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This book is an attempt to explore the ethics of public health, specifically, ethical issues with clinical trials; it is also a reflection of the wider area, and research interest forays I make in the broad field of bioethics. In it, I aim to re-conceptualize responsibility in clinical trials with the insight of the African notion of self. I strive to complement scholarly literature dealing with cross-cultural biomedical ethics, and emphasize the African perspective which is rare or even non-existent in many cases. It has become obvious that the assumptions implicit in the Western framework that makes claim to universal validity about research ethics are not shared by non-Western cultures. If not reined in, the concern seems to be that the Euro-American approach is bound to globalize a less than global view of the world and reality. In other words, the mainstream research ethics which is grounded on principlism is itself inherently linked to Western individualistic notions of personhood, whereas the rest of the world, particularly Africa, sees the person not as an isolated individual, but as a part of the community who is embedded in kinship, group, community and the environment. While opposing individualism (a Euro-American mantra), the African perspective stresses communitarianism. By definition, the communalist philosophical view point instantly recognizes that ethical issues with biomedical studies are far more broad-based than the four principles of autonomy, beneficence, non-maleficence, and justice. In other words, there is need to establish a higher tier of ethical principles to cater for research ethics protection at the level of communities as well as the physical environmental level.
Some specific topics discussedThis book presents a tripartite thesis: ‘responsibility’, ‘clinical trials,’ and ‘personhood’ (specifically, the African notion of personhood). The challenge was to harmoniously blend these seemingly disparate themes (full-fledge concepts in their own rights), to justify why it makes sense to analyze them together for my purpose. The study structure and rationale therefore was cognizant of the need to establish the intersectional standpoints and the confluence between the three arms of the project .
With the philosophical dimension of ‘African personhood’ as a third panel to the equilibrium, I wish to provide a perspective of what responsibility can mean in an African context and then apply that understanding to biomedical clinical trials with human subjects. The overall analysis therefore follows through as the trifecta themes of responsibility, clinical trials, and African personhood, come to a full circle.
The formulation of what I have referred to as the ‘BEC Principle’ excites me the most. Bio-eco-communalism, or BEC, like the concept of one-in-all, refers to the inseparability of the individual within his/her community and the environment. I have used it to argue that when clinical trials (much of which are currently conceived in the Global North) involve other cultures (particularly Africa – in the Global South, where many of the trials are often offshored to), there is need to frame and apply some additional considerations. The status quo (Principles of Research Ethics) is deficient in multicultural settings because of its over emphasis on individualism. As I have articulated in the book, the philosophical/cultural significance of the person in the African setting differs markedly from the Western perspective. I therefore see my suggestion to re-conceptualize responsibility from an understanding of the African perspective as a landmark point at which to address myriad publica health issues one of which responsibility in clinical trials in one; and to provide a path to head off unnecessary philosophical, cultural and ideological tensions that are still lurking ahead.
The crux of my re-conceptualizing project is as follows: when communalist principle (personhood within the context of the community and his milieu) is applied to the public health sphere, at least two outcomes are immediately discernible. One, because of the interconnectedness and interrelatedness of human persons (and indeed of everything else in nature) whatever happens to the individual happens to the community in which he belongs. The individual is integrally located and anchored in a mesh of relationships within the family, village and clan (living and dead), all of whom are primordial sources of that person’s physical, psychic, emotional, and spiritual existence – wellbeing or otherwise. By implication, if you are responsible for one, you are responsible for all (at least in some degree hence, I view it as a one-in-all paradigm or BEC). Research ethics is right, just, proper, and culturally sensitive so long as it expresses respect for communal relationships in which people both identify with each other and exhibit solidarity with each other.
Two, because of this communal disposition, it follows that almost every issue with the individual is correspondingly regarded as a communal affair, sometimes to the point that the family (or community) has a stake in becoming aware of another’s illness/wellbeing and having a role in the decisions regarding their treatment or upkeep -- a phenomenon that conflicts with the Euro-American proclivity to individual right to confidentiality. This comparative analysis should be a teaching moment for researchers, clinicians, bioethicists, students and academics as they confront the African perspectives on morality.
Relevance to the contemporary world:The perspective that I advance in my book is not radically novel. However, I have provided it some historical currency and made it relevant to the contemporary mind. For instance, I see the African ‘self’ (vital force) as a being that is hooked on a grid. The energy that he generates serves his individual needs, but it is also shared with other forces around him. But as the need arises, he supplements his individual energy as well with those of other elemental forces. In other words, existing as a power point in an interconnected network, he is a generator, a supplier as well as a consumer of the voltage energy of the distribution network. The African ‘person’ is capable of these interpersonal dynamisms due to his elemental attributes of being a vital force who is imbued and animated with a vital principle and above all, is anchored in the communal operations of other forces. As such, he is a force in the hierarchy of forces, habitually in intimate consanguinity with other forces above and below him. Therefore, the fulfillment of his life is predicated on the support of other forces (humans, spirits, the biota, etc.). As a consequence, consideration for the community of other forces is always in the mix whenever ethical, juridical, ontological, epistemological, and other decisions are made. It is upon this platform that my reconceptualization stands.
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