Pregnant, dead, and on a ventilator: A few thoughts in response to Prof. McQuoid-Mason

Advances made by medical science are able to extend human life,  sometimes by highly technical means such as life-support systems. Oftenthese procedures prove life-saving, and the patient recovers fully; at other times, however, life-extending treatment is futile, such as when the patient is declared brain dead. Advances in reproductive technologies, similarly, have been able bring hope by treating and curing infertility. This article responds to an article by Professor McQuoid-Mason entitled ‘Terminating the pregnancy of a brain-dead mother: Does a fetus have a right to life?’ He examines the law in South Africa and the legal implications of the Munoz case, which concerned an application for a court order to have a brain-dead pregnant woman removed from a ventilator. Departing from Prof. McQuoid-Mason’s discussion, this article highlights a few of the ethical and legal implications of new technologies that enable pregnancy to be extended beyond the pregnant woman’s life. This article questions the ethical and legal appropriateness of the use of new technologies, especially in situations where such use is contrary to the pregnant woman’s express wishes. In this context, the article deliberates on whether the dead may be considered to be the bearers of rights that must be respected

Informed consent to participation in preventive HIV vaccine efficacy trials in the light of section 12(2)(c) of the South African Constitution

Clinical trials to develop an effective vaccine against HIV are currently underway in South Africa. The scientific, epidemiologic and socio-economic backgrounds against which these trials are likely to take place are described, as well as the risks and benefits attaching to participation. It is argued that, against this background, informed consent will be difficult to achieve. In the light of this reality, the extent of the constitutional guarantee in section 12(2)(c) is investigated. The content of section 12(2)(c) is analysed, and recent case law that deals with section 12 is examined critically. It is concluded that the constitutional guarantee contained in section 12(2)(c) is an important buttress against communities’ exploitation during HIV vaccine trials

Two cheers for equality: A critical appraisal of Act 4 of 2000 from a plain language viewpoint

Legislative writing is often criticised by the lay person for its use of obscure words and complicated sentence structure. This contribution appraises the comprehensibility of the language of South Africa’s new equality legislation, Act 4 of 2000. In its preamble, Act 4 of 2000 promises to undertake the facilitation of “the transition to a democratic society, marked by human relations that are caring and compassionate”. I consider the question as to whether the promise contained in the preamble to the Act does not effectively nullify itself given that the Act is written in language that is accessible  almost exclusively to legislators and members of the legal profession

The right to physical integrity and informed refusal: Just how far does a patient’s right to refuse medical treatment go?

The article presents a legal analysis of the right to physical integrity as guaranteed by the South African Constitution, 1996, and the subsequent right of a competent adult person to refuse medical treatment under South African law. We consider whether the right to refuse treatment is an absolute right and very briefly reflect on the application of the constitutional limitations clause to this right. Instances in which patients’ right to physical integrity is limited by factors, which detract from (patient) autonomy, are considered: these represent a limitation of their right to refuse medical treatment. We conclude that forced medical interventions, for the most part, are not desirable but, indeed, necessary in some narrowly defined circumstances. When a person makes a decision to refuse a medical intervention, which may seem unusual or may be perceived as irrational, it does not mean that person does not warrant the protection of the constitution and the courts. Provided that the patient makes an informed refusal while of sound mind, generally there is no reason to discredit his/her decision, difficult as it may be for others to accept. At all times the right to bodily integrity is pivotal in any health-related context and should not be lightly disregarded

Role of Interventional Treatment of Thoracic Aorta

An aging western and oriental population coupled with breakthrough advances in modern diagnostic imaging modalities has evoked renewed interest in the hitherto underdiagnosed acute and chronic diseases of the aorta, which also include aortic aneurysm and aortic dissection. Although classical surgical strategies still dominate the clinical management of acute and chronic pathologies of the ascending aorta and the proximal arch region, the emergence of novel endovascular concepts has offered an interesting therapy alternative for the treatment of descending aortic pathology in suitable patients and is highly likely to evolve as the primary treatment strategy in majority of the cases. Moreover, the use of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an attempt to improve clinical outcome in aortic arch pathologies has helped avoid the high risk of open arch repair or complete replacement. Notwithstanding these recent advancements, the complex nature of the underlying vascular disease still dictates that the proposed management of every diagnosed patient is discussed in a team constituting cardiologists, cardiac surgeons, anesthesiologists, and radiologists, with the conceptualization of individualized therapeutic strategies and conducted in a center with significant surgical and endovascular experience

Obesity and Coronary Artery Disease

The impact of obesity can be better understood by studying the growing medical and socioeconomic burden of this often neglected public health epidemic. Traditionally associated with cardiovascular risk factors like hypertension, hyperlipidemia, and diabetes mellitus, morbid obesity has increasingly contributed to mortality among Western as well as Third World populations. Contemporary evidence has also consistently linked this patient cohort with a greater risk to develop coronary artery disease. Recent population‐based registries indicate that 43 and 24% of all cases of coronary revascularization were performed in overweight and obese patients, respectively. In this context, although popular thought has reaffirmed the positive correlation between obesity and increased cardiovascular morbidity, some authors have opined a better clinical outcome in overweight and obese patients, a phenomenon they termed “obesity paradoxon.” Conflicting data and the possibility of confounding bias have festered an ongoing debate challenging this “obesity paradox.” In this review article, we present updated evidence and discuss the validity of the “obesity paradoxon” in a variety of clinical settings

The Roles of Experts and Expert-Based Information in the Advocacy Coalition Framework: Conceptual and Empirical Considerations Based on the Acid Mine Drainage Case Study in Gauteng, South Africa

The Advocacy Coalition Framework (ACF) remains one of the leading conceptual models in the policy sciences because it continues to be revised and updated as required. A focus area of the ACF that requires further theorization is the roles of experts and expert-based information in influencing policy problem contexts. Our article takes a necessary step in this direction by (1) evaluating the usefulness of Weible’s expectations regarding the uses of expert-based information in different types of policy subsystems and factors that contribute to shifts from one subsystem to another; and (2) making critical observations that result from this evaluation in the context of the controversial acid mine drainage policy case study in South Africa. The findings of our case study analysis indicate that Weible’s framework performed reasonably well but also revealed opportunities for further improvement. We therefore suggest adding awareness raising as a use of expert-based information, developing a typology of different types of experts who participate in policy subsystems, and including a focus on the use of expert-based information in policy subsystem shifts. We also reflect upon the relevance and importance of continuing to expand ACF applications to countries outside of North America and Western Europe