Browsing by Author "Benatar, Solomon R"

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    Achieving gold standards in ethics and human rights in medical practice
    (2005) Benatar, Solomon R
    Chen Reis and colleagues’ study in this month’s PLoS Medicine showed that most Nigerian physicians commendably appeared to be providing appropriate care for HIV/AIDS patients [1]. However, 9% refused to care for such patients, 9% admitted they had refused a patient with HIV/AIDS admission to hospital, and 20% felt that many of these patients had behaved immorally and deserved the disease. The authors also noted the adverse impact of limited health care resources upon ethical practice and protection of human rights (this impact is not surprising in a very poor country with a per-capita GDP of US$290 [2], less than 1% of the United States per-capita GDP). They conclude that discriminatory behaviour and breaches of ethical codes could be addressed effectively through education, enforcement of anti-discrimination policies, increasing resources for health care, and attempts to change attitudes and cultural beliefs. Presumably, their motivations for this study were (1) to better understand how well physicians in Nigeria respect human rights and meet universal ethical standards of medical practice in caring for patients with HIV/AIDS, and (2) to make recommendations that could improve professional practice. Their fi ndings would be more convincing if they could compare their data with similar studies done elsewhere in the world, including the US (home to some of the authors of the study). In particular, it would be valuable to have comparative international data on ethics and human rights standards achieved in medical practice, and on health professionals’ attitudes to patients with HIV/AIDS and other stigmatised conditions. However, Reis and colleagues’ study raises several important questions.
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    Diagnostic, prognostic and therapeutic considerations in primary pulmonary hypertension
    (1987) Chapman, P J; Benatar, Solomon R; Bateman, Eric D
    The diagnosis of primary pulmonary hypertension (PPH) and prediction of its course, whether treated or untreated, presents several problems. These are of particular relevance when selection of patients for, and timing of heart-lung transplantation is being considered. I performed a retrospective study on patients with PPH and chronic large vessel thromboembolic pulmonary hypertension (TPH) seen at Groote Schuur Hospital between 1957 and 1985 in an attempt to: 1. Establish the diagnostic and prognostic value of clinical features, lung function tests, cardiac catheterisation, isotope lung scans and, in the PPH group, response to therapy; 2. Review our experience of the effects of treatment with vasodilators and oral anticoagulants, and the results of heart and lung transplantation in the PPH group; 3. Attempt to identify features which could be used to predict prognosis in PPH; and thereby 4. Define criteria for selecting PPH patients whose prognosis could be improved by heart-lung transplantation.
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    Global health challenges: The need for an expanded discourse on bioethics
    (2005) Benatar, Solomon R; Daar, Abdallah S; Singer, Peter A
    Although the 20th century saw a major expansion of the world economy, impressive military/security advances, and spectacular progress in science and technology, the grim reality in the first decade of the new millennium is that human life, health, and security remain under severe threat—but now from the adverse effects of inexorably widening disparities in wealth, health, and knowledge within and between nations. The gap between the income of the richest and poorest 20% of people in the world increased from a 9-fold difference at the beginning of the 20th century to 30-fold by 1960—and since then to over 80-fold by 2000 (Figure 1). Although life expectancy has improved dramatically worldwide during this century, this trend has been reversed in the poorest countries in recent years [1]. The challenge of achieving improved health for a greater proportion of the world's population is one of the most pressing problems of our time and is starkly illustrated by the threat of infectious diseases.
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    Moral imagination: The missing component in global health
    (2005) Benatar, Solomon R
    The deplorable state of global health and the failure to improve this state have been debated extensively. Recent editorials in the Lancet in relation to the failure of Roll Back Malaria and the potential failure of the 3 by 5 programme [1, 2] illustrate how disappointment, surprise, and admonitions about such failures are usually followed by optimism about the success envisaged from future efforts [1, 3]. There are several possible reasons for our failure to ...
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    Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country
    (Public Library of Science, 2016) Moosa, Mohammed Rafique; Maree, Jonathan David; Chirehwa, Maxwell T; Benatar, Solomon R
    Universal access to renal replacement therapy is beyond the economic capability of most low and middle-income countries due to large patient numbers and the high recurrent cost of treating end stage kidney disease. In countries where limited access is available, no systems exist that allow for optimal use of the scarce dialysis facilities. We previously reported that using national guidelines to select patients for renal replacement therapy resulted in biased allocation. We reengineered selection guidelines using the 'Accountability for Reasonableness' (procedural fairness) framework in collaboration with relevant stakeholders, applying these in a novel way to categorize and prioritize patients in a unique hierarchical fashion. The guidelines were primarily premised on patients being transplantable. We examined whether the revised guidelines enhanced fairness of dialysis resource allocation. This is a descriptive study of 1101 end stage kidney failure patients presenting to a tertiary renal unit in a middle-income country, evaluated for dialysis treatment over a seven-year period. The Assessment Committee used the accountability for reasonableness-based guidelines to allocate patients to one of three assessment groups. Category 1 patients were guaranteed renal replacement therapy, Category 3 patients were palliated, and Category 2 were offered treatment if resources allowed. Only 25.2% of all end stage kidney disease patients assessed were accepted for renal replacement treatment. The majority of patients (48%) were allocated to Category 2. Of 134 Category 1 patients, 98% were accepted for treatment while 438 (99.5%) Category 3 patients were excluded. Compared with those palliated, patients accepted for dialysis treatment were almost 10 years younger, employed, married with children and not diabetic. Compared with our previous selection process our current method of priority setting based on procedural fairness arguably resulted in more equitable allocation of treatment but, more importantly, it is a model that is morally, legally and ethically more defensible.