Thanks to the work done at CMEL, Stellenbosch University plays a leading role in equipping the country's healthcare practitioners and researchers for the ethical, social and clinical challenges they face during their careers.
Prof Keymanthri Moodley has always been the driving force behind the Centre, identifying a gap in bioethics training at a time when few other South African academics understood its relevance. Bioethics includes not only the philosophical study of the ethics of medicine, but also such areas as medical law, medical sociology, health politics and health economics.
Since its inception in 2003, Moodley has established a dynamic facility that not only offers undergraduate and postgraduate training in bioethics and law, but also empirical research into bioethical issues as well as consultancy services to hospitals in the region.
“My ﬁrst involvement in ethics started when I was working as a family physician in 1997," Moodley recalls. “I had to teach bioethics to medical students and worried about not having adequate knowledge about the subject. I noticed that Stellenbosch University offered an MPhil in Applied Ethics and felt the need to ﬁll the gap in terms of my own education."
An academic at heart, she was immediately hooked, and enjoyed the very different way of thinking that the ﬁeld of ethics offered. But it was only after pursuing a master's degree in epidemiology at Columbia's Mailman School of Public Health – and not being able to complete her studies – that Moodley truly settled down into her role as a bioethics change agent.
A mother of two toddlers at the time, the plan was for Moodley's family to join her in the United States. But the catastrophic events of 9/11, and the fear of ﬂying it instilled in her children, forced her to change her plans. And so, a few months after starting her studies at Columbia, Moodley returned to South Africa and started to explore the idea of establishing a bioethics centre in the country.
A nudge from the HPC
Encouraged by what she saw at Columbia University, Moodley proposed the idea to the Faculty of Medicine and Health Sciences at SU. But, bioethics was a fairly new concept at the time and management wasn't convinced of the need for a unit or centre at the Tygerberg Campus yet.
Soon, however, the Health Professions Council of South Africa (HPCSA) started pressurising academic institutions to offer bioethics training – a direct result of the Truth and Reconciliation Commission's (TRC) highly publicised proceedings, which exposed many of the dark, unethical uses of medicine during the apartheid era. “The Faculty then approached me to create a curriculum that would comply with the HPCSA's new set of regulations. In 2003, ofﬁce space was allocated and I could ﬁnally create the unit."
The Unit for Bioethics, as it was initially called, at ﬁrst only offered undergraduate training. Gradually, good clinical practice (GCP) training for researchers and other training courses were added for post-graduate students. Every time a new course or service was added to the list, Moodley had to search for funding. “This pushed me on to an entrepreneurial path I didn't anticipate. But I managed to raise enough funds to ensure the growth of the unit."
Over the years, the Centre has repeatedly proven that its services are on par with the very best in the world.
In 2011, for example, the Centre was awarded a capacity development grant from the prestigious Fogarty International Centre of the US National Institutes of Health (NIH) to develop the Advancing Research Ethics in Southern Africa (ARESA) training programme – a collaboration with the University of North Carolina. As part of the programme, the Centre offered a postgraduate diploma in health research ethics and graduated 40 mid-career professionals from 10 African countries over ﬁve years.
Another noteworthy achievement was when, in April 2015, the Centre became a member of the Global Network of Collaborating Centres for Bioethics – a designation awarded by the World Health Organisation (WHO) to only 10 academic centres dedicated to the ethics of public health and research from around the world. SU's Centre for Medical Ethics and Law became the ﬁrst on the African continent to be awarded this privilege.
Enormous academic value
There's hardly ever a quiet moment at the Centre, and many interesting projects are currently underway.
CMEL recently launched a project aimed at implementing a process for involving participants in the governance of a genomic biobank at Tygerberg Hospital. Educational materials were developed for potential participants, explaining why genetic research is important, how a genomic biobank is used, and how it will beneﬁt South Africans in future. The team has also been awarded a ﬁve-year NIH grant to develop a historically grounded theoretical and ethical framework around HIV cure research – once again collaborating with the University of North Carolina.
Moodley furthermore spearheaded the development of a continuous professional development ethics online programme in response to the growing demand for postgraduate education in medical ethics, health law and human rights in South Africa. She also co-authored two books for tertiary-level students and developed educational material around genetics and HIV for school children. In addition, CMEL started a PhD programme in Clinical and Research Ethics in 2017.
The Centre has already proven its enormous value within the country's unique clinical, social and ethical context, and is set to become even more instrumental in shaping healthcare practices in future. For example, CMEL has only just started to apply indigenous African philosophies and values to bioethical issues, and so there's much work to be done by Moodley and her team.
With so much to be proud of, one wonders what Moodley's biggest achievement has been thus far. “My biggest challenge has been to grow the Centre with minimum resources, which meant that I really had to dig deep to ﬁnd the entrepreneur within me. Fortunately, I come from a family of strong, entrepreneurial women!"