Question 1

Various provisions of the Constitution of the Republic of South Africa, 1996 deal with the state's obligation to provide medical treatment or care. Which of the following accurately conveys an aspect of the constitutional obligation?

Under the Constitution of the Republic of South Africa, 1996

(1) everyone has the right to access to health care services at state expense.

(2) every detained person is guaranteed the provision of adequate medical treatment at state expense and the prison authorities may never aver that they are unable to provide such care due to lack of funds or budgetary limitations, as this right is not qualified by express reference to "available resources".

(3) every child has the right to adequate healthcare services.

(4) everyone has the right to free emergency health services from state as well as private healthcare providers.

(5) everyone has the right to reproductive health care, and the state has a duty to take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of the right.

Question 2

A professional conduct committee holds an inquiry into the conduct of Dr Manual. The professional conduct committee finds that Dr Manual indeed acted unprofessionally, and that there is evidence of poor performance on her part. The committee is of the view that a performance assessment should be arranged. Which of the following statements is correct?

(1) If a performance assessment is held, and Dr Manual fails to adhere to the directives that the performance assessment committee has given to improve her performance, the performance assessment committee may direct the registrar to remove Dr Manual's name from the register.

(2) The professional conduct committee is responsible for appointing a performance assessment committee.

(3) The professional conduct committee may either impose a penalty for unprofessional conduct, or order the registrar to arrange a performance assessment, but cannot do both.

(4) Where a performance assessment is held, the performance assessment committee may lift practice restrictions and finalise the matter once Dr Manual has complied with its directives and submitted the required reports, and the committee has ascertained that she has acquired the required skills to enable her to perform optimally in practising her profession.

Question 3

Medical practitioners' freedom of trade is limited by certain legal and ethical provisions that require them to treat patients in certain circumstances. Which one of the following statements is correct?

(1) There is no ethical rule or guideline that requires a doctor to arrange for accessibility when s/he is off duty.

(2) According to ethical guidelines, where a doctor is faced by an emergency situation calling for the administration of healthcare that falls outside his/her experience and competency, s/he should nevertheless first assist to stabilise the patient before referring him/her to a suitable healthcare provider.

(3) Even when a doctor is obliged to treat a patient, there is no reciprocal legal duty on the patient to cooperate with the doctor when using health services or to adhere to the rules of the health establishment.

(4) A doctor in private practice can accept or refuse patients as they choose and are not bound by the provisions of section 5 of the National Health Act 61 of 2003.

(5) Doctors who work in a public health care establishment are compelled to treat all patients admitted to the facility, but doctors who work in a private health care establishment are not compelled to do the same.

Question 4

Dr Amelho has been practising as an ophthalmologist in a small town in the Eastern Cape where he has been serving a very large area as only ophthalmologist. Dr Amelho enters into a partnership agreement with Dr Olhos, a recently qualified ophthalmologist. They conclude a restraint of trade agreement restraining Dr Olhos from practising in this field for eight years within a radius of 100 km from the practice when leaving the practice. Dr Olhos leaves the practice and is of the opinion that the restraint clause is extremely harsh. Which one of the following statements regarding litigation concerning the enforceability of the restraint clause is true?

(1) The clause will necessarily be unenforceable as freedom of trade has to have priority over the sanctity of contracts.

(2) In considering whether the restraint is reasonable or not, the court may only take into account the circumstances prevailing at the time it is requested to enforce the clause.

(3) A court will consider the effect that enforcement of the clause would have on the availability of ophthalmological services in the area concerned, and the effect that it would have on ensuring that ophthalmological services are made available over a larger area.

(4) Dr Amelho bears the burden of proving that enforcing the restraint clause will be in the public interest.

(5) Should Dr Amelho stop practising ophthalmology upon the dissolution of the partnership, the fact that he no longer has any practical interest in enforcing the restraint should have no effect on the enforceability of the clause since restraint clauses are in principle valid and enforceable.

Question 5

A doctor NEED NOT inform a patient of a risk associated with a procedure if

(1) the risk is serious but uncommon.

(2) it is unlikely that the reasonable person in the patient's position would attach significance to it, but the doctor knows that the particular patient would be likely to attach significance to it.

(3) the risk is not one that the reasonable doctor would disclose, but is one that meets the criteria for a material risk.

(4) the patient clearly implies, tacitly, that he/she does not want to be informed of the risks attached to the procedure.

Question 6

It is Saturday evening, and Sindiswa is brought in to Caritas Hospital in Polokwane by a stranger who came across him where he was lying in a park, semi-naked and apparently the victim of an assault with some nasty but not life-threatening wounds that need to be attended to. He is totally incoherent and confused and does not seem to be fully aware of his surroundings. He seems to lap in and out of consciousness. He has no form or means of identification on his person, and the only information that anyone can get out of him is that his name is Sindiswa. It is impossible to communicate with him in any meaningful way, and it is clear to all that Sindiswa needs to be hospitalised and is unable to give consent. Which of the following describes the best solution offered in terms of the National Health Act 61 of 2003 for his admission to hospital for care, observation and tests?

(1) A court order must be obtained to allow him to be admitted without consent, or to appoint someone to consent on his behalf.

(2) He can only be admitted to the hospital without consent if substituted consent can be obtained from his spouse or partner, parent, grandparent, adult child, brother or sister.

(3) He can only be admitted without his or a substitute's informed consent if it can be shown that any delay in the provision of health services might result in his death or irreversible damage to his health, and he has not expressly, impliedly or by conduct refused that service.

(4) He can be admitted without consent, but Caritas Hospital must notify the head of the Limpopo Department of Health within 48 hours after Sindiswa's admission of the fact that he was admitted

Question 7

Clarke v Hurst NO 1992 (4) SA 630 (D) is a landmark judgment which clarified several major legal issues relating to the withdrawal of life-sustaining treatment. Which one of the following statements is correct?

(1) The court held that the discontinuance of the artificial feeding would hasten Dr Clarke's death and would thus be a cause of it.

(2) Dr Clarke suffered irreversible brain damage due to cerebral anoxia which left him permanently comatose and brain dead.

(3) The court acknowledged that society adjudges the conduct of a doctor who, with the object of relieving a terminally ill patient's pain, prescribes a drug in a quantity merely sufficient for such purpose, while knowing that the drug will certainly shorten the patient's life, as justified.

(4) The court held that in our law, a person appointed as the curator personae appointed to the person of a patient is under a duty to act in accordance with the wishes of the patient, the patient's right to self-determination being the paramount consideration.

Question 8 Which one of the following is necessarily unlawful?

(1) Reproductive cloning

(2) Cosmetic operation without any therapeutic objective

(3) Research on primordial germ cells obtained from aborted foetuses

(4) The surgical removal of the gonads and genitalia of a transsexual, and the alteration of such a person's physical sexual characteristics by surgery and medical treatment (including the administration of hormones) in order to match the person's gender identity.

(5) Medical experimentation conducted on a minor

Question 9 In S v Kramer 1987 (1) SA 887 (W) the court of appeal held that

(1) the surgeon was not at fault to have ordered the anaesthetist to inject more muscle relaxant as it was necessary to facilitate the insertion of a new endotracheal tube.

(2) the surgeon should not have delayed commencing resuscitative measures by first removing the left tonsil after he had noticed that the patient had become cyanosed.

(3) the anaesthetist had not been negligent in failing to insert the tube into the trachea as it could be attributed to his inexperience.

(4) there was a duty on the surgeon to have looked down the patient's trachea to ensure that the tube was correctly placed before commencing the operation.

Question 10

A doctor is negligent if s/he fails to live up to the standard of care required by law. Suppose Dr Mamba, a cardiothoracic surgeon, is charged with culpable homicide for causing the death of Mr Lamb whilst operating on him. Which of the following need NOT be established in order to prove that Dr Mamba was negligent?

(1) That the reasonable cardiothoracic surgeon would have taken steps to prevent Mr Lamb's death

(2) That Dr Mamba reconciled herself to the possibility that Mr Lamb may die as a result of her conduct

(3) That the reasonable cardiothoracic surgeon would have foreseen the possibility that his/her conduct could lead to Mr Lamb's death

(4) That Dr Mamba failed to take such steps as would have been taken by the reasonable cardiothoracic surgeon to prevent Mr Lamb's death