The humanistic side of medical education

The hope of teaching the humanities in medicine is that improvement in attitude and practice may result from sensitising students to the many complex social and ethical issues faced in healthcare, and through providing them with insight into the role of moral reasoning in ranking potential solutions with justifying reasons and transparency

The state of our prisons and what this reveals about our society

In the third decade of a new South Africa (SA), major challenges are being faced in almost every aspect of life, ranging from meeting minimum daily subsistence requirements, through providing education and primary healthcare, to the functioning of our legal system and governance at local and national levels. While in this context levels of crime and corruption are reaching new heights, we should not lose sight of the need for humane and accountable approaches to crime and imprisonment. The 37th anniversary on 12 September of Steve Biko’s death under inhumane conditions and without adequate medical care in prison provides an opportunity to remember past failings and to reconsider the lessons these hold for our society

COVID-19, global health and climate change: Causes and convergences

Despite massive global economic growth and advances in science and medicine with spectacular aggregate and individual improvements in health and life expectancy over the past century, the world has now become severely unstable in multiple domains – biological, sociological, political, ecological, economic, and health care. These pervasive instabilities are organically interactive within a complex world system that has reached crisis status at local, global, and planetary levels. Lying at the heart of this complex crisis are long-neglected disparities in health and well-being within and between countries, the refusal to face how these and climate change have arisen, and how economic considerations have fuelled the trend towards entropy (gradual decline of the planet into disorder). The critical point we have reached, starkly highlighted by the emergence of the COVID-19 pandemic pari passu with ongoing climate change and planetary degradation, reminds us of our global interconnectedness with each other and with nature. Comprehending and acknowledging the myriad, humanly constructed forces in each of these domains influencing all aspects of life, are the first steps towards effectively facing challenges to our health, our humanity (collectivity as humans) and our planet. Overcoming denial, acknowledging the magnitude and complexity of these challenges, prescient vision and dedicated action capable of fostering the cooperation for overcoming obstacles are now vital to seeking peaceful pathways towards more equitable and sustainable lives. South Africa is a microcosm of the world, with its local threats and challenges mirroring the global. Significance: Instabilities that pervade the world, highlighted by the COVID-19 pandemic, are especially significant for South Africa, where they manifest most starkly because of its apartheid legacy, its relative success economically on the African continent, and the implications of ongoing widening disparities and antagonism amongst South Africa’s diverse people. Belief in moving towards narrowing wide disparities through decolonisation and reversion to an ‘idyllic African heritage’ via a transformation that includes widespread corruption, and the ANC government’s perverse erosion of lives today and in the future through ‘state capture’, intensifies rather than ameliorates our predicament in an era when cooperation and a clear vision of current threats and future possibilities are desperately needed. In an accompanying article, potential pathways towards a better future are offered through suggested shifts in paradigms of thought and action

The State, Society, Human Rights & Health: Ethical Challenges in the Development of New Interventions.

The theme of this presentation is that major impediments to the development of new interventions to improve global health comprise the combination of (1) an inadequate value system that is heavily dominated by selfish individualism, (2) an excessively downstream focus on health and (3) overriding emphasis on market forces. Moral imagination is required to move beyond the current impasse in which the lives of some seem to be of infinite value while the lives of others are apparently dispensable. A broader discourse on ethics and human rights coupled to demonstration of high moral standards by influential nations could facilitate the introduction of new interventions with the prospect of greatly improving population health.The theme of this presentation is that major impediments to the development of new interventions to improve global health comprise the combination of (1) an inadequate value system that is heavily dominated by selfish individualism, (2) an excessively downstream focus on health and (3) overriding emphasis on market forces. Moral imagination is required to move beyond the current impasse in which the lives of some seem to be of infinite value while the lives of others are apparently dispensable. A broader discourse on ethics and human rights coupled to demonstration of high moral standards by influential nations could facilitate the introduction of new interventions with the prospect of greatly improving population health.The theme of this presentation is that major impediments to the development of new interventions to improve global health comprise the combination of (1) an inadequate value system that is heavily dominated by selfish individualism, (2) an excessively downstream focus on health and (3) overriding emphasis on market forces. Moral imagination is required to move beyond the current impasse in which the lives of some seem to be of infinite value while the lives of others are apparently dispensable. A broader discourse on ethics and human rights coupled to demonstration of high moral standards by influential nations could facilitate the introduction of new interventions with the prospect of greatly improving population health

Moral imagination: The missing component in global health

The deplorable state of global health and the failure to improve this state have been debated extensively. Recent editorials in the Lancet in relation to the failure of Roll Back Malaria and the potential failure of the 3 by 5 programme [1, 2] illustrate how disappointment, surprise, and admonitions about such failures are usually followed by optimism about the success envisaged from future efforts [1, 3]. There are several possible reasons for our failure to ..

Health in a post-COVID-19 world

In the previous article in this issue (S Afr J Sci. 2022;118(11/12), Art. #13165), the emergence and spread of COVID-19 pari passu with climate change and planetary degradation were interpreted as late manifestations in the trend towards gradual decline into disorder (entropy) in an unstable and ecologically threatened planet. In this article, as we contemplate a post- COVID world, the question is whether new insights could generate courageous, prescient leadership towards new paradigms of health, politics, economics, society, and our relationship with nature. A gloomy prognosis is postulated because of the power of many impediments to such changes, both in an increasingly polarised world and in South Africa as a microcosm. Despite many squandered opportunities and a decline in local and global cooperation between all who have a stake in the future, some hope is retained for innovative shifts towards sustainable futures. Significance: Precarious local and global instabilities are vivid reminders of our interconnectedness with each other and with nature. Insights into local and global threats and opportunities, call for paradigm shifts in thinking about and taking action towards a potentially sustainable future in a country that has its own unique history and problems but is also a microcosm of the world. The impediments to making appropriately constructive paradigm shifts in many countries with their tendencies to authoritarianism that threaten peace and democracy, are even more complex in South Africa, where opportunities for dialogue and cooperation are diminishing. Retaining some hope, with vision and courage for innovative shifts towards a sustainable economic/ecological paradigm locally and globally, is arguably essential

Reflections on ethical challenges associated with the Ebola epidemic

The recent tragic, horrifying and extensively reported Ebola epidemic must surely lead us to question why, despite major medical progress, such epidemics continue to emerge. We should also consider their implications for our global collective future. Seeking to understand the Ebola epidemic requires viewing it in the broadest historical and sociopolitical contexts that have shaped health globally, and specifically in West Africa

Health, ethics and society

Includes bibliographical references.In my research and academic work over 35 years l have addressed a wide range of issues relevant to the health of individuals, the structure and nature of health care delivery systems, and the ethical, social and economic forces that influence the health of individuals and whole populations in South Africa and globally. The attached selected publications (92 of 231 peer review articles and book chapters) are representative of my research and serial academic involvement with health care considerations that cut across many disciplines (medicine, public health, applied ethics, political science, sociology and anthropology)

Global Health Challenges: The Need for an Expanded Discourse on Bioethics

Benatar and colleagues argue that the world has changed profoundly since the birth of modern bioethics in the 1960s, and that bioethics needs to address today's global health problems