Resource allocation during COVID-19: A focus on vulnerable populations

South Africa (SA) is a country of contrasts, with abundant resources, hard-won civil rights and a diverse population. Woven into the fabric of our society is a large divide between its poorest and its wealthiest members. In this article we highlight the vulnerabilities in our society that have been amplified by the COVID-19 crisis. Based on recent projections, it is very likely that the healthcare system will be overwhelmed. We acknowledge the recognition by government and civil society of these vulnerabilities, and note that difficult decisions will need to be made with regard to resource allocation. Our plea, however, is to ensure that human dignity and the principle of distributive justice are maintained, and that when difficult decisions are made, vulnerable people do not suffer disproportionately. Furthermore, it is of great concern that there is no national directive guiding resource allocation, prioritisation and triage decisions in both public and private hospitals. The Health Professions Council of SA should, as a matter of urgency, issue guidance on priority-setting and triage decisions in the context of COVID-19, based on distributive justice principles

Pandemics, professionalism and the duty of care: Concerns from the coalface

It is likely that the SARS-CoV-2 pandemic will affect a large part of the world's population and will last for several years. Many critical ethical issues have arisen in the healthcare context. While response from healthcare professionals to participating in the care of patients in the era of COVID-19 has generally been positive, there have also been disturbing experiences on the ground. The practice of medicine is a social contract with humanity. Challenges have arisen because the patient is both a victim and a vector of the coronavirus. All humans should have a natural instinct to care for those in need. Ethically and legally, healthcare professionals cannot be expected to assume a significant and unreasonable risk of harm. While fear is understandable, altruism and interest in serving the sick exemplify the value of solidarity. Social harms like stigmatisation and discrimination can occur. Concerns have been raised regarding protection of privacy and respect for rights of infected individuals. In the era of COVID-19, fear, misinformation and a detachment from one's calling put professionalism strongly to the test

Surgeons and HIV: South African Attitudes

Objectives. The HIV status of surgeons; in the context of the informed consent obtained from their patients; is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. Design. A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa; regarding their attitudes to the preceding issues. Results. The salient findings included the view that a patientcentred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients; and that HIV-positive surgeons should determine their own scope of practice. Conclu- sion. Patient-centred approaches and restrictive policies; related to this issue; do not accord with clinician sentiment. In the absence of comparable local or international data; this study provides clinicians' views with implications for the development of locally relevant policies and guidelines

Ethics in occupational health research in South Africa

Occupational health research encompasses the same ethical issues that apply to all research on human subjects; together with unique challenges related to the workplace setting. This article covers the main principles of research ethics relating to the occupational environment; illustrated by the authors' experiences related to ethical challenges in conducting occupational research; and reports an analysis of submissions made to the Research Ethics Committee of the University of the Witwatersrand during the period 2004 to 2006 and some lessons learnt in that regard. It also provides an overview of the international and national ethical guidelines pertinent to occupational health research with a view to assisting researchers in doing ethically acceptable research