New rules for doctors and other medical staff in South Africa
The Health Professions Council of South Africa (HPCSA) has introduced new regulations that all doctors and other medical professionals must now adhere to.
The new rules relate to dealing with end-of-life decisions and the use of artificial intelligence (AI) in healthcare.
According to law firm Bowmans, the changes are meant to protect patients while giving practitioners clearer guidance.
Bowmans senior associate Jay Page said the updates “show a clear intention to reinforce patient dignity and ensure that medical professionals keep up with ethical and technological developments.”
The first set of updates appears in Booklet 7, which deals with withholding or withdrawing life-prolonging treatment.
While the main principle remains unchanged—decisions must always be in the patient’s best interests—the HPCSA now gives more detailed instructions on how those decisions should be made.
Page explained that one of the most significant updates is the introduction of a “patient representative.
This is someone the patient chooses to make medical decisions for them if they cannot, or do not want to, make those decisions themselves.
The guidelines now formally define who this representative can be and what their role is. The HPCSA also makes it clear that patients should be consulted before any decision to stop or withhold treatment, as long as they are able to take part.
However, some patients may not want to know the details or be involved in the discussion. “The new rules now allow the practitioner to speak directly to the patient’s nominated representative in these situations,” Page said.
The representative must be someone who can reflect the patient’s stated wishes or, if those are not known, what the patient would likely have wanted.
If a patient cannot make decisions at all, the HPCSA has tightened the rules on who may give consent. Page explained that while the old guidelines hinted at this, the new rules spell it out properly.
Use of AI
A patient can grant someone written authority to decide for them; otherwise, a court order or other applicable law may give someone that authority.
If neither applies, consent must be obtained in a specific order: first from a spouse or partner, then from a parent or grandparent, then from an adult child, and finally from a sibling.
Doctors may still decide to withhold or withdraw treatment they believe to be futile, even if the family wants it to continue.
However, the HPCSA now states clearly that this can only happen if the decision is in the patient’s best interests.
Page said this is an important addition because it strengthens the protection of vulnerable patients.
The second set of changes appears in Booklet 20, which covers the ethical use of AI in healthcare.
Page added that the HPCSA takes a balanced approach. It supports innovation but warned that new technologies come with risks.
These include concerns about data privacy, the potential for discrimination against underrepresented groups in datasets, and the lack of proper regulation or standards for many AI tools.
“The idea that anonymised data is always safe is no longer true when algorithms can identify people from complex information,” Page said.
To help manage these risks, the HPCSA has introduced three “pillars of AI”: ethical, legal and technical.
Practitioners must ensure AI tools respect patient autonomy and confidentiality, comply with South African laws such as the Protection of Personal Information Act, and meet standards for safety, reliability and security.
Most importantly, “AI must always be used to benefit the patient, not to make the practitioner’s job easier,” Page said.
The guidelines also noted that AI may never replace a doctor’s own judgment. A practitioner must always make the final call and cannot pass responsibility to an algorithm.
Another key change is that only validated and culturally appropriate AI tools may be used.
This ties in with recent rules from the South African Health Products Regulatory Authority, which listed the types of AI tools used in healthcare—from imaging software to predictive algorithms and wearable monitoring devices—and outlined how they should be regulated.
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