Bioethics: an African perspective

In this paper I have attempted to open a window on an African approach to Bioethics — that of the Nso' of the Bamenda Highlands of Kamerun — from the vantage position of someone who has familiarity with both African and Western cultures. Because of its scientific-cum-technological sophistication and its proselytising character, Western culture, as well as Western systems of thought and practice, have greatly affected and influenced other cultures, particularly African culture. But Western culture, systems of thought and practice, have been highly impervious and immune to influences from other cultures, philosophies, systems of thought and practice, even where these might have been salutary and enriching to Western culture and systems. What I have here termed Nso' eco-bio-cummunitarianism clearly indicates a viable alternative world-view within which some of the bioethical perplexities and controversies of today might be more satisfactorily resolved than within a Western framework. I have further attempted to show, by way of example, how within such a world-view, abortion and suicide, for instance, would be disapproved of while euthanasia, in its etymological purity, is approved of.     

生命伦理学委员会

生命伦理学委员会是从伦理学角度审查人体试验研究,保护受试者权益的决策咨询组织。该委员会一般由来自法学、伦理学、医学、药学等领域的专家学者组成,其审查遵循的重要依据是世界医学会制订的《赫尔基辛宣言》。近年来,伦理委员会快速发展,但各伦理委员会审查质量参差不齐。因此,相关部门尚需加强对伦理委员会成员的培训,并加强对伦理委员会的监管,方能促进我国伦理委员会的良性发展。     

Bioethics and culture: an African perspective

The project of Bioethics seems to me to require paying attention to the cultural realities and assumptive frame of reference of different peoples. I assume that this must be one of the views of the organizers of this conference too and that this is why the idea of country reports is taken seriously. If I am right about this, then it makes sense for me to start my discussion with a very brief discussion of some aspects of the cultural realities of Africa with particular reference to the Yoruba of Nigeria. Then I will discuss how this world view raises issues for bioethics. Two aspects of people's worldview relevant to bioethical issues are their conception of the human person and their conception of cause. What they consider themselves to be, and what they consider to be the principles of causation will normally influence their attitudes to health and illness and their choices regarding health care. I will briefly discuss these issues with regard to the Yoruba worldview.     

Bioethics and biotechnology

Biotechnology is at the intersection of science and ethics. Technological developments are shaped by an ethical vision, which in turn is shaped by available technology. Much in biotechnology can be celebrated for how it benefits humanity. But technology can have a darker side. Biotechnology can produce unanticipated consequences that cause harm or dehumanise people. The ethical implications of proposed developments must be carefully examined. The ethical assessment of new technologies, including biotechnology, requires a different approach to ethics. Changes are necessary because new technology can have a more profound impact on the world; because of limitations with a rights-based approach to ethics; because of the importance and difficulty of predicting consequences; and because biotechnology now manipulates humans themselves. The ethical questions raised by biotechnology are of a very different nature. Given the potential to profoundly change the future course of humanity, such questions require careful consideration. Rather than focussing on rights and freedoms, wisdom is needed to articulate our responsibilities towards nature and others, including future generations. The power and potential of biotechnology demands caution to ensure ethical progress.     

Bioethics and law: a developmental perspective

In most Western countries, health law bioethics are strongly intertwined. This strong connection is the result of some specific factors that, in the early years of these disciplines, facilitated a rapid development of both. In this paper, I analyse these factors and construe a development theory existing of three phases, or ideal-typical models.
In the moralistic-paternalistic model, there is almost no health law of explicit medical ethics and the little law there is is usually based on traditional morality, combined with paternalist motives, the objections to this modal are that its paternalism and moralism are unacceptable, that it is too static and knows no external control mechanisms.
In the liberal model, which is now dominant on most Western countries, law and ethics closely cooperate and converge, both disciplines use the same framework for analysis: they are product-oriented rather than practice-oriented; they use the same conceptual categories, they focus on the minimally decent rather than the ideal, and they are committed to the same substantive normative theory in which patient autonomy and patient rights are central. However, each of these four characteristics also result in a certain one-sidedness.
In some countries, a third model is emerging. In this postliberal model, health law is more modest and acknowledges its inherent and normative limits, whereas ethics takes a richer and most ambitious self image. As a result health law and ethics will partly diverge again.     

Recombinant Identities: Biometrics and Narrative Bioethics

In recent years, there has been a growing interest in finding stronger means of securitising identity against the various risks presented by the mobile globalised world. Biometric technology has featured quite prominently on the policy and security agenda of many countries. It is being promoted as the solution du jour for protecting and managing the uniqueness of identity in order to combat identity theft and fraud, crime and terrorism, illegal work and employment, and to efficiently govern various domains and services including asylum, immigration and social welfare. In this paper, I shall interrogate the ways in which biometrics is about the uniqueness of identity and what kind of identity biometrics is concerned with. I argue that in posing such questions at the outset, we can start delimiting the distinctive bioethical stakes of biometrics beyond the all-too-familiar concerns of privacy, data protection and the like. I take cue mostly from Cavarero’s Arendt-inspired distinction between the “what” and the “who” elements of a person, and from Ricoeur’s distinction between the “idem” and “ipse” versions of identity. By engaging with these philosophical distinctions and concepts, and with particular reference to the example of asylum policy, I seek to examine and emphasise an important ethical issue pertaining to the practice of biometric identification. This issue relates mainly to the paradigmatic shift from the biographical story (which for so long has been the means by which an asylum application is assessed) to bio-digital samples (that are now the basis for managing and controlling the identities of asylum applicants). The purging of identity from its narrative dimension lies at the core of biometric technology’s overzealous aspiration to accuracy, precision and objectivity, and raises one of the most pressing bioethical questions vis-à-vis the realm of identification.     

Bioethics for clinicians: 8. Confidentiality

Physicians are obliged to keep information about their patients secret. The understanding that the physician will not disclose private information about the patient provides a foundation for trust in the therapeutic relationship. Respect for confidentiality is firmly established in codes of ethics and in law. It is sometimes necessary, however, for physicians to breach confidentiality. Physicians should familiarize themselves with legislation in their own province governing the disclosure of certain kinds of information without the patient''s authorization. Even when no specific legislation applies, the duty to warn sometimes overrides the duty to respect confidentiality. The physician should disclose only that information necessary to prevent harm, and should reveal this information only to those who need to know it in order to avert harm. Whenever possible any breach of confidentiality should be discussed with the patient beforehand.     

Chinese Traditional Bioethics

Chinese traditional bioethics is based on the life origin theory of “Qi (vital force) permeates everything under heaven”, the attitude towards life theory of “loving people” and “loving things”, and the life transcendence theory of “eternity” and “immortality”. The life origin theory answers the question of how life comes into being, which is the basis for exploring the mystery of life. The attitude towards life theory gives answers to the question of how to treat life properly and establishes the basic requirements and criteria for treating life. The life transcendence theory responds to the question of how to make life more meaningful. Those three thoughts support each other and explain each other with the inner logical band between these three basic thoughts, and tentatively offers a reasonable way for the reconstruction of traditional Chinese bioethics, which can be a special theoretical resource for today's bioethical research.