BackgroundThe worsening COVID-19 pandemic in South Africa poses multiple challenges for clinical decision making in the context of already-scarce ICU resources. Data from national government and the last published national audit of ICU resources indicate gross shortages. While the Critical Care Society of Southern Africa guidelines provide a comprehensive guideline for triage in the face of overwhelmed ICU resources, such decisions present massive ethical and moral dilemmas for triage teams. It is therefore important for the health system to provide clinicians (...) and critical care facilities with as much support and resources as possible in the face of impending pandemic demand. Following a discussion of the ethical considerations and potential challenges in applying the CCSSA guidelines, the authors propose a framework for regional triage committees adapted to the South African context.DiscussionBeyond the national CCSSA guidelines, the clinician has many additional ethical and clinical considerations. No single ethical approach to decision-making is sufficient, instead one which considers multiple contextual factors is necessary. Scores such as the Clinical Frailty Score and Sequential Organ Failure Assessment are of limited use in patients with COVID-19. Furthermore, the clinician is fully justified in withdrawing ICU care based on medical futility decisions and to reallocate this resource to a patient with a better prognosis. However, these decisions bear heavy emotional and moral burden compounded by the volume of clinical work and a fear of litigation.ConclusionWe propose the formation of Provincial multi-disciplinary Critical Care Triage Committees to alleviate the emotional, moral and legal burden on individual ICU teams and co-ordinate inter-facility collaboration using an adapted framework. The committee would provide an impartial, broader and ethically-sound viewpoint which has time to consider broader contextual factors such as adjusting rationing criteria according to different levels of pandemic demand and the latest clinical evidence. Their functioning will be strengthened by direct feedback to national level and accountability to a national monitoring committee. The potential applications of these committees are far-reaching and have the potential to enable a more effective COVID-19 health systems response in South Africa. (shrink)

The ubiquity of technology in our lives and its culmination in artificial intelligence raises questions about its role in our moral considerations. In this paper, we address a moral concern in relation to technological systems given their deep integration in our lives. Coeckelbergh develops a social-relational account, suggesting that it can point us toward a dynamic, historicised evaluation of moral concern. While agreeing with Coeckelbergh’s move away from grounding moral concern in the ontological properties of entities, we suggest that it (...) problematically upholds moral relativism. We suggest that the role of power, as described by Arendt and Foucault, is significant in social relations and as curating moral possibilities. This produces a clearer picture of the relations at hand and opens up the possibility that relations may be deemed violent. Violence as such gives us some way of evaluating the morality of a social relation, moving away from Coeckelbergh’s seeming relativism while retaining his emphasis on social–historical moral precedent. (shrink)

Africanisation refers to a renewed focus on Africa, a reclaiming of what has been taken from Africa, and forms part of a post-colonialist and an anti-racist discourse. Africanising the curriculum involves developing scholarship and research established in African intellectual traditions. The idea is that this education will produce people who are not alienated from their communities and are sensitive to the challenges facing Africa. However, the idea of Africanisation is highly contested and may evoke a false or at least a (...) superficial sense of 'belonging,' further marginalisation, or it may emphasise relevance. This article discusses the possibility of Africanisation and takes further the argument of Graham Duncan of how Africans can reclaim their voices in the space of theological education. It unpacks the idea of Africanisation within higher education in general, examining the rationale behind the calls for Africanisation, followed by a discussion on the implications of Africanisation for theological education. (shrink)

The analysis presented here lays out the ethical warrants for requiring community oversight of health research conducted in international settings. It reviews the inadequacies with the current standards of individual informed consent and research ethics committee review, and then, shows how a broader population-based public health perspective raises new demands on justice involving due consideration of the rights, harms and benefits to the community as a whole. As developed here, an ethical standard that requires community oversight of health research is (...) justified on three principled grounds: respect for community autonomy and their right to self-determination; due consideration of the consequences of the research for the community as a whole; and, a more complete understanding of human autonomy. The paper concludes with practical recommendations regarding the composition of Community Advisory Boards to ensure that they have legitimate decision-making authority in diverse socio-cultural contexts. (shrink)

This article seeks to present challenges of negotiating difference and diversity in Christiancommunities in South Africa today. It reflects the intersectional nature of racial, gender, ethnicand economic difference, and ways in which land, capital and other power constructs continueto underpin and deepen exclusion. It then considers the status of diversity in Christiancommunities highlighting ways in which the fault lines in society are running throughChristian communities, and how such communities almost spontaneously engage in ‘othering’more naturally than in ‘embracing’. The article proposes (...) the re-conceptualisation of diversitywithin the bigger South African project of socio-economic transformation, and that theconversation about difference and diversity in Christian communities should be brought intodialogue with critical diversity theory, which considers diversity in relation to equity, humanrights and social justice. Finally, the article provides an overview of the contributions that formpart of this collection of articles, tracing how a number of Christian communities seek tonegotiate diversity and difference ecclesially and theologically. (shrink)

The study reports on the results of an empirical investigation of the education and recruitment processes used in HIV vaccine trials conducted in South Africa. Interviews were conducted with 21 key informants involved in HIV vaccine research in South Africa and three focus groups of community advisory board members. Data analysis identified seven major themes on the relationship between education and recruitment: the process of recruitment, the combined dual role of educators and recruiters, conflicts perceived by field staff, pressure to (...) achieve recruitment targets, problems in achieving comprehension, accountability and education as capacity building. The results raise ethical concerns about the adequacy of current informed consent processes in these settings. The study findings bear directly on current debates about issues of exploitation and the scope of moral responsibilities of researchers and funding agencies to assure that HIV clinical prevention research is conducted ethically. (shrink)

Ministerial formation is a multifaceted activity involving critical thinking, the acquisition of knowledge, skills development, religious identity formation and the development of ministerial and spiritual maturity expected of church ministers. Education is not merely the accumulation of a prescribed set of academic credits but includes the holistic formation of all aspects of the individual. However, theological educators are concerned about the capacity to foster such values and skills in the distance and electronic environment. Some see distance education as ‘distancing’ the (...) students in more significant ways than simply geographic distance. These issues are of fundamental importance for they reflect the deeper convictions of theologians that distance education may not be a suitable medium for ministerial formation. This article creates a conceptual map of the theological and pedagogical challenges for ministerial formation and highlights how the possibility of formation is being carried out in the distance-learning environment. (shrink)

South Africa is a complex society filled with diversity of many kinds. Because of the enormous and profound changes of the last 20 years of democracy, this can be perceived as a society in social identity crisis which is increasingly spilling over into many areas of life. Churches have also gone through a process of reformulating their identity and have restructured theological education for all its members resulting in growing multicultural student bodies. These new student constituencies reflect a wide spectrum (...) of cultural backgrounds, personal histories and theological commitments, and represent diversity in race, ethnicity, culture, class, gender, age, language and sexual orientation. These issues of diversity are theologically complicated and contested as they are attached to religious dogma. Diversity exists as a threat and promise, problem and possibility. Using current conceptualisations of diversity in South African Higher Education this article will seek to understand the notion of diversity and difference and the possibility of developing transformative remedies within the theological education curriculum. (shrink)

The reality of globalisation is that it has knitted the world into a single time and place and has introduced the dominant force of consumerism. In adopting this framework, it has frayed the moral fabric of theological education and has short changed students who are configured as consumers to please rather than characters to build. While the demographic centre of faith has shifted southward, its ways of thinking and engaging culture have not yet caught up with that shift. Global interconnectedness (...) and the globalisation of knowledge together with homogenisation forces have shaped African theological education to the extent that it has absorbed the almost irreversible traits of the West. This paper highlights how transnational cultural forms have profoundly impacted the production of theological education and will attempt a response to the homogenising forces by the focus of African identity. (shrink)

South African churches are struggling to form cohesive communities and strategies are needed to bring people together. Because of a deficiency in trust, people are reluctant to get to know each other, impacting on the quality of relationships and a positive sense of belonging and community. Congregations need to find ways to nurture an inclusive identity instead of the current norm of all-white or all-black churches, which can be perceived as being inaccessible or exclusive. Innovative strategies like storytelling can unlock (...) the power to understand each other breaking down prejudice, racism and xenophobia. Because intercultural socialisation is found wanting in congregations, sharing different perspectives and experiences can deepen engagements overcoming superficial interactions. This article expands on how storytelling can be used to facilitate an inclusive and intercultural congregational identity through identity formation, liberative practices of reconciliation, community building and as an educational resource. (shrink)

Race, ethnicity and national identity are important discussions that are unfinished ecclesial business for churches in South Africa. Churches remain mono-cultural to a large extent; a significant challenge is the fact that churches still largely reflect the social divisions of a society. Although not common in South Africa, there are, at the same time, congregations that are successful at reaching across racial and cultural divides to attract new members and build social capital. This article discusses the reconciliation potential of multicultural (...) churches in that they are able to accommodate multiple racial groups, in a society where religious life remains overwhelmingly segregated. Racial integration is a sensitive issue that has divisive potential and churches and religions in general tend to avoid the issue. Religious communities played a critical role in the transition to democracy; what is needed now is for churches to deepen this reconciliation potential. (shrink)

There is a debate regarding the use of the white coat, a traditional symbol of the medical profession, by students. In a study evaluating final-year South African medical students' perceptions, the white coat was associated with traditional symbolic values (e.g., trust) and had practical uses (e.g., identification). The coat was generally perceived to evoke positive emotions in patients, but some recognized that it may cause anxiety or mistrust. Donning a white coat generally implied a responsibility to the profession. For a (...) few, without the coat, patients would not cooperate, resulting in some perceiving no need to be distinguished from qualified practitioners. There was thus some evidence of entitled (vs. earned) respect. In the light of the underresourced health care setting in which these students learn clinical medicine, we recommend that students be able to recognize the potential for unprofessional or unethical behavior. Students should also be able to identify role models. (shrink)

Clinical trials are essential to establish the safety and efficacy of investigational products, contributing to risk/benefit assessments that ultimately determine whether these products meet the criteria for market authorisation. Clinical trials are also an important source of revenue and expertise generation for countries in which they are conducted. In developing countries, they represent substantial foreign direct investment. In spite of the substantial capital input that clinical trials require, the issue of funding post-trial access to beneficial therapies remains contentious, especially in (...) resource-limited settings. In this article, we explore this situation and propose mechanisms to establish ‘win-win’ situations where both patients and clinical trial sponsors derive benefit from post-trial access programmes in low- and middle-income countries. (shrink)

This paper examines the varied learning experiences that integrated socio-cultural theory, community engagement and e-learning offered by the “Diversity, Social Justice and Schooling” subject at the University of Western Sydney. This subject engaged university students in the learning process in a reflective and critical way, by responding to a need identified by community. Together with education technology, subject content knowledge and community engagement, the social justice subject aimed to enhance the educational achievement of marginalised groups, while simultaneously supporting pre-service teachers (...) in the context of their development as educators committed to a social justice ethos. (shrink)

The study reported in this paper utilised a qualitative approach to investigate the everyday lives of two children with cerebral palsy, as experienced by their carers. Analysis of the data collected through in-depth interviews with the girls’ teachers, mothers and therapists was informed by the reflective lifeworld research approach of Dahlberg et al.. The broader theme identified, negotiating motor in/capabilities, comprised the constituent sub-themes identity and difference, and living motor in/capabilities in a disabling/enabling environment. The phenomenological approach employed revealed that, (...) as experienced by their carers, the two girls, both of whom have quite profound forms of motor impairment, flourish by utilising their bodily and psychosocial resources towards experiencing enhanced autonomy and a sense of mastery. Overall, their respective carers served as resources for each of the girls, providing them with enabling social and physical environments that promote their optimal functioning. Theory-driven intervention efforts to promote social participation and well-being in children with cerebral palsy who have severe motor impairments would benefit from taking into account the nuances and complexities inherent in the everyday experiences of these children. (shrink)

Philosophy, Practical and Systematic Theology.

South African churches are struggling to form cohesive communities and strategies are needed to bring people together. Because of a deficiency in trust, people are reluctant to get to know each other, impacting on the quality of relationships and a positive sense of belonging and community. Congregations need to find ways to nurture an inclusive identity instead of the current norm of all-white or all-black churches, which can be perceived as being inaccessible or exclusive. Innovative strategies like storytelling can unlock (...) the power to understand each other breaking down prejudice, racism and xenophobia. Because intercultural socialisation is found wanting in congregations, sharing different perspectives and experiences can deepen engagements overcoming superficial interactions. This article expands on how storytelling can be used to facilitate an inclusive and intercultural congregational identity through identity formation, liberative practices of reconciliation, community building and as an educational resource. (shrink)

Medical Research Council, Capetown, South Africa Nasheen Naidoo Medical Research Council, Capetown, South Africa Shamagonam James Medical Research Council, Durban, South Africa Priscilla Reddy Medical Research Council, Capetown, South Africa * Corresponding author: 306 Arnold House, School of Public Health & Health Sciences, University of Massachusetts, Amherst, MA 01003, USA. Tel.: (413) 545 1005; Email: Buchanan{at}schoolph.umass.edu ' + u + '@' + d + ' '//--> . Abstract The analysis presented here lays out the ethical warrants for requiring community (...) oversight of health research conducted in international settings. It reviews the inadequacies with the current standards of individual informed consent and research ethics committee review, and then, shows how a broader population-based public health perspective raises new demands on justice involving due consideration of the rights, harms and benefits to the community as a whole. As developed here, an ethical standard that requires community oversight of health research is justified on three principled grounds: respect for community autonomy and their right to self-determination; due consideration of the consequences of the research for the community as a whole; and, a more complete understanding of human autonomy. The paper concludes with practical recommendations regarding the composition of Community Advisory Boards to ensure that they have legitimate decision-making authority in diverse socio-cultural contexts. CiteULike Connotea Del.icio.us What's this? (shrink)

The situation and human rights of people living with HIV and AIDS were explored through focus groups in five African countries (Lesotho, Malawi, South Africa, Swaziland and Tanzania). A descriptive qualitative research design was used. The 251 informants were people living with HIV and AIDS, and nurse managers and nurse clinicians from urban and rural settings. NVivo™ software was used to identify specific incidents related to human rights, which were compared with the Universal Declaration of Human Rights. The findings revealed (...) that the human rights of people living with HIV and AIDS were violated in a variety of ways, including denial of access to adequate or no health care/services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans. The informants living with HIV and AIDS were also abused verbally and physically. Country governments and health professionals need to address these issues to ensure the human rights of all people. (shrink)

The situation and human rights of people living with HIV and AIDS were explored through focus groups in five African countries . A descriptive qualitative research design was used. The 251 informants were people living with HIV and AIDS, and nurse managers and nurse clinicians from urban and rural settings. NVivo™ software was used to identify specific incidents related to human rights, which were compared with the Universal Declaration of Human Rights. The findings revealed that the human rights of people (...) living with HIV and AIDS were violated in a variety of ways, including denial of access to adequate or no health care/services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans. The informants living with HIV and AIDS were also abused verbally and physically. Country governments and health professionals need to address these issues to ensure the human rights of all people. (shrink)

The South African government’s COVID-19 pandemic risk mitigation strategies significantly limited social contact, which necessitated a novel approach to existing face-to-face career guidance practices. The Grade 9 Career Guidance Project, originally developed as a group-based career development intervention, required radical adaptation into a self-directed, manualized format to offer career guidance to Grade 9 learners from low-income communities amid a global pandemic. The adaptation and continuation of the project was deemed essential as secondary school learners in low-income communities have limited career (...) guidance support. Furthermore, a close collaboration with the teachers at eight resource-constrained South African secondary schools was vital for successful implementation. To assess the success of the adaptation to a self-directed format, a mixed-methods design was employed, and Life Orientation teachers’ evaluative feedback was solicited. Favorable quantitative results were obtained; majority of teachers agreed that learners enjoyed the booklet and that it was deemed an adequate substitute to the previous contact-based format of the Career Guidance Project. This was also confirmed by the qualitative findings revealing teachers’ satisfaction with the booklet’s content, specifically that the booklet is complementary to the Life Orientation curriculum. Qualitative findings identified specific contextual barriers that contributed to some learners struggling to use the booklet optimally. The results suggest that it is feasible and acceptable to implement a self-directed career guidance intervention among secondary school learners amid a global pandemic. Teachers recommended ways to integrate the booklet, resources, and contact sessions as a preferred way forward. These findings have important implications for similar resource-constrained settings that may not have readily access to in-person career guidance and counseling human development. (shrink)