Andrew Baldassarre

Background. Over the past decade, South Africa (SA)’s healthcare landscape has shifted significantly as a result of policy reforms, including the Consumer Protection Act and amendments to the National Health Act. These changes have reframed the doctor-patient relationship, introducing economic and systemic pressures that may influence ethical decision-making. Objectives. To revisit the patterns of professional misconduct of SA medical practitioners from 2014 to 2023, comparing findings with those of a previously published study (covering 2007 - 2013) to identify emerging trends and to reflect on the efficacy of past recommendations. Methods. A mixed-methods approach was used to analyse published disciplinary records from the Health Professions Council of South Africa, excluding 2019 owing to data unavailability. Quantitative data were analysed using statistical tests to assess differences in transgression frequencies and sanction patterns between time periods. Qualitative analysis was used to categorise transgressions into several general and specific types to assess shifts in the patterns of professional misconduct. Results. The average percentage of practitioners found guilty of misconduct decreased significantly from 0.164% (2007 - 2013) to 0.087% (2014 - 2023) of registered practitioners. However, the average number of guilty verdicts per practitioner remained statistically unchanged, indicating a persistent pattern of repeat offences. Notable shifts in transgression types included a decrease in fraudulent conduct and an increase in documentation-related negligence. Conclusion. Although fewer practitioners were found guilty over the period of the present study, professional misconduct transgressions remained concentrated among repeat offenders. The study underscores the value of reinforcing the social contract in healthcare by recommending individualised ethics coaching for transgressors and revising current sanctioning practices to more effectively deter repeat misconduct.

While palliative medicine has a clear mandate to address the somatic suffering of patients, it remains less clear how palliative medicine should intervene—if at all—in the management of existential suffering. We detail the case of a patient with terminal gastrointestinal cancer. Through consideration of this case, we make determinations regarding what is ethically required, as well as ways in which these implications may generalize to appropriately similar cases. Specifically, we draw two conclusions. First, standard risk-benefit calculus must be recalibrated to account for the irrelevance of certain imagined harm in imminently terminal cases. Additionally, respect for autonomy in the context of a “good death” entails respecting consistent, well-considered preferences on the part of the patient.