Setting Core Competencies in Bioethics, Human Rights and Health Law: The HPCSA Process

1. Setting Core Competencies in Bioethics, Human Rights and Health Law: The HPCSA Process A.Dhai Human Rights, Ethics and Professional Practice Committee – HPCSA Bioethics Division – University of the Witwatersrand Medical School

2. BACKGROUND • Medical practice raises ethical and legal issues and demands an understanding of both to facilitate decision-making and its processes and create a better basis for knowing what should be done in any given situation and why. • Focus shifting more towards softer people skills to shape positive attitudes for best clinical intervention. • Important distinction between treating an ailment and treating a person with an ailment • Humanity has a set of entitlements - practitioners’ unguarded and cold application of clinical skills might erode the essence of people’s rights.

3. BACKGROUND • Complaints by public increasing: • practitioners ill prepared to manage ethical dilemmas competently • practitioners involved in activities of a criminal nature • May 2005 request by Council for details on ethics, human rights and medical law content of curricula • Lack of uniformity

4. Workshop – March 2006 • Aims: • sharing of best practices in education and training of bioethics, human rights, and medical law • identification of gaps and areas where improvements may be made; • creation of synergies and establishment of a common framework and base for education and training in bioethics, human rights and medical law

5. Workshop – March 2006 • CHALLENGES: • Traditional medical curriculum has made teaching of E, HR & ML eclectic and scarce. • Tutors not adequately qualified to teach on the subject • Not regarded as integral part of practice of medicine • No clear consensus as to what should be taught, how it should be taught and who should teach it • Issue of language – especially where English not the first language • Intricacy of discussing issues relating to apartheid era particularly in white dominated institutions • Complexity of black lecturers teaching the three subjects in white dominated institutions and vice-versa. • Assessment of skills and competency in the three subjects • Monitoring

6. Workshop – March 2006 • WAY FORWARD: • a uniform core competency framework to be drafted for use by the education institutions who will define the curriculum to be used as a model for the various disciplines. • Specialists from the three fields to compile a draft document for presentation to the HR & E Committee of the HPCSA. • Document to be circulated to stakeholders • Professional conduct cases to be made available for teaching purposes.

7. DEFINITIONS • Medical Ethics:careful and systematic reflection on and analysis of moral decisions and behaviour in the healthcare environment. • Human Rights: rights of individuals, inherent in the fact that they are human. All individuals must be treated in a fair and equal manner taking into consideration freedom and human dignity. • Medical Law:law governing the relationship between providers and users of healthcare. The Common Law and Statute Law governing the field of medicine has to conform to the norms, values and standards of the Constitution

8. HPCSA – Core Curriculum • Not prescriptive - varying needs of different professions • minimum guidelines: to be used as framework for teaching programs - essential to improving service delivery and professional conduct • in line with Council’s mission to promote the health of all people in South Africa by determining standards of professional education and training, and setting and maintaining the highest standards of professional and ethical behavior for its registered health care professionals • HPCSA cannot design the curriculum - this is the responsibility of the education institutions

9. CORE COMPETENCIES • In line with SAQA Critical Cross Field Outcomes: • Identify and solve problems by using the critical and creative thinking skills. • Work effectively with others as a member of the team. • Organize and manage oneself and one’s activities responsibly and effectively. • Collect, analyze, organize and critically evaluate information. • Effectively communicate • Effectively and critically use science and technology showing responsibility towards the environment and health of others. • Demonstrate an understanding of the world as a set of related systems by recognizing that problem solving contexts do not exist in isolation. • Contribution to full personal development of the society at large.

10. ETHICS • Rational approaches towards systematic reflective analysis. • Professionalism • The healthcare practitioner – patient relationship • Ethics in healthcare practice in a multicultural context • Dual loyalty • Resource Allocation • Mental Health & ethical issues • Public Health Ethics • Beginning & End of Life’s Decisions • Reproductive Health Ethics • Genetics & Ethics • Research Ethics • Collegiate Duties • Business Ethics • The Hidden Curriculum

11. HUMAN RIGHTS • International declarations and codes • History of human rights abuses in SA and the role played by the healthcare practitioners under apartheid • SA Constitution, Batho-Pele and Patients Rights Charter • Identification of Vulnerable groups • Clarity about the forms of justice in the SA context • Awareness of constitutional structures and agencies to promote human rights, e.g. HRC, Gender commission etc. • Legislation pertaining to health and health care. • Understanding of the relationship between bioethics, human rights and medical law.

12. MEDICAL LAW • Sources of Law : • Regulatory framework: Bill of Rights of the Constitution, Statutory Law, Common Law, Criminal Law, Civil Law, “Soft Law” • Application: • Practitioner-patient relationship • Medical malpractice, professional negligence • Practice regulation • Documentation, report writing and record keeping

13. CORECOMPETENCIES • Show respect for patients and other health care service providers without prejudice, with an understanding and an appreciation of their diversities of background and opportunity, language and culture. • Demonstrate awareness, through action or in writing, of the legal and ethical responsibilities involved in individual patient care and the provision of care to populations. • Consider the impact of healthcare on the environment and the impact of the environment of health. • Strive to improve patient care, to reduce inequalities in healthcare delivery, to optimize the use of healthcare resources in our society and use his or her professional capabilities to contribute to the community as well as to the individual patient welfare. • Demonstrate awareness, through action or in writing, of the legal and ethical responsibilities involved in research participant and research population protections

14. CONCLUSION • The importance of the incorporation of E, HR & ML into the health sciences curriculum cannot be emphasised enough especially in South Africa, a country that has a legacy of disregard for human rights and ethics • Although most of the countries have taken a lead in the implementation of a bioethics core curriculum, South Africa is still not keeping pace with prominence and academic rigor given to bioethics as discipline globally

15. QUESTIONS FOR DISCUSSION • Monitoring • Identifying actual learning impact