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. 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. (shrink)

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. (shrink)

Organ donation after a circulatory determination of death is possible in selected patients where consent is given to support donation and the patient has been legally declared dead by two doctors. The National Health Act (61 of 2003) and regulations provide strict controls for the certification of death and the donation of organs and tissues after death. Although the National Health Act expressly recognises that brain death is death, it does not prescribe the medical standards of testing for the determination (...) of brain death (neurological determination of death), circulatory death (circulatory determination of death) or for determination of death based on somatic criteria. However, in all cases of organ donation, including after circulatory death, the National Health Act mandates that two doctors certify the death, with one doctor possessing more than 5 years of experience. Additionally, both doctors must be independent from the transplant team. The standard for such determination, as for brain death, aligns with accepted medical standards. The Critical Care Society of Southern Africa has published South African (SA) Guidelines on Death Determination that outline rigorous standards for death determination in hospital settings by either a neurological or circulatory method. Legislation and the Health Professions Council of SA’s (HPCSA) professional guidance direct clinicians on obtaining informed consent for donation either from the patient or in cases of incapacity from their surrogate decision maker. Collectively, the legislation, regulations and professional guidelines in SA provide a robust ethical framework that supports organ donation after circulatory death. (shrink)

While open science gains prominence in South Africa with the encouragement of open data sharing for research purposes, there are stricter laws and regulations around privacy – and specifically the use, management and transfer of personal information – to consider. The Protection of Personal Information Act No. 4 of 2013 (POPIA), which came into effect in 2021, established stringent requirements for the processing of personal information and has changed the regulatory landscape for the transfer of personal information across South African (...) borders. At the same time, draft national policies on open science encourage wide accessibility to data and open data sharing in line with international best practice. As a result, the operation of research ethics committees (RECs) in South Africa is affected by the conflicting demands of the shift towards open science on the one hand, and the stricter laws protecting participants’ personal information and the transfer thereof, on the other. This article explores the continuing evolving role of RECs in the era of open data and recommends the development of a data transfer agreement (DTA) for the ethical management of personal health information, considering the challenges that RECs encounter, which centres predominantly on privacy, data sharing and access concerns following advances in genetic and genomic research and biobanking. (shrink)

The existing ethico-legal regulation of adolescent children's participation in health research in South Africa is currently unclear. The article interrogates the existing framework governing children's consent to research participation, with specific emphasis on discrepancies in consent norms in law and ethical guidelines. Against the backdrop of the constitutional directive that requires that a child's best interests are of paramount importance in every matter concerning the child, the article assesses whether sufficient consideration is given to children's evolving maturity and capacities when (...) consent to their participation in health research is sought. The article provides specific recommendations and proposes a legislative change to consent provisions in the National Health Act 61 of 2003 in order to address the existing lacunae and to align the framework with constitutional imperatives and international fundamental rights considerations. (shrink)

This collection addresses a post-WWII shift in the hierarchy of scientific explanations, where the highest goal moves from reductionism towards some ...

For the theorists of crisis, the revolutionary state comes into existence through violence, and due to its inability to provide an authoritative katechon (restrainer) against internal and external violence, it perpetuates violence until it self-destructs. Writing during extreme economic depression and growing social and political violence, the crisis theorists––Joseph de Maistre, Juan Donoso Cortés, and Carl Schmitt––each sought to blame the chaos of their time upon the Janus-faced postrevolutionary ideals of liberalism and socialism by urging a return to pre-revolutionary moral (...) and religious values. They are united by three counterrevolutionary principles, all of which are purported to remedy revolutionary violence: traditional constitutional fidelity, the philosophy of the decision, and opposition to bourgeois liberalism. This essay is followed by the first complete English translation and publication of Donoso’s letter of October 24, 1851, which contains Donoso’s only reference to the “discussing class,” a political entity later popularized by Schmitt in his 1922 work Political Theology. (shrink)

Some theories of goodness are descriptively rich: they have much to say about what makes things good. Neo-Aristotelian accounts, for instance, detail the various features that make a human being, a dog, a bee good relative to facts about those forms of life. Famously, such theories of relative goodness tend to be comparatively poor: they have little or nothing to say about what makes one kind of being better than another kind. Other theories of goodness—those that take there to be (...) absolute goodness—are comparatively rich: they offer grounds for judging some types of things better than others because they have more absolute goodness. Moorean accounts, for example, can tell us that humans and human experiences are superior to bees and blades of grass. But such theories tend to be descriptively poor: they struggle to tell us in virtue of what this is so. In this essay we motivate and flesh out a view that splits the difference between accounts of goodness as relative and accounts of goodness as absolute. Such a view holds promise only if the mechanics of this kind of metaphysics of goodness can be worked out. Here we present a view on which the paradigm for absolute goodness is God and the paradigm for each kind of relative goodness is a divine idea. (shrink)

The topic of professionalism has dominated the content of major academic medicine publications during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges, the American (...) Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations". Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing, describing, decrying, and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

In much of the current academic and public discussion, conspiracy theories are portrayed as a negative phenomenon, linked to misinformation, mistrust in experts and institutions, and political propaganda. Rather surprisingly, however, philosophers working on this topic have been reluctant to incorporate a negatively evaluative aspect when either analyzing or engineering the concept conspiracy theory. In this paper, we present empirical data on the nature of the concept conspiracy theory from five studies designed to test the existence, prevalence and exact form (...) of an evaluative dimension to the ordinary concept conspiracy theory. These results reveal that, while there is a descriptive concept of conspiracy theory, the predominant use of conspiracy theory is deeply evaluative, encoding information about epistemic deficiency and often also derogatory and disparaging information. On the basis of these results, we present a new strategy for engineering conspiracy theory to promote theoretical investigations and institutional discussions of this phenomenon. We argue for engineering conspiracy theory to encode an epistemic evaluation, and to introduce a descriptive expression—such as ‘conspiratorial explanation’—to refer to the purely descriptive concept conspiracy theory. (shrink)

Private medical aids are essentially non-profit organisations that aim to deliver speedy treatment and should prevent members from unexpected, out of pocket expenses for medical care. However, although the latest statistics show that 16.2% of individuals in South Africa were 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 Case decision, this article seeks to explore whether there is justice in the provision of healthcare services, specifically within the private sector in South Africa. (shrink)

Donald Davidson has made enormous contributions to the philosophy of action, epistemology, semantics and philosophy of mind and today is recognized as one of the most important analytical philosophers of the late twentieth century. _Donald Davidson: Truth, Meaning and Knowledge_ addresses * Davidson's writings on epistemology and theory of language with their implications of ontology and philosophy of mind * the central issue of whether truth is the ultimate goal of enquiry, challenged by contributions from Richard Rorty and Paul Horwich (...) * Davidson's approach to semantics and applied linguistics as addressed by Kirk Ludwig, Gabriel Segal, Peter Pagin, Stephen Neale, Herman Cappelen and Ernie Lepore and Reinaldo Elugardo * Davidson's advances in the philosophy of mind in relation to the views of Williard V. Quine, John McDowell and Peter F. Strawson, in essays by Roger Gibson and Anita Avramides. (shrink)

The spiritual geography of Russian cosmism. General characteristics ; Recent definitions of cosmism -- Forerunners of Russian cosmism. Vasily Nazarovich Karazin (1773-1842) ; Alexander Nikolaevich Radishchev (1749-1802) ; Poets: Mikhail Vasilyevich Lomonosov, (1711-1765) and Gavriila Romanovich Derzhavin (1743-1816) ; Prince Vladimir Fedorovich Odoevsky (1803-1869) ; Aleksander Vasilyevich Sukhovo-Kobylin (1817-1903) -- The Russian philosophical context. Philosophy as a passion ; The destiny of Russia ; Thought as a call for action ; The totalitarian cast of mind -- The religious and spiritual (...) context. The kingdom of god on earth ; Hesychasm: two great Russian saints ; The Third Rome ; Pre-Christian antecedents -- The Russian esoteric context. Early searches for "deep wisdom" ; Popular magic ; Higher magic in the time of Peter the Great ; Esotericism after Peter the Great ; Theosophy and anthroposophy -- Nikolai Fedorovich Fedorov (1829-1903), the philosopher of the common task ; The one idea ; The unacknowledged prince ; The village teacher ; First disciple: Dostoevsky and Tolstoy ; The Moscow librarian ; Last years: Askhabad: the only portrait -- The "common task" ; Esoteric dimensions of the "common task" ; Fedorov's legacy: projectivism, delo, regulation -- The religious cosmists. Vladimir Sergeevich Solovyov (1853-1900) ; Sergei Nikolaevich Bulgakov (1871-1944) ; Pavel Aleksandrovich Florensky (1882-1937) ; Nikolai Aleksandrovich Berdyaev (1874-1948) -- The scientific cosmists. Konstantin Edouardovich Tsiolkovsky (1857-1935) ; Vladimir Ivanovich Vernadsky (1863-1945) ; Alexander Leonidovich Chizhevsky (1897-1964) ; Vasily Feofilovich Kuprevich (1897-1969) -- Promethean theurgy. Life-creation ; Cultural immortalism ; God-building ; Re-aiming the arrows of Eros ; Technological utopianism ; Occultism -- Fedorov's twentieth century followers. Nikolai Pavlovich Peterson (1844-1919) and Vladimir Aleksandrovich Kozhevnikov (1852-1917) ; Svyatogor and the biocosmists ; New wine and the universal task ; Alexander Konstantinovich Gorsky (1886-1943) and Nikolai Alexandrovich Setnitsky (1888-1937) ; Valerian Nikolaevich Muravyov (1885-1932) ; Vasily Nikolaevich Chekrygin (1897-1922) -- Cosmism and its offshoots today. The N.F. Fedorov museum-library ; The Tsiolkovsky museum and Chizhevsky center ; ISRICA - Institute for Scientific Research in Cosmic Anthropoecology ; Lev Nikolaevich Gumilev (1912-1992) and neo-eurasianism ; The hyperboreans ; Scientific immortalism: Igor Vishev, Danila Medvedev ; Conclusions about the Russian cosmists. (shrink)

Twentieth-century developments in quantum physics, together with an emerging science of consciousness, have created the need for a new cosmology, or model of the universe. The theory of process contained in THE REFLEXIVE UNIVERSE places consciousness within the context of contemporary science. One of the central themes of this extraordinary work is that each successive organization of matter, from fundamental particles in physics to living organisms, expresses a particular stage in the evolution of mind. Starting with the photon, the basic (...) unit of light, and moving through atomic physics, molecular chemistry, the morphology of plants and animals and finally to levels of human evolution, Young develops his theory in vivid step-by-step detail. Consciousness, in his point of view, is not isolated from the material universe. It exists in a continuum, one in which physical and nonphysical realms can be linked and the teachings of mythology and religion can be integrated. To order: FAX: 415-883-9280; e-mail: [email protected]; or write: Anodos Foundation, c/o Publishers Services, P.O. Box 2510, Novato, CA 94948. Visa and MasterCard only. Trade STOP orders 40% plus postage. (shrink)

From folk tales to movies, stories possess features which naturally suit them to contribute to the growth of virtue. In this article I show that the fictional exemplars help the learner to grasp the moral importance of internal states and resolves a tension between existing kinds of exemplars discussed by virtue ethicists. Stories also increase the information conveyed by virtue terms and aid the growth of prudence. Stories can provide virtuous exemplars, inform learners as to the nature of the virtues (...) and offer practice in developing situational judgement. As such they are a significant resource for virtue ethics and moral education. (shrink)

Bioethics has paid surprisingly little attention to the special problems faced by women and to feminist analyses of current health care issues other than ...

Arguably no concept is more fundamental to science than that of causality, for investigations into cases of existence, persistence, and change in the natural world are largely investigations into the causes of these phenomena. Yet the metaphysics and epistemology of causality remain unclear. For example, the ontological categories of the causal relata have been taken to be objects (Hume 1739), events (Davidson 1967), properties (Armstrong 1978), processes (Salmon 1984), variables (Hitchcock 1993), and facts (Mellor 1995). (For convenience, causes and effects (...) will usually be understood as events in what follows.) Complicating matters, causal relations may be singular (Socrates’s drinking hemlock caused Socrates’s death) or general (Drinking hemlock causes death); hence the relata might be tokens (e.g., instances of properties) or types (e.g., types of events) of the category in question. Other questions up for grabs are: Are singular causes metaphysically and/or epistemologically prior to general causes or vice versa (or neither)? What grounds the intuitive asymmetry of the causal relation? Are macro-causal relations reducible to micro-causal relations? And perhaps most importantly: Are causal facts (e.g., the holding of causal relations) reducible to non-causal facts (e.g., the holding of certain spatiotemporal relations)? (shrink)

Much discussion about experimental philosophy and philosophical methodology has been framed in terms of the reliability of intuitions, and even when it has not been about reliability per se, it has been focused on whether intuitions meet whatever conditions they need to meet to be trustworthy as evidence. But really that question cannot be answered independently from the questions, evidence for what theories arrived at by what sorts of inferences? I will contend here that not just philosophy's sources of evidence, (...) but also its inferential resources, are in great need of closer examination. (shrink)

Linguistic anthropologists have studied emotion in societies around the world for several decades. This article defines the discipline, introduces its general relevance to emotion theory, then presents five of the most important contributions linguistic anthropology has made to the study of emotion.

This volume provides a philosophical introduction to and analysis of the study of metaphor. By proceeding from the concrete analysis of complex metaphors, White is able to identify a range of features which are incompatible with standard accounts of the way words function in metaphor.

In this paper I argue that both defence and criticism of the claim that humans act ‘under the guise of the good’ neglects the metaphysical roots of the theory. I begin with an overview of the theory and its modern commentators, with critics noting the apparent possibility of acting against the good, and supporters claiming that such actions are instances of error. These debates reduce the ‘guise of the good’ to a claim about intention and moral action, and in so (...) doing have become divorced from the theory's roots in classical and medieval philosophy. Aristotle and Aquinas’ ‘guise of the good’ is primarily a metaphysical claim resting on the equivalence between actuality and goodness, from which conclusions about moral action are derived. I show the reasoning behind their theory and how it forms the basis for the claims about intention and action at the centre of the modern debate. Finally, I argue that the absence of its original foundation is apparent in recent attacks on the ‘guise of the good’. It is unsurprising that modern action theory and ethics have not always been able to comfortably accommodate the ‘guise of the good’; they are only telling half of the story. (shrink)