Higher education institutions play a pivotal role in knowledge creation and distribution. Teacher education is at the forefront of this engagement. The role of teacher educators is significant in engaging teacher knowledge for shaping and informing ways of being and doing in the world. In recent years higher education has undergone considerable transformation. In South Africa there is a call for real-world transformation in pedagogical practices to address academic, socio-economic, and cultural inclusion and emancipation. As a human right for enabling (...) student voices, a key issue for engaging relevant and fair pedagogical practices is critical thinking. Critical thinking is a rich concept and an attribute of consciousness required in all human activity. It is exercised through sound reasoning and dialogue. Critical thinking is also associated with understanding and engaging deep issues of socio–cultural and political domains of power and justice. However, engaging and enabling critical thinking pedagogy in education is complex and contradictory in nature. Conceptualizing critical thinking is expedient as an initial stage. The objective of this article, part of a larger study, is to provide a conceptualisation of critical thinking pedagogy toward addressing: In what ways is critical thinking pedagogy engaged in South African teacher education? Here, this article aims to address the question: what is critical thinking and critical thinking pedagogy? Methodologically, an interdisciplinary psycho–social philosophic educational documentary design is employed based on a selection of key critical thinking proponents. It further presents a conceptualisation of critical thinking pedagogy underpinned in critical theory especially those of Freire and Foucault. This article aims to spotlight the need for engaging critical thinking through a conceptualisation of critical thinking pedagogy in teacher education required for addressing new ways of teaching today. (shrink)

Doing philosophy for/with children and exposing students to multiple perspectives, exemplified within the Austrian Centre of Philosophy with Children’s implementation project of the Philosophical Enquiry Advancing Cosmopolitan Engagement (PEACE) curriculum in schooling, may offer a valuable written, taught, and tested curriculum for democratic citizenry. This paper provides an analysis that seeks to present, describe, critique, and make recommendations on the PEACE curriculum. The paper asks the question: In what ways does the Philosophical Enquiry Advancing Cosmopolitan Engagement as a 21st century (...) curriculum address education for democratic citizenry? In this evaluation the ways in which issues of culture and identity, human rights and democracy are perceived and addressed, along with issues of critical thinking and reasoning in verbal and non-verbal language are attended. Concepts of collaboration, cooperation, teacher support and development are also critiqued. This critique is based on a ten-day Austrian Center of Philosophy with Children conference and training course on the PEACE curriculum, and consists of open-ended interviews, personal observations, and published reports on pre- and post-test results of the PEACE curriculum. Exploring the integration of the Austrian Center of Philosophy with Children PEACE curriculum and the Philosophy for/with Children methodology, this paper utilizes Hansen’s (1995) five principles for guiding curriculum development practice as a framework for analysis. It is hoped that findings and recommendations from this study may stir further exploration and contribute to the work of Philosophy for/with Children in democratic education for 21st century citizenry worldwide. (shrink)

The use of biological samples in research raises a number of ethical issues in relation to consent, storage, export, benefit sharing and re-use of samples. Participant perspectives have been explored in North America and Europe, with only a few studies reported in Africa. The amount of research being conducted in Africa is growing exponentially with volumes of biological samples being exported from the African continent. In order to investigate the perspectives of African research participants, we conducted a study at research (...) sites in the Western Cape and Gauteng, South Africa. (shrink)

Biobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers (...) must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented. In-depth qualitative interviews were conducted with a purposive sample of 21 researchers – 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40–60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors. Researchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust. Building trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa. (shrink)

In October of 2014, news outlets began reporting on a case of a lesbian couple suing a sperm bank for receiving the wrong donor's sperm.1 As the lawsuit Cramblett v. Midwest Sperm Bank alleged, not only did the couple receive the wrong donor's sperm but they had specifically chosen a white donor with blonde hair and blue eyes and the sperm they received had been from a black donor.2 Both women were white. The couple gave birth to a black/mixed-race child (...) in 2012 and claimed that their daughter's race posed particular challenges for their family, from facing prejudice in their nearly all white community to difficulties dealing with their daughter's hair. The couple sued for "wrongful birth" and "breach of warranty,"... (shrink)

The Covid‐19 pandemic has sparked rapid and voluminous production of bioethics commentary in popular media and academic publications. Many of the discussions are new twists on an old theme: how to fairly allocate scarce medical resources, such as ventilators and intensive care unit beds. In this essay, we do not add another allocation scheme to the growing pile, partly out of appreciation that such schemes should be products of inclusive and transparent community engagement and partly out of recognition of their (...) limited utility for physicians working in the field. Instead, we make the more modest claim that context matters when making such decisions and, more specifically, that recommendations from high‐income countries about fair allocation during Covid‐19 should not be cut and pasted into low‐income settings. We offer a few examples of why seemingly universal, well‐intentioned ethical recommendations could have adverse consequences if unreflectively applied in sub‐Saharan Africa. (shrink)

Background HIV prevention research has been fraught with ethical concerns since its inception. These concerns were highlighted during HIV vaccine research and have been elaborated in microbicide research. A host of unique ethical concerns pervade the microbicide research process from trial design to post-trial microbicide availability. Given the urgency of research and development in the face of the devastating HIV pandemic, these ethical concerns represent an enormous challenge for investigators, sponsors and Research Ethics Committees (RECs) both locally and internationally. Discussion (...) Ethical concerns relating to safety in microbicide research are a major international concern. However, in the urgency to develop a medically efficacious microbicide, some of these concerns may not have been anticipated. In the risk-benefit assessment of research protocols, both medical and psycho-social risk must be considered. In this paper four main areas that have a potential for medical and/or psycho-social harm are examined. Male partner involvement is controversial in the setting of covert use of microbicides. However, given the long-term exposure of men to experimental products, this may be methodologically, ethically and legally important. Covert use of microbicides may impact negatively on relationship dynamics leading to psychosocial harm to varying extents. The unexpectedly high rates of pregnancy during clinical trials raise important methodological and ethical concerns. Enrollment of adolescents without parental consent generates ethical and legal concerns that must be carefully considered by RECs and trial sites. Finally, paradoxical outcomes in recent trials internationally have advanced the debate on the nature of informed consent and responsibility of researchers to participants who become HIV positive during or after trials. Summary Phase 3 microbicide trials are an undisputed research and ethical priority in developing countries. However, such trials must be conducted with attention to both methodological and ethical detail. It is imperative that guidelines are formulated to ensure that high ethical standards are maintained despite the scientific urgency of microbicide development. Given the controversy raised by emergent ethical issues during the course of microbicide development, it is important that international consensus is reached amongst the various ethics and regulatory agencies in developing and developed countries alike. (shrink)

This study explores the relationship between moral intensity and the use of different sensemaking strategies in military critical incidents. First, narratives of military personnel were used to select prototypical high/low moral intensity critical incidents. In a follow-up, a scenario study was conducted with active duty military personnel to examine the relationship between moral intensity and the use of sensemaking tactics. This study offers three main conclusions. First, the use of sensemaking tactics is strongly tied to the level of moral intensity (...) in the situation. In high-intense situations, the servicemen draw on previous experiences, prediction of consequences, and help of others to recognize and interpret the situation. Less attention goes out to higher level critical thinking. Thus, it seems that in these critical incidents, the servicemen react without giving room for thorough consideration and deliberation. Second, the number of deployments a serviceman experienced influences the perceived seriousness and harmfulness of the situation negatively in low-intense situations. Finally, and in line with earlier studies, the results indicate that the concept of moral intensity is formed out of three rather than the six dimensions originally proposed by Jones. The implications of these findings are discussed. (shrink)

Background and objectives: There are few insights from sub-Saharan Africa on research participants’ experiences of the informed consent process, particularly in the context of randomised controlled trials, where issues of randomisation and the use of placebos may be confusing concepts for participants. This study investigated the knowledge and perceptions of the informed consent process among individuals participating in influenza vaccine trials in two disadvantaged communities in South Africa.Method: Four to 12 months after completion of the trials, participants were contacted to (...) return to participate in the informed consent study. The semistructured questionnaire administered to assess recall of trial procedures and the informed consent process covered key issues including: purpose of the study; awareness that the study was not part of routine treatment; voluntary nature of participation and freedom to withdraw; randomisation; placebos; and remuneration.Results: A total of 334 participants completed the questionnaire. Only 21% were able to recall that they were allocated randomly to the different treatment arms. Only 19% of those involved in the placebo controlled study had interpreted the concept of placebo as an inactive medication.Conclusion: Although a good general recall of trial concepts was demonstrated, only a small proportion of the participants correctly interpreted and recalled the concepts of randomisation and placebos. Informed consent in this and similarly disadvantaged communities may often be inadequate and new ways to improve understanding of the research process should be explored. (shrink)

BackgroundBiobanking provides exciting opportunities for research on stored biospecimens. However, these opportunities to advance medical science are fraught with challenges including ethical and legal dilemmas. This study was undertaken to establish perspectives of South African stakeholders on the ethico-legal dimensions of biobanking.MethodsAn in-depth exploratory study was conducted with 25 purposively selected biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee (REC) members in South Africa. Potential study participants were recruited through known hubs for biobanking in the country, (...) online searches and the snowball sampling technique. A semi-structured face-to-face or Skype interview was arranged. Data was analysed using thematic analysis.ResultsThe emergent themes included: inconsistency in understanding consent models, disconnect between biobank researchers and biosample donors, inadequate processes to support re-consenting minors, inconsistent governance processes for biobanking research; challenges with sample and data sharing, and suboptimal strategies for benefit sharing and return of results. Biobanking practice in general appeared to be inconsistent and fragmented. While the need for consent in research is explicitly outlined in legislative documents, some respondents were unclear on the type of consent model to apply in biosample collection. They also reported inconsistencies in research participants’ understanding of consent. Furthermore, these respondents’ own understanding of consent and consent models were dependent on where they were positioned in biobanking practice (roles occupied). Respondents were unsure about the process to follow to re-consent child participants once the age of majority (≥ 18 years) was reached. It was not surprising that consent was identified as one of the major ethical challenges in biobanking practice. In certain settings, some respondents reported suboptimal governance processes for sample collection. Participants were generally unsure about how to operationalise benefit sharing and how to approach the idea of returning results to research participants and biobank donors.ConclusionThe study findings indicated inconsistencies in stakeholder understanding of ethico-legal considerations related to biobanking in South Africa. A need for ongoing ethics capacity development among stakeholders was identified. Improving understanding of the ethics of biobanking could be facilitated by acknowledging the disconnect created by biosamples in the relationship between biobank researchers and donors. (shrink)

The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income countries suffering from chronic shortages in (...) health care resources, and chronic high morbidity and mortality from non‐COVID‐19 causes. A parallel is drawn between the distribution of severity of COVID‐19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID‐19 on the ‘thick’ part of the pyramid in Low‐to‐Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post‐COVID‐19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID‐19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non‐pandemic times. (shrink)

This paper examines how everyday practices of ‘bordering’, as conceived by Yuval- Davis, Wemyss, and Cassidy (2019) as the ongoing proliferation of border sites where migrants are assessed to be fit for inclusion or exclusion, may violate moral respect by subjecting migrants to a wide array of discriminatory treatment, leading to what I call ‘status-harms’. Section II begins by providing an overview of bordering and the various forms it has taken, such as internal immigration checkpoints or even online visa application (...) processes. Section III develops an account of comparative and non-comparative status-harms and why they constitute violations of moral respect. There, I pay special attention to comparative status-harms by proposing three conditions under which a comparative status-harm can be said to have occurred: (a) if an individual or group is singled out for disadvantageous treatment that others are not subjected to on the basis of a socially salient attribute, (b) if the attribute marks them out as inferior relative to those who are not affected thus, and (c) ascriptions of inferior status occur within a morally objectionable social hierarchy where they are targeted by hostile norms and practices centred around that attribute. I then consider how discriminatory practices of bordering routinely imposes status-harms on migrants. Section IV draws a distinction between two types of discrimination that migrants may be subjected to at border sites, which I term policy-based discrimination and procedure-based discrimination, and explores their relationship to the comparative and non-comparative status-harms suffered by migrants. I conclude in Section V. (shrink)

For implementing ethics in AI technology, there are at least two major ethical challenges. First, there are various competing AI ethics guidelines and consequently there is a need for a systematic overview of the relevant values that should be considered. Second, if the relevant values have been identified, there is a need for an indicator system that helps assessing if certain design features are positively or negatively affecting their implementation. This indicator system will vary with regard to specific forms of (...) AI technology. An adequate indicator system for the ethical development of recommendation algorithms, for example, will diverge considerably from another for autonomous road vehicles, although both are based on shared values. In this contribution, we propose solutions to both challenges with regard to the special case of the development of an AI-assisted rescue robot. (shrink)

Consent processes for clinical trials involving HIV prevention research have generated considerable debate globally over the past three decades. HIV cure/eradication research is scientifically more complex and consequently, consent processes for clinical trials in this field are likely to pose a significant challenge. Given that research efforts are now moving toward HIV eradication, stakeholder engagement to inform appropriate ethics oversight of such research is timely. This study sought to establish the perspectives of a wide range of stakeholders in HIV treatment (...) and research to inform consent processes for cure research. In total, 68 South African stakeholders participated in two qualitative research modalities. In-depth interviews were conducted with a purposive sample of 42 individuals - audiotaped with consent. Twenty-six stakeholders participated in three focus group discussions. Thematic analysis of transcribed IDIs and FGDs was conducted. The majority of respondents indicated that there could be unique challenges in HIV cure research requiring special attention. In particular, given the complexity of cure science, translation of concepts into lay language would be critical for potential participants to adequately appreciate risks and benefits in early phase research with experimental interventions. Furthermore, to aid understanding of risks and benefits against a background of desperation for a cure, specially trained facilitators would be required to assist with a psychological assessment prior to consent to avoid curative misconceptions. Long-term participant engagement to assess durability of a cure would mean that the consent process would be prolonged, necessitating annual re-consent. Building trust to maintain such long-term relationships would be critical to retain study participants. Unique consent requirements for cure research in South Africa would include significant efforts to maximise understanding of trial procedures, risks and the need for long-term follow-up. However, the psychological dimension of cure must not be underestimated. Beyond an understanding of cure science, the emotional impact of HIV cure advances the discourse from cure to healing. Consequently, the consent process for cure research would need to be enhanced to include psychological support and counselling. This has several important implications for research ethics review requirements for consent in HIV cure research. (shrink)

BackgroundThe COVID-19 pandemic presents significant challenges to research ethics committees (RECs) in balancing urgency of review of COVID-19 research with careful consideration of risks and benefits. In the African context, RECs are further challenged by historical mistrust of research and potential impacts on COVID-19 related research participation, as well as the need to facilitate equitable access to effective treatments or vaccines for COVID-19. In South Africa, an absent National Health Research Ethics Council (NHREC) also left RECs without national guidance for (...) a significant duration of the COVID-19 pandemic. We conducted a qualitative descriptive study that explored the perspectives and experiences of RECs regarding the ethical challenges of COVID-19 research in South Africa.MethodsWe conducted in-depth interviews with 21 REC chairpersons or members from seven RECs at large academic health institutions across South Africa that were actively involved in the review of COVID-19 related research from January to April 2021. In-depth interviews were conducted remotely via Zoom. Interviews (60–125 min) were conducted in English using an in-depth interview guide, until data saturation was achieved. Audio-recordings were transcribed verbatim and field notes were converted into data documents. Line-by-line coding of transcripts was performed, and data were organised into themes and sub-themes. An inductive approach to thematic analysis was used to analyse data.ResultsFive main themes were identified, namely: rapidly evolving research ethics landscape, extreme vulnerability of research participants, unique challenges to informed consent, challenges to community engagement during COVID-19, and overlapping research ethics and public health equity issues. Sub-themes were identified for each main theme.ConclusionsNumerous, significant ethical complexities and challenges were identified by South African REC members in the review of COVID-19 related research. While RECs are resilient and adaptable, reviewer and REC member fatigue were major concerns. The numerous ethical issues identified also highlight the need for research ethics teaching and training, especially in informed consent, as well as the urgent requirement for the development of national guidelines for research ethics during public health emergencies. Further, comparative analysis between different countries is needed to develop the discourse around African RECs and COVID-19 research ethics issues. (shrink)

In this paper, questions regarding the cultural understanding of mixed race are explored, which have the ability to complicate the accepted portrayal of race in society as a black/white binary system. Thus, the acknowledgement of something other than this binary system offers new ways of theorizing about race, particularly concerning the sociopolitical implications of mixed-race designation. This paper argues that the visually mixed-race person has a certain direct ability to challenge the binary and its racist logic. Furthermore, this paper goes (...) on to offer a unique interpretation of where power for working against a racially oppressive system lies within critical mixed-race theory. (shrink)

It has been suggested that states have no right to directly discriminate against would-be immigrants on grounds of race or sex. However, while the discourse on cases of wrongful discrimination has largely focused on discrimination on grounds of gender, race, and sexual orientation, states frequently engage in discrimination of a different kind when it comes to admissions and naturalisation policies. It is assumed that the anti-discrimination principle does not include cases of talent-based discrimination, and that these fall well within the (...) rights of states. I wish to suggest, to the contrary, that selecting immigrants on the basis of talent is a form of wrongful discrimination. First, with reference to Deborah Hellman’s expressive theory of discrimination, I explain what is wrongful about particular forms of state discrimination between would-be migrants. Next, I tackle the issue of immigrant selection on grounds of talent, which I refer to as ‘talent-based selection’. Unlike gender or race-based selection, it is generally not regarded as wrongful discrimination, for the reason that it does not express disrespect in the same way that sexist or racist selection criteria does. I argue that this assumption is mistaken, as talent-based discrimination does involve the expression of disrespect. In the present context, it has the expressive effect of reproducing demeaning stereotypes about low-skilled foreigners. Finally, I anticipate four objections to my conclusion. (shrink)

Bioethics, Volume 36, Issue 3, Page 336-345, March 2022.

Background Clinical Ethics Committees 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 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. All participants were familiar with Research Ethics Committees, 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 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. (shrink)

Journal of Social Philosophy, Volume 53, Issue 3, Page 317-333, Fall 2022.

Russell’s “Meeting the Moment: Bioethics in the Time of Black Lives Matter” expertly identifies how race and racism are matters of bioethical concern that ought to be addressed via an indivi...

Concerns have been raised around the alleged commercialisation of South African genetic material by various research institutes nationally and abroad. We consider whether the Protection of Personal Information Act in South Africa will conflict with or complement existing protections in health law and research ethics. The Act is not applicable to de‐identified samples that cannot be re‐identified but we question whether genetic samples can ever be truly de‐identified. The research participants in this matter provided consent for use of their samples (...) for research but did not consent to commercialisation by global research institutions, and neither did the researchers. We suggest that consent models incorporating broad consent as an option should include explicit discussions around benefit sharing and commercialisation. Mistrust between researchers and participants impedes scientific research and can harm relationships built up over the years between South African researchers and local communities. (shrink)

La comprensión lectora de las personas con discapacidad es una cuestión escasamente estudiada y a día de hoy esta línea de investigación no ha profundizado en la comprensión específica de textos especializados. Consecuentemente, a pesar de existir ciertos procedimientos para facilitar la comprensión, como la lectura fácil, no se han analizado las dificultades que presentan determinados textos para las personas con dificultad intelectual. Ejemplo de ello son los textos sobre Historia. En el presente artículo pretende detectar los principales problemas de (...) comprensión que rodean a estos textos y formulas posibles soluciones para facilitar su comprensión. (shrink)

BackgroundThe ethical concerns associated with HIV prevention and treatment research have been widely explored in South Africa over the past 3 decades. However, HIV cure research is relatively new to the region and significant ethical and social challenges are anticipated. There has been no published empirical enquiry in Africa into key informant perspectives on HIV cure research. Consequently, this study was conducted to gain preliminary data from South African HIV clinicians, researchers and activists.MethodsIn-depth interviews were conducted on a purposive sample (...) of fourteen key informants in South Africa. Audiotaped interviews were transcribed verbatim with concurrent thematic analysis. The perspectives of HIV clinicians, researchers and activists were captured. Analyst triangulation occurred as the data were analysed by three authors independently.ResultsThe rapid evolution of HIV cure research agendas was prominent with participants expressing some concern that the global North was driving the cure agenda. Participants described a symbiotic relationship between cure, treatment and prevention research necessitating collaboration. Assessing and managing knowledge and expectations around HIV cure research emerged as a central theme related to challenges to constructing ‘cure’ - how patients understand the idea of cure is important in explaining the complexity of cure research especially in the South African context where understanding of science is often challenging. Managing expectations and avoiding curative misconception will have implications for consent processes. Unique strategies in cure research could include treatment interruption, which has the potential to create therapeutic and ethical conflict and will be perceived as a significant risk. Ethical challenges in cure research will impact on informed consent and community engagement.ConclusionsIt was encouraging to note the desire for synergy amongst researchers and clinicians working in the fields of prevention, treatment and cure. Translation of complex HIV cure science into lay language is critical. Moving forward, RECs must be adequately constituted with scientific expertise and community representation when reviewing cure protocols. It is hoped that knowledge and resource sharing in the context of collaboration between research scientists working in cure and those working in treatment and prevention will accelerate progress towards cure. (shrink)

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world’s first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe (...) resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants. (shrink)

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during the apartheid era was highlighted in 1997 during the Truth and Reconciliation Commission hearings. The Health Professions Council of South Africa subsequently realised the importance of medical ethics education and encouraged the introduction of such teaching in all medical schools in the country. Curricular reform at the University of Stellenbosch in (...) 1999 presented an unparalleled opportunity to formally introduce ethics teaching to undergraduate students. This paper outlines the introduction of a medical ethics programme at the Faculty of Health Sciences from 2003 to 2006, with special emphasis on the challenges encountered. It remains one of the most comprehensive undergraduate medical ethics programmes in South Africa. However, there is scope for expanding the curricular time allocated to medical ethics. Integrating the curriculum both horizontally and vertically is imperative. Implementing a core curriculum for all medical schools in South Africa would significantly enhance the goals of medical education in the country. (shrink)

More than two hundred and fifty years have elapsed since George Berkeley first published his Principles of Human Knowledge and thereby divided the intelligible world into “notions” and “ideas". In the ensuing period, the more articulate world has shown a marked preference for treating only his theory of “ideas” .The result has been misleading. It is therefore the purpose of this essay to present Berkeley' s theory of “notions”, in so far as it can be gleaned from the pages of (...) his extant works, and to emphasize the importance of "notions" in any fair-minded attempt to view Berkeleyan philosophy as a whole. The vital role of a theory of notions will become evident in due course. (shrink)

Proefschrift Katholieke Universiteit Nijmegen. Onderzoek naar de metaforische functie van de vrouw en het vrouwelijke in het werk van Nietzsche, gerelateerd aan Nietzsche's concept van het dionysische. Dit concept van het dionysische wordt uitgewerkt als thematisering van het verlangen.

According to a growing body of studies, people’s ability to forecast future emotional experiences is generally biased. Nonetheless, the existing literature has mainly explored affective forecasting in relation to specific events, whereas little is still known about the ability to make general estimations of future emotional states. Based on existing evidence suggesting future-oriented disposition as a key factor for mental health, the aims of the current study were (1) to investigate the relationship between negative (NA) and positive (PA) affective forecasting (...) biases and perceived psychological well-being, and (2) to explore whether positively biased predictions are associated with resilience and foster one’s skills to cope with stressful events. To do so, we asked 85 undergraduate students to forecast PA and NA over 2 weeks, as well as to report their daily affect through a web-based Ecological Momentary Assessment. According to the results, positively biased PA forecasting (i.e., overestimating positive emotional states) was associated with greater perceived psychological well-being and higher resilience. When high levels of stress were experienced, participants holding an optimistic, yet biased, estimation of future PA were more likely to successfully manage stressors, thus maintaining lower levels of NA and higher levels of positive emotions. We suggest that positively biased PA forecasting is an adaptive cognitive distortion that boosts people’s resilience and mental health, thus opening new avenues for the promotion of psychological well-being. (shrink)

Trial participation in the proposed HIV Vaccine Trials in South Africa is discussed in the context of the ethical tension that exists between international ethical research standards and local standards of care and cultural norms in the Third World. The important concepts of informed consent, risk-benefit ratio and fair treatment of trial participants are interpreted differently in traditional, rural African communities, where a moderate form of communitarianism referred to as "Ubuntu" or "communalism" is still prevalent. Research is an altruistic endeavor (...) that benefits communities and societies as a result of risks taken by individuals. Universal ethical guidelines that are highly individualistic and fail to emphasize communalism may represent serious problems for the sort of research needed in Africa today. (shrink)

ABSTRACT Contemporary US discourse on reparations tends to focus on the suppression of Black economic interests, but the harms of slavery are not exhausted by the labor expropriation of slaves and its concomitant wealth accumulation for white people and the United States at large. Reproductive oppression was constitutive of the institution of slavery, and its harms continue to reverberate today. This article thus calls for reproductive reparations, or the transparent and sustained attention to the effects of racialized reproductive oppression as (...) they intersect with calls for reparations for slavery. Reconceiving reparations through histories and presents of reproductive harm is required to more fully account for the wrongs of slavery and provide a broader reach for radical societal transformation in our present. (shrink)