RECOMMENDATIONS

Since the end of apartheid, most organizations representing the health professions have restructured themselves to move toward multi-racial, democratically run associations. With varying degrees of candor and depth, they have disclosed their behavior during apartheid, particularly in undermining professional ethics through allegiance to the policies and practices of apartheid. Some of them have issued formal apologies for their conduct during apartheid. Virtually all have committed themselves to becoming organizations that respect the human rights of all members of their profession and of the people they are supposed to serve.

It is for South Africans, not us, to assess the sincerity of these commitments and the depth of the apologies. Motives, however, may be less important than taking the concrete steps necessary for professional organizations to develop a commitment to human rights within the professions. Some of these steps may require giving up some of their autonomy or power of self-regulation. The willingness to do so in the name of human rights is, we believe, another measure of their commitment.

1. Support legislation to assure the protection of human rights in the health professions

One of the key steps that organizations of health professionals can take is to support legislation designed to bring human rights to South African health professionals. The Medical Association of South Africa (MASA), the Democratic Nurses Association of South Africa (DENOSA), Psychological Society of South Africa (PSSA) and other organizations should support all the following initiatives:

(a) The promulgation of legally binding human rights standards for health practice, violation of which will subject the professional to disciplinary sanctions.

(b) Reform of the Councils' disciplinary processes to assure that allegations of human rights violations are thoroughly and independently examined by a well-trained professional staff and to guarantee inclusion of community and consumer representation in these processes.

(c) Requiring human rights training as a condition of licensure.

(d) Monitoring human rights in the health sector, both public and private, including the health professions, on an ongoing basis by non-governmental or academic organizations not employed by or associated with a professional medical association. (See Recommendation F.)

2. Investigate abuses committed by individual practitioners in the past

Despite their commitment to a new human rights era, the professional organizations by and large have resisted recommendations to conduct their own inquiries into human rights violations by members of their associations. The TRC hardly scratched the surface of violations of human rights by health professionals during apartheid. Both disciplinary bodies and professional societies should reopen cases from the past.

3. Incorporate human rights education and cross-cultural understanding to professional training

A program of training in human rights must begin during professional training and continue throughout the professional's career. While medical schools and other health professional schools will be expanding bioethics teaching and initiating human rights training in their curricula, that does not reach the overwhelming majority of physicians in practice, some of whom were complicit in violations and almost all of whom practiced when apartheid was the dominant culture. We recommend the following steps:

(a) In conjunction with the statutory councils, organizations of health professionals, e.g., MASA, DENOSA, and PSSA, should initiate a national continuing medical education program on human rights and professional accountability, involving every chapter for several sessions and including expert presentations and case discussions.

(b) Human rights training should be planned with the advice of existing South African human rights organizations and both domestic and international bioethics and human rights authorities. The training should also address the relationship between the health professional and the patient, with the goal of diminishing the power differences between the two parties to the relationship. Further, white health professionals were educated in a system that deliberately and systematically devalued the worth of black South Africans. They were provided no tools to understand cultural differences, much less to seek to bridge the gaps between cultures. The education process should therefore incorporate cross-cultural understanding and be structured to involve presentations from all racial groups. The participation of patients who have suffered violations should be considered for case presentations.

The participation of the National Progressive Primary Health Care Network, which has mounted a major campaign to inform patients of their rights in health care, could provide helpful guidance in this process. Health professional societies should also support the efforts to the Health Systems Trust to train health workers at all levels in human rights.

(c) Specialty medical societies, e.g., pediatricians, psychiatrists, obstetricians/gynecologists, surgeons, and forensic pathologists, should regularly include substantive presentations on human rights and professional accountability at their annual meetings.

4. Undertake affirmative efforts to alter the leadership structure of the organizations

Despite restructuring, most of the leadership positions in the professional organizations are still held by many of the same whites. This is a product of the demographics and histories of the organizations. Affirmative steps need to be taken to assure that qualified blacks who were previously excluded from leadership, or who formed their own organizations out of protest, assume leadership positions in these organizations. One test of MASA's commitment to human rights, for example, will be the extent to which it integrates former NAMDA members into positions of leadership within MASA.

5. Demonstrate commitment to health equity

Professional organizations are guilds, and support what they believe to be in their economic interest. For many in the health professional organizations today, that means supporting moves toward privatization. That course threatens equity in South Africa's health care system, particularly the vibrancy of its private sector. The organizations should demonstrate, in concrete ways, how they propose to assure adequate health care for the majority of South Africans.

6. Elevate human rights concerns within the organizations

Human rights committees can easily become backwaters within professional associations. The associations should demonstrate their commitment to human rights by assuring that human rights receive attention at the highest levels of the organization. Human rights presentations and discussions should be incorporated into the day-to-day work of the organizations.

Organizational leaders should also make consistent and concerted efforts to raise awareness of human rights within the organization's membership, because many members continue to identify with the old order.

7. Incorporate human rights into professional journals

The South African Medical Journal and other professional publications should establish regular sections on bioethics and human rights. These sections should include the texts of formal papers presented at the meetings described above as well as news reports and other items concerning ethics and human rights issues in health care around the world, to make clear that these are not uniquely South African concerns.