Anton A van Niekerk

In the current era patient autonomy is enormously important. However, recently there has also been some movement back to ensure that trust in the doctor's skill, knowledge and virtue is not excluded in the process. These new nuances of informed consent have been referred to by terms such as beneficent paternalism, experience‐based paternalism and we would add virtuous paternalism. The purpose of this paper is to consider the history and current problematic nature of counselling and consent. Starting with the tradition founded by Hippocrates we trace and seek to understand how relevant aspects of the patient‐doctor relationship have evolved under the influences of subsequent moral theories. Finally we tentatively endorse certain modes of counselling in the current era in order to promote morally sound, good clinical practice.

Prematurely born children who have underdeveloped lungs may suffer a potentially fatal condition called respiratory distress syndrome. A U.S. company developed a drug, called Surfaxin, to treat such poorly functioning lungs. A placebo-controlled study was planned in four Latin American countries. At the time, in 2001, four treatments were already on the market, although not available to the research populations used in the study. This case is usually discussed as part of the standard of care debate or offered as an example of exploitation. However, what concerns us in this case is rather the choice given to the parents of a prematurely born child under these circumstances: “You can give consent for your child's participation in this study. Half of the babies enrolled will receive sham air and are as likely to die as if they had not enrolled. The other half will receive an active treatment and are more likely to survive.” The parents can vastly increase their baby's chances of survival by participating in the study. Can the consent be voluntary? Do the parents have any meaningful choice?

Reproductive autonomy has been challenged by the availability of genetic information, disability and the ethics of selective reproduction. Utilitarian and rights-based approaches, as well as procreative beneficence fail to provide compelling reasons for infringing RA, and may even be likened to dangerous eugenics. Parents are not morally obliged to prevent the birth of a disabled child. Society should rather adopt inclusivity, recognising and providing persons with disabilities opportunities for capability and worthwhile lives.

In this introductory article to the volume of the South African Journal of Philosophy in tribute of Hans- Georg Gadamer, the author, first, makes a few remarks about the nature of hermeneutics and Gadamer's views on the universality of the hermeneutical experience. This universality is, in particular, explained from the perspective of the “linguistic turn” in Gadamer's thought. Secondly, there is a brief discussion of certain particular aspects of Gadamer's contribution. Aspects of that contribution that are emphasized are: Gadamer's reevaluation of prejudice, authority and tradition, his idea of “Wirkungs -geschichte”, his idea of meaning as a process rather than a given entity, his analogy between game- playing and the interpretation of art, and his dialogical conception of interpretation. The author concludes by developing his own estimate of the main thrust of Gadamer's contribution. This contribution consists of the way in which Gadamer's thought, on the one hand, represents a demonstration and embodiment of the kind of historical consciousness so typical of our times, but, on the other hand, also accomplishes this exemplification of historical consciousness while imaginatively avoiding the kind of relativistic historicism so typical of many other manifestations of the same trend. S. Afr. J. Philos. Vol.21(4) 2002: 228-241

Military metaphors are pervasive in biomedicine, including HIV research. Rooted in the mind set that regards pathogens as enemies to be defeated, terms such as “shock and kill” have become widely accepted idioms within HIV cure research. Such language and symbolism must be critically examined as they may be especially problematic when used to express scientific ideas within emerging health-related fields. In this article, philosophical analysis and an interdisciplinary literature review utilizing key texts from sociology, anthropology, history, and Chinese and African studies were conducted to investigate the current proliferation of military metaphors. We found the use of these metaphors to be ironic, unfortunate, and unnecessary. To overcome military metaphors we propose to give them less aggressive meanings, and/or replace them with more peaceful metaphors. Building on previous authors' work, we argue for the increased use of “journey” metaphors as meaningful, cross-culturally app...

In this article, the main complexities of understanding and curbing the HIV/AIDS pandemic in (South) Africa, are discussed. These are: 1. Poverty as niche or social context of the pandemic, 2. Denial, lack of leadership and the politicization of the public discourse on AIDS, 3. Problems related to accomplishing behavior changes under conditions of deprivation and illiteracy, 4. Women's vulnerability, and 5. The disenchantment of intimacy brought about by the pandemic. In each case, some solutions are suggested, although the notion of complexity does not allow for definitive solutions. Concluding remarks deal with the possible philosophical and moral sense that we might make of the pandemic.

This article is a comprehensive critical analysis of the objections of Michael Sandel to the possibilities of human enhancement as foreseen by recent developments in new biotechnologies. It is shown that enhancement has always been a feature of human development. The nature and possibilities of these new technologies are briefly discussed, followed by an explanation of Sandel’s views. In critical response to Sandel, the author raises three arguments that are discussed in detail, followed by a conclusion that contains wrap-up arguments. The three main arguments relate, first, to Sandel’s rejection of enhancement tout court, second to the consistency of his argument about the ‘gifted’ nature of reality, and third to the problems raised by his idea that the striving for mastery is the main problem with enhancement. On the basis of an extensive analysis, the author finds Sandel’s position untenable. It is shown that Sandel espouses the ‘simple conservative argument’ . The author concludes that science and technology are not value free, and that the critical evaluation of enhancements cannot lead to an overall judgment, but has to progress in a piecemeal manner. The author also concludes that the notion of ‘human nature’ cannot be regarded as a moral desideratum

The article investigates the extent to which recent developments in both the medical and the philosophical world have impacted on the nature and scope of medical ethics. A central question of the article has to do with the extent to which medical ethics itself is being transformed by that which it investigates. The author comes to the conclusion that these developments precipitate an ethics of responsibility. Such an ethics has the following characteristics: 1. It is a model according to which people accept responsibility for all their actions, rather than hide behind heteronomous rules and regulations. 2. People are morally accountable in terms of the universal moral claim or appeal on us (in the Levinasian sense of the word). 3. Moral responsibility is also a responsibility toward future generations. 4. An ethics of responsibility must come to terms with the moral ambivalence of phenomena and developments. 5. It is an ethics that requires imaginative steps to empower people for the acceptance of their responsibilities, particularly in the higher education sector. S. Afr. J. Philos. Vol.21(1) 2002: 35-43

Sub-Saharan Africa is the epicenter of the HIV/AIDS epidemic, and in this issue of the Journal, seven authors discuss the moral, social and medical implications of having 70% of those stricken living in this area. Anton A. van Niekerk considers complexities of plague in this region (poverty, denial, poor leadership, illiteracy, women's vulnerability, and disenchantment of intimacy) and the importance of finding responses that empower its people. Solomon Benatar reinforces these issues, but also discusses the role of global politics in sub-Saharan Africa, especially discrimination, imperialism and its exploitation by first world countries. Given the public health crisis, Udo Schüklenk and Richard E. Ashcroft defend compulsory licensing of essential HIV/AIDS medications on consequentialist grounds. Keymanthri Moodley discusses the importance of conducting research and the need to understand a moderate form of communitarianism, also referred to as "ubuntu" or "communalism", to help some Africans understand research as an altruistic endeavour. Godfrey B. Tangwa also defends traditional African values of empathy and ubuntu, discussing how they should be enlisted to fight this pandemic. Loretta M. Kopelman criticizes the tendency among those outside Africa to dismiss the HIV/AIDS pandemic, attributing one source to the ubiquitous and misguided punishment theory of disease. The authors conclude that good solutions must be cooperative ventures among countries within and outside of sub-Saharan Africa with far more support from wealthy countries.