Marseille 2007
| Abstract #516 - Ethics as practice. Taking care of AIDS patients in the Soweto Baragwanath Hospital | ||||
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Session: 47.5: Ethics and Law (Parallel) on Wednesday @ 08.30-10.30 in Auditorium/Overflow Chaired by Susan Newcomer, Anjali Nayyar Authors: Presenting Author: Pr Didier Fassin - EHESS, France |
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| Additional Authors: Prof Helen Schneider, Mr Julien Grard, Mrs Tebogo Gumede, Dr Frdric Le Marcis, Mrs Loveday Penn-Kekana, Dr Duane Blaauw, | ||||
| Aim: Context: South Africa is confronted to an exceptional situation with regards to AIDS, because of the importance of the epidemic (almost 6 millions HIV-positive persons for a total population of 38 millions), of its rapid progression and of its violent controversies. When the roll-out of antiretroviral drugs was announced, many thought the main obstacle to the good care of patients was suppressed. However, our previous studies had suggested that things were more complex not only in terms of shortage of personnel or of lack of training, but more profoundly for reasons linked to the representations and practices of health providers. Objectives: Our research proposes 1. to observe and describe the way in which health professionals decide and act in their everyday activity of care of HIV-patients ; 2. understand and analyze the way through which they account for it, in relation to the objective and subjective elements of their working conditions. Two dimensions of the activity of health professionals are particularly under investigation: choices in terms of hospitalization, treatment and technical explorations (local justice in situations of scarcity of resources); attention apprehended from a technical as well as humanistic perspective (moral sentiments in the interpretation of human relations around suffering). Our analytic framework attempts to relate these facts and their justifications with the historical and social context. | ||||
| Method / Issue: The investigation has been conducted in Soweto Baragwanath hospital. Techniques were: 1. participant observation during about 100 days and nights in the casualty deparment, where triage is done in terms of hospitalization, investigations and treatments, and in the medical admission and internal medicine departments, where patients are kept; 2. semi-directed interviews with 20 health actors, from nurses and physicians to administrators. Ethical issues of the study were revised by the hospital committee. | ||||
| Results / Comments: Eight areas of differentiation of care were identified: alleviating pain, calming agitation, keeping cleanliness, giving drugs, showing interest, respecting autonomy, protecting intimacy, implementing resuscitation. Local justice in terms of allocating the corresponding goods was related to implicit and sometimes explicit evaluation of the patients worth and value. Moral sentiments towards patients were less important than practical organization and routine at work. Lack of time and of resources was the usual justification of problems encountered. Professional ethos was however often a more consistent explanation. | ||||
| Discussion: Little is known about ethical issues in the care of AIDS patients in African hospitals. Our approach considers ethics not as theory (principalism) but as practice. The areas of differentiated care derive not from a priori analysis but from empirical observation which makes sense through interviews carried out with professionals. This approach underlines the role of the local context, both historical and social, and allows realistic recommendations to improve the situation. | ||||
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