Abstract
BackgroundThe COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa.MethodsTwenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses.ResultsKenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking.ConclusionsThis study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.
Highlights
The COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa
In South Africa, two new Clinical ethics committee (CEC) were established during the pandemic—a COVID-19 CEC was set by the Mediclinic hospital group that has 52 health facilities in South Africa and a provincial CEC was established in the Western Cape
With the current third wave in South Africa, these requests are again being directed to existing and new CECs to assist with difficult triage decisions for Intensive Care Units (ICU) cases and hospital beds (KMpersonal communication)
Summary
The COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The coronavirus pandemic has raised numerous clinical and ethical challenges globally. In Africa, the scarcity of all resources was exacerbated by the COVID-19 surge and this scarcity was extended to Moodley et al BMC Med Ethics (2021) 22:131 increase prompted ethics consultants to focus on providing support to HCPs who were dealing with ethical challenges surrounding critically ill patients. With the current third wave in South Africa, these requests are again being directed to existing and new CECs to assist with difficult triage decisions for ICU cases and hospital beds (KMpersonal communication)
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