TRC Final Report

Volume 4

Chapter 5

Subsection 12

Inadequate teaching of ethics and human rights

67 None of the health science faculties made the teaching of ethics and human rights a priority. Most often, courses on these subjects were optional and the students were not tested on the material, thus reducing their incentive to attend the lectures. The teaching institutions failed to integrate ethics and human rights into the curricula in a way that could have helped students understand their importance and practical applicability. In addition, students were not encouraged to question the status quo or to protest at the differences in the provision of health care by race. Professor Frances Ames told the Commission:

I think submission to authority and absolving oneself from blame by saying that one has to obey orders are widespread… I think all medical students should be taught about the research on submissiveness being a key etiological factor in the perpetuation of atrocities. They should be fully familiar with Milgrim’s work and reflect on Hannah Arendt’s concept of the ‘banality of evil’.

Relationship between the state and medical school faculties³⁵

68 One of the major points of confusion concerning the medical faculties was their relationship with the state. The hospital superintendent, who ran the hospital, was accountable only to the provincial authorities. Doctors in the public hospitals (which were often also teaching hospitals) were appointed by the province and were subject to provincial terms of employment. Professors were appointed jointly by the university and the state through a committee composed of medical faculty members, administrators and provincial representatives. The university paid only a small percentage of their salaries.

69 This arrangement may have made it more difficult for individual members of medical faculties to criticise state policies, as they may have believed that such criticism would have put their jobs in jeopardy. Professor Frances Ames related the following incident, which illustrates that this was not an unfounded fear:

[In] 1980 … I was pushed and shamed into action by UCT students. They invited me to join a panel to address a public meeting held at the Medical School to protest against the refusal of the South African Medical and Dental Council to discipline Drs Lang and Tucker, who had been accused of improper and disgraceful conduct during the public inquest into Biko’s death.

I accepted their invitation and was surprised when, some hours before the meeting, I was summoned by the superintendent of Groote Schuur Hospital. He told me that head office had 'phoned him to tell me that I was a provincial servant and forbidden to participate in political activities.

70 Although many of the racist practices in the hospitals breached international medical ethical codes of conduct, medical faculties were subjected to triple loyalties: to their patients, to their students and to their employers (the state and the university). Criticism of the failure of health science faculties to act against apartheid medical practices must also be tempered by the acknowledgement that universities in general relied on the government for a large part of their funding and were not completely independent. Failure to conform made institutions vulnerable to funding cuts.

Complicity of the medical schools

71 While some medical schools did start to speak out against the inequities of apartheid medicine, especially in the latter part of the period under review, they were generally complicit in committing human rights abuses by helping to create and perpetuate the racist environment in which health professionals were trained. Greater efforts should have been made by the lecturers and administrators to provide equal educational opportunities for all students. The medical schools could have challenged more vociferously the issue of segregated facilities, hospital rules concerning the treatment of patients, the lack of promotion of black doctors and the unequal resource allocation to black and white teaching hospitals. In addition, they could have encouraged their students to question the validity of the system and taught them how to maintain their integrity as doctors by upholding international ethical standards for the profession. Finally, they could have been more vocal in encouraging the professional organisations to take a stand against apartheid medicine and the injustices within the profession that stemmed from the maldistribution of resources.