African bioethics: methodological doubts and insights

Balancing Ethics and Culture: A Scoping Review of Ethico-Cultural and Implementation Challenges of the Individual-Based Consent Model in African Research

Objective: This review explores the ethico-cultural and implementation challenges associated with the individual-based informed consent (IC) model in the relatively collectivistic African context and examines suggested approaches to manage them. Methods: We searched four databases for peer-reviewed studies published in English between 2000 to 2023 that examined the ethico-cultural and implementation challenges associated with the IC model in Africa. Results: Findings suggest that the individual-based IC model largely misaligns with certain African social values and ethos and subverts the authority and functions of community gatekeepers. Three recommendations were proffered to manage these challenges, that researchers should: adopt a multi-step approach to IC, conduct a rapid ethical assessment, and generate an African-centered IC model. Conclusions: A pluriversal, context-specific, multi-step IC model that critically harmonizes the cultural values of the local population and the general principles of IC can minimize ethics dumping, safeguard the integrity of the research process, and promote respectful engagement.

Where is knowledge from the global South? An account of epistemic justice for a global bioethics

The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We first introduce several different conceptions of justice and decolonisation in relation to knowledge, purposefully drawing on work emanating from the global South as well as the global North. We then apply those conceptions to the global health ethics context to generate a tripartite account of the layers of epistemic justice in the field: who is producing ethics knowledge; what theories and concepts are being applied to produce ethics knowledge; and whose voices are sought, recorded and used to generate ethics knowledge. These layers reflect that the field spans conceptual and empirical research. We conclude by proposing that, going forward, three avenues are key to achieve greater epistemic justice at each layer and to help decolonise global health ethics: namely, understanding the problem, dialogue and structural change.

Epistemic justice, African values and feedback of findings in African genomics research

This article draws on key normative principles grounded in important values – solidarity, partiality and friendliness – in African philosophy to think critically and deeply about the ethical challenges around returning individual genetic research findings in African genomics research. Precisely, we propose that the normative implication of solidarity, partiality and friendliness is that returning findings should be considered as a gesture of goodwill to participants to the extent that it constitutes acting for their well-being. Concretely, the value of friendliness may imply that one ought to return actionable results to participants even when their preferences regarding feedback are unknown. Notwithstanding, returning individual genetic results will have a cost implication. The cost of feeding back is relevant in the context of African genomics research projects, which are often funded by international sponsors and should be researched further.

Bioethics after the COVID-19 pandemic: More research, fewer committees?

In the face of the pandemic, bioethics, once again, proved its scientific utility. In France, in particular, the academic approach (= peer-reviewed, scientific publications, etc.) should be given priority over the institutional approach (= public surveys, public meetings, etc.), in hospitals, research institutes, universities, and companies, with the professionalization that this would imply (i.e. bioethicists).

African perspectives of moral status: a framework for evaluating global bioethical issues

This paper offers an African perspective on moral status grounded on an understanding of personhood. These concepts are key to understanding the differences in emphasis and the values at play when global ethical issues are analysed within the African context. Drawing from African philosophical reflections on the descriptive and normative concepts of personhood, I propose a dual notion of subject and object moral status. I explain how object moral status, duties owed to persons, is differently grounded with respect to subject moral status, which refers to communally directed agency. This distinction influences the African way of conceptualising and addressing ethical issues, where, without ignoring rights of persons, moral consideration about the agency of right bearers is often factored into ethical deliberation. As a practical example, I look at the debate surrounding legal access to safe abortion on the African continent. I suggest a Gadamerian approach to diffuse the tensions that sometimes arise between universalist advocates of rights and cultural decolonisationists.

Paliativos pediátricos en África

En este artículo planteamos la necesidad de la imprescindible implantación de estos programas en África. Y que se haga desde la experiencia cultural propia del continente y a la luz de unos principios éticos ajustados a su realidad.

Fairness and accountability of AI in disaster risk management: Opportunities and challenges

Disaster risk management (DRM) seeks to help societies prepare for, mitigate, or recover from the adverse impacts of disasters and climate change. Core to DRM are disaster risk models that rely heavily on geospatial data about the natural and built environments. Developers are increasingly turning to artificial intelligence (AI) to improve the quality of these models. Yet, there is still little understanding of how the extent of hidden geospatial biases affects disaster risk models and how accountability relationships are affected by these emerging actors and methods. In many cases, there is also a disconnect between the algorithm designers and the communities where the research is conducted or algorithms are implemented. This perspective highlights emerging concerns about the use of AI in DRM. We discuss potential concerns and illustrate what must be considered from a data science, ethical, and social perspective to ensure the responsible usage of AI in this field.

A Systems-Based Framework for Immunisation System Design: Six Loops, Three Flows, Two Paradigms

Despite massive progress in vaccine coverage globally, the region of sub-Saharan Africa is lagging behind for Sustainable Development Goal 3 by 2030. Sub-national under-immunisation is part of the problem. In order to reverse the current immunisation system's (IMS) underperformance, a conceptual model is proposed that captures the complexity of IMSs in low- and middle-income countries (LMICs) and offers directions for sustainable redesign. The IMS model was constructed based on literature and stakeholder interaction in Rwanda and Kenya. The model assembles the paradigms of planned and emergency immunisation in one system and emphasises the synchronised flows of vaccinee, vaccinator and vaccine. Six feedback loops capture the main mechanisms governing the system. Sustainability and resilience are assessed based on loop dominance and dependency on exogenous factors. The diagram invites stakeholders to share their mental models and. The framework provides a systems approach for problem structuring and policy design.

Cultural Values and Beliefs of Selected Local Communities in Botswana: Implications for Human Subject Research Ethics Practice

Calls have been made for researchers prospectively and continuously to engage study communities. If done, this typically occurs through a specific research study or collaboration. Rarely are community mores examined in-depth to understand implications for research ethics policy processes. We describe a qualitative study designed to understand local community values, beliefs, and practices that relate to research ethics in Botswana and explore how communities would want their interests represented. Through focus group discussions across two different selected ethnic communities and in-depth interviews with paramount chiefs, we highlight a range of community values and expectations that represent concrete behavioral representations of respect and trustworthiness. Communities are willing to engage in the process of enhancing research and research ethics policies and procedures. We invite future research and training that seek to connect local conceptualizations of substantive and procedural aspects of research ethics.