Steve Biko Centre for Bioethics 2007 Annual Report


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Steve Biko Centre for Bioethics 2007 Annual Report

  1. 1. 1 Activities of theSteveBiko Centrefor Bioethicsforthe period1st January2007– 31 December2008
  2. 2. 2 It gives me great pleasure to present to the Faculty the first report on the activities of the Steve Biko Centre for Bioethics for the period 1st January 2007 to 31st December 2008. The Centre is involved in a number of activities as per the Centre’s objectives which are: a. Development of national and international research programs b. Ongoing curriculum development and teaching c. Collaboration with other developing and developed world-based bioethicists on training and research projects. d. Advising health providers on policy matters, including resource allocation, rationing of health care services and monitoring standards of care in the ethical practice of the caring professions including medicine, dentistry, nursing, physiotherapy, occupational therapy, and pharmacy. e. Providing an ethics consultation service at hospitals and clinics within the academic hospitals as well as the primary health care settings. f. Providing NGOs and other community groups with health care ethics advice g. Community outreach as a social responsibility. Implementing the aims and objectives of the Centre has thus far been exciting, challenging and gratifying. Centre activities started off with a successfuland very well attended launch at Constitution Hill in February 2007. The Faculty has been extremely supportive of the Centre’s activities and for this we are indeed grateful. __________________ A. Dhai Centre Director
  3. 3. 3 A. UNDERGRADUATE TEACHING ACTIVITIES The Centre is responsible for the coordination of teaching and evaluation of Bioethics to a range of undergraduate students registered in the faculty of Health Sciences. These include students registered for the following degrees: Dentistry; Pharmacy; Bachelor of Health Sciences; Physiotherapy; Occupational Therapy and the Graduate Entry Medical programme. Class sizes are diverse as indicated in the beak-down below:  Dentistry 1 - +45 students  Dentistry 4 - + 40 students  Pharmacy 3 - +45 students  Bachelor of Health Sciences 2 - + 40 students  Bachelor of Health Sciences 3 - + 15 students  Therapeutic Sciences 1 - + 100 students  Therapeutic Sciences 3 -+ 100 students  Therapeutic Sciences 4 -+ 100 students  Graduate Entry Medical Programme 1 - + 220 students  Graduate Entry Medical Programme 2 - + 220 students  Graduate Entry Medical Programme 3 - + 220 students  Graduate Entry Medical Programme 4 - + 220 students As the Centre has had to fit into an inherited teaching program, there have been several challenges faced by Centre staff. A particular challenge has been to address some of the concerns/criticisms that have been leveled at the approach to teaching. Two particular issues have been that the course is taught in the abstract i.e. philosophical, and not applied (in the sense that it does not relate directly to the students’ field of study), and that the readings given to students were not easy to read/understand. In an effort to address these criticisms, the Centre has: (i) revised the Bioethics course content to cover the core topics as proposed by the Health Professions Council of South Africa; (ii) introduced some additional teaching methods to the traditional formal lecture approach so as to facilitate the diverse learning needs of students, and (iii) developed course information packs, which basically spells out what the course will cover, how it will be assessed and what the requirements for promotion are. (iv) developed a program for the GEMP students that will comprehensively cover the core curriculum using a structured, systematic and applied approach. Additional teaching strategies to the formal lecture approach employed by the Centre include: case study discussions; written assignments and course-directed readings that we believe to be appropriate for non-philosophy students. In some of the teaching sessions, and where the facilities are available film has been used as the medium of instruction. We have found this to be a useful way of explaining and assessing students understanding and ability to (as a start) identify and/or discuss an ethical issue.
  4. 4. 4 B. POSTGRADUATE TEACHING ACTIVITIES The Centre has continued with delivering programs developed by the Division. In addition, the Centre is involved in teaching in other Postgraduate programs including the School of Public Health, Family Medicine, and Student Writing Workshops run by the Postgraduate Projects Office. The MScMed (Bioethics & Health Law) course has been further developed to encompass the objectives and outcomes of the programme. We have held internal meetings to evaluate our course and have tried to improve our level and scope of teaching practices in the fields of bioethics, human rights and health law. Such internal discussions have resulted in the development of our new 2008 Student Information Booklet. We introduced our new unit, Environmental Bioethics (FAMH 7036) in 2008 which has proven to be a great success. We are currently working on another elective unit, Bioethics, the Media and the Law which is intended to reflect on the ways in which the media portrays medical issues. Key issues we will look at are: media ethics, potential problems healthcare professionals face when requesting comment by journalists on healthcare issues, and the law concerning whistleblowing and information disclosure. In December 2008, four students received their MSc Med (Bioethics & Health Law) degree. Of this date, we have five students whose Research Reports have been accepted and are scheduled to graduate in June 2009. In 2008, 19 students enrolled in our course. Of the 19, one was murdered, and 2 were unsuccessful in their coursework and chose not to register in 2009. Four students are repeating some elective units and two have taken the year in abeyance due to financial difficulties. One student was successful in completing the course full time in one year. The remaining students entered their second year of study. Our teaching periods ran from 8:30-5:30 x four (Core units and Environmental Bioethics five days) days per week. In 2007, the units included Introduction to Bioethics, Introduction to Health Law, Environmental Bioethics, Research Ethics, HIV,Ethics and the Law , Genetics, Ethics & the Law & Human Rights, Ethics & the Law. A particular challenge for meaningful delivery of this program is the support for individuals to pursue postgraduate degrees in the Faculty. Concerning Bioethics & Ethics, per se we have very few journals in the library in these fields, very few books, and the internet resources available do not have the major academic journals in Ethics on their sites. This makes it difficult not only for those of us working in academia but greatly disadvantages our students as well. MSc BIOETHICS AND HEALTH LAW: STUDENTS Graduated students 2007 4 Graduated students 2008 4 Registered students 2007 16 Registered students 2008 19 Research Report stage 38
  5. 5. 5 GRADUATED STUDENTS: Master ofScience (Med) Bioethics and Health Law 2007 Ewart-Smith, Michael. Involuntary treatment of mentally incompetent individuals in South Africa. Gardner, Jillian. Limitation of autonomy and constitutional rights to prevent prenatal harm. Tint, Khin San. The ethical dimensions of current issuesregarding safe blood donation. Szabo, Christopher. Surgeons and HIV: A South African study. 2008 Armstrong,Russell. Selecting patients for anti-retroviral care at a rural clinic in Lesotho: Results froma case study analysis. Fick,Bazil Shaughn. The impact of embodiment on autonomy. Rens,Heather. Ethical issues concerning the implementation of an o pt out approach for human organsdonation in South Africa. Vangu, Mboyo Di-Tamba Heb’En Willy. Patients seen at the university hospital in Johannesburg: Theirviews on truth-telling. C. NATIONAL IMPACT This has been achieved by Centre staff serving on severalNational Committees including Medical and DentalBoard of Health Professions Council of South Africa (HPCSA). Human Rights, Ethics and Professional Practice Committee of HPCSA - Significant input from the Centre on updating the HPCSA’s ethics guideline booklets for health practitioners in the country. Centre staff has also been responsible for compiling the Reproductive Health Ethics, Biotechnology Ethics and Telemedicine Ethics Guideline booklets. In addition, the Centre contributed extensively towards compiling the HPCSA’s Core Curriculum for undergraduate health sciences students. HPCSA Subcommittee for Foreign Graduates Examinations. Responsible for setting of the ethics, human rights and health law component of the examinations, for candidates from medicine and dentistry. National Health Research Ethics Council - regulation and guideline writing for ethics in health research for South Africa. Will also be involved in registering and auditing of Research Ethics Committees in the country.
  6. 6. 6 South African Medical Association Human Rights and Ethics Committee: contributed towards current revisions to the Declaration of Helsinki. Agricultural Research Council : Research Ethics Policy developed by the Centre. Medical Research Council Ethics Committee Cancer Research Initiative of South Africa Research Committee Expert Advisory Committee for XDR Tuberculosis. South African National AIDS Council Women’s Sector Task Team Centre staff participates regularly at conferences and workshops arranged at a national level. D. INSTITUTIONAL COMMITTEES Centre staff actively participate in the following committees: Human Research Ethics Committees (Medical and Humanities) and Animal Research Ethics Committee Equal Opportunities Committee Professional Ethics and Standards Committee Clinical Audit Committee Postgraduate Committee Faculty Advisory Committee on Admissions Policy Faculty Executive Committee Faculty Board E. INTERNATIONAL ACTIVITIES The Centre has contributed significantly to activities outside South Africa: 2007 February – Organization of Economic Cooperation and Development Global Sciences Forum “Workshop on Best Practices for Ensuring Scientific Integrity and Preventing Misconduct – Tokyo, Japan. Staff member sent as South African representative by Department of Science and Technology. Paper presented on “Best Practices for Ensuring Scientific Integrity and Preventing Misconduct – South African Processes and Procedures”
  7. 7. 7 May – invited to participate in European Commission Conference “Ethics, Globalization and Research” in Brussels, Belgium. May - UNESCO International Bioethics Committee (In Kenya). “What is special about Bioethics in Africa?” June - Austrian School of Clinical Research (In Gabon). Several lectures presented on research ethics at the Research Methodology Workshop. July - Research Ethics lectures for the Reproductive Health Research Unit’s Annual Research Methods Program for students from Africa. September – invited to present paper at the First World Conference on Research Integrity in Lisbon, Portugal. Title of paper: “Preserving, Protecting and Improving Research Integrity in Africa – Challenges and Recommendations” September – ran Research Ethics Workshop in Durban for South African Netherlands Partnership for Alternate Program. November – represented Africa at the International Dual Use Conference hosted by the Polish Academy of Scientists in Warsaw,Poland. Presented paper titled “Biomedical Research in the Developing World – A Double-Edged Sword”. November / December:Annual PRIM&R (Public Responsibility in Medicine and Research) Conference in Boston, USA. On PRIM&R Faculty for International Track. Presented three papers: “The Ethical Review of Research:Understanding and Applying the Relevant Ethical and Regulatory Guidelines in Different Cultures and Settings.”; “Requirements for Responsible Conduct of Research – Ethical& Regulatory Framework in South Africa.”; and “Research involving vulnerable populations – children, wards,incarcerated,homeless.” Throughout the course of the year: Pfizer GCP Research Ethics lectures: Pietermaritzburg, Cape Town, Johannesburg, Namibia, Botswana 2008 March – NEPAD Workshop – Pretoria. Presentation on “ Ethics in Research and Development” May : Presented “Ethical and Regulatory Framework for Clinical Research in South Africa” at the Pan African Bioethics Congress Conference : “Achieving the Millennium Development Goals in Africa through the Implementation of an Integrated Ethical Scope” in the Cameroons. August: Consultation “Public Health Code of Ethics for Pandemic Influenza detection and Control in Africa - Identifying African Perspectives on Pandemic Influenza Ethics; Building Consensus on Ethical Challenges”, Kampala, Uganda.
  8. 8. 8 In addition to the above, Centre staff are involved in severalinternational Data Safety Monitoring Boards activities. F. FACULTYLECTURES The following Faculty lectures were hosted by the Centre: 2007 David Mcquoid-Mason: Professor of Law at the Centre for Socio-Legal Studies at the University of KwaZulu-Natal"Public Figures and Disclosures about Their Health: Do the Public have a Right to Know?" David Borasky: Head,IRB program, Family Health International “North /South collaborative research - Ethical dilemmas and possible solutions.” Miriam Kelty: Consultant in Bioethics and Research Management – USA. “ Responsible Research and Scientific Integrity” Merryll Vorster: Chair HREC. “Should Ethics BE Regulated?” Between the 12 – 14th September, the Centre ran a series of Faculty Lectures in Ethics by the Faculty’s first Steve Biko Faculty Lecturer,Professor Daniel Wikler: Mary B. Saltonstall Professor of Population Ethics in the Department of Population and International Health at the Harvard School of Public Health. Lectures presented by Professor Wikler: “Whats Fair? Population Level Bioethical Dillemas.” “Race and Research:Single and Multiple Standards of Care” “Ethics and Health Resource Allocation: Some Puzzles” 2008 Children and consent in the health care sector. Professor David McQuoid-Mason, Monday 28 January 2008, 1.00-2.00pm Genetics and Research. Professor Trefor Jenkins. 26 February 2008. Litigation, lintels, liability & life. Dr Graham Howarth, 25 February 2008. Health & health care under apartheid: The Biko case . Symposium 19 March 2008. G. OUTREACH PROGRAMME TO UNDER SERVICED MEDICAL UNIVERSITIES We continue to support the University of Limpopo (Faculty of Health Sciences [School of Dentistry & School of Medicine]) with lectures and curriculum-planning.
  9. 9. 9 H. OTHER PROJECTS Collaboration with the Harvard Ethics Program : hosted two students from June till August. Worked on project: “A pilot study of preferences and values among potential recipients of antiretroviral therapy regarding the choice between a likelihood of treatment versus a no- abandonment pledge”. Collaborations with the Academy of Science of South Africa (ASSAF) – Consensus Study on the Enhancement of Clinical Research in South Africa. Centre staff members serve as reviewers for grant applications including Fogarty and Wellcome Trust. I. GUEST LECTURES / PRESENTATIONS / OTHERACTIVITIES ON BEHALF OF STEVE BIKO CENTRE FOR BIOETHICS Lectures: South African Department of Defence Lectures: School of Public Health (University of Pretoria) in Environmental Ethics South African AIDS Conference – participation in panel discussion in Preconference Workshop on Microbicides Research Participation in the Colleges of Medicine of South Africa’s CMSA Policy Forum on Tertiary Academic Medicine and Specialist Training and Education Centre staff lecture regularly in Faculty and University related programs, e.g, Physicians Update, departmental academic activities and postgraduate courses. J. JOURNALS Centre Staff is also involved in the South African Journal of Bioethics and Law,with Editor – in Chief and member of the Editorial Board appointed from the Centre. First issue published in June 2008. Centre staff member serves as section editor for Developing World Bioethics Centre staff serve as reviewers for the following journals: The Lancet, Bioethics, Journal of Medicine and Philosophy, South African Journal of Family Medicine, Nature, Developing World Bioethics, South African Medical Journal, Social Science and Medicine, Science and Engineering Ethics. K. PUBLICATIONS Armstrong R. Mandatory HIV testing in pregnancy. Is there ever a time? Developing World Bioethics 2008; 8(1): 1-10. Barday Z, Dhai A,Davids R, Jacobs J, Kahn D, Kotzenberg C, McCulloch M, Meintjes G, Miller D, Naicker S, Naiker IP, Ndhlovu CE, Venter WDF, Wadee S. Guidelines for renal replacement therapy in HIV-infected individuals in South Africa. The Southern African Journal of HIV medicine 2008; 34-42.
  10. 10. 10 Cleaton-Jones P,Vorster M. Workload of a South African university-based health research ethics committee in 2003 and 2007. SAJBL 2008; 1: 38-43. Dhai A McQuoid-Mason D. What does professionalism in health care mean in the 21st century? Editorial SAJBL 2008; 1 (1): 2-3. Dhai A. Informed consent – 2008. SAJBL 2008; 1(1): 27-29 Dhai A. An introduction to informed consent: ethico-legal requirements. SADJ 2008; 63(1): 018-020 Dhai A. Understanding professionalism in health care in the twenty-first century. SADJ 2008; 63(3): 174-177. Dhai A. HIV and AIDS I Africa: social, political and economic realities. Theor Med Bioeth 2008; 29: 293-296. Dhai A. Through the looking glass. Editorial. SAJBL 2008; 1(1): 34-35. Knapp van Bogaert D, Ogunbanjo GA. ‘Don’t ask,don’t tell’. Ethical issues concerning learning and maintaining life-saving skills. SA FamPract 2008; 50: 52-53. Knapp van Bogaert D, Ogunbanjo GA. Post-birth rituals: Ethics and the law. SA FamPrac 2008; 50(2) 45-46. Knapp van Bogaert D, Ogunbanjo GA. Cosmetic surgery and the practice of medicine. SA Fam Prac 2008; 50 (1): 50-52. Knapp van Bogaert D. Review of Beyond mothering earth: ecological citizenship and the politics of care. In-Spire: Jnl of Law,Politics & Societies 2008; 3(1): 58-59. Knapp van Bogaert D, Ogunbanjo GA. Concepts concerning ‘disease’ causation, control and the current Cholera outbreak in Zimbabwe. SA Fam Prac 2008; 50 (6): 30-32. Kramer Efraim. ‘No one may be refused emergency medical treatment’ – ethical dilemmas in South African emergency medicine.. SAJBL 2008; 1(2): 53-56. Ogunbanjo GA, Knapp van Bogaert D. Voluntary active euthanasia: Is there a place for it in modern day medicine? SA Fam Prac 2008; 50: 38-39. PatelBhavna. Medical negligence and res ipsa loquitur in South Africa. SAJBL 2008; 1(2): 57-60. Richter M. Does the power of overripe tomatoes and dusty photos equal that of the bomb? SAMJ 2008; 98(7): 565. Richter M, Knapp van Bogaert D. The ghost of AIDS denialism: Manguzi Hospital and dual loyalty. The Southern African Journal of HIV Medicine. 2008; 8-14
  11. 11. 11 Richter M. Sex work, reform initiatives and HIV/AIDS in inner-city Johannesburg. African Journal of AIDS Research 2008; 7 (3): 323-333. van Bogaert L-J, Dhai A. Ethical challenges of treating the critically ill pregnant patient. Best Practice & Research Clinical Obstetrics and Gynaecology 2008; 22(5): 983-996. Venter WDF, Naicker S, Dhai A, Fabian J, Wadee S, Britz R, Paget G, Meintjes G. Uniquely South African: Time to consider offering HIV-positive donor kidneys to HIV-infected renal failure patients? SAMJ 2008; 98: 182-182 Cleaton-Jones P. Commentary 14.2: Research ethics in South Africa: Putting the Mpumalanga case into context. In: Lavery J, Crady C, Wahl ER, Emanuel FJ, eds. Ethical issues in international biomedical research:a casebook. New York: Oxford University Press. 2007: 240-245. Dhai A. HIV and AIDS: Ethical and legal challenges. SADJ 2007; 62: (10) 428-430. Dhai A, Szabo CP,McQuoid-Mason DJ. The impaired practitioner – scope of the problem and ethical challenges. Transactions 2007; 51(2) 62-64. (repeat S Afr Med J) Knapp van Bogaert. Ethical considerations in African traditional medicine: a response to Nyika. Developing World Bioeth 2007; 1: 35-40. Knapp van Bogaert D, Tangwa G. Commentary 14:1: Context, dual obligations and the vulnerability of independent review. In: : Lavery J, Crady C, Wahl ER, Emanuel FJ, eds. Ethical issues in international biomedical research:a casebook. New York:Oxford University Press. 2007. Naidoo S, Ross MH, Dhai A. Ethics in occupational health research in South Africa. Occupational Health Southern Africa 2007; 4-9. Schuklenk U, Kleinsmidt A. Rethinking mandatory HIV testing during pregnancy in high HIV-prevalence regions: ethical and policy issues. Am J Pub Health L. Chapters in books Gardner J. Criminalizing the act of sex work in South Africa. In: The Prize and the Price: Shaping Sexualities in South Africa. Edited by M van Zyl and M Steyn. 2008; HSRC Press. (In Press) M. Book Published: “What it means to be part ofa clinical trial”. Collaborators: Steve Biko Centre for Bioethics, World Medical Association, South African Medical Association, South African Depression and Anxiety Group.
  12. 12. 12 N. Accepted for publication Gardner J. HIV home testing – problem or part of the solution. SA Pharmaceutical Journal. 2008 Biempe Bikopo D, van Bogaert L-J. Reflection on euthanasia: Western and African Ntomba perspectives on the death of a chief. World Developing Bioethics 2008 O. GRANTS AND FUNDING R50 000 – Pfizer: towards Centre launch. R80 000 – Pfizer – towards March 2008 Human Rights Activities R1,724,050 – Pfizer: towards Bioethics lecturer over a four year period. R23,000 – SANPAD:seed funding towards proposal writing workshop for project: BIOETHICS IN SOUTHERN AFRICA:POLICY,PRACTICE AND TRAINING R 40, 000 – Agricultural Research Council: towards ARC Research Ethics Policy R66 000 - Funds raised from workshops and consultations R20 000 – SAMA grant towards Centre activities Collaborator with RHRU for Wellcome Trust Grant on Clinical trials and community engagement. Successful at first round. Awaiting results from second round. Work in progress towards SANPAD grant for project: “INVESTIGATING THE STATEOF MEDICAL ETHICS AND LAW TRAINING FOR DOCTORS IN SOUTH AFRICA.” P. Spring Tea On the 12th of September 2008, the Centre celebrated Spring 2008 by hosting a Spring Tea at the Centre. It commemorated the day for the following reasons:  the 31st commemoration of Steve Biko's death on 12 September 1977;  the launch of the "Marie Coetzee Notice Board on Animal Rights & Bioethics" in memory of one of our MSc (Med) students who died tragically earlier in the year; and  the launch of the Centre's new logo Professor Y Veriava paid tribute to Steve Biko while Professor Keith Bolton - one of Marie Coetzee's classmates - said a few words in her honour and officially launched the notice board. Marie was killed during an armed robbery at her house the day before she presented her research report ideas to the Centre and her class mates. Her research focused on animal rights.
  13. 13. 13 Q. MEDIA Centre staff have been involved in severaltelevision programs including Rights and Recourse,ETV Morning Live, SABC Africa. Staff have also participated on talk shows e.g. SAFM, 702, Khaya FM. In addition, staff comments and opinions are reported in the newspapers on a regular basis. R. CHALLENGES Staff are having difficulty keeping up with workload. This obviously impacts on research output. The workload carried by the Centre requires strong administrative and secretarialsupport. A halfday administrator post is inadequate for the optimal functioning of the Centre, bearing in mind the Centre’s very heavy teaching component. Hence,Centre staff spends severalhours on administration. However,despite the challenges, this period has been invigorating and stimulating. The Centre is grateful to its funders and of course,the Faculty for its unstinting support for all of the Centre’s activities. S. STAFF COMPONENT Professor Ames Dhai, Director Professor Peter Cleaton-Jones, Specialist - Research Ethics Professor Donna van Bogaert, Academic Director – MSc (Med) Bioethics and Health Law Ms Jillian Gardner, Lecturer,Undergraduate Academic Coordinator Dr Norma Tsotsi, Lecturer,Postgraduate Academic Coordinator Ms Marlise Richter, Lecturer,Community Outreach Coordinator Ms Harriet Etheredge,Lecturer, Special Projects Coordinator Mrs Eileen Skuy, Administrative Secretary