Thinking out loud about ethics
When the family disagrees: navigating conflicting wishes at the bedside
A patient's daughter insists on aggressive treatment. His son wants comfort care. The patient is no longer able to speak for himself. This is one of the most emotionally raw situations in clinical practice — and one of the most ethically complex. Here's how to think it through, step by step.
Burnout is not a personal failure — and the ethics won't let us pretend otherwise
Moral distress is real, it's heavy, and it has concrete ethical consequences. When we're exhausted, our capacity for ethical reasoning shrinks. This post makes the case that protecting your wellbeing is itself an ethical obligation.
Truth-telling when the truth is devastating: a South African perspective
In many South African contexts, there are cultural expectations that shape how — and whether — difficult diagnoses are shared with patients. Respecting culture and upholding autonomy don't have to be in conflict. But it takes thought.
Informed consent in a hurry: when the system makes it almost impossible to do it properly
You have three minutes per patient. The waiting room is full. And the consent form is two pages long. This is the reality for many South African clinicians. Here's how to uphold the spirit of informed consent even when conditions make it hard.
Who benefits? The ethics of research in under-resourced healthcare settings
When international researchers come to South African communities for data, the ethical question isn't just "did participants consent?" It's also "who actually gains from this?" A frank look at justice and exploitation in healthcare research.
The ethics of scarcity: how to make allocation decisions you can live with
One ICU bed. Two patients who both need it urgently. There's no clean answer — but there are better and worse ways to reason through it. This is what fair, transparent, defensible decision-making looks like under pressure.
Real situations. Worked through.
The minor who refuses treatment — and the parents who insist
A 15-year-old with a treatable but serious condition declines intervention on religious grounds. Her parents disagree strongly. What does the law say, and more importantly, what does good ethical practice look like here?
Work through this case ConfidentialityConfidentiality vs. public safety: a patient reveals plans to harm someone
Your patient, in a moment of distress, tells you something you cannot ignore. But they are relying on your discretion. This case unpacks where the duty of confidentiality ends — and what you're actually obligated to do.
Work through this case CommunicationWhen you don't share a language: consent, dignity, and the limits of a family interpreter
In many South African clinical encounters, a family member interprets. This is practical — and ethically fraught. What gets lost? What gets distorted? And what are your responsibilities when the only interpreter available has a stake in the outcome?
Work through this case Professional ResponsibilityThe colleague whose practice is worrying you — and your fear of what happens if you speak up
Healthcare providers often know when a colleague is struggling or behaving in ways that put patients at risk. Knowing and acting are very different things. This case is about courage, loyalty, and the duty to patients above all.
Work through this case End of LifeWithdrawing treatment in a public hospital: when doing less is the more ethical act
The patient is unlikely to recover. Continuing treatment is prolonging suffering rather than life. But the family is not ready to let go. And the ward is overcrowded. This case confronts one of the most difficult decisions clinicians face.
Work through this case Digital EthicsWhatsApp, social media, and patient information: where the line actually is
The team uses a WhatsApp group to coordinate patient care. It's efficient. It's also a potential privacy minefield. This case looks at the ethics of digital communication in clinical teams — and what good practice looks like in 2025.
Work through this caseFrameworks that hold up under pressure
These guidelines won't do your thinking for you — and they're not trying to. They're practical frameworks to reach for when you need a place to start, a vocabulary to reason with, or something to point to when you explain your decision.
Informed consent in South Africa: a plain-language guide
What the National Health Act says, what it means in practice, and how to document it properly — including for patients with limited literacy.
PDF GuideAssessing decision-making capacity: a quick clinical framework
A four-part framework for assessing whether a patient has the capacity to make a specific decision — including what to do when you're not sure.
Web ResourceEnd-of-life care: ethical principles for South African clinicians
From advance directives to withdrawing treatment — a practical guide to the principles and legal framework that apply in the South African context.
PDF GuideConfidentiality, disclosure, and when the law overrides them both
A clear-eyed look at the exceptions to patient confidentiality — notifiable conditions, child abuse, risk to third parties — and how to navigate them without losing trust.
Web ResourceEthical reasoning step-by-step: a framework for clinical dilemmas
When you don't know where to start, start here. A seven-step process for identifying the ethical issues, exploring options, and reaching a defensible decision you can explain.
PDF GuideResearch ethics essentials for clinical staff who aren't researchers (yet)
Many clinicians in South Africa are involved in research projects without fully understanding their ethical obligations. This guide closes that gap in plain English.
Web ResourceWorking alongside traditional healers: a relational ethics approach
In South Africa, many patients move between biomedical and traditional healthcare. This guide offers a practical, respectful framework for those intersections — grounded in conviviality, not condescension.
PDF Guide