Human guinea pigs? The ethics of undergraduate and postgraduate student involvement in medical training in South Africa

Abstract

Contrary to what the title might imply, I refer not to research subjects, but to guinea pigs of another ilk. Indeed, South Africa (SA) has a well-institutionalised and developed ethics review system. Clinical researchers should be trained in and comply with SA good clinical practice [1] and international ethical research guidelines and standards. SA research ethics committees and institutional review boards are rigorous in their demands for authentic informed consent (IC) for research subjects. Regrettably, however, there are no comparable structured courses and requirements for ethics at the clinical patientprofessional interface, and perhaps there should be, although all medical students undergo an approved ethics training programme. What concerns me and inspired this article is the question as to what extent patients in training hospitals in SA are used as 'training material' for medical students and registrars without being fully informed and providing explicit IC. Before responding to this question I shall argue that the metaphorical elephant in the room is a fundamental asymmetry in the doctor-patient relation. [2] Furthermore, the social and economic circumstances of many patients attending SA training hospitals exacerbate this asymmetry, contributing to the disempowerment of patients, increased vulnerability and resignation to the inevitable-to being used as 'training material' even if without explicit prior IC. First then, let us examine the asymmetrical professional-patient power relation. Asymmetry in the doctor-patient power relation This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.