Ethics

History of ethics
In the 4th century BC, Hippocrates, renowned as the father of Western medicine,
introduced foundational ethical principles into the practice of healthcare, notably
encapsulated in the Hippocratic Oath, which emphasized the imperative of "do no
harm."
The intellectual milieu of ancient Egypt, flourishing around 3400 to 343 BC, saw
the emergence of philosophical inquiry, including explorations into fundamental
concepts and ideas that would later form the basis of philosophical discourse,
encompassing ethics.
While ancient Greece is traditionally credited with the birth of Western
philosophy, scholarly debates persist regarding the potential influence of ancient
Egyptian civilizations on the development of philosophical thought, with
evidence suggesting cross-cultural exchange and intellectual interchange
between these ancient civilizations.
Approximately 2500 years ago, Greek philosophers such as Socrates, Plato, and
Aristotle engaged in profound debates on morality, grappling with enduring
questions about the nature of a virtuous life, the essence of goodness, and the
principles of justice.
Fast forward to the 1960s, a period marked by unprecedented advancements in
medical technology, which gave rise to novel ethical dilemmas within the realm
of healthcare, including issues related to distributive justice and the definition of
brain death, prompting renewed reflections on ethical principles and
responsibilities.
In the contemporary landscape, medical ethics, as a branch of philosophy, delves
into the ethical dimensions of clinical care and medical research, addressing
complex questions surrounding treatment decisions, patient autonomy, and the
professional obligations of healthcare providers.
Within the realm of ethics, meta-ethics occupies a pivotal role, focusing on the
development of theoretical frameworks and approaches to addressing ethical
challenges, drawing upon diverse philosophical traditions and systems of moral
reasoning that have evolved over millennia across various cultures and
civilizations.
Traditionally rooted in the principle of "do no harm," medical ethics has evolved
to embrace a patient-centered approach, with an emphasis on respect for patient
autonomy, reflected in contemporary ethical frameworks such as the four-
principles approach, which prioritizes autonomy, beneficence, non-maleficence,
and justice.
Critical engagement with ethical issues, informed reflection on personal values,
and a nuanced understanding of legal considerations are essential competencies
for healthcare professionals navigating the complexities of ethical decision-
making in their daily practice.
Despite the challenges inherent in navigating ethical dilemmas, fostering an
ethos of open dialogue, tolerance for ambiguity, and respectful engagement with
differing perspectives remains fundamental to the ethical discourse surrounding
healthcare practice and research.

Importance of ethics in healthcare

Ethics

• Subdiscipline of philosophy. Outcome of reflection on the meaning of the

concepts good and bad or right and wrong. Reflection on range of ideas about
what confer value and disvalue. (This means that ethics involve thinking about
different beliefs and principles regarding what actions are right or wrong,
valuable or harmful. It's about exploring various perspectives to understand
what is considered morally acceptable or unacceptable).
• Human action is not something that happens without us being in control or
not being conscious of what we are doing. Humans know what they are doing
and also critique what they are doing by considering their obligation. (This
means that people tend to assess their behaviours and decisions based on
some standard of duty or responsibility. This suggests that there is a common
tendency among humans to consider what they ought to do in a given
situation, guided by a sense of moral duty or obligation).
• All humans question themselves on “what they ought to do” and “am I doing
the right thing”.

Moral Questions

• “What ought I to do” and “Is what I am doing the right thing to do”
• Cannot be answered by observation and using relevant factual information
• Is abortion murder?
• Include a persons personal judgements on what is right or wrong

Factual Questions

• “Which city has the most people”

 • Cannot be answered by observation and using relevant factual information

Morality and Ethics

• When we engage in moral questions we engage in ethics

• HOWEVER, ethics and morality are different
• Morality: Actual human practices in the world that are informed/influenced by
one’s values e.g. people shouldn’t drink and drive. It is what people do when they
are guided by values and norms. Thus it is the actual behaviours and practices
people engage in which are informed (they make decisions based on) by their
values. Its about what people actually do in the world based on their values and
societal norms
• Ethics: is a philosophical discipline that is the outcome of systematic and
rationally justifiable process of reflection. It is what people think they should do
and how what they think they should do is reflectively and systematically
motivated. Thus, it is not about what people actually do but what they believe
they should do based on ethical principles and reasonings. It is how people think
they should behave and the motivations/reasons behind those beliefs.
Systematic means ethics follows a structured approach and rationally justifiable
means that ethics are based on reasons that can be explained using logic,
evidence and arguments.

Law and ethics

• Law and ethics often overlap but are not the same thing
• What is demanded or forbidden by law might not always be demanded or
forbidden by ethics.
• For example, ethically it is morally forbidden to lie. By law, it is not forbidden to
lie. Or it is immoral to smoke ethically but not illegal by law.
• Similarly, actions can be required by law but NOT ethical. This occurs through
unjust laws.
• For example, during apartheid marriage between black and white people were
illegal. To obey this was required by law but the entire concept and law is
unethical and immoral.
• Illegal activities = punishment
• Unethical activities = blame
Moral responsibility and the need to argue

• In ethical issues there are hardly definite or clear-cut answers.

• Ethics comes from the constant human struggle of not being able to
comprehend or understand the uncertainty of our existence and why we exist.
• We know a lot due to science but we have only scratched the surface
• Our ethics are guided by wonder but also a sense of responsibility. The impulse
to act ethically comes from our sense that we are accountable to ourselves and
other people for how we live and what we do.
• That’s why ethics is important in medicine and health sciences. Healthcare
workers are responsible and accountable for those who are sick.
• Our inquiries in terms of ethics are driven by our sense of responsibility. We feel
accountable to ourselves, others or a higher power for our actions and how we
live our lives. This responsibility is evident in healthcare as we are responsible for
our patients wellbeing.
• Being ethical = being responsible which requires us to be able to clearly,
systematically and rationally argue for our actions and beliefs. Ethics as a part of
philosophy deals with ARGUMENTS because ethical issues cant be resolved by
facts alone. Facts can support or challenge ethical positions.
• For example, in HIV AIDS, when first discovered people didn’t want to go for
testing as HIV meant death and they were afraid because of stigmas and fear.
When ARVs were developed, people didn’t need to look at HIV as a death
sentence and could start going for routine testing and treatments.
• Ethics cant be decided by facts but facts can support the ethic.

Building moral arguments

• To be able to argue well and persuasively is important for ethics

• Read case study and comments

From slides

Ethics definition: ethics is the study of morality, the careful and systematic reflection
on and analysis of moral decisions and behavior whether past, present or future.

Philosophy and ethics

Philosophy helps us to:

1. Understand our own viewpoints

2. Consider and understand other possibilities
3. Become aware of criticism against our viewpoints
4. Adjust our own positions
 5. Justify our positions with clear arguments

Why study ethics

• Medicine is a profession
• We need to be held accountable for our actions
• Ethical theories help us to justify our decisions

Principlism (4 principles of ethics)

1. Respect for patient autonomy

2. Beneficence (doing “good”, doing what is best for patients to improve their health
and wellbeing whilst minimizing harm)
3. Non-maleficence (doing no harm)
4. Justice

Ethical dilemmas are a conflict between these principles. The dominant principle in a
situation depends on numerous factors. When a patient has sufficient capacity to make
their own decisions, respect for autonomy is the main principle. Where young children
are concerned, healthcare workers might have to act in the best interest of the child
even if the parents refuse treatment.

Respect for patient autonomy

• Informed consent
• Confidentiality
• Truth telling
• Communication

Autonomy

• Literally means self-rule

• The right of every individual to make decisions for themselves
• In healthcare, this would be allowing patient to make the final decision regarding
their treatment AFTER all the necessary and relevant info has been provided
 • Personal privilege ends where public peril begins essentially means that
individual rights or freedoms have limits when they pose a threat to the safety
or well-being of the broader community.
• Personal liberties may be upheld as long as they don’t infringe on the rights of
others
• Smoking regulations limit individual rights in the best health interests of
others

Rules for autonomy

1. Tell the truth

2. Respect the privacy of others
3. Protect confidential info
4. Obtain CONSENT for interventions with patients
5. When asked, help others make important decisions

These rules are prima facie meaning that it must be fulfilled UNLESS it conflicts
with an equal or stronger rule

Obligations for respect of autonomy

1. Informed consent
2. Confidentiality
3. Truth telling
4. Effective communication

Informed consent
• Before subjecting patients to any investigations or treatments, we must get their
agreement
• Ethical AND legal requirement

Informed consent needs

1) Threshold elements
a) Competence (able to understand and decide)
b) Voluntariness (in deciding)
2) Information elements
a) Disclosure of material info (must tell patients info)
b) Recommendations (of plan)
c) Understanding (of info and plan)
3) Consent elements
a) Decision (against or in favour of)
 b) Authorisation (of chosen plan)

Hence, informed consent is a process. In communities where individuals cannot make

important decisions without consulting spouses, extended family and community
elders the process is prolonged. Decisions around elective procedures (not emergency)
can be prolonged. True informed consent is time consuming

HIV pretest counselling protocol

Prior to testing patient for HIV the following info has to be discussed with the patient

1) Need for testing

2) Their understanding of HIV/AIDS
3) Info about the test
4) Advantages and disadvantages of testing
5) How test is done
6) Implications of positive result
7) Time to reflect
8) Time for questions

• Informed consent is complex and challenging

• If ignored, the consequences are both ethical and legal
• If elements of consent aren’t followed it is also problematic
• Taking consent from a patient who does not have the capacity to consent is
the same as not asking consent at all
• Informed decision making in healthcare is only possible if the patient is
competent to consent.
• Capacity refers to a clinical judgement, a doctor can determine capacity
• Competence refers to a legal judgement of a patient to decline or provide
consent, a judge or legal authority can determine competency
• Critical to establish whether a patient is competent to consent to balance the
conflict between respecting autonomy and beneficently (in the best interest of
an impaired patient)

Criteria to assess competence

A competent patient will be able to:

• Communicate a choice
• Understand the info given to them
 • Appreciate the medical consequences of the situation
• Reason about treatment options

• Mini mental state examination (MMSE) scores range from 0-30

• Scores lower than 19 mean incompetence
• In situations where patients lack competence a surrogate decision maker is
consulted
• For competent patients, consent MUST be voluntary
• The patient mustn’t be manipulated or coerced into consenting.
• The patient must also be given all the relevant info related to the procedure or
treatment in a language they understand
• The risks and benefits of the treatment must be clearly stated and the doctors
recommendation is important
• This is relevant in SA where the concept of autonomy is not fully developed and
patients place high value in the advice of doctors
• When advising patients, we must always be motivated by the patients best
interests
• Recommendations motivated by a doctors financial gain is problematic
• Patients must be allowed and respected for discussing issues with family
members before making a decision
• Important to ensure that the info given is correctly understood and the
opportunity for questions has been provided
• The patient will make the decision and either authorize intervention or decline
the procedure or treatment
• The patient can WITHDRAW consent
• Competent patients can also make “wrong decisions” due to illness, depression
or coercion

If a patient is unable to consent

1) Consent may be obtained from a person mandated by the patient in writing to grant
consent on their behalf or by a person authorized to give consent by any law or court
of order
2) If NO PERSON is mandated or authorized to give consent , consent may be given by
a spouse or partner of the patient, parent, grandparent, adult child, brother or sister
in this order
3) Provision of health services without informed consent may occur if it is authorized in
terms of law or a court order
4) If failure of treatment of patient will be a risk to public health, the treatment must be
provided
5) If any delay in the provision of the health service to the patient may result in his or
her death or irreversible damaged to their health and the patient has not refused
such treatment the treatment must be provided

Confidentiality

• Medical confidentiality respects a patients autonomy

• Doctors explicitly or implicitly promise patients that they will keep info
confidential
• In the absence of such promises of confidentiality, patients are unlikely to prvide
private and sensitive info that is needed for optimal care

Exceptions to maintaining confidentiality

1) The patient consents to disclosure in writing

2) A court order or any law requires the disclosure
3) Non-disclosure of the info will be a threat to public health

Read case studies regarding confidentiality

Truth telling

• Respect for patient autonomy means we cannot deceive patients

• This means telling the truth about their illness unless they indicate they do not
want to know
• Important where terminal illness is concerned (they will eventually die)
• Concealing the diagnose is unacceptable unless there is a good or exceptional
reason for doing so
• Patients need to know the truth so they can plan for the future

Communication

• The patient centered care approach is keeping respect for autonomy

• Listening to the patient allows the doctor to decide what info the patient needs,
how this info can be transmitted to the patient and what the patients preferences
are
• Good communication makes it possible to compile a complete and accurate
patient history and makes the patient feel reassured and cared for
 Beneficence
• Refers to doing good and the promotion of goodness, kindness and charity
• All doctors have responsibility to provide beneficial treatment and
avoid/minimize harm
• Provision of such treatment requires rigorous and effective communication
• Clinical competence = ethical requirement

Rules of beneficence

1) Protect and defend the rights of others

2) Prevent harm for others
3) Remove conditions that will cause harm for others
4) Help persons with disabilities
5) Rescue persons in danger
• Beneficence or doing good is complex
• When are we doing good and when are we “playing God”
• Often we prolong life with the intent of doing good but end up reducing the
quality of life and prolonging suffering
• Doctors must promote life and prevent harm
• Assisted dying- relieves suffering and protects best interests of patient
• Beneficence extends beyond individual patients
• Global level, international community has a collective duty of care to ensure
that effective and affordable measures are available
• Duty of care and duty to rescue dictate that effective immunizations against
direct disease threats should be available to those at risk

Beneficent care

1) Clinical competence
2) Risk-benefit analysis
3) Paternalism

Clinical competence

• One must be competent to do good and minimize harm

 • If harm is not minimized it could result in negligence
• Doctors responsibility is to benefit the patient by not inflicting harm, preventing
harm, removing harm and providing beneficial treatment
• In medicine this means that students must receive sound medical training in
terms of knowledge and skills
• Students’ responsibility to attend lectures, tutorials, clerk patients, practice
procedures until perfection, pay attention to keeping medical records.
• Medical science continues to develop so doctors must continue to develop their
knowledge and skills by participating in continuing professional development
(CPD) activities that provide info, strengthen clinical competencies and enhance
professional judgement
• Doctors should be familiar with clinical developments that affect their area of
practice
• Commitment of lifelong learning
• Doctors should maintain basic levels of competence and restrict patient care to
areas where they are competent
• Doctors must know boundaries of their competence so their abilities and
limitations
• Competence requires an acceptable standard of care and appropriateness of
the care
• Society is becoming sensitized to the competence oftheir doctors
• They google their doctors search for websites where patients have commented
on the care they received, look at the HPCSA to see if any judgements exist
against the doctor, investigate scoring systems that rate the competence of their
doctor
• Judgement is also involved when we apply our knowledge, skills and experience
to treatment
• Even the best clinical abilities are minimized when used with bad judgement
• Good judgement is critical
• Failure to provide competent medical care of the highest possible standard at all
times results in harm to patients and violates the BASIS of medical practice, do
no harm

Risk-benefit analysis

• Whenever we help others we inevitably risk harming them

• Its essential to balance beneficence and non-maleficence to achieve benefit for
patients
• The risk-benefit ratio is crucial
• The benefit must outweigh the risk before advising or prescribing treatment
 • To protect beneficence, FDA and MCC will withdraw registration of drug if it
causes more harm than good

Paternalism

• Before, doctors relied on their own judgement about patient diagnosis, need
for info and treatment
• Now, there is increased emphasis on respecting patient autonomy has
reduced paternalism
• However there are instances where its necessary for doctors to act
paternalistically for patients
• Paternalism is the intentional overriding of one persons known preferences or
actions by another person, where the person who overrides is doing this to
benefit the patient or mitigating harm to the patient

Active paternalism

• Here a doctor can override a patients choice to decline an intervention because

the doctor things the intervention will be beneficial
o WEAK (SOFT) PATERNALISM – doctors prevent people from from making
decisions that they cant decide on their own or autonomously due to lack
of capacity or influence
▪ Consent or refusal that is not adequately informed
▪ Sever depression preventing rational decision making
▪ Addiction or substance abuse that impacts free choice and action
o STRONG (HARD) PATERNALISM – the doctor intervenes to benefit a
patient despite the fact that a persons choices and actions are informed,
voluntary and autonomous
▪ Parental decisions on religious based grounds of life-saving
treatment for a child
▪ Parental refusal of immunization for a child in a serious infectious
disease outbreak
▪ Refusal to respect an advance directive – legal documents

Passive paternalism

• A doctor refuses to perform an intervention or provide treatment for reasons of

patient centered beneficence
 Non-maleficence
• Medical malpractice rooted in principle of first do no harm
• Primary duty of healthcare professionals is to help patients by optimizing health,
wellbeing, alleviating pain and suffering (beneficence) HOWEVER it is possible to
cause harm
• Avoiding or minimizing harm to patients is a fundamental obligation
• Requires thorough, good and rigorous medical training
• In SA, we need to consider harm in terms of African philosophy, thus harm to
individuals, families and communities are one issue
• Harm can extend beyond physical and can include psychological impairment
and economic disadvantage
• AI causes potential harm in healthcare

Rules of non-maleficence

• Do not kill
• Do not cause pain or suffering to others
• Do not incapacitate others
• Do not cause offense to others
• Do not deprive others of the goods of life
• These are universal rules
• Not absolute but prima facie must be fulfilled unless it is overridden by an equal
or stronger rule
• Euthanasia is tricky, is it good or is it harm
• Harm is caused by distortion in risk-benefit assessments
• When risk exceeds benefit, we must determine if it was unavoidable or
intentional
• Accidental events can occur that’s not in hands of doctor, like equipment failure
• A well justified decision turns out badly
• There are disagreements about treatment due to difference in opinion
• Doctor exercises poor judgement or skill
• Outrageous violations occur where health/life of patient is threatened
• All interventions in healthcare carry a risk element
• Doctors are required to warn patients of material risks

System or latent errors

 • Occur due to flaws in the system
• The system sets up doctors to make mistakes
• For example unavailability of medical records, confusing labelling of meds, long
work hours, faulty equipment

Individual errors

• Result from omissions or commissions due to the doctors lack of knowledge,

skill or attentiveness and the doctor is primarily responsible for this
• Omissions examples
o Failure to correctly identify patient
o Failure to take adequate history
o Failure to conduct thorough examination
o Failure to order correct investigations
o Failure to check blood tests/results
o Failure to make correct diagnosis
o Failure to treat
o Failure to follow up patient
o Failure to have good medical records
o Failure to ensure security of records and protect info
• Commissions examples
o Keeping illegible or poor medical records
o Reaching incorrect diagnosis
o Prescribing treatment incorrectly
o Operating on wrong limb
o Overcharging/overservicing patients
o Altering notes after event
o Using equipment without necessary training, skills and experience

Resolve medical errors and minimize harm

Disclosure of medical error

• When mistakes are made theres question of whether error should or should not
be disclosed to patient
o Consequentialism considers the outcome of disclosure to patients
▪ Benefits:
• Patient can correct problems and prevent further harm
• Resolves uncertainty about cause of condition
• Patient can make informed decisions about future care
• Patien can get compensation
 • Trust in doctor may increase
▪ Harm:
• May cause alarm or anxiety
• May result in unwelcome confusion, patient may not want
to know
• Trust decrease in doctors
o Consequentialism considers the outcome of disclosure to doctors
▪ Benefits:
• Relief and absolution
• Strengthen relationship with patient
• Decrease likelihood of lawsuit
• Learn from mistakes and improve practice
▪ Harm:
• Difficult and painful process
• Risk of malpractice lawsuit
• Loss of referrals, hospital admitting privileges, credentials,
license
• Harm to career or dismissal

Deontology

• Deontologists would argue for disclosure based on doctors duty to disclose

based on the nature of doctor patient relationship
• The relationship between doctor and patient is built on trust

Virtue ethics

• Good or virtuous doctor is expected to be honest and have integrity

• Argument based on virtues supports disclosure

Tips for disclosure

1. Disclosure should be done at good time

2. The doctor must make the disclosure, its their responsibility, if doctor in training,
both the trainee and supervisor
3. Special skills required
4. Doctor should start with telling mistake
5. Discuss decisions made
6. Course of events must be described in detail in simple language
 7. Doctor must express personal regret and apologise
8. Doctor should invite questions
9. Incompetent patients apologies must be made to family members or decision
makers

Disclosure of mistakes made by OTHER doctors

• A doctor who hears of or witnesses’ mistakes must

o Wait for other doctor to disclose mistake
o Advise other doctor to disclose mistake
o Arrange a joint meeting to discuss error
o Tell patient yourself

Justice and Health Law

Why learn about law?

Law regulates all aspects of living and dying including medical practice

Why learn about malpractice

• Theres an increase in litigation

o Criminal and civil
• Patients know their rights
• Patients are not hesitant to sue

Justice – principle of ethics, refers to fair treatment

• Legal justice – respect for morally acceptable laws

• Rights-based justice – respect for peoples rights
• Distributive justice – fair distribution of limited resources

Legal justice

• Fairness to patients from a legal perspective

• Important to have good working knowledge of laws that impact healthcare
• When patients harmed when receiving treatment, it is injustice
• Feel as though they have been treated unfairly
• To restore sense of justice they seek redress or compensation
• Failure to resolve problem means law involved, litigation

Rights based justice

 • Right is regarded as an entitlement to something that is considered valuable
• A claim to a right requires no justification
• Rights
o Right to healthcare
o Right to be seen on time for appointment
o Right to high standard of healthcare
o Rights are reflected in Patients’ Rights Charter, Chapter 2 of Constitution,
Bill of Rights
o Link between rights and obligation
o One person may be entitled to a specific right, another person must
ensure they enjoy the right
o The person enjoying the right also has an obligation

Distributive justice

o Distribution of scarce resources

o Fairness

Criminal vs. Civil Law

Criminal law

o Public law, individual vs state

o State must prove the person guilty beyond reasonable doubt
o Accused person must raise to doubt about their guilt

Civil law

• Private law, one person (plaintiff) brings and action vs another (defendant)
• State not involved
• Plaintiff must prove their case on a balance of probabilities
• Plaintiff can claim damages for losses, pain, suffering, compensation for lost
wages
 Health and Human Rights
Human rights: Entitlements people can claim relating to their basic needs because
they are human

Fundamental to all human rights is respect for human dignity

Rights are related to responsibities

• For ever right a person has they have a responsibility connected to that right
• You have the freedom of expression but you also have the responsibility to not
deliberately tell lies about someone else

History of human rights

1. Historically there was discrimination based in gender, religion, age

2. Slavery and abuse went on into the 20th century in some place
3. 1938-1945 World War 2 with Nazis
4. 1947 Nuremberg Trials with doctors trials
5. 1948 Universal Declaration of Human Rights, International Human rights law

Bill of rights

• Cornerstone in democracy in SA
• Has rights of all people in our country and affirms the democratic values of
human dignity, equality and freedom
• State must respect, protect, promote and fulfil rights in BOR

Patient rights and responsibilities

Rights
Responsibilities

How do we achieve human rights accountability in the health sector

• Prioritise accountability to our patients, ourselves, society

• Identify human rights abuse
• Treat patients with dignity and respect
• Act within the larger social and political context
• Clarify values and define and be aware of conflicting loyalties

Why is it important to document the history of abuse

• So as not to forget the abuses of the past

• To acknowledge and reflect on history to learn for the present
• To ensure such abuses are never repeated again
 Professionalism and the HPCSA
Profession: a publicly declared dedication, promise or commitment

• Healthcare workers are obligated to act in their patients best interests

• They must fully and honestly inform patients, enable them to make their own
treatment choices and provide competent and continually improving care
• Being a doctor requires lifelong commitment to good professional and ethical
practices and dedication to patients and the public

What constitutes being part of a profession

• Being committed to serving the public and providing an important public service
• Must have significant knowledge and training to practice the profession
• Standards must be made for conducting the professional work set by the
profession as well as self-regulation
• Certification or licensing procedure that determines who can be a part of
profession
• Existence of professional body (HPCSA) that sets professional standards,
disciplinary mechanisms, determines training content and carries out
certification or licensing procedures

HPCSA

• Mission: To regulate and guide registered healthcare professions and protect the
public through setting and ensuring compliance with standards for
o Healthcare training and practice
o Ethical and professional practice
o Continuing competence

Purpose

• Privilege to practice self-regulating profession

• Accountable to service users
• Regulatory responsibility to uphold social contract between health professions
and public
• Protect the public and Guide the professions
• Controls education and training
• Registers qualified practitioners
• Ensure professional and ethical standards upheld
• Investigates complaints
 • Manages disciplinary actions

Registration

• Students registered with HPCSA

• Duty to self, patients and colleagues
• Accredited programs
• Maintenance of own health
• Successful completion of accredited learning program - obtain qualification
from SU
• Can practice professionally AFTER registration with HPCSA as practitioner
• Upon graduation register with HPCSA
o Uphold professional standards and code of conduct
o Update knowledge and skill CPD
o Annual registration
• Not registered, cannot practice profession
• If you want to work overseas
o Maintain or terminate registration you must inform HPCSA and be CPD
compliant
• Legal requirement- HPCSA must have current contact detail

Impairments

• Physical – limitations to physical functioning that affect practioners ability to

perform duties properly
• Mental – conditions affecting cognitive ability, emotional wellbeing or mental
health of practitioners which can affect their practice
• Sensory – Deficiencies in sensory functions like hearing loss which hinders a
practitioners duties

POPIA – Protection Of Personal Information

• Right to privacy is protected
• Personal info or data belongs to individual
• Right to privacy must be respected but lawful processing of data can be done

POPIA people involved

• The person that the personal info belongs to is the DATA SUBJECT
 • The organization public and private that decides how and why to process
personal info is the RESPONSIBLE PARTY
• Party that processes personal info on behalf of the responsible party -
OPERATOR

Definitions

• Competent person – any person who is legally competent to consent to any

action or decision being taken in any matter concerning child
• Consent – any voluntary specific and informed expression of will in which
permission is giving for processing personal info
• Data subject - the person to whom the personal info relates
• Personal info – info relating to an identifiable, living, natural person
• Processing -any operation or activity or any set of operations whether or not by
automatic means concerning personal info

Examples of personal info

• ID number
• Physical address
• Date of birth and age
• Phone number
• Email
• Social media profile

Principles of POPIA

1. Accountability – organisations are responsible to ensure compliance wih POPI

2. Processing limitation- personal info must be collected and processed lawfully,
no infringement of privacy, data subject may object to processing of personal
info, consent must be given
3. Purpose specification -Personal info must be collected for a SPECIFIC AND
EXPLICIT lawful purpose, records cant be kept longer than necessary
4. Further processing -Must be in accordance or compatible with the purpose it
was collected for
5. Information quality -organisations must take reasonable steps to ensure that
personal info is complete, accurate, not misleading and updated
6. Openness – organization must inform data subject that the info is collected, the
purpose of collecting the info, supply info
7. Security -organisation must ensure the integrity and confidentiality of personal
info
8. Data subject participation – data subject has right to
 a. Request organization to confirm it holds the personal info
b. To request access to the personal info
c. To request correction or deletion of personal info

To keep data secure consider

• Identity and access management

• Prevention of data loss
• Encryption of personal info
• Creating an incident response plan
• DPAs and third party risk management
• Regular review of policies

Consent

• Voluntary, specific and informed expression of will where permission is given for
processing personal info
• Must be informed consent
• Data subject must be informed of their rights
o To opt out
o Right to object
o Right to correct data
• Consent must be in writing
• Children must get parent or guardians consent
• Provide for written consent on digital forms
• Consent may be withdrawn
• Reason for consent must be provided

Privacy and data protection in healthcare

• Health related personal info can be sensitive

• Protected in terms of right to privacy
• Data subjects could suffer harm if health data not protected
• Doctor patient privilege requires protection of personal info
• NHA ACT 61of 2003 regulates confidentiality and disclosure or personal health
info

Health data can include

• Info about health status

• Genetic data, biological samples, clinical treatment, medical records
 • Can be obtained from various sources like medical records, doctors notes,
smart devices

Privacy and data protection in healthcare

• Health info is special personal info

• PROCESSING personal info about data subjects health is prohibited unless
special conditions met
• People that can legally access persons health info
o Medical professionals, healthcare institutions
o Medical aid schemes, health insurance companies
o Schools
o Any public or private body managing care of child
• All personal info in a health facility stays confidential
• No person can disclose info unless
o The person gives consent
o Court order or law requires disclosure
o Non-disclosure of info is a threat to public health
• Healthworker can disclose info if
o It is necessary for any legitimate purpose within the ordinary scope of
their duties
o Disclosure or access is in interest of patient
• Healthcare provider can access health records for purposes of
o Treatment with consent
o Study, teaching or research with authorization of patient, head of health
facility and relevant health research ethics committee
• Security of the health records is responsibility of health establishment
• They must set up control measures to prevent unauthorized access to the
records and keep the storage facility or system where records are kept
• POPI does not replace HPCSA guidelines

• POPIA and the NHA and ethical guidelines have different purposes

• POPIA applies to healthcare services but focuses on data protection

• Medical schemes need to ensure claims, medical conditions and treatment are
only shared if theres consent

• Sharing info between patients, doctors, healthcare workers must be done I

secure way
 • Medical practitioner must inform patient if personal info obtained from another
source and the purpose

• Security and integrity of personal info must be provided by organization

• Cyybersecurity is increasingly important

• There must be regular risk assessment and reasonable security measures

• Risks in healthcare

o Unlawful access to patient records

o Theft or loss of patients files
o Software viruses destroying patient files
• Risk of non-compliance
o Criminal or civil action
o Potential impact on health of patient
o Damage to professional reputation

POPI with children

A responsible party may not process personal info of children unless authorized

• Prior consent by competent person

• If the info is necessary for establishment, exercise or defense of right or
obligation in law
• If info necessary to comply with an obligation of international public law
• For historical, statistical or research purposes
• If info was deliberately made public by child with consent of competent person
• Personal info is required by school
• Child joins a gym and needs to give info, parent must consent
• Parent opens bank account for child, must give consent
• Child goes to hospital to get medical treatment and data is collected