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

Abstract

Irrespective of theoretical and skills laboratories training, clinical competencies need to be honed through real patient contacts. South African (SA) medical training takes place mainly in tertiary hospitals. Most patients come from disadvantaged backgrounds, are scientifically naïve, have difficulty communicating with medical staff and may be intimidated by their surroundings. These patients may be particularly vulnerable and resigned to insidious paternalism. The question is whether authentic informed consent is actually provided by these patients for their involvement in medical training. Implied consent for this purpose is invalid. I justify the demand for explicit consent on the grounds of ethical and regulative frameworks. The human rights of patients and the dictums of the SA National Health Act and the Health Professions Council of SA should actively be promoted and upheld. I conclude with practical suggestions intended to stimulate debate and action at institutional and clinical departmental levels.