Apartheid medicine: health and human rights in South Africa

Article Abstract:

Social changes are occurring within South Africa that have recently resulted in suspension of executions, lifting of state of emergency in principal South African provinces, and the release of numerous political prisoners. In May 1990 the Minister of National Health announced that all hospitals would be opened to people of all races; however, individual patients would still be grouped according to cultural, religious, social and language criteria. Other concerns about continuing practices of the South African government that have led to a system which gives priority to white patients over others, and to human rights violations, have motivated the Committee on Scientific Freedom and Responsibility of the American Association for the Advancement of Science, the Committee on Health and Human Rights of the Institute of Medicine of the National Academy of Sciences, and the American Public Health Association to sponsor a brief investigatory trip. Decades of apartheid have had a seriously adverse impact upon the health care of many South African groups. Each of 14 different racial, ethnic or tribal group has their own ministry of health, and this multiplicity of ministries leads to a confused medical environment, inefficient provision of services, and a generally segregated system of health care. A deliberate policy of not providing an adequate system of primary and secondary schooling for blacks greatly decreases the number of blacks entering the health professions. English-language medical schools today accept all qualified students without regard to race, and provide financial assistance for blacks. However, of 708 physicians who graduated from white schools in 1988, only 28 were black. Taken together, today there are only a few hundred black physicians in South Africa, who are not permitted to treat white patients. Former detainees interviewed by the visiting group vividly described tortures, death threats, and prolonged periods of solitary confinement and deprivation. The group concluded that the recent reforms are a highly welcomed beginning, but that many violations of human and health rights continue. In particular the prison health system is unable to protect prisoners from torture and abuse by jailers. The South African health delivery system is flawed at is core, and from this flows a fragmented system of health delivery. Despite many inequities of the system, there are nevertheless some changes and improvements in health and human rights occurring in South Africa. South Africa faces a monumental task of producing lasting and profound improvements in human health care for all citizens without regard to race. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical care, South Africa, Medical policy, Health policy, Apartheid

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Ethical aspects of human experimentation in health services research

Article Abstract:

There is ample medical literature about the ethical issues surrounding human experimentation during conventional research, which usually compares the effectiveness of two drugs, or a drug and a placebo in treating a disease. However, health services research, which in the past relied on previously collected data or observations, now engages more and more often in direct intervention in areas of social experimentation as diverse as early discharge of low-birthweight babies and health care financing. In spite of the burgeoning number of these studies, ethical issues have not been scrutinized as carefully as they have been for conventional research. The three basic ethical principles of respect for persons, beneficence and justice are defined and applied to medical research. Defining a clinical activity as ''research'' separates it from clinical care because the goals are different. The goal of research is the acquisition of knowledge, such as when a drug is given to healthy volunteers to study the drug's metabolism, with no intended benefit to the subjects. Therapeutic research may benefit the patient, but the research is designed to provide generalized conclusions. The goal of clinical care is to provide benefit only for a specific patient. Health services research will contribute to quality care, but five points must be considered. First, researchers must carefully define their goals, the values underlying these goals and the research protocols. Second, conflicts between policymakers (or institutional agendas) and the medical interests of the individual must be addressed. Third, if informed consent is to be waived, the researcher must justify it. Fourth, potential conflicts between patient care and research must be recognized. Fifth, all health services research involving humans should be reviewed by institutional review boards. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ethical aspects, Medical research, Human experimentation in medicine, Human medical experimentation

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Health Care of Torture Survivors

Article Abstract:

A method of identifying and treating victims of torture is presented. Many doctors may not recognize the signs of torture and many victims may not mention it. More than 400,000 survivors of torture live in the US and this number will probably increase.

Care and treatment, Torture victims

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