Дисертації з теми "Medical laws and legislation – moral and ethical aspects"

This thesis seeks to demonstrate, by way of a multidisciplinary study, that consent is, despite its legal definition which refers to the free and enlighted expression of individual will, in fact, at times limited if not eliminated, by social considerations, arising from the medical, economic and legal context. These considerations reflect what one might call the social norm. An appropriate understanding of consent serves, therefore, to express the social norm as a constraint, which, in turn, acts as a measure of what it means to belong in society. Thus, while consent is often presented as the fundamental principle to be respected in biomedical research, it is in reality, merely one principle to respect among others. These limitations connected to consent are exacerbated in emergency situations where consent is sometimes reduced to mere signature, and in some cases it has been recognized that research can be undertaken without the subject's prior consent.

Given the considerable advances in the field of biotechnology in the last decades, new issues of scientific, social, legal and ethical nature have been raised, particularly concerning inventions making use of living material, and their patentability.
Notwithstanding some reluctance at the outset, most of patent offices as well as courts and tribunals in the United States, Canada and Europe have finally accepted patentability of living organisms. Oppositions are however numerous and, more than a criticism towards the patent system itself, it is genetic engineering that is put into question.
Europe has recently regulated the legal protection of biotechnological inventions. Being a text of compromise, the Directive is already subject of controversies. The United States and Canada have not yet decided to explicitly legislate in this field. Some decisions taken in particular cases allow to determine the state of the question in these two countries. It is however not certain that they can be satisfied with an unregulated technology that raises so many moral questions.
The question of the foremost importance concerns the research branch, as well as the use that will be done with inventions emerging from the biotechnology industry. Patent law being unable to prevent technological creations, it is above all the utilisation of it that will allow to retain the most beneficial inventions for humankind and its environment.

Thesis (MPhil)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: The implementation of eugenic policies reached its peak during the zo" century when thousands of people with intellectual disabilities and other "undesirable qualities" were involuntary sterilized. Although most of the eugenic policies have been removed, countries such as South Africa, still make legally provision for the involuntary sterilization of people with intellectual disabilities. Torbjërn Tannsjë (1998) used the "argument from autonomy" to argue that involuntary sterilization practices are wrong because it involves compulsion. According to him, society should never interfere with people's reproductive choices and people should never be required to qualify for the right to have children. The aim of this assignment was to systematically assess the "argument from autonomy" as far as the policy of involuntary sterilization of people with intellectual disabilities is concerned. To this end, the concept of autonomy and the principle of respect for autonomy are discussed and applied to the intellectually disabled. It is argued that autonomy and respect for autonomy are useful concepts to apply to some people with intellectual disabilities. These individuals should not be automatically assumed to be incompetent, but their competence needs to be determined on an individual level, with reference to the complexity of the decision to be made. Special effort is needed from health care professionals to obtain (where possible) informed consent from people with intellectual disabilities. The application of the principle of respect for autonomy to matters of reproduction leads to the conclusion that people with severe to profound levels of disability, are unable to provide informed consent for sexual intercourse. Therefore some form of paternalistic protection is needed for these individuals. People with mild to moderate intellectual disabilities who are however competent to consent to sexual intercourse should never be prohibited from procreation by means of involuntary sterilization. State interference in matters of reproduction should be limited to interventions where (i) children are seriously harmed by parents and (ii) to protect those who are incompetent to consent to sexual interactions with others. Apart from these exceptions, the intellectually disabled is entitled to the same procreative rights as all other citizens.
AFRIKAANSE OPSOMMING: Die implementering van eugenetiese beleid het gedurende die 20 ste eeu 'n hoogtepunt bereik met die onwillekeurige sterilisering van duisende persone met intellektuele gestremdhede en ander "ongewensde kwaliteite". Alhoewel meeste van die eugenetiese wetgewing verwyder is, maak lande soos Suid-Afrika steeds wetlik voorsiening vir die onwillekeurige sterilisasie van persone met intellektuele gestremdhede. Torbjërn Tannsjo (1998) maak gebruik van die "outonomie argument" om te argumenteer dat onwillekeurige sterilisasie praktyke onaanvaarbaar is omdat dit dwang bevat. Hy voer aan dat die samelewing nooit in die reproduktiewe keuses van mense behoort in te meng nie en dat dit nooit vir mense nodig moet wees om vir ouerskap te kwalifiseer nie. Die doel van hierdie werkstuk was om sistematies die "outonomie argument" te analiseer ten opsigte van die beleid van die onwillekeurige sterilisasie van persone met intellektuele gestremdhede. Met hierdie doel voor oë word die konsep outonomie en die beginsel van respek vir outonomie bespreek en toegepas op die intellektueel gestremde persoon. Daar word aangevoer dat outonomie en respek vir outonomie nuttige beginsels is om in ag te neem in kwessies rakende intellektueel gestremdes. Hierdie individue moet nie outomaties as onbevoeg beskou word nie, maar hul bevoegdheid moet eerder op 'n individuele basis beoordeel word, inaggeneem die kompleksiteit van die besluit wat geneem moet word. Voorts word daar van gesondheidsorgpersoneel verwag om moeite te doen met die verkryging van oorwoê toestemming (waar moontlik) by persone met intellektuele gestremdhede. Die toepassing van die beginsel van respek vir outonomie op aspekte rakende reproduksie, lei tot die gevolgtrekking dat persone met ernstige intellektuele gestremdhede nie in staat is om toestemming tot seksuele omgang te verleen nie. Dus, is 'n vorm van paternalistiese beskerming in hierdie gevalle aangedui. Persone met intellektuele gestremdhede wat egter wel bevoeg is om toestemming tot seksuele omgang te verleen, moet nooit weerhou word van voortplanting deur middel van onwillekeurige sterilisering nie. Inmenging deur die staat in kwessies rakende reproduksie moet beperk word tot intervensies waar (i) kinders ernstige skade berokken word en (ii) die beskerming van persone wat onbevoeg is om toestemming tot seksuele interaksies met ander te verleen, benodig word. Afgesien hiervan, is die intellektuele gestremde persoon geregtig op dieselfde reproduktiewe regte as alle ander landsburgers.

Aim: The 1996 Choice on Termination of Pregnancy Act decriminalized abortion in South Africa and the South African Medicines Control Council in 2000 approved the dispensing of emergency contraceptive methods by pharmacists to women without a doctor's prescription. This legislation has been hailed as among the most progressive in the world with respect to women's reproductive justice. However the realisation of these rights in practice has not always met expectations in part due to medical practitioners' ethical objections to termination of pregnancy and the provision of related services. The aim of this study was to interpret the varying ways in which medical practitioners frame termination of pregnancy and emergency contraceptive services, their own professional identities and that of their patients/clients. Methods: Sample of 58 doctors and 59 pharmacists drawn from all nine provinces of South Africa. Data collected using an anonymous confidential internet-based self-administered questionnaire. Participants were randomly recruited from online listings of South African doctors and pharmacists practicing in both private and public sectors. Data were analysed using theoretically derived qualitative content analysis. Results: Participants drew on eight frames to justify their willingness or unwillingness to provide termination-of-pregnancy related services: the foetal life frame, the women's rights frame, the balancing frame, the social justice frame, the do no harm frame, the legal and professional obligation frame, the consequences frame and the moral absolutist frame. Conclusion: Health professionals' willingness or unwillingness to provide termination of pregnancy related services is highly dependent on how they frame or understand termination of pregnancy, and how they understand their own professional identities and those of their patients/clients.

Thesis (LLM)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: The monitoring of electronic communication is likely to face all employers sooner or later. The rapid advancement in technology aimed at helping to monitor electronic communication, makes it easier than ever before for employers to monitor the electronic communications of their employees. There are important questions to consider when dealing with the topic of monitoring electronic communication. Examples include "mayan employer legally monitor electronic communications?" and "how does monitoring affect the employee's right to privacy?" This thesis is an attempt to answer these and other related questions by analysing, inter alia, South African legislation, the Constitution and case law, as well as comparing the law as it applies in the United Kingdom and the United States of America. The analysis and conclusion offered in this thesis aim to provide theoretical consideration to academics and practical application for employers that are faced with the reality of monitoring electronic communications.
AFRIKAANSE OPSOMMING: Alle werkgewers sal waarskynlik die een of ander tyd met die monitering van elektroniese kommunikasie gekonfronteer word. Die snelle voortuitgang in tegnologie wat daarop gemik is om te help met die monitering van elektroniese kommunikasie, maak dit vir werkgewers makliker as ooit tevore om sodanige kommunikasies van hulle werknemers te monitor. Daar is egter belangrike vrae wat oorweeg moet word wanneer die onderwerp van monitering van elektroniese kommunikasie ter sprake kom. Voorbeelde hiervan is "mag 'n werknemer regtens elektroniese kommunikasies monitor?" en "hoe raak monitering die werknemer se reg tot privaatheid?" Hierdie tesis is 'n poging om hierdie en ander verwante vrae te beantwoord deur die ontleding van, onder andere, Suid-Afrikaanse wetgewing, die Grondwet en die reg soos deur hofuitsprake ontwikkel, sowel as vergelyking van die reg soos wat dit van toepassing is in die Verenigde Koninkryk en die Verenigde State van Amerika. Die ontleding en gevolgtrekking wat in hierdie tesis aangebied word, is gemik op die verskaffing van teoretiese oorweging aan akademici en praktiese toepassing vir werkgewers wat met die realiteit van die monitering van elektroniese kommunikasies gekonfronteer word.

Thesis (LLD (Public Law))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: The unique and intimate relationship that exists between a medical practitioner and his/her client is possibly one of the most important relationships that can come into being between any two people. This relationship is characterised and influenced by the qualities and attributes specific to the nature and historical development of medical care, as well as medical science in general. The doctor-patient relationship is also influenced by the social dynamics of a particular community, environmental factors, technological advances and the general social and commercial evolution of the human race. With regard to medical care and health service delivery, the doctor-patient relationship is furthermore vital to the quality of the care provided, as well as to the outcomes and relative success of the specific medical intervention or treatment. One of the distinct characteristics of the doctor-patient relationship is the power imbalance inherent in this relationship. The medical practitioner has expert knowledge and skill, while the patient finds himself or herself in an unusually dependent and vulnerable position. It is because of this important role that the doctor-patient relationship still plays in health service delivery today; the susceptibility of the relationship to a variety of influences, and the characteristic power imbalances inherent in this relationship, that a study of the doctor-patient relationship in South African medical- and health law is necessary. The characteristic power imbalances will be considered from a legal perspective in this dissertation. This study provides a comprehensive source of the doctor-patient relationship from a legal perspective. Where relevant, references are made to theories and principles from other disciplines, including sociology, economy and medical ethnomethodology. The prevalence and consequences of power imbalances in the doctor-patient relationship are identified and discussed with the aim of bringing these to the attention of both the legal fraternity, and medical practitioners. Specific problem areas are identified and solutions are offered, including the following: • The adverse consequences of power imbalances inherent in the doctor-patient relationship on the medical decision-making process are considered from various perspectives. With regard to these adverse consequences, the doctrine of informed consent is analysed and evaluated in great detail. • The influence of paternalistic notions in health service delivery; the business model of health service delivery and the effects of managed care and consumer-directed health care on the doctor-patient relationship and health service delivery in general are also analysed from a legal perspective, and specifically with regard to the power imbalances inherent in this relationship. • The role of autonomy, self-determination and dignity, as well as the principles of beneficence in medical practice, are reconsidered in an attempt to provide a solution for redressing the power imbalances inherent in the doctor-patient relationship. • The fiduciary nature of the doctor-patient relationship and the special role of trust in the relationship are emphasised throughout the dissertation as the focal point of departure in the doctor-patient relationship and the main constituent in any legal endeavor to redress the power imbalances inherent in it.
AFRIKAANS OPSOMMING: Die unieke en intieme verhouding wat bestaan tussen ‘n mediese praktisyn en ‘n pasiënt is wêreldwyd waarskynlik een van die belangrikste verhoudings wat tussen twee persone tot stand kan kom. Hierdie verhouding word gekenmerk en beïnvloed deur kwaliteite en eienskappe eie aan die besonderse aard en historiese ontwikkeling van gesondheidsorg, sowel as die mediese wetenskap in die algemeen. Die dokter-pasiënt verhouding word verder beïnvloed deur die sosiale dinamika van ‘n bepaalde gemeenskap, omgewingsfaktore, tegnologiese vooruitgang en die algemene sosiale en kommersiële ontwikkeling van die mensdom. Op die terrein van gesondheidsorg en mediese dienslewering is die dokter-pasiënt verhouding voorts ook sentraal tot die kwaliteit van die mediese sorg wat verskaf word, sowel as die uitkomste en relatiewe sukses van die spesifieke mediese behandeling. Een van die kenmerkende eienskappe van die dokter-pasiënt verhouding is die magswanbalans wat daar tussen dokter en pasiënt bestaan. Die mediese praktisyn beskik oor deskundige kennis en vaardighede, terwyl die pasiënt hom- of haarself in ‘n ongewone, afhanklike en kwesbare posisie bevind. Dit is dan veral weens die besondere rol wat hierdie verhouding steeds in hedendaagse gesondheidsorg speel, die beïnvloedbaarheid van hierdie verhouding deur ‘n verskeidenheid faktore, sowel as die kenmerkende magswanbalans inherent in die verhouding, dat ‘n ondersoek na die dokter-pasiënt verhouding in die Suid-Afrikaanse mediese reg noodsaaklik is. Hierdie kenmerkende magswanbalans sal vanuit ‘n regsperspektief verder in hierdie proefskrif ondersoek word. Hierdie studie bied ‘n omvattende bron van die dokter-pasiënt verhouding benader vanuit ‘n regsperspektief, terwyl verwysings na teorieë en beginsels van ander dissiplines soos die sosiologie, ekonomie en mediese etnometodologie ook waar nodig ingesluit word. Die voorkoms en gevolge van ‘n magswanbalans in die dokter-pasiënt verhouding word verder geïdentifiseer en bespreek ten einde dit onder die aandag te bring van beide regslui en medici. Spesifieke probleemareas wat geïdentifiseer is en die oplossings wat daarvoor aan die hand gedoen is sluit die volgende in: • Die nadelige gevolge van die bestaan van ‘n magswanbalans in die dokter-pasiënt verhouding op die mediese-besluitnemingsproses word bespreek vanuit verskillende persepktiewe. Met betrekking tot hierdie nadelige gevolge, word die leerstuk van ingeligte toestemming in besonder geanaliseer en geëvalueer. • Die invloed van ‘n paternalistiese benadering tot gesondheidsorg, die besigheids-model van gesondheidsorg, en die effek van bestuurde- en verbruikersgedrewe gesondheidsorg inisiatiewe op die dokter-pasiënt verhouding en die verskaffing van gesondheidsdienste in die algemeen word ook vanuit ‘n regsperspektief ge-analiseer. Spesifieke aandag word in dié verband gegee aan die invloede van hierdie benaderings en perspektiewe op die magswanbalans inherent aan die dokter-pasiënt verhouding. • Die besondere rol van autonomie, selfbeskikking en menswaardigheid, asook die beginsels van weldadigheid in gesondheidsorg, word heroorweeg in ‘n poging om ‘n meer gelyke distribusie van mag in die dokter-pasiënt verhouding te verseker. • Die fidusiêre aard van die dokter-pasiënt verhouding en die besondere rol wat vertroue in hierdie verhouding speel, word in hierdie proefskrif beklemtoon en word voorts as die basis van die dokter-pasiënt verhouding beskou. Vertroue, as ‘n kenmerk van die dokter-pasiënt verhouding, behoort ook die fokuspunt te wees van enige poging om die magswanbalans in die dokter-pasiënt verhouding aan te spreek.

Gender reassignment procedures are performed for the treatment of the gender dysphoria syndrome (transsexualism). Although this modality of treatment is therapeutic in nature and therefore not contra bonos mores, the legal status of the post-operative transsexual remains that of his/her previous sex. The purpose of the gender reassignment procedures is that of acceptance within the community as a person of the sex indicated by his/her changed appearance. Nothing will be achieved by the successful completion of treatment if the person's changed sexual appearance is not recognised by the law as a change in sexual status as well. The law, by keeping aloof of the problem of the post-operative transsexual, has created a legal "vacuum" where there is social and judicial acceptance of reassignment procedures, but a refusal to give legal effect to the change in status that the transsexual obsessively desires and the operation simulates. This work will analyse the medical issues associated with gender reassignment procedures. The legal status of the transsexual after reassignment procedures will be explored, and in doing so, the human rights violations with which such people have to contend, will be highlighted. The constitutionality of the lack of a legal recognition of the post-operative transsexual's sexual status will be examined. It will be shown that there are compelling reasons for legislation to be introduced as a matter of urgency to safeguard the fundamental rights of the post-operative transsexual.
Thesis (LL.M.)-University of Natal, 2000.

This dissertation examines the legal position relating to the participation of children in research, especially in HIV preventive clinical research in South Africa. HIV/AIDS presents a real threat to humanity and particularly to the welfare of children. The participation of children in this type of trials is therefore vital. Children, as vulnerable participants, must also be protected from harm resulting from research. The study also considers the nature of HIV preventive clinical research, pointing to the inconsistencies in the legislation governing children’s participation in HIV preventive vaccine trials. The dissertation concludes that the question of the participation of children in HIV preventive clinical research poses many challenges, as the position in the South African law and relevant ethical guidelines are inconsistent and contradictory. The study recommends in the final instance that the relevant statutory provisions and ethical guidelines be harmonised in order to clear up the inconsistencies.
Jurisprudence
LL.M. (Legal Aspects of HIV/AIDS)

The dissertation critically examines and compares the decisions of the Constitutional Court and the High Courts in cases dealing with the right to life, as contained in section 11 of the Constitution of South Africa Act 108 of 1996. The dissertation analysis the issues of adjudication and the concept of justice in perspective. The main question is as follows: Are the Constitutional Court decisions objective, based on the interpretation of the constitutional text, or do they rather reflect the individual judge(s) personal perspective(s) or preference(s). The purpose of this dissertation is to undertake a comparative study and analysis of the Constitutional Court decisions on the right to life, same aspect from different perspective, and show that the right to life is not given proper effect to on account of the subjective approach to its interpretation undertaken by the judges. It examines and scrutinises the Constitutional Court’s adjudication process. It found that the law is indeterminable, because the court’s decisions are not based on the interpretation of the law, but on the individual judges’ background and personal preferences. This is so because the court uses the majority rule principle in its decisions: The perception of the majority of the judges becomes a decision of the court. It is argued that when taking a decision a judge does not apply the law but instead uses the law to justify his predetermined decision on the matter. The conclusion supports the critical legal scholars’ theory relating to the indeterminacy of the law. It tests the objectivity of the judges using their own previous decisions.
Criminal & Procedural Law
LLM

This dissertation deals with a theological-ethical evaluation of the Termination of Pregnancy Act of 1996 on the area of abortion on demand. It aims at empowering women and also solving the problem of backstreet abortion. Chapter one gives a brief introduction to the Termination of Pregnancy Act of 1996. Chapter two gives a historical background of abortion and the factors tbat eventually led to the Termination of Pregnancy Act of 1996. Chapter three focuses mainly on the teachings of the Roman Catholic Church on abortion. Issues relating to the value of human life are discussed in this chapter. Is~~es relating to the Termination of Pregnancy Act of 1996 and their theologicalethical in.Jplications are discussed in this chapter, i.e. chapter four. Empowering of women, sex education, instilling good moral values to the youth and also changing the pastoral attitude of churches towards sexuality can help to alleviate the problem of unwanted pregnancy.
Philosophy, Practical & Systematic Theology
M. Th. (Theological Ethics)

There are thousands of desperate people globally who need a kidney for transplantation. The number of people who require a kidney transplant continues to escalate faster than the number of kidneys available for a transplant. The aim of this dissertation is to examine and analyse the judicial framework pertaining to kidney transplants in South Africa. The examination is conducted within the framework of the South African Constitution and the National Health Act 61 of 2003. The specific focus of this dissertation is to determine whether the payment of kidney donors could be regarded as constitutionally acceptable. A comparative study is undertaken, with Singapore and Iran as a background against which recommendations for the South African regulatory framework are made. The most important finding is that people should at least be granted the choice whether they would prefer to receive payment for their kidney donations or not.
Jurisprudence
LL.M.

Defence date: 20 February 2006
Examining Board: Prof. Karl-Heinz Ladeur (Supervisor, Universität Hamburg) ; Prof. Christian Joerges (European University Institute) ; Prof. Graeme Laurie (Edinburgh University) ; Prof. Tim Murphy (London School of Economics)
PDF of thesis uploaded from the Library digitised archive of EUI PhD theses completed between 2013 and 2017

The advent of ARTs has enabled many individuals to have children and build families. Although ARTs have from the start been designated to serve as alternative way for heterosexual infertile individuals and couples to have genetically related children, ARTs are nowadays widely used by gays and lesbians to have even genetically unrelated children and build their families. This study addresses the well-being of children born as a result of ARTs and growing up in homosexual families in South Africa. South Africa has legalised homosexual unions, granting gays and lesbians several rights, including the right to marry, use ARTs to reproduce, and build families in which they raise their children. South Africa has also provided constitutional and statutory protection of children’s rights and has further required that the child’s best interests be considered as paramount in every matter concerning the child. Although ARTs may have allowed people to have children, they have proven to put the child’s interests at risk. ARTs are associated with several physical and psychological problems for resulting children. The legal protection provided for those children seems to be inadequate in respect of their best interests. Unlike Australian statutes that have provided strong protection for the child’s best interests, South African legislations regulating ARTs are far from protecting ART-born children’s interests. The application of the child’s best interests criterion to ART procedures has revealed that in the USA and Australia efforts of the state, ART providers and parents have been centred on the transfer of the custody of the ART-born child to the commissioning parent(s). Although in South Africa the application of the child’s best interests in the context of surrogacy procedures has revealed the protection of the child’s interests, it should be noted that that protection seems to focus on the child’s post-birth period. This situation leaves ART-born children without any protection, especially before their birth. In order to give effect to section 28 of the Constitution of the Republic of South Africa, 1996 and protect ART-born children’s interests, I make certain proposals for law reform in the final chapter of this thesis.
Private Law
LL. D

Since their creation in Europe in the seventeenth century, pension funds have grown to become one of the main sources of capital in the world. A number of role players ultimately manage the pension money of members on their behalf. Accordingly, the focus of this study is on the role players involved in the actual investment of pension fund money. For the purposes of the study, the key role players in the pension fund investment chain are identified as pension fund trustees, asset managers and asset consultants. These role players have a specific responsibility in terms of the service that they ought to provide. One of the key aspects of this dissertation is therefore determining whether their responsibility is a fiduciary responsibility. The main purpose of the study is, however, to answer one overarching research question: Does fiduciary responsibility create barriers to the implementation of responsible investment in the South African pension fund investment chain? Clearly, there are two key terms in this research question, fiduciary responsibility and responsible investment. It is suggested that responsible investment takes at least two forms: a “business case” form1 in which environmental, social and governance (ESG) issues are considered only in so far as they are financially material; and a social form in which ESG issues are considered over maximising risk adjusted financial returns. Three key questions were asked in order to find qualitative descriptions and interpretations of fiduciary responsibility: Question 1: Are the key role players in the pension fund investment chain fiduciaries? Question 2: If so, to whom do the key role players owe their fiduciary duty? Question 3: What are the fiduciary duties of the key role players in the pension fund investment chain? It is also suggested that the duty to act in the best interests of beneficiaries could be described as the all-encompassing fiduciary duty. Two main interpretations of the
Private Law
(LL.M.(Private Law))

The South African government promulgated the Choice on Termination of pregnancy Act (CTOP Act, 92 of 1996). This was a dramatic declaration of intent unprecedented in the African continent and globally. This act changed the outlook of the practice of termination of pregnancy by ensuring that services play a critical role in the delivery of the service. This study, which is qualitative in nature, explored the experiences of Termination of Pregnancy service providers working in three designated public health institutions in the Limpopo Province. Interviews were conducted with six service providers to look at how they construct their practice of providing termination of pregnancy services. The information was analyzed and interpreted by means of a thematic analysis method. Major themes that emerged from the participants’ experiences centred on their relationship with family, colleagues, management, clients, and the community reflecting a sense of alienation and lack of adequate infrastructural support. Inadequate support has been found to greatly contribute to the loss of interest in the work around abortion.
Psychology
M. A. (Clinical Psychology)