Abstract:
This study was designed to evaluate the quality of informed consent practiced by healthcare
professionals in South Africa using an empirical quantitative methodology combined with medicolegal
analysis to produce an interdisciplinary thesis on bioethics and medical law. Informed
consent is an ethical and legal doctrine derived from the principle of respect for autonomy,
whereas the rights to bodily integrity, privacy and human dignity are constitutionally protected in
South Africa. The National Health Act 61 of 2003 codified requirements for informed consent by
stipulating that healthcare providers must inform healthcare users about diagnosis, risks, benefits,
treatment options, and the right of refusal, while taking into consideration users language and
literacy levels. However, African communities are inherently challenged by problems of poverty,
poor education, power asymmetry, and unfamiliarity with libertarian rights-based autonomy, which
could affect informed consent practice. An empirical study was conducted at randomly selected
public hospitals in EThekwini metropolitan municipality involving 927 participants; comprising 168
medical doctors, 355 professional nurses, and 404 patients. The study showed that healthcare
professionals had limited knowledge regarding ethical and legal requirements for informed
consent, and were partially compliant with current informed consent regulations. Barriers to
informed consent identified were language, poor education, workload, and lack of interpreters.
Most patients attending public hospitals were indigent, but preferred full information disclosure,
and a shift from informed to shared-healthcare decision-making. The study recommends that a
corps of trained interpreters should be introduced at public hospitals. This will improve providerpatient
communications and minimize workloads, increase job satisfaction, and the overall quality
of healthcare service delivery. Analysis of recent South African case law on informed consent
revealed vacillations between the “reasonable doctor” and “prudent patient” standards of
information disclosure which are inconsistent with the jurisprudence from comparative foreign
common law jurisdictions. Therefore, South African court judgments on informed consent ought
to be re-evaluated to establish a uniform standard of information disclosure consistent with
international jurisprudence, current legislation, and constitutional protections relating to human
dignity and security of the person.
