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Private medical aids are essentially non-profit organisations that aim to fund the delivery of speedy treatment, and should protect members from unexpected, out-of-pocket expenses for medical care. However, although the latest statistics show that 16.2% of individuals in South Africa (SA) are members of medical aid schemes, making the promise of private healthcare accessible to a small percentage of the population, they are not without their own unique set of challenges. The restrictions that exist within the private sector have a direct bearing on the types of healthcare services patients can access, which in turn impacts on the fundamental right to access healthcare. Using a recent High Court decision, this article seeks to explore justice in the provision of healthcare services, specifically within the private sector in SA. [ABSTRACT FROM AUTHOR]

The purpose of this article is to address the questions as to whether a criminal conviction of a healthcare practitioner should affect his or her professional standing, and whether such conviction constitutes 'unprofessional conduct' in terms of the Health Professions Act. The article also explores a related matter, namely whether the Health Professions Council of South Africa (HPCSA) has a legal duty to refer complaints regarding unprofessional conduct that displays criminal elements for criminal prosecution. After considering relevant case law on these issues, the article concludes that a practitioner, after being convicted of an offence, should be afforded an opportunity to explain him- or herself to the board, not only in extenuation of the conduct in question, but also in response to the question of whether the conduct constitutes improper or disgraceful conduct. Moreover, the article explains why the HPCSA and professional boards have a legal duty to refer matters of unprofessional conduct with criminal elements in terms of section 34 of the Prevention and Combating of Corrupt Activities Act to law enforcement agencies. [ABSTRACT FROM AUTHOR]

Abstract Never let me go: science fiction and legal reality This article offers a law and literary perspective on Kazuo Ishiguro's novel 'never let me go'. The article engages with [...]

Abstract This article discusses the representation of animals and nature in selected lyrics from the oeuvre of singer, songwriter and producer David Kramer and considers his engagement with historical and [...]

Aims: The susceptibility patterns of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, and Streptococcus pyogenes isolated from specimens submitted to 12 private laboratories in South Africa were determined. Methods: [...]

The doctor-patient relationship is the foundation of any medical intervention. Over time, the relationship has changed, from the era of paternalism to the era of self-determination or patient autonomy, following changes resulting from consumerism and lately, in South Africa, socialised medicine as a result of the proposed National Health Insurance (NHI). The premise of this article is that patient autonomy is invariably limited by a determination of who will carry the cost of a medical intervention. In recent years, legislative developments have affected the understanding of a patient and doctor through the introduction of new references, such as 'user', 'data subject' and 'consumer' for a patient, and 'service provider' and 'responsible party' for a doctor, each giving different meanings to the doctor-patient relationship. Recent statutory additions also include new remedies available to aggrieved patients as parties in the doctor-patient relationship. The article concludes with brief observations on how the NHI will alter the essence and nature of the doctor-patient relationship in future. [ABSTRACT FROM AUTHOR]

Transplantation is the only therapeutic option for terminal organ failure. The principle that donation should be a routine component of end-of-life care is recognised in many countries, but only 38% of them have official deceased-donor programmes, and South Africa (SA) does not have one. Scrutinising the policies in countries such as Spain, the UK and the USA (Pennsylvania), where official referral programmes exist, could help to determine which option will be best suited to SA. It is concluded that the best basic step to start with in SA would be if the Department of Health could implement a routine-referral policy document, compelling physicians to refer every death to be evaluated for the possibility of organ retrieval. [ABSTRACT FROM AUTHOR]

Modern medicine makes it possible to transplant not only kidneys but any solid organs from one human body to another. Although it is the ideal to harvest organs from a brain-dead person, a kidney or a part of the liver or lung can be transplanted from a living donor to a patient. The majority of countries where organ transplants are performed have a dire need for transplantable organs as the current systems of organ procurement are not obtaining a sufficient amount of transplantable organs. Today's cruel reality is that many patients are dying while waiting for a transplant. Few nations are able to meet the organ demand through their domestic transplant systems and there is a constant debate about ethical ways of procuring organs for transplantation purposes. This article will scrutinise the Israeli system of organ procurement and it will be compared with the current system of organ donation in South Africa (SA) in order to indicate whether SA could possibly, or should, follow the example of Israel to improve its acute donor organ shortage. [ABSTRACT FROM AUTHOR]

One of the most exciting areas of medical research involves the use of stem cells for the treatment of patients with a variety of diseases and for tissue repair. Although stem cell research is accelerating rapidly in many countries, it has in the past been limited in South Africa (SA); very little has been done in this country to explore the great potential offered by stem cells to address the high disease burden. Stem cell therapy has however been practised for many years, in SA and worldwide, in the form of haematopoietic stem cell transplantation, mainly for haematological malignancies. From a therapeutic perspective, two types of stem cells can be defined: pluripotent stem cells and adult stem cells. Pluripotent cells derived from the inner cell mass of blastocysts (either from in vitro fertilisation or following somatic cell nuclear transfer) are called embryonic stem (ES) cells, while those derived by reprogramming adult cells are called induced pluripotent stem (iPS) cells. Adult stem cells include haematopoietic, mesenchymal and neural stem cells. The purpose of this article is to critically examine the SA legislation with regard to elements that impact on pluripotent stem cell research and the use of pluripotent stem cells for therapeutic purposes. This includes (but is not limited to) legislation from the National Health Act (Chapter 8 in particular) and its regulations, and deals with matters related to research on embryos in the stem cell context, somatic cell nuclear transfer, reproductive and therapeutic cloning and the generation and therapeutic use of iPS and ES cells. [ABSTRACT FROM AUTHOR]

The South African (SA) legislative framework follows a hierarchical structure aligned with the relevant level of government (national, provincial or local) responsible for applying and monitoring the legislation, with the overarching and progressive Constitution as the supreme law. Delegated legislation (also known as secondary or subordinate legislation, e.g. regulations) 'adds flesh' to Acts of Parliament, or other forms of original legislation. The control and use of human tissue in South Africa is primarily governed by the National Health Act and relevant regulations, although other national acts, in differing degrees, are also relevant to this complex field. These include, among others, the Medicines and Related Substances Act, the Consumer Protection Act, the Children's Act and the Inquest Act. Regulations generally only require ministerial and not parliamentary approval and are therefore (theoretically) easier to amend. In principle, the drafting of Acts should be preceded by policy documents, which contain broad foundational guidelines or a statement of intent in the area in question. Another useful source in the interpretation of legislation, albeit not officially recognised as legislation, is guidelines (sometimes referred to as standards), that may provide greater granularity than the regulations. Although neither policy documents nor guidelines are directly legally binding, a lack of compliance with the latter may have legal significance. In this article, the components of the hierarchical structure relevant to the legal regulation of human tissue in SA will be examined, with a specific focus on stem cell research and therapy. A critical analysis of the accuracy, relevance, redundancy and completeness (or lack thereof) of these components will be provided. Furthermore, recommendations outlining the procedures that should be undertaken to remedy the inadequacies of the current legislative framework will be suggested. Given the well-defined structure of this framework and the relative youth of human tissue legislation in SA, the legislator has an opportunity to mirror the values and principles embodied in the Constitution by addressing these inconsistencies, and in the process develop a globally-applicable and appropriate legislative model in the fields of stem cell research and therapy. [ABSTRACT FROM AUTHOR]

The past few years have seen a sharp rise in the propagation of unproven stem cell 'treatments', also known as 'stem cell tourism'. Patients suffering from a variety of diseases unresponsive to conventional medical therapy often travel to certain destinations to receive these therapies, mostly from bogus operators advertising various 'stem cell treatment cures' for a wide range of conditions, and in the process mislead vulnerable patients with unfounded promises of recovery. Stem cell tourism, made possible by legal lacunae or weak national regulatory frameworks, raises grave legal and ethical concerns, as patients not only receive treatments which are unproven, but often also unregulated, potentially dangerous and fraudulent. Existing proven therapeutic applications using stem cells are limited to those for blood and immunological disorders and are based on clinical trials that have demonstrated the efficacy and safety of these applications. As a result of weak legislative enforcement in this area, South Africa has unfortunately become an attractive destination for fraudulent stem cell operators. The purpose of this article is provide an update on the South African legal position relating to stem cell therapy by evaluating the effectiveness of the Medicines and Related Substances Act and other relevant legislative provisions in regulating cell-based therapies, drawing strongly on recent international developments and case law in this field. The article will make specific recommendations aimed at improving the existing position. [ABSTRACT FROM AUTHOR]

Stem cell research and its potential translation to regenerative medicine, tissue engineering and cell and gene therapy, have led to controversy and debates similar to the calls nearly 25 years ago for a ban involving recombinant DNA. Global legislative efforts in this field have been characterised by many legal, ethical and practical challenges, stemming from conflicting views regarding human embryonic research and cloning. National policy and regulatory developments have primarily been shaped by different understandings of relevant scientific objectives, as well as those relating to the moral and legal status of the human embryo, which have been used to justify or limit a range of permissible activities. Legal obscurity in this field, a consequence of inconsistent or vague legislative responses at a national and international level, leads to negative results, which include, among others, ethical violations; lack of collaboration and co-operation among researchers across national borders; stunted scientific progress; lack of public trust in stem cell research; proliferation of untested 'stem cell therapies'; and safety issues. The purpose of this article is to explore the legal regulation of stem cell research and therapy globally, by comparing the permissibility of specific stem cell research activities in 35 selected jurisdictions, followed by a comparison of the regulatory approaches with regard to stem cell-based products in the European Union and the USA. A clearer understanding of the global regulatory framework will assist in formulating more effective legal responses at a national level and in navigating the uncertainties and risks associated with this complex and evolving scientific field. [ABSTRACT FROM AUTHOR]

Those who make postings about others on the social media would be well advised to remove such postings immediately upon the request of an offended party. It will seldom be worth contesting one's obligation to do so. After all, the social media is about building friendships around the world, rather than offending fellow human beings. Affirming bonds of affinity is what being 'social' is all about. [ABSTRACT FROM AUTHOR]

If a person with a criminal record were to apply for admission to the legal profession, the applicant would naturally harbour the hope that his or her application would succeed. However, in the absence of a reformation of his or her moral character, the certainty is that the application will fail, thus leading to disappointment. The aim of this article is to analyse the correctness of the above proposition. It is argued that a criminal record is not an insurmountable obstacle to a successful application for admission, but that such applications may succeed only in exceptional circumstances. [ABSTRACT FROM AUTHOR]

The article focuses on locum tenens, a professional temporarily replacing another one, in medical private practices. Topics mentioned include the legislation regarding the use of a locum in South Africa, including the Labour Relations Act 66 of 1995 and the Basic Conditions of Employment Act 75 of 1997, the specificity of the use of locum tenens in the health industry, and their legal status.

In South Africa, increases in both the size and amount of medical malpractice claims have resulted in a move towards so-called defensive medicine, and have had devastating emotional effects on healthcare professionals. Among several recommendations for addressing these consequences, the first author's recent doctoral study critically analysed evidence-based patient choice as a partnership model in clinical decision making. This study indicated that none of the key skills of this approach are completely adequate in honouring the principle of respect for autonomy in clinical decision making. Instead, the study proposed the concept of medical information therapy - an expanded conception of the generic concept of information therapy - as an adequate approach to reconciling the opposing perspectives of patients and healthcare professionals in a therapeutic alliance. Recent case law, as well as relevant provisions of the National Health Act, emphasise patient autonomy, as well as the notion of shared decision making in the context of informed consent. The South African healthcare context is characterised by specific challenges affecting the process of obtaining informed consent. The article submits that the concept of medical information therapy will help address the significant increase in litigation against healthcare practitioners based on a lack of informed consent, in both the public and private healthcare sectors. [ABSTRACT FROM AUTHOR]

The ownership of tissue samples donated for medical research is an ongoing subject of dispute. Some advocates assert that patients have ongoing ownership rights in their tissues, including an unfettered right to determine what happens to their tissue sample. Researchers argue that giving patients property rights in their samples will turn the human body and body parts into a commodity and bring research to a halt. The question of the human body as property involves complex and philosophical dimensions. The law displays an uneasiness in making sense of the human body in the context of ownership and property, as the notion of owning oneself (and one's tissues) implies that persons are able to objectify their selves, and in the process become susceptible to objectification by others. The creation of commercial products from human tissue has generated very difficult legal and ethical questions that have no clear, universally accepted answers. [ABSTRACT FROM AUTHOR]

The article discusses the concept of serious injury in South Africa's Road Accident Fund (RAF) Amendment Act 19 of 2005 which came into effect on August 1, 2008. It cites the limitation of the act with RAF's liability for compensation in respect of claims for non-pecuniary loss to instances where a serious injury has been experienced. It also mentions the need for a medical practitioner to prepare an RAF 4 report according to the act after performing injury assessment. Further, a practitioner is also required to apply the narrative test to identify the consequences of the injury whether it is a serious long-term impairment or loss of a body function, a permanent serious disfigurement, or a loss of a foetus.

Copyright of Literator is the property of African Online Scientific Information System PTY LTD and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on the requirements for admission and removal from the legal profession of lawyers in South Africa. It mentions that a fit and proper person is significantly needed to be admitted as a lawyer or advocate. It cites the Admission of Advocates Act 74 of 1964 which regulates the admittance of persons in the profession wherein applicants should be 21 years older and have the right academic qualification aside from being fit and proper. It points out that the said requirement has to be interpreted in an immanent way and applied by courts and seniors in the profession.

The article discusses the ethical issues concerning the sale of kidneys for the purpose of transplantation. It focuses on various ethical approaches, their limitations and their significance in today's world in view of kidney transplantation. It discusses the meaning of the term "ethics" from a moralist's as well as an ethicist's point of view. It also describes various ethical theories and their origin and evolution, and the development of ethical thinking in different eras starting from the era of Greek philosophy to Western Christianity and then the era of science. Also included are the origin and development of bioethics, which deals with the moral issues in medicine, and the four pillars of bioethics including the beneficence, non-maleficence, autonomy and justice.

Copyright of Literator is the property of African Online Scientific Information System PTY LTD and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: The susceptibility patterns of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, and Streptococcus pyogenes isolated from specimens submitted to 12 private laboratories in South Africa were determined. Methods: Minimum inhibitory concentration (MIC) determinations were performed on the isolates in the microbiology laboratory at Tygerberg Hospital according to the recommendations of the National Committee for Clinical Laboratory Standards (NCCLS). Results: According to the NCCLS breakpoints, 24% of 729 S pneumoniae isolates were sensitive, 30% intermediate, and 46% resistant to penicillin. Rates of macrolide resistance were high, with 61% of the pneumococci being resistant to clarithromycin and azithromycin. Co-trimoxazole resistance was also high, with 28% of pneumococcal strains being sensitive, 21% intermediate, and 51% resistant. β Lactamase was produced by 7% of 736 H influenzae isolates and 91% of 256 M catarrhalis isolates. The quinolones, moxifloxacin and levofloxacin, were universally active against all isolates tested, which included S pneumoniae, H influenzae, M catarrhalis, K pneumoniae, and S pyogenes. Conclusions: Haemophilus influenzae and S pneumoniae were the most commonly isolated organisms. Resistance to penicillin was one of the highest reported in the world (76%) in S pneumoniae, as was macrolide resistance in pneumonocci, although surprisingly, only 14% of S pyogenes were resistant. The quinolones, moxifloxacin and levofloxacin, were active against all organisms tested, including the penicillin and macrolide resistant strains and moxifloxacin was more active than levofloxacin against pneumococci. [ABSTRACT FROM AUTHOR]

The article presents a study that examines psychiatric disorder among the colored people living in Cape Peninsula in South Africa. Under the study, a random sampling of the colored persons who are over 20 years old , and an interview about their mental and physical health were conducted. An interview with persons who knew each respondent, as well as consultation of hospital records, was also done. Analysis of the data obtained shows of the 200,365 total population of colored people, that 11.88 percent who are over the age of 20 were psychiatrically disturbed. The evaluation conducted and results of the study are described in details.

This article explores issues relating to discrimination against persons living with albinism, against the background of colour discrimination. It also addresses calls for 'colourism' to be recognised as a distinct form of discrimination. Although colour as grounds for discrimination is prohibited in the equality clause of the Constitution, it is conventionally grouped with race and ethnicity when unfair discrimination is interpreted. We argue that discrimination against persons living with albinism should be possible based on colour as a prohibited ground, independent from race or ethnic considerations. [ABSTRACT FROM AUTHOR]

Human-wildlife conflict has taken center stage in global biodiversity degradation, yet researchers have mainly focused on animals. Medicinal plants are declining globally, partly because of over-harvesting which is considered a form of human-wildlife conflict in this study. Compared with other provinces in South Africa, Free State has limited information on the use of medicinal plants and the impacts of over-harvesting the species. We investigated the potential impacts of over-harvesting the plant species for medicinal purposes and determined the potential conservation implications of the harvesting methods in Free State Province, South Africa. We show that 89 plant species from 43 families were used for traditional medicine. The most-used species were Pachycarpus rigidus (12%; N=211), followed by Dicoma anomala (9%) with the common plant families being Asteraceae (13.5%; N=89), and Fabaceae (7.9%). The perennial herbs were substantially harvested (58.4%; N=89). The wild indigenous plant species were more preferred compared to alien species (79.2%; N=89). The roots and bulbs were mostly utilized for medicinal material (48.3%; N=89), followed by the leaves (20.2%). We found one ‘rare’ species (Schizoglossum montanum), and two ‘nearly threatened’ species (Merwilla plumbea and Eucomis bicolor). We recommend a socio-ecologically orientated policy intervention for the sustainable use of medicinal plants in South Africa.           [ABSTRACT FROM AUTHOR]

Cryopreservation of human sperm is considered a routine practice in assisted reproduction treatment (ART) laboratories. Vitrification is not yet common practice for sperm cryopreservation in ART laboratories. The aim of this study was to establish the feasibility of utilising vitrification as opposed to current conventional cryopreservation of spermatozoa. [ABSTRACT FROM AUTHOR]

All aerobic organisms must possess the means to protect themselves from the toxic effects of reduced oxygen species generated during the normal metabolic activity of cells or as a result of environmental stresses such as drought. Cells are protected from the deleterious effects of free oxygen radicals by Cu/Zn superoxide dismutase (SOD), which catalyses the initial step in neutralizing activated oxygen species. In the study reported here, the potato cultivar Aviva was transformed with a cytosolic Cu/Zn superoxide dismutase gene from Arabidopsis thaliana using Agrobacterium-mediated gene transformation. Four transgenic potato lines were identified and evaluated for drought tolerance in the greenhouse. Two transformed lines could withstand drought in the greenhouse for two weeks longer than the untransformed plants and one week longer than two other transformed lines. These findings were confirmed by data from enzyme activity as well as by 2,3,5-triphenyltetrazolium chloride reduction. [ABSTRACT FROM AUTHOR]

Introduction: In sub-Saharan Africa, accurate estimates of the HIV epidemic in female sex workers are crucial for effective prevention and care strategies. These estimates are typically derived from mathematical models that assume certain demographic and behavioural characteristics like age and duration of sex work to remain constant over time. We reviewed this assumption for female sex workers in South Africa., Methods: We reviewed studies that reported estimates on either the age or the duration of sex work among female sex workers in South Africa. We used Bayesian hierarchical models to synthesize reported estimates and to study time trends. In a simulation exercise, we also investigated the potential impact of the "constant age and sex work duration"-assumption on estimates of HIV incidence., Results: We included 24 different studies, conducted between 1996 and 2019, contributing 42 estimates on female sex worker age and 27 estimates on sex work duration. There was evidence suggesting an increase in both the duration of sex work and the age of female sex workers over time. According to the fitted models, over each decade the expected duration of sex work increased by 55.6% (95%-credible interval [CrI]: 23.5%-93.9%) and the expected age of female sex workers increased by 14.3% (95%-CrI: 9.1%-19.1%). Over the 23-year period, the predicted mean duration of sex work increased from 2.7 years in 1996 to 7.4 years in 2019, while the predicted mean age increased from 26.4 years to 32.3 years. Allowing for these time trends in the simulation exercise resulted in a notable decline in estimated HIV incidence rate among sex workers over time. This decline was significantly more pronounced than when assuming a constant age and duration of sex work., Conclusions: In South Africa, age and duration of sex work in female sex workers increased over time. While this trend might be influenced by factors like expanding community mobilization and improved rights advocacy, the ongoing criminalisation, stigmatisation of sex work and lack of alternative employment opportunities could also be contributing. It is important to account for these changes when estimating HIV indicators in female sex workers., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

This paper reports the results of a public engagement study on heritable human genome editing (HHGE) carried out in South Africa, which was conducted in accordance with a study protocol that was published in this journal in 2021. This study is novel as it is the first public engagement study on HHGE in Africa. It used a deliberative public engagement (DPE) methodology, entailing inter alia that measures were put in place to ensure that potential participants became informed about HHGE, and that deliberations between the participants were facilitated with the aim of seeking consensus. A diverse group of 30 persons was selected to participate in the DPE study, which took place via Zoom over three consecutive weekday evenings. The main results are: Provided that HHGE is safe and effective, an overwhelming majority of participants supported allowing the use of HHGE to prevent genetic health conditions and for immunity against TB and HIV/Aids, while significant majorities opposed allowing HHGE for enhancement. The dominant paradigm during the deliberations was balancing health benefits (and associated improvements in quality of life) with unforeseen health risks (such as loss of natural immunity). The seriousness of a health condition emerged as the determining factor for the policy choice of whether to allow an application of HHGE. More generally, equal access to HHGE qua healthcare service featured as an important value, and it was uncontested that the South African government should allocate resources to promote scientific research into HHGE. These results are aligned with the policy principles for regulating HHGE in South Africa suggested by Thaldar et al. They call for urgent revision of South African ethics guidelines that currently prohibit research on HHGE, and for dedicated HHGE legal regulations that provide a clear and comprehensive legal pathway for researchers who intend to conduct HHGE research and clinical trials., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Thaldar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The legal regulation of faecal microbiota transplantation (FMT) in South Africa (SA) is currently unclear. The purpose of this article, the first of three in a series, is to explore the nature, role and clinical application of FMT in SA in order to determine, from a legal perspective, the appropriate regulatory pathways governing FMT as a procedure that may combine approaches for the treatment of drugs, human tissue for transplantation, or clinical treatment as part of the practice of medicine. FMT has been shown to be a novel, safe and effective treatment for recurrent Clostridioides difficile infection (CDI). Stool banks are instrumental in enabling access to FMT for patients and clinicians and help to catalyse research in the microbiome. However, the regulatory landscape in SA remains unclear. Microbial therapies such as FMT are necessary, especially in a time of rising microbiome-associated inflammatory diseases and increasing resistance to traditional antibiotics. FMT is now considered as part of the standard of care for recurrent CDI overseas, but is currently only being used for research purposes in a minority of clinical cases of CDI in SA. This article, which lays the foundation for consideration of this question in three parts, suggests that the relevant regulatory system would depend on the categorisation of human stool as tissue, the exact composition of the FMT, how it is administered to patients, and the relevant levels of manipulation of the stool for FMT-derived products.

Faecal microbiota transplantation (FMT) has been shown to be an effective treatment for recurrent Clostridioides difficile infection. The purpose of this article, the second of a series of three articles, is to explore the legal framework governing human FMT in South Africa (SA). FMT involves different modes of administration that require different regulatory considerations. The focus of this article is to explore the legal classification of human stool as tissue in terms of the National Health Act 61 of 2003, as well as the regulation of human stool banks as tissue banks. The article concludes with specific recommendations aimed at improving the current regulatory vacuum relating to the regulation of FMT in SA.