The quality of life, sanctity of life, moral and legal status of the foetus, and whether it is ethical to deliberately end or prolong vulnerable life were just some of the issues discussed at the workshop. From left, Prof. Melodie Slabbert, (Deputy Executive Dean: CLAW), Dr Carin Maree (University of Pretoria), Patricia Molusi, (CLAW), Dr Carina van der Westhuizen (CLAW), Emmaré Stronkhorst (Private Practice), Erika Smuts (Psychatric Nurse in private practice), Prof. Sithembiso Velaphi (Wits) and Adv. Salie Joubert SC (Pretoria Bar).
According to World Health Organisation (WHO) statistics, South Africa’s infant mortality rate is 47 deaths per 1 000 children under the age of five and the average lifespan of a person at 55. WHO attributes this figure to HIV/AIDS, tuberculosis, cardiovascular diseases and violence.
While the debate rages on around the country’s public health-care effectiveness, can more be done to better equip health-care professionals when it comes to making critical care decisions? The College of Law hoped to provide some answers to that question when hosting a community engagement workshop on Critical care decisions on 24 March.
The workshop brought together law experts, nursing and medical staff, and academics to talk about critical care decisions and formulate guidelines for health-care practitioners.
Legal specialist Aimée Girdwood was invited to discuss her personal account of losing her infant son, William. Despite having what she described as “perfect pregnancy”, Girdwood’s son contracted a virus. He recovered from the initial infection but developed a brain bleed, which meant recuperation would be almost impossible. After being advised by numerous doctors and experts, Girdwood and her husband decided not to resuscitate William. She appreciates the little things that the medical staff did to help through the experience, citing communication and compassion as key components. However, she also urged health-care practitioners to explain processes in a language that everyone could understand. “We wanted to be told about processes properly, since they were important decisions, but the language the doctors used sometimes didn’t make sense and they assumed people know what they’re talking about,” she says.
At times holding back tears, Aimée Girdwood (Legal Specialist) recounted losing her newborn son and the experience that she had with medical specialists.
Deputy Executive Dean of CLAW, Professor Melodie Slabbert revealed that the difficulties that Girdwood faced are one of the primary reasons that the workshop was being held. The idea came about when Dr Carina van der Westhuizen completed her doctoral research on critical care decisions pertaining to infants and children. Her studies identified, amongst others, a significant gap as far as guidelines for critical care decisions in the health-care context are concerned. “One of the purposes of the Flagship on Biotechnology and Medical Law is to establish a point of reference for information and legal advice regarding cutting-edge issues in the fields of medical law and biotechnology,” Slabbert says.
Pertaining to legal issues, Advocate Salie Joubert (SC), who deals mainly with medical-related matters, explained the legislation on children and infants rights. According to the Constitution, children being born have rights like everyone else. He’s dealt with a number of matters at South African courts and spoke about an incident where a paediatrician contacted him to intervene when a child’s parents would not consent to a simple blood transfusion because of religious reasons. “We fast tracked a court hearing and the paediatrician said if he did not do the transfusion, the child would die. The court gave permission to do so and when the parents saw the results of the procedure, they actually consented to second transfusion without being coerced,” he said. Joubert further clarified that when a child or baby died, a medical inquest was conducted and that if there were a transgression of medical practices, there would be consequences.
While legal frameworks for health care have been discussed, the role and responsibilities of nurses and practitioners was also a significant facet. Each year 10.7 million children under the age of five years die, four million during the first four weeks of life, and 3.3 million as stillbirths. The United Nations Millennium Development Goals plan to reduce the child mortality rate by 2015 by committing countries to various measures and interventions.
Considering those figures, Dr Mokgadi Matlakala, from the Department of Health Studies, says that nurses had duties and obligations to their patients, as well as a moral duty. “Communication and family needs are especially important because many people have to take decisions about the health of a baby or person. But the environment, especially when considering understaffing, overcrowding, nursing hours versus patient day ratio and equipment and supplies, does not make for a conducive environment for health care,” she says.
*Written by Rajiv Kamal
