Tuesday, October 16, 2007

Drunkeness, thievery and health: the South African soap opera continues

In regard to ethics and health, what can South Africa do for an encore? It is not enough that its President, Thabo Mbeki, has consistantly failed to distance himself from those who deny that HIV causes AIDS. It is also not enough that his health minister, Manto Tshabalala-Msimang, is already infamous for her promotion of the use of lemons and garlic rather than anti-retroviral drugs to control AIDS. Over the last three months, Tshabalala-Msimang has been accused of stealing from medical patients in the past (as a hospital director in Botswana), loudly boozing it up while a patient herself (for a shoulder operation), and receiving special priority for a liver transplant despite violating the requirement of not drinking alcohol 6-12 months before surgery. She has been seen drinking since.

The new twist in the tale is that the journalists of the Sunday Times, the Johannesburg newspaper which broke the stories of ministrial drunkness and thievery, are accused of obtaining and publishing Tshabalala-Msimang's medical records without her consent and are threatened with arrest. An alleged represenative of the medical community, speaking on anonymity, states that such uses of medical records are simply unethical, even if what they reveal is itself unethical behavior. Defenders of the journalists cite press freedom, while pointing out that the journalists and the newspaper seem to be subject to special government pressure: the journalists are now being watched by the South African secret service, and the government is threatening to withhold its advertizing from the Sunday Times. Interestingly, the executive director of the Freedom of Expression Institute argues that disclosure of private information can be justified in the light of a significant public health threat, and Tshabalala-Msimang should be considered just such a threat. It is unusual that a Minister of Health is viewed as analogous to multi-drug resistant tuberculosis or a toxic waste spill. But in South Africa, anything is apparently possible.

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