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Bridging the regulatory gaps created by Smart and Connected technologies in South Africa 弥合南非智能和互联技术造成的监管差距
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16i2.201
M. Botes, B. Townsend
The prevalence of technology-embedded products, services, and cities, described colloquially as ‘smart’ technologies and ‘smart’ cities, has seen a spate of unprecedented growth in recent years. South Africa (SA) has not been left behind, with smartphones, smart watches, and smart voice-controlled virtual personal assistants such as Amazon’s Alexa now frequently used. But while these technologies hold great promise to revolutionise homes, offices and cities, their adoption poses challenges to individual and collective interests and wellbeing. After demonstrating the legal and ethical difficulties brought about by the introduction of these technologies, this article explores whether SA legislation is sufficiently robust to address these challenges. While the current legislative landscape addresses certain crucial difficulties – such as the safeguarding of personal data by the Protection of Personal Information Act No. 4 of 2013 (‘POPIA’) – it is suggested that the position regulating other aspects of smart technology adoption is, in large part, fragmented and ill-equipped to deal with some of the more pressing legal and ethical questions. Our contention is that, not dissimilar to the issues arising from artificial intelligence-based technological adoption, the extant legislative and regulatory frameworks do not go far enough in addressing the many concerns emerging from recent novel technological design, development, and deployment. Not only do smart technologies give rise to unique challenges, so does their deployment within the Global South and in South Africa, in particular. We suggest that appropriate and effective regulatory reform measures be undertaken in SA to provide better ethical guidance and policy prescriptions buttressed by rigorous regulatory oversight.
技术嵌入式产品、服务和城市的流行,通俗地说是“智能”技术和“智能”城市,近年来出现了前所未有的增长。南非也没有落后,智能手机、智能手表和智能语音控制的虚拟个人助理(如亚马逊的Alexa)现在经常使用。尽管这些技术有望彻底改变家庭、办公室和城市,但它们的采用对个人和集体的利益和福祉构成了挑战。在证明了引入这些技术带来的法律和伦理困难后,本文探讨了SA立法是否足以应对这些挑战。虽然目前的立法格局解决了某些关键困难,例如2013年第4号《个人信息保护法》(“OPIA”)对个人数据的保护,但有人认为,监管智能技术采用其他方面的立场在很大程度上是,支离破碎,无力处理一些更紧迫的法律和道德问题。我们的论点是,与基于人工智能的技术采用所产生的问题没有什么不同,现有的立法和监管框架在解决最近新技术设计、开发和部署中出现的许多问题方面做得不够。智能技术不仅带来了独特的挑战,而且在全球南方,特别是在南非的部署也带来了挑战。我们建议南非采取适当有效的监管改革措施,在严格的监管监督的支持下,提供更好的道德指导和政策处方。
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引用次数: 0
Inserting microethics into paediatric clinical care: A consideration of the models of the doctor-patient relationship 将微观伦理学纳入儿科临床护理:对医患关系模式的思考
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16i2.515
L. L. S Lutchman
Microethics is about the ethics of everyday clinical practice. The subtle nuances in communication between doctor and patient (the doctor’s choice of words, tone, body language, gestures, etc.) can influence the exercise of the patient’s autonomy. The four models of the doctor- patient/physician-patient relationship (paternalistic, informative, interpretive, deliberative) weigh respect for autonomy and beneficence in varying proportions. Each model may be appropriate in certain circumstances. This article considers these models from the perspective of microethics and the unique dimensions created by the doctor-child-parent relationship. In particular, the article considers the nuances to the autonomy principle created by the child’s developing maturity and the parent’s role as a co-fiduciary of the child’s interests. Ultimately, the deliberative model seems most appropriate to the paediatric setting, since it accommodates the child’s developing maturity in making healthcare-related decisions. This model infuses care into the doctor’s communication with the child and parent.
微观伦理学是关于日常临床实践的伦理学。医生和患者之间沟通中的细微差别(医生对词语、语气、肢体语言、手势等的选择)会影响患者自主性的行使。医患关系的四种模式(家长式、信息式、解释式、协商式)在不同程度上权衡了对自主性和利益的尊重。每种模型在特定情况下可能都是合适的。本文从微观伦理学的角度和医生亲子关系所创造的独特维度来考虑这些模型。特别是,文章考虑了儿童发育成熟所产生的自主原则的细微差别,以及父母作为儿童利益共同受托人的角色。最终,审议模式似乎最适合儿科环境,因为它适应了儿童在做出医疗保健相关决策时的成熟度。这种模式将关怀融入医生与孩子和父母的沟通中。
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引用次数: 0
Turning the moral compass towards transformative research ethics: An inflection point for humanised pedagogy in higher education 将道德指南针转向变革性研究伦理:高等教育人性化教育学的转折点
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16i2.232
PG Dip
Ethical guidance in research is underpinned by the need to show respect for study participants by upholding autonomy in participant decision-making, and confidentiality and protection of individual rights, privacy and interests, yet decision-making could also be influenced by the participant’s sociocultural and belief systems. This calls for a more Africanised approach to research ethics where these values and beliefs are upheld. While national and international ethics guidelines do exist, there is little evidence that such a paradigm shift in research ethics is adequately interrogated in the teaching and learning curricula in higher education, where research skills are developed and nurtured. Critical reflection is used to highlight opportunities to stimulate learning and debates underpinned by humanised pedagogy in higher education.
研究中的伦理指导的基础是需要尊重研究参与者,坚持参与者决策的自主权,以及保密和保护个人权利、隐私和利益,然而决策也可能受到参与者的社会文化和信仰系统的影响。这需要一种更加非洲化的研究伦理方法,在这种方法中,这些价值观和信仰得到维护。虽然国家和国际伦理准则确实存在,但几乎没有证据表明,在培养和培养研究技能的高等教育的教学和学习课程中,研究伦理的这种范式转变得到了充分的质疑。批判性反思被用来强调高等教育中以人性化教学法为基础的激发学习和辩论的机会。
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引用次数: 0
Revisions to the World Medical Association’s Declaration of Helsinki: Africa Region Consultation 对世界医学协会赫尔辛基宣言的修订:非洲区域协商
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16i2.1469
A. Dhai
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引用次数: 0
Unpacking the legality of termination of pregnancy based on ‘social grounds’ under South African law 根据南非法律,基于“社会原因”终止妊娠的合法性
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16i1.1033
M. Khan
The topic of abortion was in the limelight again in Dobbs v Jackson, where the US Supreme Court overturned the decision of Roe v Wade, ‘which guaranteed women and pregnant people a constitutional right to abortion’. While not bound by the judgment, this gives us an opportunity to reflect on the current law in South Africa which regulates the termination of pregnancy. The primary piece of legislation which governs abortion is the Choice on Termination of Pregnancy Act. Section 2 of the Act lists the grounds under which one may lawfully terminate a pregnancy. One of those grounds relates to the period of the 13th up until the 20th week of the gestation period, and states that if a medical practitioner, after consultation with the pregnant woman, is of the opinion that the continued pregnancy would significantly affect the social or economic circumstances of the woman, then the pregnancy may be lawfully terminated. The question is: What exactly is meant by ‘social grounds’? This article considers this aspect from a legal perspective and attempts to provide clarity on the issue, in the hope that this will be of assistance to medical practitioners who are concerned about the outcome of their actions, when assisting persons in this position.
在多布斯诉杰克逊案中,堕胎的话题再次成为人们关注的焦点,美国最高法院推翻了罗伊诉韦德案的判决,“该判决保障了妇女和孕妇享有宪法赋予的堕胎权利”。虽然不受判决的约束,但这使我们有机会反思南非现行规定终止妊娠的法律。管理堕胎的主要立法是《终止妊娠选择法》。该法第2节列出了合法终止妊娠的理由。其中一项理由涉及妊娠期的第13周至第20周,并指出,如果医生在与孕妇协商后认为继续妊娠将严重影响该妇女的社会或经济状况,则可以合法终止妊娠。问题是:“社会基础”到底是什么意思?本文从法律角度考虑了这方面的问题,并试图澄清这一问题,希望这将有助于那些关心其行为结果的医生在帮助处于这种境地的人时。
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引用次数: 0
Human dignity and researcher conduct in emergency care research with incapacitated adults 人的尊严和研究人员的行为在紧急护理研究与丧失行为能力的成年人
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16.2.378
PhD Emergency Med C Stein
Emergency care research sometimes involves incapacitated adults as research participants. The ethical principle of respect for autonomy may not necessarily apply to an incapacitated person unable to act in an autonomous manner, although it can be argued that researchers still have a duty of respect towards such people because they have moral status despite being incapacitated. Sharing some common ground with theories of moral status based on ‘humanness’ and the ability for rational thought is the notion of human dignity, which features in arguments regarding researcher conduct with incapacitated patients. However, human dignity premised upon the unique ability of humans for rational thought and moral self-regulation is contingent upon these capabilities – a limitation that possibly makes dignity a less useful framework for research conduct in emergency care research. In this article, I will discuss the different conceptions of human dignity – as equality, status and virtue – and then draw on more recent literature that explains human dignity as a social constraint and as a factor influencing the conduct of healthcare professionals and researchers. I will address questions of whether dignity as a principle ought to apply only to those who have the ability to think rationally, or to all humans regardless of their condition or mental status. I will argue that, in relation to offering protection to research participants in emergency conditions, it is immaterial which view is taken.
紧急护理研究有时涉及无行为能力的成年人作为研究参与者。尊重自主的伦理原则可能不一定适用于不能自主行事的无行为能力的人,尽管可以认为研究人员仍然有义务尊重这些人,因为他们尽管无行为能力,但仍有道德地位。与基于“人性”和理性思考能力的道德地位理论有一些共同点的是人类尊严的概念,这一概念在关于研究人员对无行为能力病人的行为的争论中占有重要地位。然而,人类尊严的前提是人类理性思考和道德自律的独特能力,这取决于这些能力——这一限制可能使尊严成为急诊护理研究中研究行为的一个不太有用的框架。在这篇文章中,我将讨论人类尊严的不同概念——平等、地位和美德——然后借鉴最近的文献,这些文献将人类尊严解释为一种社会约束,是影响医疗保健专业人员和研究人员行为的一个因素。我将讨论尊严作为一项原则是否应该只适用于那些有能力理性思考的人,还是适用于所有人,无论他们的状况或精神状态如何。我认为,在向紧急情况下的研究参与者提供保护方面,采取哪种观点并不重要。
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引用次数: 0
Changes in the empathy levels of a group of undergraduate medical students: A longitudinal study 一组医科本科生共情水平的变化:一项纵向研究
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16i2.1015
E. Archer, PhD R Turner, MSc Nursing
Background. The concept of empathy in students has gained significant attention in medical education. Whether implementing formal educational interventions to promote long-term and effective empathy levels leads to sustained increased empathy levels in students, is however less clear.Objectives. The study aimed to evaluate the trajectory of medical students’ self-perceived empathy levels during their 6-year MB ChB degree.Methods. A longitudinal, prospective study was conducted over 4 years. A cohort of 292 medical students was invited to participate. Participants completed the Jefferson Scale of Empathy for Students (JSE-S) at three intervals during their studies. The students attended two workshops related to empathic patient interactions during this time. The JSE-S mean score by age and gender was compared, making use of a linear regression model.Results. A total of 119 students completed the study. Students’ total empathy levels were similar during the first and the last measuring point (110), but there was a significant rise in the intermediate measuring point (113.3). When the male and female cohorts’ scores were interpreted separately, both genders demonstrated a similar pattern to the total score, although females’ JSE-S scores were higher than the males.Conclusion. The results of the study confirm that educational interventions can increase students’ self-perceived empathy levels; however, we suggest that students require reinforcement and multiple opportunities to practise and observe empathic communication with patients to sustain high levels of empathy. Follow-up sessions to specifically target the promotion of empathy should be implemented; otherwise the long-term effect of educational interventions might be limited.
背景学生的移情概念在医学教育中受到了极大的关注。然而,实施正式的教育干预以提高长期有效的同理心水平是否会持续提高学生的同理心,目前尚不清楚。目标。该研究旨在评估医学生在6年MB ChB学位期间自我感知移情水平的轨迹。方法。一项为期4年的纵向前瞻性研究。292名医学生被邀请参加。参与者在学习期间每隔三段时间完成杰斐逊学生移情量表(JSE-S)。在此期间,学生们参加了两个与移情患者互动有关的研讨会。采用线性回归模型比较了按年龄和性别划分的JSE-S平均得分。后果共有119名学生完成了这项研究。在第一个和最后一个测量点(110),学生的总移情水平相似,但在中间测量点(113.3)有显著上升。当分别解释男性和女性队列的得分时,尽管女性的JSE-S得分高于男性,但两性都表现出与总分相似的模式。结论研究结果证实,教育干预可以提高学生的自我感知移情水平;然而,我们建议学生需要强化和多次机会来练习和观察与患者的移情交流,以保持高水平的移情。应举办后续会议,专门针对促进同理心的问题;否则,教育干预的长期效果可能有限。
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引用次数: 0
Using the right to enjoy the benefits of scientific progress to address the needs of adolescent mothers living with HIV 利用享受科学进步惠益的权利来满足感染艾滋病毒的青少年母亲的需求
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16i2.942
M. Brotherton
Various human rights issues arise from the intersection of adolescent motherhood and HIV. While health rights may be the most obvious means by which to address such issues through policy development and legislative means, the right to health is not the only human right that may provide recourse or relief in this regard. This article considers an unexplored avenue of approaching such issues through reliance on the right to enjoy the benefits of scientific progress. The International Covenant on Economic, Social and Cultural Rights provides for the ‘right to science’ in article 15(1)(b) and more recently, as elaborated on in General Comment no. 25 of 2020. This article considers how this right can be relied upon to address issues pertaining to adolescent motherhood and HIV. Precedent from a Venezuelan Supreme Court decision is considered, as well as the normative content of the right to enjoy the benefits of scientific progress. This may be another legal means by which to hold states accountable for the health of young mothers and their children, especially as new practices, medicines and treatments emerge regarding HIV.
青少年母亲身份与艾滋病毒交织在一起,产生了各种人权问题。虽然健康权可能是通过制定政策和立法手段解决这些问题的最明显手段,但健康权并不是在这方面可以提供追索权或救济的唯一人权。这篇文章考虑了一条未经探索的途径,通过依赖享受科学进步利益的权利来解决这些问题。《经济、社会、文化权利国际公约》第15条第(1)款(b)项以及最近在2020年第25号一般性意见中详细阐述的“科学权”。这篇文章考虑了如何依靠这一权利来解决与青少年母亲身份和艾滋病毒有关的问题。审议了委内瑞拉最高法院裁决的先例,以及享受科学进步利益的权利的规范性内容。这可能是让各州对年轻母亲及其子女的健康负责的另一种法律手段,尤其是在出现有关艾滋病毒的新做法、药物和治疗方法时。
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引用次数: 0
Catch-22: A patient’s right to informational determination and the rendering of accounts by medical schemes 第22条军规:病人有权获得医疗计划提供的信息和账目
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-09-01 DOI: 10.7196/sajbl.2023.v16i2.694
M. Botes, E. A. Obasa
Many people who have reached the age of majority still qualify as financial dependents of their parents, and may be registered as dependents on their parents’ medical schemes. This poses a practical conundrum, because major persons enjoy complete autonomy over their bodies to choose healthcare services as they please, including informational determination. However, their sensitive health information may end up being disclosed in the accounts rendered to their parents, as main members of medical schemes, thereby breaching their informational privacy, medical confidentiality and possibly also damaging personal relationships. On the other hand, medical schemes must ensure that they strictly manage the business of their hospitalisation to ensure that they can adhere to their contractual and legal medical insurance obligations. Both major but financially dependent patients and medical schemes have good legal grounds to defend their respective positions. In this article, we will analyse and clarify the applicable legal and ethical grounds by considering medical confidentiality, the Protection of Personal Information Act, the Consumer Protection Act and the Medical Schemes Act and rules. We shall conclude with recommendations to accommodate the interests of both parties.
许多达到成年年龄的人仍然有资格成为父母的经济受抚养人,并可能在父母的医疗计划中登记为受抚养人。这带来了一个实际的难题,因为主要人群对自己的身体享有完全的自主权,可以随心所欲地选择医疗服务,包括信息决定。然而,作为医疗计划的主要成员,他们的敏感健康信息最终可能会在向父母提供的账户中披露,从而侵犯他们的信息隐私和医疗机密,并可能损害个人关系。另一方面,医疗计划必须确保他们严格管理住院业务,以确保他们能够遵守合同和法律规定的医疗保险义务。主要但经济依赖的患者和医疗计划都有充分的法律依据来捍卫各自的立场。在这篇文章中,我们将通过考虑医疗保密、《个人信息保护法》、《消费者保护法》和《医疗计划法》及规则,分析和澄清适用的法律和道德依据。最后,我们将提出符合双方利益的建议。
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引用次数: 0
Mandatory reporting obligations within the context of health research: Grappling with some of the ethical-legal complexities 卫生研究背景下的强制性报告义务:应对一些伦理-法律复杂性
IF 0.9 Q4 MEDICAL ETHICS Pub Date : 2023-05-08 DOI: 10.7196/sajbl.2023.v16i1.824
A. Strode, C. Badul
Mandatory reporting of various forms of abuse, from violence to corruption, is an attempt by the state to intervene in circumstances where there is a public or a private interest that ought to be protected. This intrusion of the state into what is often a very personal space, such as the home, is largely justified on the basis of the need to provide protection to prevent further harm, and in services to vulnerable populations such as children, the disabled or the elderly. In some instances, researchers and other members of the study team may encounter reportable information requiring the consideration of mandatory reporting in the design, implementation and review of health research. This is not simple. There are complex and competing interests at play, particularly as there are differing approaches in law and ethical guidelines. This article aims to describe the mandatory reporting obligations in South African law, discussing the ways in which these provisions apply within the context of health research, and to propose some factors that could be used to determine whether it is ethical or not to report information.
强制报告各种形式的虐待,从暴力到腐败,是国家在公共或私人利益应该受到保护的情况下进行干预的一种尝试。国家对通常是非常私人的空间(如家庭)的入侵,在很大程度上是合理的,因为需要提供保护以防止进一步的伤害,以及为儿童、残疾人或老年人等弱势群体提供服务。在某些情况下,研究人员和研究小组的其他成员在设计、实施和审查卫生研究时可能会遇到需要考虑强制报告的可报告信息。这并不简单。这其中存在着复杂而相互竞争的利益,特别是在法律和道德准则方面存在不同的做法。本文旨在描述南非法律中的强制性报告义务,讨论这些规定在卫生研究背景下的适用方式,并提出一些可用于确定报告信息是否合乎道德的因素。
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引用次数: 0
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South African Journal of Bioethics and Law
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