workers in dealing with non-consensual disclosure of DR-TB status of patients who are unwilling to disclose, continue to go to work and remain infectious. Methods A comprehensive literature search was conducted to draw on evidence relating to public health best practices and human rights normative standards. We used the findings, along with guidance from DR-TB programme managers, clinicians, occupational health physicians and human rights lawyers to develop an occupational health protocol for disclosure. Results This protocol establishes the normative, ethical and legal framework for dealing with the complexities of non-consensual disclosure and provides a set of practical standard operative procedures for health-workers in the South African setting. It also provides a legal safeguard to protect health-workers from potential litigation that may result from such duty. Conclusion Non-consensual disclosure to address the spread of DR-TB in occupational settings should be based on professional, ethical and legally-sound guidance for health-workers.
背景尽管南非正在进行控制工作,但耐药结核病的负担仍然很高。具有传染性并继续工作的DR-TB患者在工作场所传播疾病的风险很大。当这些患者拒绝或中断治疗,也不愿意透露自己的工作状态时,他们在工作场所会构成传染风险,从而在公共卫生利益和个人人权之间产生冲突。卫生工作者是否应该违反保密规定,披露患者的DR-TB状态,或者在患者在职业环境中构成传播风险时不采取行动?目的为卫生工作者提供专业和道德指导,以处理不愿披露、继续上班和保持传染性的患者的DR-TB状态的非自愿披露。方法进行全面的文献检索,以获取与公共卫生最佳实践和人权规范标准有关的证据。我们利用这些发现,以及DR-TB项目经理、临床医生、职业健康医生和人权律师的指导,制定了一份职业健康协议,以供披露。结果本议定书为处理非自愿披露的复杂性建立了规范、道德和法律框架,并为南非的卫生工作者提供了一套实用的标准操作程序。它还提供了一种法律保障,以保护卫生工作者免受此类职责可能导致的潜在诉讼。结论应对DR-TB在职业环境中的传播进行非自愿披露,应基于对卫生工作者的专业、道德和法律健全的指导。
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引用次数: 0
Ethical practice in the nursing profession: A normative analysis 护理职业的伦理实践:规范分析
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-07-07 DOI: 10.7196/SAJBL.2020.V13I1.00690
J. Mathibe-Neke
ABSTRACT Background In response to an increasing number of litigations relating to nursing care errors, negligence or acts and omissions that arise mostly due to unprofessional or unethical behaviour compounded by the growing awareness of patient’s rights, nurse practitioners as such need an intervention by the regulatory body, the South African Nursing Council (SANC). Aim and purpose The argument presented pertains to the obligatory role of SANC as a regulatory body to uphold professional and ethical practice for nurses in terms of the nursing curriculum, the scope of practice, the code of ethics and continuing professional development. Methodology The methodology was based on the analysis of relevant SANC legislation under the provision of the Nursing Act 33 of 2005 as amended. Document review, a technique used to “categorise, investigate, interpret and identify limitations of written documents” was undertaken. The study referenced some of the general literature relating to nursing ethics and professionalism. A waiver for ethical clearance was obtained from the Human Research Ethics Committee. Conclusion The overall impact of the analysis lies in its contribution to enhancing nursing practice, with specific focus on upholding professional and ethical practice. SANC as a custodian of the nursing profession need to address limitations and develop a balance for the regulation and monitoring of ethical practice in both nursing education and clinical practice. Keywords: ethical practice; normative analysis; nursing profession; role; South African Nursing Council
摘要背景针对越来越多的与护理失误、疏忽或作为和不作为有关的诉讼,这些诉讼主要是由于不专业或不道德的行为,再加上对患者权利的日益认识,执业护士需要监管机构南非护理委员会(SANC)的干预。目的和目的所提出的论点涉及SANC作为一个监管机构在护理课程、实践范围、道德规范和持续职业发展方面维护护士职业和道德实践的义务作用。方法该方法基于对经修订的2005年《护理法》第33条规定的相关SANC立法的分析。文件审查是一种用于“对书面文件进行分类、调查、解释和识别其局限性”的技术。该研究引用了一些与护理伦理和专业精神有关的一般文献。从人类研究伦理委员会获得了伦理许可豁免。结论该分析的总体影响在于它有助于加强护理实践,特别关注维护职业道德实践。SANC作为护理专业的守护者,需要解决护理教育和临床实践中道德实践的监管和监督的局限性,并建立平衡。关键词:伦理实践;规范分析;护理专业;角色南非护理理事会
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引用次数: 4
COVID-19: Mental health and clinical equipoise in the face of moral injury COVID-19:面对道德伤害的心理健康和临床平衡
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-07-07 DOI: 10.7196/SAJBL.2020.V13I1.00724
C. Grobler
The COVID-19 pandemic may result in ‘moral injury’ and mental illness to health care workers (HCWs). Resources may at some point run out and situations may arise where difficult ethical decisions need to be made. Properly preparing staff for the job and the associated challenges reduces the risk of moral injury and mental health problems. Under conditions of information overload and uncertainty-related anxiety such as with the COVID-19 pandemic, doctors may stop acting with clinical equipoise and make cognitive errors. These circumstances require doctors to be the voice of reason and lead by example. Doctors must reason critically, be aware of the biases that may influence thinking processes and critically appraise evidence in deciding how to treat patients. Health care systems must address the stress of HCW’s by continuously monitoring reactions and and creating mechanisms to offer psychosocial support.
新冠肺炎大流行可能会对医护人员(HCW)造成“道德伤害”和精神疾病。资源可能会在某个时候耗尽,可能会出现需要做出艰难的道德决策的情况。为员工做好工作准备和应对相关挑战可以降低道德伤害和心理健康问题的风险。在信息过载和不确定性相关焦虑的情况下,如新冠肺炎大流行,医生可能会停止临床平衡,并出现认知错误。这些情况要求医生成为理性的代言人,以身作则。医生必须批判性地推理,意识到可能影响思维过程的偏见,并在决定如何治疗患者时批判性地评估证据。卫生保健系统必须通过持续监测反应和建立提供心理社会支持的机制来解决HCW的压力。
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引用次数: 7
Moral challenges in handling pregnant school adolescents in Tanga municipality, Tanzania 坦桑尼亚坦噶市处理怀孕在校少女的道德挑战
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-07-07 DOI: 10.7196/SAJBL.2020.V13I1.00684
S. S. Mkumbugo, J. Shayo, D. Mloka
Background: In Tanzania, about 8,000 girls drop out of schools due to pregnancy every year and it has been reported that this group is faced with discrimination. Mishandling of pregnant adolescents may be reason for discrimination and may lead them to opt for risky actions such as unsafe abortion, abandonment of newborns and even suicide. Objectives: The study aimed to explore the moral challenges in handling pregnant school adolescents in Tanga municipality, Tanzania. Methods: This was an exploratory study which used criterion type of purposive sampling and qualitative methods of data collection. Content analysis methods ware used to obtain themes from data scripts. Results: A total of 21 participants were involved which include teachers, parents/guardians, community leaders and religious scholars. Three main themes were obtained: Parent’s decision on the fate of pregnant school adolescents; education policy and laws with regards to school pregnant cases, and discrimination in handling pregnant school adolescents. Conclusion: From the findings of this study, it is concluded that; there are moral challenges in handling pregnant school adolescents as result of implementation of education policy, laws and community culture that breach bioethical principles. The study recommended that; the government should revise the current education regulations to eliminate the sense of gender discrimination and to promote equality in education.
背景:在坦桑尼亚,每年约有8000名女孩因怀孕而辍学,据报道,这一群体面临歧视。对怀孕青少年的不当处理可能是歧视的原因,并可能导致他们选择危险的行为,如不安全的堕胎、遗弃新生儿甚至自杀。目的:本研究旨在探讨坦桑尼亚坦加市处理怀孕学校青少年的道德挑战。方法:采用目的性抽样的标准型和数据收集的定性方法进行探索性研究。内容分析方法用于从数据脚本中获取主题。结果:共有21名参与者参与,其中包括教师、家长/监护人、社区领袖和宗教学者。获得了三个主要主题:家长对怀孕青少年命运的决定;关于学校怀孕案件的教育政策和法律,以及在处理怀孕的学校青少年方面的歧视。结论:根据本研究的结果,可以得出以下结论:;由于实施违反生物伦理原则的教育政策、法律和社区文化,在处理怀孕的学校青少年方面存在道德挑战。该研究建议:;政府应修订现行教育条例,消除性别歧视意识,促进教育平等。
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引用次数: 1
Is intentional publishing in predatory journals a form of scientific misconduct? 故意在掠夺性期刊上发表论文是一种科学不端行为吗?
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-07-07 DOI: 10.7196/SAJBL.2020.V13I1.00708
Christopher Stein
Predatory journals are widely acknowledged as a significant problem in scholarly publishing and, more broadly, as a threat to the responsible conduct of research. Because predatory publishers base their operations on deception, it is possible for well-intentioned researchers to unwittingly end up publishing their work in predatory journals. Of a more problematic nature is the behaviour of researchers who intentionally publish in predatory journals as a way of bypassing legitimate peer-review. In such cases it is important to decide what such behaviour constitutes as a way of developing policy aimed at deterrence. The aim of this study was to answer the question of whether intentional publishing in predatory journals can be considered a form of scientific misconduct, based on the critical application of four conditions taken as being requirements for this. It is not currently possible to satisfy all four conditions that would include intentional predatory publishing as a form of scientific misconduct. However, there are grounds to argue that this behaviour satisfies the definition of a questionable research practice. Regardless of exactly where intentional predatory publishing is placed in the spectrum of unethical research behaviours, there is an urgent need for coherent institutional policy to effectively deal with it and, more broadly, naive publishing in predatory journals.
掠夺性期刊被广泛认为是学术出版中的一个重大问题,更广泛地说,是对负责任的研究行为的威胁。因为掠夺性出版商的运作是建立在欺骗的基础上的,好心的研究人员很可能在无意中最终在掠夺性期刊上发表了他们的研究成果。更有问题的本质是,研究人员故意在掠夺性期刊上发表论文,以绕过合法的同行评审。在这种情况下,重要的是要决定这种行为是什么,作为制定旨在威慑的政策的一种方式。本研究的目的是回答在掠夺性期刊上故意发表论文是否可以被认为是一种科学不端行为的问题,基于四个条件的关键应用被认为是这一要求。目前还不可能满足所有四个条件,包括故意掠夺性出版作为一种科学不端行为的形式。然而,有理由认为这种行为符合可疑研究实践的定义。不管故意的掠夺性发表在不道德研究行为的光谱中处于什么位置,我们都迫切需要连贯的制度政策来有效地处理它,更广泛地说,在掠夺性期刊上发表幼稚的文章。
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引用次数: 2
The need to invest in pandemic preparedness: COVID-19 is not the first pandemic, nor will it be the last 投资于大流行防范的必要性:COVID-19不是第一次大流行,也不会是最后一次
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2020-07-07 DOI: 10.7196/SAJBL.2020.V13I1.00737
A. Dhai
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引用次数: 0
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South African Journal of Bioethics and Law
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