Browsing by Author "Kling, Sharon"

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    Autonomy in asthma management
    (Allergy Society of South Africa (ALLSA), 2021-12) Kling, Sharon
    The principle of autonomy is one of the pillars of the four principles approach to medical ethics. Autonomous patients should be respected and have the right and the freedom to make their own decisions regarding their healthcare. This individualistic view of autonomy is particularly prevalent in Western cultures and clinical practice; a relational type of autonomy prevails in cultures which are communitarian in their approach. Autonomy and shared decision making are important concepts in managing asthma.
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    Autonomy of the child in the South African context : is a 12 year old of sufficient maturity to consent to medical treatment?
    (BioMed Central, 2016-11-02) Ganya, Wandile; Kling, Sharon; Moodley, Keymanthri
    Background: A child is a developing person with evolving capacities that include autonomy, mental (decisional) capacity and capacity to assume responsibility. Hence, children are entitled to participatory (autonomy) rights in South Africa as observed in the Children’s Act 38 of 2005. According to section 129 of the Act a child may consent to his or her own medical treatment provided that he or she is over the age of 12 years and is of sufficient maturity and decisional capacity to understand the various implications of the treatment including the risks and benefits thereof. However, the Act does not provide a definition for what qualifies as ‘sufficient maturity’ nor does it stipulate how health professionals ought to assess the decisional capacity of a child. In addition, South Africa is a culturally diverse country. The Western liberal notion of autonomy may not necessarily find equal prominence in the mores of people with a different worldview. Hence we demonstrate a few salient comparisons between legal liberal moral theory and African communitarianism as pertinent to the autonomy of the child. Discussion: Children are rights-holders by virtue of their humanity. Their dignity as individual human persons affords them the entitlement to human rights as contemplated under the Constitution of the Republic of South Africa. However, contrary to the traditional Western notion of individual autonomous persons African societies hold a communalistic notion of person hence there is less regard for individual autonomy and rights with more emphasis on the communal good and maintaining the continuity of relationships and interdependencies shared within a community. A child considered in this view is not regarded as a full person. This implies that decisions concerning the child, including consent to medical treatment are discussed and determined by the community to which the child belongs. Lastly, in this article, we draw on the notion of capacity for responsibility to produce a pragmatic definition of sufficient maturity. Conclusion: It seems reasonable to suggest a move away from a general legal age of consent for medical treatment toward more individualised, context-specific approaches in determining the maturity of a child patient to consent to medical treatment. Perhaps, decision-making with respect to consent to the medical treatment of a child belonging to a traditional African community where the notion of a person is embedded in communitarianism ought to involve the child’s parents/guardians/caregivers where possible provided that the best interests of the child are awarded priority.
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    Clinical Ethics Committees in Africa : lost in the shadow of RECs/IRBs?
    (BioMed Central, 2020) Moodley, Keymanthri; Kabanda, Siti Mukaumbya; Soldaat, Leza; Kleinsmidt, Anita; Obasa, Adetayo Emmanuel; Kling, Sharon
    Background: Clinical Ethics Committees (CECs) are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services (CESs) on the continent. Methods: A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data were subjected to descriptive analysis and Fischer’s exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results: In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics (p = 0.005). All participants were familiar with Research Ethics Committees (RECs), and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants (81.7%) were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions: This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed. Keywords: Clinical ethics committees, Clinical ethics consultation service, Africa, Developing countries, Ethics, Clinical ethics, Dilemma
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    Confidentiality in medicine
    (Allergy Society of South Africa, 2010-11) Kling, Sharon
    Confidentiality in medicine ensures respect for the patient's privacy and improves health care by enabling the patient to trust the health professional with very personal information. Confidentiality may be breached if required in terms of the law, such as in the case of gunshot wounds, child or other abuse and communicable diseases. Other justifiable exceptions to the confidentiality rule are in an emergency situation, where the patient is incompetent or incapacitated, and in the case of psychiatrically ill patients who need to be committed to hospital. The final reason to breach confidentiality is to protect third parties, whether this is concern for the safety of a specific person or in the public interest. Two examples of the latter are the Tarasoff case and HIV / AIDS.
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    Dual loyalties, human rights violations, and physician complicity in apartheid South Africa
    (American Medical Association, 2015-11) Moodley, Keymanthri; Kling, Sharon
    Introduction: From 1948 to 1994, South Africans were subjected to a period of sociopolitical segregation and discrimination based on race, a social experiment known as apartheid. South African history was tainted by a minority Afrikaner Nationalist Party that sought to plunder, exploit, divide, and rule. When that party took power in 1948, human rights abuses permeated all levels of society, including the medical profession, which was to a large extent complicit in various human rights violations. These discriminatory practices had a negative impact on the medical education of black students, the care of black patients in private as well as public institutions, and the careers of black medical doctors. Medical student training programs at most universities ensured that white patients were not examined by black medical students either in life or after death. Postmortems on white patients were conducted in the presence of white students only; students of color were permitted to view the organs only after they were removed from the corpse [1]. Public and private hospitals reflected the mores of apartheid South Africa. Ambulance services were segregated, and even in emergencies a designated “white ambulance” could not treat and transport critically ill or injured patients of color [2]. Public hospitals had separate wings for white and black patients and medical staff. Many private practices had separate entrances and waiting rooms for patients with medical insurance and those paying cash, effectively segregating white and black [1, 2]. Doctors treating political prisoners faced dual loyalties on a regular basis. Some, like Dr. Wendy Orr, resisted the gross human rights violations, while many were complicit [2]. In particular, the abhorrent treatment of medical student and political activist Steve Biko received international attention [2].
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    Exercise-induced asthma (EIA) -- Pathogenesis
    (Health and Medical Publishing Group (HMPG), 2008-04) Kling, Sharon
    Exercise-induced asthma (EIA) is defined as ‘the condition in which exercise induces symptoms of asthma in patients who have asthma’.1 The question is whether EIA is a distinct phenotype of asthma or whether it is just another trigger of symptoms in asthmatic patients.
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    Informed consent in paediatric critical care research : a South African perspective
    (BioMed Central, 2015-09) Morrow, Brenda M.; Argent, Andrew C.; Kling, Sharon
    Background: Medical care of critically ill and injured infants and children globally should be based on best research evidence to ensure safe, efficacious treatment. In South Africa and other low and middle-income countries, research is needed to optimise care and ensure rational, equitable allocation of scare paediatric critical care resources. Ethical oversight is essential for safe, appropriate research conduct. Informed consent by the parent or legal guardian is usually required for child research participation, but obtaining consent may be challenging in paediatric critical care research. Local regulations may also impede important research if overly restrictive. By narratively synthesising and contextualising the results of a comprehensive literature review, this paper describes ethical principles and regulations; potential barriers to obtaining prospective informed consent; and consent options in the context of paediatric critical care research in South Africa. Discussion: Voluntary prospective informed consent from a parent or legal guardian is a statutory requirement for child research participation in South Africa. However, parents of critically ill or injured children might be incapable of or unwilling to provide the level of consent required to uphold the ethical principle of autonomy. In emergency care research it may not be practical to obtain consent when urgent action is required. Therapeutic misconceptions and sociocultural and language issues are also barriers to obtaining valid consent. Alternative consent options for paediatric critical care research include a waiver or deferred consent for minimal risk and/or emergency research, whilst prospective informed consent is appropriate for randomised trials of novel therapies or devices. Summary: We propose that parents or legal guardians of critically ill or injured children should only be approached to consent for their child’s participation in clinical research when it is ethically justifiable and in the best interests of both child participant and parent. Where appropriate, alternatives to prospective informed consent should be considered to ensure that important paediatric critical care research can be undertaken in South Africa, whilst being cognisant of research risk. This document could provide a basis for debate on consent options in paediatric critical care research and contribute to efforts to advocate for South African law reform.
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    Life-threatening asthma in children: a review
    (Allergy Society of South Africa (ALLSA), 2021-12-01) White, Debbie A; White, William A; Kling, Sharon
    We present a case of a child presenting with well-described but poorly recognised symptoms of life-threatening asthma that were initially missed. We present a management protocol for life-threatening asthma, for which evidence in the literature is lacking.
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    Misinformation in the Covid-19 era
    (NeuroInterventional Surgery, 2020-08-14) Kling, Sharon
    Misinformation in the digital era has the potential to undermine the efforts of health authorities and professionals to keep the public informed. This is evident in the slew of misinformation around COVID-19 prevention, treatments and vaccines. Mis- and disinformation in the field of allergies is also prevalent. The consequences include harm to the public and increased healthcare costs.
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    Telemedicine, allergy and the COVID-19 pandemic
    (Allergy Society of South Africa (ALLSA), 2021-06) Kling, Sharon
    The global COVID-19 pandemic has changed the world and healthcare practice. Telemedicine is important in reaching underserved and rural populations. But it has also become important in limiting the exposure of patients and healthcare professionals to infection, while at the same time still providing access to healthcare consultations for patients with acute and chronic conditions.