Ethics, Medicine, and Health in South Africa

Article excerpt

Ethics, Medicine, and Health in South Africa

In many countries throughout the world, the health care professions and society as a whole are increasingly being confronted with ethical dilemmas. The spectrum of problems may be very similar across countries, but the specific issues raised by and the prominence given to a particular problem vary enormously from country to country. This divergence can be explained by differences in moral values and cultural traditions, in national development and priorities, in population structures and growth rates, in economies, and in ideologies underlying the struggle for political and economic power at national and international levels.

Although health care professionals are trained to provide care for ill patients as individuals and generally see this as their principal responsibility, it is increasingly necessary to reiterate to practitioners of Western medicine that health, medicine, medical education, and health care delivery systems cannot be considered in isolation from the political, economic, psychosocial, and communal factors that determine the milieu within which people live and that may promote their health or predispose them to disease.

South Africa is a country of paradoxes and contrasts. It is geographically beautiful, rich in natural and human resources, and has the potential to facilitate the economic development of many countries in southern Africa. [1] It is also a country in which the dehumanizing policies of apartheid have stultified and degraded the lives of millions, ingrained hatred, cynicism, and despair into many generations of its citizens, silenced or driven to other countries innumerable talented citizens, created an opposition in exile, and isolated the country internationally. This sociopolitical-economic milieu and its context have been alluded to in more detail elsewhere. [2]

The elimination of apartheid is the first and most important step towards reducing the very wide disparities between different groups in this country. Yet the road toward the reversal of this abhorrent policy and the establishment of an internationally recognized state in South Africa in which human rights are accorded to all on a nondiscriminatory basis has not been clearly identified, let alone embarked on. Moreover, other major social, economic, and political changes will be required, and debate centers on whether these can or should take place within the Western liberal paradigm or whether alternative ideological paradigms such as socialism offer greater potential for success.

Availability of Medical Services

Medical services in South Africa (comprising public, private, and voluntary organizations) are concentrated in major hospitals in urban centers and are typically Western in structure. They are equipped with most, but not all, modern diagnostic and therapeutic technologies, and focus predominantly on diagnosing and treating cardiovascular, neoplastic, degenerative, and infectious diseases, often in their advanced stages. Community hospitals are by comparison relatively poorly developed, especially in areas of high population density and low socioeconomic status where they are most needed. Family practice, primary care facilities, and ancillary medical services are disproportionately distributed among the affluent, and considerable development is needed in both urban and rural areas. Facilities for rehabilitation are likewise very inadequate. In addition, population growth and an influx of people into urban areas are creating demands that are outstripping the resources of teaching hospitals, resulting in erosion of the quality of clinical and academic functions. The and political circles. [9] The failure of Western, curative-oriented medicine to give adequate consideration to preventive, promotive, rehabilitative, and other social aspects of health care is particularly relevant in South Africa, where greater attention must be directed to the social underpinnings of health and disease. …