Don\'t Ask, Don\'t Tell: Ethical Issues Concerning Learning and Maintaining Life-Saving Skills

Undergraduate and postgraduate medical education entails acquiring and maintaining technical skills of various natures. Peripheral venous cannulation, splinting of fracture, wound suturing, venous cut-down and intra-osseous catheter placement for the most part, are considered minimally invasive procedures. The traditional way of skill acquisition could be summarised by the adage “See one, do one, teach one”. Although the saying may be a misrepresentation of the reality, it should not be an optional educational approach. Patients undergoing a procedure under general anaesthesia are often not informed of the possibility that they could be used for “ghost procedures”- part or whole of the procedure is performed by a trainee. An attitude of “don't ask, don't tell” devalues patients' autonomy and the trainee's moral integrity. In view of the polarisation of the views about teaching, acquiring, and maintaining technical skills, institutions should consider and deliberate on these principles and reach consensus on a set of guidelines to clarify and limit the practice of learning technical skills on patients and on the newly dead. Informed consent procedures and requirements must be clearly established and communicated. The learning and proficiency practices should be restricted to the staff that can truly benefit from the experience. The practice of ‘don't ask, don't tell' is not an option. South African Journal of Family Practice Vol. 50 (4) 2008: pp. 52-5

Ethics in health care: Confidentiality and information technologies

Before the advent of the new communication and information technologies (NCITs), patient care was sometimes delayed because of the lengthy time it took to transmit patient information from a doctor in one location to a colleague in another. NCITs bring many advances to medicine, including to the area of communication. With a simple click, rural doctors can access their patients’ laboratory test results, transmit images immediately, and receive feedback from a number of specialists working far away in teaching hospital centres. Doctors have a general obligation to preserve patient confidentiality, which includes keeping patients’ information confidential. Medical  confidentiality remains a vital part of ethical professional practice and it is likely that it will remain so. However, data transfer in this age of NCITs presents new ethical challenges in maintaining patient confidentiality

Informed Consent: Over- and Under-interpretation

Informed consent is the expression of an individual's autonomy or selfrule. To be autonomous one has to be competent and acting freely. Ethicists make a distinction between a “thin” and a “thick” concept of autonomy. The thin concept of autonomy refers to “a competent person, in possession of the relevant facts making a free decision about what to do with his or her life”.1 While, the thick concept of autonomy refers to persons possessing the capacity to act on the basis of normative reasons. In other words, we are autonomous when we act according to relevant normative considerations. In this perspective we refrain from an action because we have good reasons not to and act accordingly, and viceversa.2For full text, click here:SA Fam Pract 2006;48(3):62-6

Ethical Issues in Family Practice: My Culture – Right or Wrong?

Health professionals educated in and practicing Western medicine in multicultural settings often face moral dilemmas resulting from exchanges with patients whose cultural background holds different beliefs and standards than does their own. For example, one of the best known is that of female genital mutilation (FGM). The main argument held by societies in which FGM is traditionally practised is that the prohibition of the practice would lead to the dissolution of the society’s cohesion. The moral objection, however, is that FGM is intrinsically wrong. As emphasised by Rachels Rachels, J. 2001. The Challenges of Cultural Relativism. In: Moral Relativism: A Reader. P K Moser & T L Carson,(Eds.)New York: Oxford University Press: 63., if a practice is harmful – as it is with FGM – objective moral reason to condemn it. But there are some cultural practices and beliefs which are not as clear when it comes to moral judgment. As health professionals, we should be culturally sensitive. We ought to respect other cultures’ values and show appropriate tolerance for various reasonable cultural codes and beliefs. This, however, does not mean that all beliefs and practices are equally admirable or that we ought to withdraw moral judgements that strike us as being clearly justifiable or right. These attitudes reflect nothing but moral relativism. SA Fam Pract 2005;47(4): 47-4

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

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. South African Family Practice Vol. 50 (6) 2008: pp. 30-3

Ethics in health care: Healthcare fraud

Healthcare fraud is a type of white-collar crime involving the filing of dishonest healthcare claims in order to achieve a profit. Healthcare fraud is a worldwide problem and is on the increase in South Africa. In this article, healthcare fraud is explored, healthcare fraud identified as a white-collar crime and the South African legal term, “fraud”, defined. Common types of medical aid fraud, a rising concern within South African healthcare practice, are detailed. Finally, the role of ethical and moral reasoning is deliberated and the psychological factors that are believed to contribute to fraud discussed. Healthcare fraud is not a victimless crime. Therefore, healthcare professionals must inform on  colleagues who practice it

Ethics in health care: The practice of defensive medicine

Defensive medicine is the practice of diagnostic or therapeutic measures that are conducted primarily as a safeguard against possible malpractice liability, rather than to ensure the health of the patient. Defensive  medicine, a significant problem, is discussed in this article. First, an overview of the nature of defensive medicine is provided, with a focus on how it damages the doctor-patient relationship. It has been determined that doctors who utilise  defensive medicine ultimately exact more harm than good on the practice of medicine. Finally, it is suggested that through ensuring that the doctor-patientrelationship is impenetrable, fear of medical litigation will dissipate. The best antidote to malpractice allegations is ethical clinical practice. Core decisions remain bound in dialogue between the doctor and his or her patient.  Continuing the tradition of the therapeutic alliance, informed consent and confidentiality in medical practice will diminish threats of medical liability

Ethics in health care: “Physician, heal thyself”

Doctors have an obligation, derived from duty to protect patients from harm, to take positive action if a colleague is impaired. In this article, the Health Professions Council of South Africa ethical guidelines concerning the duty of a doctor to report impaired practitioners is reviewed, followed by an overview of the regulations relating to the impairment of students and practitioners. Problems that doctors face, which may contribute to their impairment, will be discussed. Finally, while supporting the ethical duty to report impairment, a suggestion is made that during medication education, more emphasis should be placed on doctors recognising that they are human and fallible

Voluntary Active Euthanasia: Is There Any Place for it in Modern Day Medicine?

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. South African Family Practice Vol. 50 (3) 2008: pp. 38-3

Post-birth Rituals: Ethics and the Law

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. South African Family Practice Vol. 50 (2) 2008: pp. 45-4