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Access to paediatric critical care in South Africa: an ethical dilemma
White, Debbie Ann. 2025. Access to paediatric critical care in South Africa: an ethical dilemma. Unpublished masters thesis. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/handle/10019.1/132317
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867613807017197568 |
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| access_status_str | Open Access |
| author | White, Debbie Ann |
| author2 | Kruger, Mariana |
| author_browse | Kruger, Mariana White, Debbie Ann |
| author_facet | Kruger, Mariana White, Debbie Ann |
| author_sort | White, Debbie Ann |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | White, Debbie Ann. 2025. Access to paediatric critical care in South Africa: an ethical dilemma. Unpublished masters thesis. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/handle/10019.1/132317 |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/132317 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:42:00.137Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/132317 Access to paediatric critical care in South Africa: an ethical dilemma White, Debbie Ann Kruger, Mariana Kling, Sharon Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Philosophy. Applied Ethics. Pediatric intensive care -- South Africa Ethical problems Physicians -- Professional ethics Medical ethics -- South Africa UCTD White, Debbie Ann. 2025. Access to paediatric critical care in South Africa: an ethical dilemma. Unpublished masters thesis. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/handle/10019.1/132317 Thesis (MPhil)--Stellenbosch University, 2025. ENGLISH ABSTRACT: Paediatric critical care is a scarce resource globally. It is defined as the care of children with illnesses, injuries or post-surgical states that result in organ dysfunction or failure, necessitating sophisticated interventions to prevent deterioration or death. Critically ill children are inherently vulnerable through the nature of their disease, as well as due to lack of decisional capacity regarding their wellbeing and healthcare. They rely on others to protect their welfare. Decisions regarding the care of these children with life-threatening illnesses are always highly emotive and ethically challenging. Ethical codes demand of healthcare professionals to uphold the sacred doctor-patient relationship, balancing decisions in the patient’s best interests. They should act beneficently, with non-maleficence, protecting patient autonomy, while ensuring fair and judicious access to this scarce resource including life-sustaining treatment, advanced medical technology and skilled care. South Africa is an upper-to-middle income country with a two-tiered healthcare system: a state funded healthcare system that services 85% of the country’s 63 million people and a privately funded one servicing a minority, resulting in huge disparity in the availability of resources between the two healthcare sectors. The government run health system is in crisis, largely due to maladministration. Budgetary constraints, staff and equipment shortages and high patient demand impact negatively on the ability to provide effective critical care. South Africa has a limited availability of intensive care and high care beds, with only 25% of the country’s intensive care unit beds available to the public sector. Less than 20% of these beds are available to children, significantly limiting access to this life-sustaining resource. Numerous ethical dilemmas in decision-making influence who gains access to the paediatric intensive care unit (PICU). The scarcity of PICU beds requires physicians to make rationing decisions where children with better overall prognoses are admitted, often to the detriment of other children. It is challenging to prognosticate the long-term outcome or expected ‘quality of life’ of children requiring PICU. Difficult end-of-life decisions invariably need to be made, resulting in withholding or withdrawal of life-sustaining treatment. The nature of working in a paediatric critical care setting gives rise to moral distress, contributing to a high rate of disillusionment and staff burnout which impacts negatively on quality of care. Healthcare institutions with healthy ethical climates have been shown to enhance staff well-being, improve patient care and reduce overall healthcare costs. There is a great need to develop clear and explicit guidelines, both institutionally and nationally, detailing decisions on PICU admission policies and allocation of scarce resources by means of open, informed and fair procedures. The aim of this thesis is to propose an ethical guide to assist healthcare professionals managing critically ill children in PICU to make timely and defensible decisions, based on sound ethical, legal and locally relevant principles. Various strategies are proposed to manage the queue of patients as well as to select patients with better prognoses. This will enable children with the best possible outcome of pursuing a quality of life to benefit from the scarce critical care resources. AFRIKAANSE OPSOMMING: Pediatriese kritieke sorg is wêreldwyd 'n skaars hulpbron. Dit word gedefinieer as die versorging van kinders met siektes, beserings of post-chirurgiese toestande wat lei tot orgaandisfunksie of - versaking, wat gesofistikeerde intervensies noodsaak om agteruitgang of dood te voorkom. Kritiese siek kinders is inherent kwesbaar deur die aard van hul siekte, sowel as weens 'n gebrek aan besluitnemingskapasiteit rakende hul welstand en gesondheidsorg. Hulle maak staat op ander om hul welsyn te beskerm. Besluite rakende die versorging van hierdie kinders met lewensbedreigende siektes is altyd hoogs emosioneel en eties uitdagend. Etiese kodes vereis van gesondheidsorg personeel om die heilige dokter-pasiënt-verhouding te handhaaf en besluite in die pasiënt se beste belang te neem. Hulle moet welwillend optree, sonder kwaadwilligheid, met respek vir die pasiënt se outonomie, terwyl hulle billike en oordeelkundige toegang tot hierdie skaars hulpbronne verseker, insluitend lewensinstandhoudende behandeling, gevorderde mediese tegnologie en kundige gesonheidsorg. Suid-Afrika is 'n hoër-tot-middel-inkomsteland met 'n tweevlakkige gesondheidsorgstelsel: 'n staatsondersteunde gesondheidsorgstelsel wat 85% van die land se 63 miljoen mense bedien en 'n privaatondersteunde gesondheidsorgstelsel vir ‘n minderheid, wat lei tot groot ongelykheid in die beskikbaarheid van hulpbronne tussen die twee gesondheidsorgsektore. Die staatsbeheerde gesondheidstelsel is in 'n krisis, grootliks weens wanadministrasie. Begrotingsbeperkings, personeel- en toerustingtekorte en hoë pasiënt lading het 'n negatiewe impak op die verskaffing van effektiewe kritieke sorg. Suid-Afrika het ’n beperkte beskikbaarheid van intensiewe sorg- en hoësorgbeddens, met slegs 25% van die land se intensiewesorgeenheid beddens beskikbaar in die openbare sektor. Minder as 20% van hierdie beddens is vir kinders beskikbaar, wat toegang tot hierdie lewensinstandhoudende hulpbron aansienlik beperk. Die skaarsheid van pediatriese intensiewe sorg beddens vereis dat professionele gesondheidswerkers rantsoeneringsbesluite neem in belang van kinders met moontlike beter algehele prognose, dikwels ten koste van ander kinders. Dit is uitdagend om die langtermyn-uitkoms of verwagte 'lewenskwaliteit' van kinders wat pediatriese intensiewe sorg benodig, te voorspel. Moeilike besluite oor die einde van die lewe moet altyd geneem word, wat lei tot die weerhouding of onttrekking van lewensinstandhoudende behandeling. Gedeelde besluitneming tussen die gesondheidsorgspanlede en die ouers/versorgers moet multidissiplinêr en samewerkend wees. Die aard van werk in 'n pediatriese kritiekesorg-omgewing gee aanleiding tot morele nood, wat bydra tot 'n hoë koers van ontnugtering en personeeluitbranding wat 'n negatiewe impak op kwaliteit van sorg het. Daar is getoon dat gesondheidsorginstellings met gesonde etiese klimaat pasiëntsorg, personeewelstand en ervarings verbeter en algehele gesondheidsorgkoste verminder. Daar is 'n groot behoefte om duidelike riglyne te ontwikkel, beide institusioneel en nasionaal, met besonderhede oor besluite oor pediatriese intensiewe sorg toelatingsbeleide en toewysing van skaars hulpbronne deur middel van oop, ingeligte en regverdige prosedures. Die doel van hierdie tesis is om 'n etiese raamwerk voor te stel om professionele persone in gesondheidsorg wat kritiek siek kinders bestuur te help om tydige en verdedigbare besluite te neem. Hierdie besluite moet gebaseer wees op gesonde etiese, wetlike en plaaslik relevante beginsels. Verskeie strategieë word voorgestel om die tou van pasiënte te bestuur asook om pasiënte met beter prognoses te selekteer. Dit sal kinders met die beste moontlike uitkoms om 'n lewenskwaliteit na te streef in staat stel om voordeel te trek uit die skaars kritiesesorghulpbron. Masters 2025-06-03T11:14:20Z 2025-06-03T11:14:20Z 2025-03 Thesis https://scholar.sun.ac.za/handle/10019.1/132317 en Stellenbosch University 82 pages application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Pediatric intensive care -- South Africa Ethical problems Physicians -- Professional ethics Medical ethics -- South Africa UCTD White, Debbie Ann Access to paediatric critical care in South Africa: an ethical dilemma |
| title | Access to paediatric critical care in South Africa: an ethical dilemma |
| title_full | Access to paediatric critical care in South Africa: an ethical dilemma |
| title_fullStr | Access to paediatric critical care in South Africa: an ethical dilemma |
| title_full_unstemmed | Access to paediatric critical care in South Africa: an ethical dilemma |
| title_short | Access to paediatric critical care in South Africa: an ethical dilemma |
| title_sort | access to paediatric critical care in south africa an ethical dilemma |
| topic | Pediatric intensive care -- South Africa Ethical problems Physicians -- Professional ethics Medical ethics -- South Africa UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/132317 |
| work_keys_str_mv | AT whitedebbieann accesstopaediatriccriticalcareinsouthafricaanethicaldilemma |