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Khan M, Ewuoso C. Epistemic (in)justice, social identity and the Black Box problem in patient care. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:227-240. [PMID: 38353801 PMCID: PMC11076305 DOI: 10.1007/s11019-024-10194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 05/08/2024]
Abstract
This manuscript draws on the moral norms arising from the nuanced accounts of epistemic (in)justice and social identity in relational autonomy to normatively assess and articulate the ethical problems associated with using AI in patient care in light of the Black Box problem. The article also describes how black-boxed AI may be used within the healthcare system. The manuscript highlights what needs to happen to align AI with the moral norms it draws on. Deeper thinking - from other backgrounds other than decolonial scholarship and relational autonomy - about the impact of AI on the human experience needs to be done to appreciate any other barriers that may exist. Future studies can take up this task.
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Affiliation(s)
- Muneerah Khan
- Steve Biko Centre for Bioethics, University of Witwatersrand, Johannesburg, South Africa.
| | - Cornelius Ewuoso
- Steve Biko Centre for Bioethics, University of Witwatersrand, Johannesburg, South Africa
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Ewuoso C. Decolonial health literature can increase our thinking about ethics dumping. J Med Ethics Hist Med 2023; 16:10. [PMID: 38260765 PMCID: PMC10801100 DOI: 10.18502/jmehm.v16i10.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/12/2023] [Indexed: 01/24/2024] Open
Abstract
This article draws on the underexplored or novel accounts of inclusion and the moral accounts of decolonization in African health decolonial literature to increase our understanding of how ethics dumping manifests in health research partnerships, and what more ought to be done to eliminate this phenomenon. African decolonial health literature proposes "inclusion that matters" - conceptualized as substantial, respectful and deep engagement with African agency - as a solution to end domination or mitigate the "appearance" of inclusion. Based on this supposition, the harm of ethics dumping - and I demonstrate how - is that it fails to engage the agency of Africans, and listen to or echo their voices in health and health research collaborations on the continent, or research collaborations that have significant implications for them. This account of inclusion can usefully increase our thinking about ethics dumping, which is ultimately and in several ways a failure to practice responsible science. Research is required to increase our understanding of what could reasonably constitute responsible science from a variety of perspectives.
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Affiliation(s)
- Cornelius Ewuoso
- Steve Biko Centre for Bioethics, University of Witwatersrand, Johannesburg, South Africa.
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Lokugamage AU, Robinson N, Pathberiya SDC, Wong S, Douglass C. Respectful maternity care in the UK using a decolonial lens. SN SOCIAL SCIENCES 2022; 2:267. [PMID: 36531139 PMCID: PMC9734803 DOI: 10.1007/s43545-022-00576-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Respectful maternity care (RMC) is part of a global movement addressing the previous absence of human rights in global safe maternal care guidance. RMC is grounded in kindness, compassion, dignity and respectful working conditions. The decolonisation movement in healthcare seeks to dismantle structural biases set up from a historically white, male, heteronormative Eurocentric medical system. This article applies a decolonising lens to the RMC agenda and examines barriers to its implementation in UK healthcare systems. Searches of peer-reviewed journals about decolonising maternity care in the UK revealed little. Drawing from wider information bases, we examine power imbalances constructed throughout a history of various colonial biases yet lingering in maternity care. The overarching findings of our analysis revealed 3 areas of focus: professional structures and institutional biases; power imbalances between types of staff and stakeholders of care; and person-centred care through a decolonial lens. To uproot inequity and create fairer and more respectful maternity care for women, birthing people and staff, it is vital that contemporary maternity institutions understand the decolonial perspective. This novel enquiry offers a scaffolding to undertake this process. Due to significant differences in colonial history between Western colonising powers, it is important to decolonise with respect to these different territories, histories and challenges.
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Affiliation(s)
| | - Nathan Robinson
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
| | | | - Sarah Wong
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
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Jecker NS, Atuire CA, Kenworthy N. Realizing Ubuntu in Global Health: An African Approach to Global Health Justice. Public Health Ethics 2022. [PMCID: PMC9494480 DOI: 10.1093/phe/phac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next infectious disease outbreak and what we owe to people in other countries during normal times. While the prevailing bioethics literature addresses these questions drawing on values and concepts prominent in the global north, this paper articulates responses prominent in sub-Saharan Africa. The paper first introduces a figurative ‘global health village’ to orient readers to African traditional thought. Next, it considers ethical requirements for governing a global health village, drawing on the ethic of ubuntu to formulate African renderings of solidarity, relational justice and sufficiency. The final section of the paper uses these values to critique current approaches, including COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) accelerator, and a proposed international Pandemic Treaty. It proposes a path forward that better realizes ubuntu in global health.
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Affiliation(s)
- Nancy S Jecker
- Department of Bioethics and Humanities, University of Washington, School of Medicine , 1959 NE Pacific Street, Seattle, WA 98195-7120 , USA
- Department of Philosophy, University of Johannesburg , Auckland Park, Gauteng , South Africa
| | - Caesar A Atuire
- Nuffield Department of Medicine, University of Oxford , Oxford , UK
- Department of Philosophy and Classics, University of Ghana, Legon , Accra , Ghana
| | - Nora Kenworthy
- Nora Kenworthy University of Washington, School of Nursing and Health Studies , Bothell, WA , USA
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Bridging East-West Differences in Ethics Guidance for AI and Robotics. AI 2022. [DOI: 10.3390/ai3030045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Societies of the East are often contrasted with those of the West in their stances toward technology. This paper explores these perceived differences in the context of international ethics guidance for artificial intelligence (AI) and robotics. Japan serves as an example of the East, while Europe and North America serve as examples of the West. The paper’s principal aim is to demonstrate that Western values predominate in international ethics guidance and that Japanese values serve as a much-needed corrective. We recommend a hybrid approach that is more inclusive and truly ‘international’. Following an introduction, the paper examines distinct stances toward robots that emerged in the West and Japan, respectively, during the aftermath of the Second World War, reflecting history and popular culture, socio-economic conditions, and religious worldviews. It shows how international ethics guidelines reflect these disparate stances, drawing on a 2019 scoping review that examined 84 international AI ethics documents. These documents are heavily skewed toward precautionary values associated with the West and cite the optimistic values associated with Japan less frequently. Drawing insights from Japan’s so-called ‘moonshot goals’, the paper fleshes out Japanese values in greater detail and shows how to incorporate them more effectively in international ethics guidelines for AI and robotics.
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Kulesa J, Brantuo NA. Barriers to decolonising educational partnerships in global health. BMJ Glob Health 2021; 6:e006964. [PMID: 34789513 PMCID: PMC8601064 DOI: 10.1136/bmjgh-2021-006964] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/01/2021] [Indexed: 12/22/2022] Open
Abstract
Global health partnerships between high-income countries and low/middle-income countries can mirror colonial relationships. The growing call to advance global health equity therefore involves decolonising global health partnerships and outreach. Through decolonisation, local and international global health partners recognise non-western forms of knowledge and authority, acknowledge discrimination and disrupt colonial structures and legacies that influence access to healthcare.Despite these well-described aims, the ideal implementation process for decolonising global health remains ill-defined. This ambiguity exists, in part, because partners face barriers to adopting a decolonised perspective. Such barriers include overemphasis on intercountry relationships, implicit hierarchies perpetuated by educational interventions and ethical dilemmas in global health work.In this article, we explore the historical entanglement of education, health and colonialism. We then use this history as context to identify barriers that arise when decolonising contemporary educational global health partnerships. Finally, we offer global health partners strategies to address these challenges.
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Affiliation(s)
- John Kulesa
- Graduate School of Education and Human Development, George Washington University, Washington, DC, USA
- Department of Hospital Medicine, Children's National Hospital, Washington, DC, USA
| | - Nana Afua Brantuo
- Graduate School of Education and Human Development, George Washington University, Washington, DC, USA
- Department of Education, University of Maryland at College Park, College Park, Maryland, USA
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Wardrope A. Health justice in the Anthropocene: medical ethics and the Land Ethic. JOURNAL OF MEDICAL ETHICS 2020; 46:791-796. [PMID: 33028625 DOI: 10.1136/medethics-2020-106855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
Industrialisation, urbanisation and economic development have produced unprecedented (if unevenly distributed) improvements in human health. They have also produced unprecedented exploitation of Earth's life support systems, moving the planet into a new geological epoch, the Anthropocene-one defined by human influence on natural systems. The health sector has been complicit in this influence. Bioethics, too, must acknowledge its role-the environmental threats that will shape human health in this century represent a 'perfect moral storm' challenging the ethical theories of the last. The US conservationist Aldo Leopold saw this gathering storm more clearly than many, and in his Land Ethic describes the beginnings of a route to safe passage. Its starting point is a reinterpretation of the ethical relationship between humanity and the 'land community', the ecosystems we live within and depend upon; moving us from 'conqueror' to 'plain member and citizen' of that community. The justice of the Land Ethic questions many presuppositions implicit to discussions of the topic in biomedical ethics. By valuing the community in itself-in a way irreducible to the welfare of its members-it steps away from the individualism axiomatic in contemporary bioethics. Viewing ourselves as citizens of the land community also extends the moral horizons of healthcare from a solely human focus. Taking into account the 'stability' of the community requires intergenerational justice. The resulting vision of justice in healthcare-one that takes climate and environmental justice seriously-could offer health workers an ethic fit for the future.
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Affiliation(s)
- Alistair Wardrope
- Academic Neurology Unit, The University of Sheffield, Sheffield, UK
- Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Bitter CC, Ngabirano AA, Simon EL, Taylor DM. Principles of research ethics: A research primer for low- and middle-income countries. Afr J Emerg Med 2020; 10:S125-S129. [PMID: 32837877 PMCID: PMC7423570 DOI: 10.1016/j.afjem.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/17/2020] [Accepted: 07/11/2020] [Indexed: 12/15/2022] Open
Abstract
Ethical oversight in the form of review boards and research ethics committees provide protection for research subjects as well as guidance for safe conduct of studies. As the number of collaborative emergency care research studies carried out in low- and middle-income countries increases, it is crucial to have a shared understanding of how ethics should inform choice of study topic, study design, methods of obtaining consent, data management, and access to treatment after closure of the study. This paper describes the basic principles of Western research ethics - respect for persons, beneficence, and justice - and how the principles may be contextualized in different settings, by researchers of various backgrounds with different funding streams. Examples of lapses in ethical practice of research are used to highlight best practices.
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Affiliation(s)
- Cindy C. Bitter
- Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis MO, USA
| | - Annet Alenyo Ngabirano
- Aga Khan University, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Erin L. Simon
- Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - David McD. Taylor
- University of Melbourne, Department of Medicine, Parkville, Victoria, Australia
- Austin Health, Heidelburg, Victoria, Australia
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Barugahare J. African bioethics: methodological doubts and insights. BMC Med Ethics 2018; 19:98. [PMID: 30587189 PMCID: PMC6307138 DOI: 10.1186/s12910-018-0338-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background A trend called ‘African bioethics’ is growing on the continent due to perceptions of existing bioethics, especially guidelines for international collaborative research, as ‘ethical imperialism’. As a potential alternative to ‘Western Principlism,’ ‘African bioethics’ is supposed to be indigenous to Africa and reflective of African identity. However, despite many positive insights in the on-going discussions, it is feared that the growth of bioethics in Africa lacks a clear direction. Some of the views threaten to distort the essence of bioethics and its development on the continent. Main text This paper presents some of the dominant views on ‘African bioethics’, an examination of which reveals some valuable insights into the direction bioethics in Africa ought to take, but at the same time confirms some methodological challenges in some contributions to the discussion. On top of acknowledging critical insights in the discussion, the paper reveals that some views are characterized by arbitrariness and rhetorical discussions based on a strong negative and yet hard-to-accept assumption; doubtful designation; lack of a clearer problem being addressed and consequently obscure question(s) and aim(s) of the discourse. Finally, some methodological insights are proposed to guide bioethics research and scholarship in Africa. Specifically, the paper proposes that in search for the legitimacy of bioethics in Africa, we ought to protect the essence of bioethics by giving considerable attention to the utility of subsequent bioethics. To achieve this we need to specify the problem and proper designation for the discourse; focus on principles qua principles with impartiality and how to ensure their strict implementation; and encourage critical thinking as part of bioethics. Conclusion In cultivating bioethics in Africa, the pursuit of identity is legitimate but must be conditional in light of other competing considerations. We should focus on an objective search for bioethical principles that can be effective in responding to African and global health challenges of moral significance, irrespective of the origin of the principles and at the same time focus more on strategies for ensuring compliance with resulting principles.
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Affiliation(s)
- John Barugahare
- Department of Philosophy, Makerere University, P. O. Box 7062, Kampala, Uganda.
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Rennie S, Ravez L, Makindu D, Fox A, Grauls B, Yemesi R, Kayembé P, Chalachala JL, Kashamuka M, Behets F. Bioethics education in Democratic Republic of Congo: Experiences and challenges. ACTA ACUST UNITED AC 2018; 15:192-200. [PMID: 34135995 DOI: 10.1016/j.etiqe.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In regions marked by socio-economic turmoil, the task of teaching bioethics to health professionals and researchers can be more challenging than elsewhere. To demonstrate this, in this article we describe some of our teaching experiences in the Democratic Republic of Congo over the past decade. A first difficulty is linguistic. Anglo-Saxon language and culture largely dominates the field of bioethics, complicating teaching and education for those who do not master the language. A second obstacle is conceptual. Bioethics is often misunderstood as reflection on technological developments in medicine, which distorts its objectives and narrows its scope, particularly in resource-constrained settings. A third difficulty is cultural and political. Ethics in this setting is difficult to distinguish from common morality and the work of moralists, who comment on problems in medicine from a religious standpoint. Moreover, when interacting with communities and institutions that are strongly hierarchical, the critical stance of bioethics can give rise to resistance and rejection. These are among the array of difficulties that undoubtedly have given rise to sharp critiques of bioethics training initiatives in developing countries, where the introduction of bioethics has been depicted as a form of Western imperialism. While taking these criticisms seriously, our experiences in the field show how these seemingly insurmountable difficulties can be transformed into (more or less) manageable challenges.
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Affiliation(s)
- S Rennie
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, États-Unis
| | - L Ravez
- Département Sciences-Philosophies-Sociétés, Centre de Bioéthique de l'Université de Namur, Institut, Université de Namur, rue de Bruxelles, 61, 5000 Namur, Belgique
| | - D Makindu
- École de Santé Publique, Centre Interdisciplinaire de Bioéthique pour l'Afrique Francophone (CIBAF), Université de Kinshasa, République Démocratique du Congo.,Université Pédagogique Nationale, République Démocratique du Congo
| | - A Fox
- Département Sciences-Philosophies-Sociétés, Centre de Bioéthique de l'Université de Namur, Institut, Université de Namur, rue de Bruxelles, 61, 5000 Namur, Belgique
| | - B Grauls
- Département Sciences-Philosophies-Sociétés, Centre de Bioéthique de l'Université de Namur, Institut, Université de Namur, rue de Bruxelles, 61, 5000 Namur, Belgique
| | - R Yemesi
- Université Pédagogique Nationale, République Démocratique du Congo.,Université de Lodja, République Démocratique du Congo
| | - P Kayembé
- École de Santé Publique, République Démocratique du Congo
| | - J L Chalachala
- University of North Carolina at Chapel Hill, DRC Country Representative, Family Planning Country Action Process Evaluation (FP CAPE)/Carolina Population Center, États-Unis
| | - M Kashamuka
- École de Santé Publique, République Démocratique du Congo
| | - F Behets
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, États-Unis
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Bell L, Calder B, Hiller R, Klein A, Soares NC, Stoychev SH, Vorster BC, Tabb DL. Challenges and Opportunities for Biological Mass Spectrometry Core Facilities in the Developing World. J Biomol Tech 2018; 29:4-15. [PMID: 29623005 DOI: 10.7171/jbt.18-2901-003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The developing world is seeing rapid growth in the availability of biological mass spectrometry (MS), particularly through core facilities. As proteomics and metabolomics becomes locally feasible for investigators in these nations, application areas associated with high burden in these nations, such as infectious disease, will see greatly increased research output. This article evaluates the rapid growth of MS in South Africa (currently approaching 20 laboratories) as a model for establishing MS core facilities in other nations of the developing world. Facilities should emphasize new services rather than new instruments. The reduction of the delays associated with reagent and other supply acquisition would benefit both facilities and the users who make use of their services. Instrument maintenance and repair, often mediated by an in-country business for an international vendor, is also likely to operate on a slower schedule than in the wealthiest nations. A key challenge to facilities in the developing world is educating potential facility users in how best to design experiments for proteomics and metabolomics, what reagents are most likely to introduce problematic artifacts, and how to interpret results from the facility. Here, we summarize the experience of 6 different institutions to raise the level of biological MS available to researchers in South Africa.
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Affiliation(s)
- Liam Bell
- Centre for Proteomic and Genomic Research, Observatory, Cape Town 7925, South Africa
| | - Bridget Calder
- University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Reinhard Hiller
- Centre for Proteomic and Genomic Research, Observatory, Cape Town 7925, South Africa
| | - Ashwil Klein
- University of the Western Cape, Bellville, Cape Town 7925, South Africa
| | - Nelson C Soares
- University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Stoyan H Stoychev
- Council for Scientific and Industrial Research, Pretoria 0001, South Africa
| | - Barend C Vorster
- Centre for Human Metabolomics, North-West University, Potchefstroom 2520, South Africa; and
| | - David L Tabb
- Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
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Afolabi MOS, Sodeke SO. A Multifaceted Approach Is Needed to Respond to the Plight of Bioethicists in Accessing Literature. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:37-39. [PMID: 29020558 PMCID: PMC5730332 DOI: 10.1080/15265161.2017.1365188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Rennie S, Moodley K. The Paywall as Metaphor and Symptom. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:17-18. [PMID: 29020545 DOI: 10.1080/15265161.2017.1365195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Chattopadhyay S, Myser C, Moxham T, De Vries R. A Question of Social Justice: How Policies of Profit Negate Engagement of Developing World Bioethicists and Undermine Global Bioethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:3-14. [PMID: 29020562 DOI: 10.1080/15265161.2017.1365185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We identify the ways the policies of leading international bioethics journals limit the participation of researchers working in the resource-constrained settings of low- and middle-income countries (LMICs) in the development of the field of bioethics. Lack of access to essential scholarly resources makes it extremely difficult, if not impossible, for many LMIC bioethicists to learn from, meaningfully engage in, and further contribute to the global bioethics discourse. Underrepresentation of LMIC perspectives in leading journals sustains the hegemony of Western bioethics, limits the presentation of diverse moral visions of life, health, and medicine, and undermines aspirations to create a truly "global" bioethics. Limited attention to this problem indicates a lack of empathy and moral imagination on the part of bioethicists in high-income countries, raises questions about the ethics of bioethics, and highlights the urgent need to find ways to remedy this social injustice.
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