Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate... more Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula.
South African Journal of Bioethics and Law, Aug 16, 2021
Background The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering mo... more Background The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering momentum internationally. There is interest in it being included within the offering of Critical Care services in South African State Hospitals. Objectives Most discussions about ECMO's appropriateness in State hospitals have been focused on healthcare economics and cost: benefit. To date, the bioethical considerations of this topic have not been comprehensively addressed. This research aims to articulate some of the normative ethical considerations to be considered when making decisions about government funding of medical therapies in general and costly life-sustaining therapies, such as ECMO specifically, within a limited resource environment. Methods Using a standard normative/philosophical design and the application of the ethical theories of Responsive Communitarianism and Ubuntu (African Moral Theory), to interrogate whether it is morally justifiable for Intensive Care Units in South African State Hospitals to be implementing ECMO programmes, at present. Conclusions Both Responsive communitarianism and Ubuntu (African Moral theory) advocate that when considering expensive therapies that extend or save lives such as ECMO, it is essential to consider the collective effect of such therapies on the community large – both the benefits as well as burdens. Accordingly, considering the National Department of Health's current state, it is ethically unjustified for ECMO to be included in the current critical care service in State Hospitals at present.
Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate... more Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula.
South African Journal of Bioethics and Law, Aug 16, 2021
Background The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering mo... more Background The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering momentum internationally. There is interest in it being included within the offering of Critical Care services in South African State Hospitals. Objectives Most discussions about ECMO's appropriateness in State hospitals have been focused on healthcare economics and cost: benefit. To date, the bioethical considerations of this topic have not been comprehensively addressed. This research aims to articulate some of the normative ethical considerations to be considered when making decisions about government funding of medical therapies in general and costly life-sustaining therapies, such as ECMO specifically, within a limited resource environment. Methods Using a standard normative/philosophical design and the application of the ethical theories of Responsive Communitarianism and Ubuntu (African Moral Theory), to interrogate whether it is morally justifiable for Intensive Care Units in South African State Hospitals to be implementing ECMO programmes, at present. Conclusions Both Responsive communitarianism and Ubuntu (African Moral theory) advocate that when considering expensive therapies that extend or save lives such as ECMO, it is essential to consider the collective effect of such therapies on the community large – both the benefits as well as burdens. Accordingly, considering the National Department of Health's current state, it is ethically unjustified for ECMO to be included in the current critical care service in State Hospitals at present.
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Papers by Ames Dhai