Abstract

BackgroundThe Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding informed consent and potential limitations to the principle of respect for autonomy in African communities.MethodsWe conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach.ResultsBased on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/Botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities.ConclusionsWe conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities.

Highlights

  • The Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms

  • RM56 shared the result of a study he conducted in this area: We conducted a study in South Africa, and we found out that almost 65% of the general population of South Africans that were going to public hospitals have no jobs nor a form of income, including grants

  • We wanted to see if we could implement via the empirical bioethics approach in African communities dominated by a culture of communitarianism and relational autonomy; this involves combining normative ethical analysis with empirical data, to arrive at results that would not be possible otherwise [16, 57, 58, 64]

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Summary

Introduction

The Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. Collective decision-making processes take precedence over individual autonomy or consent This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. Aside from human development, further reductions in mortality rates in human populations require advances in medical technologies, medications, and vaccinations. To achieve such advances, biomedical research has to be undertaken in human populations to determine the safety, efficacy, and cost-effectiveness of these interventions. To provide this evidence base, human participants are required for randomised controlled trials and studies using other designs. The Khoisan people of South Africa recently developed their code of ethics, motivated by the fact that much biomedical research has been conducted in San communities without obtaining proper consent from the San leaders [1, 2]

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