Medical ethics and the politics of the South African HIV/AIDS epidemic

Abstract

Politics has been defined as the 'art and science of government' and ethics as 'moral principles, the science of morals in human conduct, rules of conduct. The reader would know politics by its public face - its leaders, their words, their actions: 'levelling the playing fields', 'quiet diplomacy', 'kill the farmer, kill the boer', 'shifting the goal posts', 'redressing the imbalances', 'playing the race card'. Ethical issues in health are familiar too: triaging survivors, prioritising limited budgets, maintaining confidentiality, obtaining informed consent, deciding upon ventilator/dialysis access, euthanasia and embryo research. Making choices has never been easy. Writing from prison in 1945, Bonhoeffer commented upon ethics: 'Rarely has any generation shown so little interest in any kind of theoretical or systematic ethics. Our period of history is oppressed by an abundance of ethical problems. Today, there are once more villains and saints. These emerge from the primeval depths to open the infernal or divine abyss and allow us to see briefly into mysteries of which we had never dreamed. What is worse than doing evil is being evil. It is worse for a liar to tell the truth than for a lover of the truth to lie. A falling away is of infinitely greater weight than a falling down. One is distressed by the failure of reasonable people to perceive the depths of evil or the depths of the holy. With the best of intentions they believe that a little reason will clamp together the parting timbers of their house'.