'No one may be refused emergency medical treatment' - ethical dilemmas in South African emergency medicine

Abstract

Enshrined in section 27(3) of the Constitution of South Africa is the right that ‘no one may be refused emergency medical treatment'. While this universal human right is altruistic in its simplistic meaning and appears to be in tune with the requirement of freedom, equality and dignity for all in South Africa, in-depth analysis reveals ethical concerns. The definition of a medical emergency, although present on the statute books, recently seems to have been revised by the Constitutional Court, which may have practical ramifications for patients in life-threatening situations. Additionally, there is no definition of what constitutes basic emergency medical treatment, and the author has ventured to resolve this glaring deficiency. The Department of Health's introduction of a hierarchy of health services in South Africa to increase efficiency in the use of scarce health care resources nationally, with emergency medical treatment a notable exclusion, has presented ethical issues concerning patient redirection and transfer from health care establishments. Similarly, redirection and transfer of financially disadvantaged emergency medical patients from private health care establishments present major ethical concerns. It is incumbent upon all health care providers to render basic medical treatment without fear, favour or undue financial demand. The Constitutional Court needs to ensure that it does not excessively limit section 27(3) from an initial absolute provision to one dominated by progressive realisation that potentially may prohibit every individual in South Africa receiving basic emergency treatment when required. South African Journal of Bioethics & Law Vol. 1 (2) 2008: pp. 53-56