Open Journal of Philosophy
2013. Vol.3, No.4, 507-516
Published Online November 2013 in SciRes (
Open Access 507
Bioethics Education in Africa: Still Complex Challenges
Cletus T. Andoh
Department of Philosophy, University of Yaounde I, Yaounde, Cameroon
Received May 7th, 2013; revised June 5th, 2013; accepted June 15th, 2013
Copyright © 2013 Cletus T. Andoh. This is an open access article distributed under the Creative Commons At-
tribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
In recent times, bioethics has emerged as a burgeoning interdisciplinary field of scholarly investigation
which has in the past decades migrated from bedside consultations to public policy debates and wider
cultural and social conversations that privilege all discourse about everyday life issues. Today, bioethics
is increasingly seen as a field departing from a multi-disciplinary perspective to an autonomous discipline.
In most Western countries, the field is now more organized, complete with undergraduate minors and
majors, and even high school courses in bioethics, master’s degrees and doctoral programs, and profes-
sional associations. Also, there is a shift from a field populated by bioethics pioneers to a field made up of
bioethics professionals. However, in Africa the emergence and evolution of the field is still problematic as
bioethics is not yet an escalating discipline in the tradition of books, journals, classroom teachings and
conferences. In this paper, it is argued that the lack of an authentic discourse on the nature and contents of
bioethics, interdisciplinary research approaches, institutional and infrastructural needs and a critical mass
of African experts constitutes the major challenges to the teaching of bioethics in Africa. There is a need
to reinvigorate standards for teaching bioethics through a radical critique of traditional values, principles,
methods and a careful assessment of the new megatrends and challenges in science, technology and
Keywords: African Bioethics; Bioethics Education; Critical Thinking; Empirical Research; Ethics
Expertise; Interdisciplinary Research; Medical Ethics; Turning a Blind Eye
The new advances in science and the megatrends in health-
care management and delivery are irrevocably transforming the
nature and content of bioethics. As new innovation in science
increasingly transforms human wellbeing, concerns about its
applications are increasingly under serious scrutiny as there is
increasing awareness of the ambivalence of scientific develop-
ment. These advances in science are creating moral questions
that challenge accepted ethical thinking and require urgent an-
swers. Also, confronted with these advances, traditional modes
of understanding and teaching bioethics are proving incom-
mensurable with new developments and the dilemmas created.
This imposes the need for more critical and radical approaches
to the teaching of bioethics in Africa, as citizens will need to
make important decisions that affect their lives and society as a
Furthermore, academic bioethics programs have proliferated
Western universities and bioethics has been institutionalized as
an integral part of mainstream education in academia and the
task of teaching bioethics has increasingly become inescapable.
Bioethics education within Africa is still sub-marginal and in-
sufficient due to the fact that it is not yet an escalating disci-
pline in the tradition of books, journals, classroom teachings
and conferences. The field has not yet had any considerable
recognition and penetrance in academia as it is not yet a vibrant
field in terms of scholarly presentations, publications and learn-
ing in academic institutions and educational system in Africa.
There is an insufficient scholarly intellectual recognition of the
field in Africa as no major steps are being undertaken to insti-
tute and initiate the teaching of bioethics in schools and univer-
sities. Bioethics is yet to be recognized by most African gov-
ernments as a legitimate field of scholarly investigation.
Added to the forgoing, there is greater recognition and routi-
nization of the field’s proactive and critical stance in the aca-
demia, the polity and the media in Western countries. In Africa,
bioethics is not yet proactive but has remained diminishingly
reactive, corrosive and evanescent as it is not yet institutional-
ized and legitimized in academia. There are no experts or
trained professional bioethicists in Africa to support the pro-
duction of high quality journal articles and there are almost no
published books on bioethics by African scholars that can en-
courage the development and production of research within the
continent. A critical investigation of the status of bioethics in
Africa reveals that bioethics education and ethical concerns
have unwittingly been unrecognized, downplayed or overlooked
by local governments in Africa for the past fifty to sixty years
of its existence. This situation is unacceptable considering the
fact of the influence of bioethics as the most important field
that serves and protects the wellbeing of humanity. Its impact
on the lives of Africans and the future of bioethics education in
Africa is characterized by ambiguity and uncertainty. Africans
are increasingly confronting bioethics issues without sufficient
expertise and this imposes the needs for new and critical ap-
proaches to bioethics education to raise students’ awareness and
enable African scholars to assess these advances in an ethical
manner. This need is of utmost urgency for Africa today since
we need to recreate ethical life and standards.
Methodological and Interdisciplinary Research
Bioethics has now evolved to an interdisciplinary field of
scholarly investigation on every aspect of life, and this trans-
forms it into a disparate discipline that uses different methods
and approaches. As new scientific innovations moves forward
introducing complex challenges or sophisticated problems, the
need for an expansion and broadening of the scope and horizon
of bioethics became acute requiring inputs from different ex-
perts from various disciplines. As interdisciplinarity becomes
fundamental in bioethics attracting different practitioners, there
is conceptual boundary crossing and crosstalk as the borderlines
and intersection between the human, social and exact sciences
are blurred. In this current context, research and decision mak-
ing becomes complex due to the methodological convergence
or the synergistic combination of empirical and theoretical
methods to investigate facts and beliefs. Interdisciplinary re-
search is a reality on most campuses of Western universities as
academic bioethics programs proliferates these institutions and
this creates the challenge to know if this burgeoning teaching
approach to education is possible within Africa and if not what
is required to enable bioethics education in this form develops.
Bioethics is complex and multifaceted, drawing on philoso-
phy and law as well as science and medicine (Schaller, 2008).
Many bioethical works express what seems to be a rather wor-
thy objective, notably, of investigating ways of making people
better or making better people. Conceivably, this invites a pretty
broad approach to the question of how we achieve greater
health, happiness, and the living of the good life (Priaulx, 2011).
Initially, works in bioethics used a normative analysis of bio-
ethical issues, arguing for or against the moral permissibility of
a particular technology, practice, or policy. Around the 70s,
physicians and lawyers became involved and started making
normative claims about bioethical issues. But by the mid 90s,
bioethics attracted scholars from varied disciplines, among
which were social scientists and empirically trained clinicians,
both physicians and nurses and this transformed the “methods”
of bioethics. Much bioethical work today has taken “an empiri-
cal turn,” featuring social scientific perspectives on relevant
issues and behaviors.
The shift of bioethics research from normative analysis to
empirical study is not in order to curtail the former, but rather
to make the field more practically based in the generation, pres-
entation and analysis of its vital evidence. In this approach the
gap between normative and empirical analysis become an arti-
ficial one. The boundaries between them are blurred in much of
the relevant work as they share interests in the conceptual, cul-
tural, political and practical aspects of the social world (Haimes,
2006). Empirical research provides the data upon which norma-
tive judgments are made: Moral theories, informed by facts,
judge practices. In this context, researchers collaboratively are
actively engaged in exploring the dynamic interplay of psycho-
logical, social, cultural, cross-cultural, and biological factors in
health, illness, and care; in studying the experiences, feelings,
and behavior of patients and families, doctors and nurses; in
describing and analyzing the attributes and impact of the hospi-
tal as a social world; and in observing and delineating the so-
cialization process through which medical students were pro-
gressively transmuted into physicians (Fox, 1999).
From Percival to the present day, medical ethics and its dis-
courses always privilege professional medical perspectives. In
striking contrast to medical ethics, bioethics is a multidiscipli-
nary field addressing ethical issues in the biomedical sciences,
as well as in health care, without privileging physicians’ (or
scientists’) conceptions or discourses—hence bioethicists’ in-
sistence on a non-professional presence on hospital ethics
committees and their emphasis on concepts like autonomy and
respect for persons as a counterweight to professional authority.
In the multidisciplinary context, members are united by the
common purpose of analyzing, researching, studying, and/or
attempting to address, mediate, and/or offer solutions, or reso-
lutions to ethical problems arising in biomedical science and
healthcare. The multidisciplinary nature and anti-elitist stance
endemic to bioethics creates significant challenges to the pro-
fessionalization process and is a factor in the cautious approach
bioethics organizations have taken towards professionalization
(Baker, 2009).
Interdisciplinary research is defined as bringing together dif-
ferent disciplines to focus on a circumscribed problem, but
keeping the disciplines distinct. It is a mode of research by
teams or individuals that integrates information, data, tech-
niques, tools, perspectives, concepts, and/or theories from two
or more disciplines or bodies of specialized knowledge to ad-
vance fundamental understanding or to solve problems whose
solutions are beyond the scope of a single discipline or area of
research practice. The virtue of this is that the strengths of one
method may help overcome the limitations of another, while
using two or more methods in any specific research project will
help to build up a richer data set (Pickering, 2008). Researchers
work as part of multidisciplinary teams, informing theory with
data and orienting descriptive studies to help find solutions to
knotty normative questions (Sugarman & Sulmasy, 2010).
Interdisciplinary research takes bits and pieces from the con-
tributing disciplines and integrates them in ways that produce a
new conceptual framework. For instance biomedical research
today would include experts from different specialties such as
clinicians, social scientists, lawyers, epidemiologists and phi-
losophers. In the bioethics landscape, a whole range of different
disciplines engage with a research question. The field is com-
prised of practitioners from medicine, philosophy, theology,
law, nursing, social psychology, epidemiology, health services
research, medical history, medical anthropology, medical soci-
ology, economics and related fields all working in the field of
bioethics (Sugarman & Sulmasy, 2010). Bioethics entertains
relationship with literature, history, religion, philosophy, law,
economics, the social sciences and policy.
Interdisciplinary research approach in bioethics emphasizes
the use of empirical methods to study the role of empirical re-
search in bioethics, and how empirical findings could be used
in ethical analysis. The empirical turn in bioethics has brought
the methods of the human and social sciences into an explicit
dialogue with those of normatively focused analytic applied
philosophy (Emmerich, 2011). Researchers may use empirical
or hypothesis-based methods (similar to science) and theoreti-
cal or principled-based methods (as in traditional philosophy).
Researchers using empirical methods in doing normative bio-
ethics wish to understand “how knowledge about what is can be
helpful in deducing what ought to be done?” Empirical methods
in bioethics investigate the ways in which data generated by
empirical research can be relevant to bioethical thinking and
Open Access
regulation concerning health care and human use of biotech-
nology (Holm & Jonas, 2004). Due to the methods, empirical
research has grown substantially as a tool for normative ethics
and public policy. It has helped elucidate the magnitude of
specific issues, explore the beliefs and experiences of stake-
holders, and counter erroneous empirical claims of existing
policy positions. Empirical approach seeks to collect empirical
data needed to shed light on a bioethical problem, or it attempts
to stand outside the discipline in order to study the field itself.
Projects use either qualitative or quantitative social science
methodology to collect data needed to make persuasive bio-
ethical arguments.
Qualitative research is used broadly to refer to text-based,
non-statistical methods. Generally, qualitative methods involve
asking open-ended questions of a relatively small number of
informants to gather data to address particular research ques-
tions. Although qualitative data can be gathered to test hy-
potheses, more typically the research questions addressed by
qualitative methods are discovery, descriptive, and explorative.
Qualitative methods expand understanding of what types of
experiences, beliefs, or attitudes exist. Meanwhile, quantitative
methods are most appropriate when some previous understand-
ing of phenomenon exists; they are used to estimate the propor-
tion of individuals with particular experiences, beliefs, or atti-
tudes and to explore statistical associations between these ex-
periences, beliefs, and attitudes (i.e., outcomes) and various
socio-demographic characteristics or other hypothesized pre-
dictors of such outcomes. Accurate estimates generally require
conducting research with larger numbers of respondents (Tay-
lor, Hull, & Kass, 2010).
Yet, decision making in bioethics is deeper and more than
just the methods of qualitative and quantitative inquiry. The
fact is ethical deliberation and explanations go deeper than
simply providing interesting data for bioethicists to examine.
Bioethicists test to what extent the different claims made by
practitioners “that something is right” are actually justifiable, or
are sound, consistent, and based on good reasons. It is for this
reason that we must continue to examine such research with
caution and use deconstruction and deliberation to spot out
fuzzy thinking and demolish bad arguments before establishing
it validity. We must spot out the logical fallacies, disambiguate
the meaning of propositions, criticize definitions, map the logi-
cal structure of arguments, and pinpoint their missing premises
and flawed inferences. We must be attentive to the fact that
research is done rigorously, we must scrutinize conclusions for
their soundness, and we must be vigilant that we do not inad-
vertently use empirical findings to justify practices that are
morally objectionable (Braddock, 2010).
Bioethics research recognizes the fact that the empirical
method has its place since it can help sharpen and accurately
focus the dimensions of an ethical challenge or bring clarity to
core premises and assumption of an argument, but rigor can
come in many forms. Although carefully conducted empirical
studies can help elucidate facts, there is need to carefully scru-
tinize research findings to ensure that researchers do not con-
flate “is” with “ought” or “the naturalistic fallacy” which flows
from the observation that the moral rightness of actions cannot
be justified simply by the observation that such acts are com-
mitted, no matter how common. Also, empiricism should not be
confused with good academic work. It is important to appreci-
ate that many of the best designed empirical studies will fail to
answer important value questions and that bioethics without
such questions is really, nothing at all. If all our studies resulted
in an objective outcome, even success would mean failure be-
cause we had limited our inquiry to questions that would result
in bite-sized answers (Fins, 2010).
However, the interdisciplinary approach to research poses
challenges to bioethics as different experts in the field attempt
to propose solutions. John Coggon writes that, there can be
difficulty in finding sound resolution between the competing
perspectives. Where fundamentals differ, we face apparent
deadlock, with theorists seemingly able only to talk across each
other. He further writes that what becomes clear is the great
unlikelihood of finding a methodology for bioethics. It com-
prises too many analysts from too many backgrounds (Coggon,
2011). Which discipline (or method) would be capable of doing
which job? And how can different approaches and their contri-
butions be integrated without stepping into an “anthology trap”
of just referring to a variety of historically developed methods
(from consequentialism to deontology, virtue or discourse eth-
ics, care or narrative approaches) one after the other, leaving
people simply faced with the different results and thereby jetti-
soning the clarifying and guiding role of ethical investigation?
(Rehmann-Sutter, Düwell, & Mieth, 2006).
What is the state of the art of interdisciplinary scholarship,
education, and service in bioethics in Africa? With the increas-
ing use of empirical method in bioethics and the quest for more
objective evidence through qualitative methods, numbers, it
seems, have replaced values, and because of that, much of our
deliberations have become impoverished. Further still, there is
need to make clear the boundaries that ought to guide interdis-
ciplinary research in bioethics and ensure that the autonomy of
research disciplines are always respected and understood in
authentically interdisciplinary research. Moreover, interdisci-
plinary research is a challenging and complex domain where
Africa is still to introduce and integrate in its programs. Its
interdisciplinary nature necessitates mastering an extremely
broad area of knowledge which bioethics in Africa still needs to
improve its scholarly standards. Its complex, indeterminate,
interdisciplinary and multidisciplinary character creates con-
ceptual and theoretical challenges to it teaching, as well as, the
need to define it object and scope.
The challenge of combining the empirical and theoretical
approaches of research in Africa and for African researchers to
integrate interdisciplinary approaches to resolving dilemmas in
scientific research and their application is the most daunting
task for researchers within the African context. Also, the chal-
lenge to conflate is with ought to this methodological mix re-
main the vital problem that burden research in the interdiscipli-
nary context. African institutions have not yet develop the theo-
retical and normative frameworks for assessment-making and
evaluation of interdisciplinary research that integrates different
methodologies. Additionally, assessment faces serious chal-
lenges in providing reliable, well-communicated, and policy-
neutral but policy-relevant aggregation of knowledge in science,
technology and medicine. Bioethics in Africa is still largely
empirically uninformed as it is still limited in terms of approach
and methodology in this interdisciplinary or multidisciplinary
nature of the field and the challenges of doing research with
different values and research methodologies. There is little
systematic treatment of this area from a cross-disciplinary and
cross-cultural perspective. Africa still lacks the technical
know-how, human capacity, knowledge on various research
methods or approaches of teaching bioethics and sound training
Open Access 509
in different disciplines which can make interdisciplinary re-
search more productive and relevant for bioethics in the conti-
Relevance of Teaching Bioethics in Africa
The purpose and aims of education or of any educational ini-
tiative are to increase and improve human knowledge, virtue
and responsibility. Bioethics education is an essential tool for
character development, knowledge, skills and behavior that
serves to enrich students’ moral sensibilities. Its pedagogic
goals are to enable students identify conflicts of values, in-
crease their sensitivity to morally perplexing issues, improve
their understanding of their own values, and to deal more
openly with bioethical dilemmas. It offers better reasoned re-
sponses, and provides the context to explore more thoroughly
the implications of different courses of action before taking
action. Studies have demonstrated that certain outcomes im-
prove as a consequence of bioethics education. The existing
literature shows that learner awareness, attitudes, knowledge,
confidence, decision making, and, to some extent, moral rea-
soning improve with educational interventions. As such, teach-
ing bioethics becomes a moral imperative for Africa as long as
new breakthroughs in science, technology and medicine con-
tinue to offer new possibilities and capabilities to humans to
alter their lives, environment and improve their well being.
To many of these scientists, moral objections to their works
are not valid especially as science by definition is neutral, so
any moral judgment on it simply reflects scientific illiteracy.
However, in spite of the confidence in the power of modern
scientific technology today and the claim to it value neutrality,
awareness of its ambivalence has grown considerably. Human-
ity is becoming more conscious of the fact that innovations are
potentially harmful or can pose serious risks which raise serious
ethical questions about their use, the protection of members of
society from harm and to secure the conditions of its preserva-
tion that confront Africans every day. New developments also
create situations for Africans to make serious decisions about
their lives. Should they allow this or that kind of innovation
without understanding the potential harm from the benefit?
How can they understand and evaluate costs and benefits asso-
ciated with scientific advances?
There is also the realization that certain innovations are be-
coming unpalatable and leading to moral panic on science or the
fear of a “slippery path” which is if science is not reined in now,
it will cross red lines in the future. As such, something might be
scientifically possible but unethical to do and this calls for in-
creased prudence and caution. Also, there is the realization that
there are no standards to regulate and guide the progress and
this creates a need to reinvigorate standards for teaching re-
search ethics within Africa. Confronted with these challenges,
the aim of bioethics is to reflect on the implications of progress
before it is too late to do so. Another challenging issue is the
fact that African students are seldom exposed to teachings and
courses addressing ethical questions and principles which im-
plies that they lack the skills to anticipate potential harm to
their lives and society that can arise from scientific activities or
Furthermore, in spite of the exponential growth bioethics
education is experiencing in the world scene today, there is a
noted low growth of bioethics in Africa as bioethics education,
teaching and understanding of its processes and challenges to
our lives and communities are still sub-marginal. There is a lack
of infrastructures to match today’s progress in bioethics; a gen-
eral lack of training to bring about leadership and lack of pro-
grams to foster the development and growth of bioethics educa-
tion in Africa. This situation is unfortunate, considering that
various research that aim at finding solutions to the multiple
problems affecting our communities and the need to address and
assess these problems in ethical terms are of crucial importance
to us.
Further still, when most research is conducted by researchers
from developed countries and in Africa in particular, the social,
cultural and economic context of the research has a major
bearing on ethical conduct of research. African views on the
ethics of this research are neither sufficiently developed nor
heard. In most debates both sides are represented almost exclu-
sively by researchers and bioethicists from the developed world,
even though this is an ethical issue of crucial importance to
Africa. To confront and overcome these challenges, African
countries need to develop human, institutional and infrastruc-
tural capacities to enable them address optimally the new
megatrends in medical technologies and the bioethical chal-
lenges created. Africa needs experts to combat most ill in-
formed challenges facing the continent in the face of challeng-
ing diseases and limited health facilities. There is the need to
design courses and introduce their teaching at undergraduate
and graduate levels in universities so that students are exposed
to current bioethical issues which enable them acquire tools to
address ethical issues in professional life and raise their aware-
ness concerning responsible conduct of research (Turrens,
Since we must determine what is acceptable or not, in the
light of our values and cultures, bioethics education provides a
real-world context for introducing and underscoring the “need
to know”. Knowledge of bioethics can inspire students to gain a
deeper understanding of scientific facts so they can make
well-reasoned ethical arguments. The most dominant approach
to teaching bioethics to students in the humanities, social sci-
ences and sciences has been founded on some combination of a
philosophical approach and practical problem solving. This
teaching approach is a dynamic balance between conceptual
analysis and the concrete engagement of cases. In most con-
temporary work in medical ethics it is divided into three parts:
ethical analysis and arguments of large-scale issues in science,
practice and policy (such as consideration of the ethical issues
concerning cloning or resource allocation); theoretical inquiry
into the foundations of medical ethics; and practical analysis of
particular dilemmas in clinical practice (Ashcroft, Parker, Verk-
erk, & Widdershoven, 2005). In the philosophical approach,
some versions of principles or duties, either deontological or
utilitarian are used.
Meanwhile, other versions such as virtue, narrative, casuistry
and feminist ethics are also utilized. In this approach, groups of
students are provided the opportunity to research, analyze, dis-
cuss, and propose public policy on emerging topics in bioethics
(Harwood, 2004-2005). The purpose is to develop in students
the capacities for values clarification; Clarification of reasoning;
Listening to others; Understanding human relationship; Pro-
moting creativity; Strengthening moral conviction. The practi-
cal “case and issue” based approach is reinforced by the tradi-
tional healthcare teaching model in which knowledge is passed
on through a series of case encounters (Liaschenko, Oguz, &
Brunnquell, 2006). Here activities are highly participatory and
Open Access
inquiry-guided as students are encouraged to integrate abstract
concepts with concrete reality and to develop essential skills in
critical reasoning. Small-group work and collaborative teaching
involving bioethicists and clinicians are the effective strategies
for case-based teaching. Brief lectures, short readings, case-
based teaching sessions, discussion forums, and assignments
constitute the teaching approaches. Also, students explore mul-
tiple possibilities/solutions and experience making decisions
which sharpens their interpersonal, communication, and moral
reasoning skills. This is justified by the fact that, morality is
something that is learned through clarification of our values and
application of these values to cases.
A careful study of the pedagogic approaches adopted in most
medical faculties in universities and medical schools in Africa
indicates that the “case and issue based” approach to teaching
bioethics to medical students is still insufficiently developed.
Much still need to be done to enable students learn the impor-
tance of demonstrating compassion, caring, and respect in their
interactions with patients, families, and colleagues. Meanwhile
non-physician medical ethicists or bioethicists do not form part
of the teaching staff in these medical faculties and schools.
There is an apparent lack of rigor as students are not encour-
aged to engage into lengthy or extended discussions about
ethical principles and conflicting values at stake in the care of a
patient. In most instances, the impression is that ethical think-
ing is a routine and mechanical business, which collapses into a
vulgar utilitarianism over any other concern as ethics seems to
have become excessively simplified. The medical literature on
the ethics of the profession and ethical principles are neither
expansive, nor current, and those students reading them are
those who have a particular interest in the history of medicine.
This situation rarely invites critical inquiry into distinctions
between what is customarily done and what ought to be done
based upon standards, values, and priorities that reflect the
larger society and not merely the insular perspective of the
practitioners of the profession. In this light, bioethics education
has made no major impact on the health care delivery systems
in general in Africa. Additionally, coupled with defective
healthcare systems, appalling infrastructures and inefficient
healthcare management and paucity of new healthcare tech-
nologies, facilities and methods, healthcare education is largely
beyond standards. The content of medical ethics and ethics
education remain insufficient and questionable to the extent that
upon graduation the delivery of medical care and kind of care
administered to patients (the ability of doctors to care for their
patients as individuals) and the relationship medical doctors
entertain with their patients especially in the African context
characterized by lawlessness is so sub-marginal. Medical edu-
cation or medical ethics, and more particularly its inclusion in
the medical school curriculum, still has to “come of age” in
Bioethics education and teaching are today gradually ori-
ented towards forms of education through professionalism, in
terms of virtue ethics, cultivating altruism, respect of the per-
sonality of the other, honesty and integrity, responsibility and
dedication to the fulfillment of one’s duties, as prominent vir-
tues. In the last decade, dozens of ethics centers and programs
devoted to “business ethics”, “legal ethics”, “medical ethics”,
and “ethics in public policy” have sprung up. These centers are
designed to examine the implications moral principles have on
our lives. The standard bioethics teaching scheme of classifica-
tion which essentially attempts to carve up the field according
to the schools of moral philosophy: Consequentialism, deon-
tology, communitarianism, virtue ethics, feminist ethics, care
ethics, and so forth. It was commonplace for anthologies used
in bioethics courses to include a section on medical paternalism
and its errors. For example, one of the first and most widely
used anthologies, Moral Problems in Medicine, had a section
devoted to paternalism with eleven selections. In addition, the
first edition of Principles of Biomedical Ethics made medical
paternalism a central focus (McCullough, 2011). Most teaching
programs aim at introducing students to various normative and
meta-ethical theories (cultural relativism, emotivism, subjectiv-
ism, utilitarianism, social contract, and Kantianism).
The most fundamental and surreptitious goal of bioethics
education has been outlined as: to evacuate ethical decision-
making of its ambivalence and discomfort, and to offer a set of
best-practice guidelines to produce ethical “outcomes,” to pre-
empt lawsuits, and to safeguard the putative goodness of one’s
good conscience (Murray & Holmes, 2009). The real struggle
to arrive at an ethical outcome compels the direct participants to
dig down into their underlying moral assumptions. They must
bring to the surface what they find most valuable and most
meaningful. As such, bioethics education aims to nurture the
development of moral sensitivity, perception, judgment and
capacity for action, which will sustain moral agency and ethical
practice. The purpose of bioethics education is to provide in-
formation regarding bioethical issues and knowledge of those
issues so as to raise students’ level of awareness and sensitivity
to ethical problems. It aims at enhancing students skills about
normative ethical judgments and promote behavior change.
Also, it is to teach students methods of reasoning and logical
argument (Itai, Asai, Tsuchiya et al., 2006). It also aim to
stimulate moral sensitivity, respect for the patient’s autonomy,
instead of the earlier paternalism, attainment of consent, devel-
opment of analytical skills in moral reasoning and morally jus-
tified decision-making.
It enables students to be able to construct reasoned argu-
ments to support their positions on the ethical and social impact
of advances in science, technology and medicine. One of the
intellectual skills expected is “recognizing the moral and ethical
issues of investigations and appreciating the need for ethical
standards and professional codes of conduct”. The target in
bioethics education is to enable students develop content
knowledge and reflective processes that facilitate the explora-
tion of morals or values analysis. It aim to develop in students
skills for developing “informed choices” and to cultivate re-
spect for persons, minimizing harms while maximizing benefits
and fairness as they encounter and confront ethical choices in
their daily living. Bioethics education can influence students to
ground bioethics in human dignity, autonomy and ultilitarian-
ism. Students develop competence in a kind of reasoning about
ethical issues encountered in day-to-day practice. As observed
by some teachers, competence in identifying ethical dilemmas
in our own practice is also viewed as a manifestation of a suc-
cessful ethics education.
Furthermore, the study of bioethics can encourage important
critical thinking which develops a sense of responsibility and
problem solving skills. Bioethics activities emphasize the im-
portance of justification, a process of giving reasons for views.
Critical thinking capacity is essential for empowering persons
to cope with changing times and encourages active engagement
in the deliberation of issues in the areas of medicine and bio-
technology. It develops the ability to make well-informed and
Open Access 511
well-considered judgments, the ability to understand and evalu-
ate arguments, the ability to make well reasoned decisions, and
the tendency to be fair-minded. As Darryl Macer puts it: critical
thinking should not only promote the creation of ideas but also
the formation and adoption of humane moral values while
treating patients, or while forming social decisions with regard
to human health and life (Macer, 2008). It is a process that in-
volves the analysis of concepts and arguments and the interpre-
tation of concrete data or evidence, which requires capacities
for self-criticism, moral imagination, and empathy (Memeyer,
As such, developing the capacity for critical thinking in stu-
dents becomes a legitimate and valuable goal for teaching bio-
ethics in various scientific fields and in the humanities and
social sciences. It equips students with concepts, cases, fact
sheets, and teaching strategies that will help them examine
crucial questions and critically analyze problems in a more
careful and nuanced way. The introduction of this process into
higher educational system in Africa would train and empower a
critical mass of African experts. However, the question of
whether there exist experts in ethics or bioethics has been an
issue of serious debate. Not only do many authors disagree on
whether ethics expertise exists, they disagree on what it is.
A host of salient questions have been raised on the issue of
ethics expertise and they include: 1) How does ethics expertise
relate to morality and ethics in general? That is, does an ethics
expert possess moral wisdom in the sense of knowing the truth
about the right and the good? 2) What kind of training gives
one ethics expertise? Is it only graduate school education in
philosophy or theology? 3) What kind of political or legal au-
thority does an ethics expert possess? If an ethics expert advises
on government policy, are policy makers mistaken to override
that advice? Would a bioethics consultant’s expert opinion be
sufficient to override the wishes of others, including the patient
or family member? Even if that were illegal, would it be unwise,
morally speaking? 4) How (apart from credentialing dependent
on question 2) can the rightness of an ethics expert’s opinion be
assured? On what basis can it be challenged? (Rasmussen,
By expert in bioethics, it should be understood as those en-
dowed with special and some normal faculties in an extraordi-
narily high dose. Experts in bioethics comprise those who have
certain competences and mature knowledge of ethical theory,
the relevant facts and moral codes in different societies and the
ability to justify coherently moral judgments. They exhibit the
qualities listed by Peter Singer: 1) ethicists are familiar with
moral arguments, 2) they can infer correctly, 3) they are famil-
iar with moral concepts 4) they are able to study moral prob-
lems more deeply and over more time than other people, 5) they
have the ability to empathize with other people (Singer, 1972).
Additionally, they have some self-awareness, which means they
can discover and defeat their own prejudices.
However, they are not experts in the weak sense but experts
in the strong sense. Bernward Gesang describes ethicists of the
weak sense of expertise as those who have knowledge in certain
areas, because they can justify their judgments well and be-
cause they have reached a certain level of education. Mean-
while, people are called experts in the “strong sense” if their
judgments are correct with high probability and for the right
reasons. They need not have a special quality of knowledge
that the person on the street can never access. (Gesang, 2010).
They are the persons to develop teaching programs and intro-
duce bioethics in school curricula. Also, they have to engage
students into critical thinking and active engagement or par-
ticipation in shaping social policies. This will enhance student’s
ability to see the ethical dimensions of a given situation. The
ability of students to distinguish an ethical question from other
kinds of questions, such as legal, scientific, or personal-pref-
erence is crucial for bioethics education.
This goal of teaching bioethics is to raise the moral sensibili-
ties or moral imagination of students to think about choices
from a variety of viewpoints and interests, and to think on their
own since conscious thinking and participation are the hall-
marks of democratic citizenship (Kohlberg, 1981). Moreover,
bioethics is in most Western countries a dynamic, multidisci-
plinary field with several dedicated journals, a national organi-
zation, and numerous centers and institutes. Yet in most Afri-
can countries most of these instruments that give bioethics le-
gitimacy are still lacking. To salvage this crucial problem, ex-
perts can train and encourage African researchers to write and
publish books and initiate journals centered on African bio-
ethics and in which works bringing out African approaches and
specificities are published.
A conceptual framework for the introduction and teaching of
bioethics at the undergraduate levels in universities in Africa
would consist at addressing the following issues: What is ethics
(descriptive ethics, normative ethics, analytic ethics or meta-
ethics)? Make a distinction between what is often taken to be
the three main theories of ethics—utilitarianism (or more
broadly, consequentialism), deontology and virtue ethics. De-
velop understanding in communitarian ethics and values (Afri-
can communitarian ethics) (Andoh, 2011), culturally relevant
bioethics for Africa, the role of bioethics in medical education
in Africa and intercultural bioethics. What is morality and how
is morality distinct from ethics? What ethics is NOT:
Ethics is not the same as feelings: Feelings provide important
information for our ethical choices. Some people have highly
developed habits that make them feel bad when they do some-
thing wrong, but many people feel good even though they are
doing something wrong. And often our feelings will tell us it is
uncomfortable to do the right thing if it is hard.
Ethics is not religion: Many people are not religious, but
ethics applies to everyone. Most religions do advocate high
ethical standards but sometimes do not address all the types of
problems we face (Velasquez et al., 2009).
Ethics is not following the law: A good system of law does
incorporate many ethical standards, but law can deviate from
what is ethical. Law can become ethically corrupt, as some
totalitarian regimes have made it. Law can be a function of
power alone and designed to serve the interests of narrow
groups. Law may have a difficult time designing or enforcing
standards in some important areas, and may be slow to address
new problems.
Ethics is not following culturally accepted norms: Some cul-
tures are quite ethical, but others become corrupt or blind to
certain ethical concerns (as the United States was to slavery
before the Civil War). “When in Rome, do as the Romans do”
is not a satisfactory ethical standard.
Ethics is not science: Social and natural science can provide
important data to help us make better ethical choices. But sci-
ence alone does not tell us what we ought to do. Science may
provide an explanation or facts for what humans are like. But
ethics provides reasons for how humans ought to act. And just
because something is scientifically or technologically possible,
Open Access
it may not be ethical to do it (Velasquez et al., 2009). Graduate
program for bioethics education include: Research ethics,
medical ethics, reproductive ethics, end-of-life ethics, medical
law, clinical bioethics, moral reasoning, genetics, transplanta-
tion, neuroethics, pharmaceutical ethics, disability bioethics,
animal biotechnology and environmental ethics.
From the above, it can be seen that ethics is not a set of spe-
cific, immutable, unchanging laws applied the same way today
as a hundred years ago. Rather, ethics stem from values and
beliefs whose expression continues to evolve as they are in-
formed by advances in science, politics, art, culture, and society.
New developments cause us to reconsider previously held as-
sumptions, comparing them with our values and, at times,
changing our notion of how those values should be expressed.
Students are challenged to make a demarcation between ethics
and other disciplines and to provide justification or reasons for
their positions. Students’ skills should be developed on the
distinction between procedural and policy issues, foundational
issues and substantive bioethical concepts, problems and di-
lemmas that constitute the field of bioethics.
Also, emphasis should be laid on the fact that in the profes-
sional development of bioethics in the past fifty years, a sub-
stantial body of knowledge has emerged. Such knowledge not
only provides a global frame of reference for bioethical deci-
sion-making, it also provides information, analysis and clarifi-
cation that will be useful for interpreting and discussing cases,
problems and policies in specific cultural, religious and politi-
cal contexts. Moreover, a case based approach, which is teach-
ing to real life or by basing teaching on cases students can rec-
ognize from their own experience, or which they might en-
counter later on in their professional life, should be integrated
in the teaching of bioethics in Africa.
Challenges to the Teaching of Bioethics in
According to Catherine Myser, bioethics is currently taught
around the globe. She writes that in developing and developed
countries alike, educators are taking on the challenges of iden-
tifying and developing the most appropriate objectives, content,
methods and assessment strategies to teach bioethics (Myser,
2001). Despite the fact that bioethics education has become an
integral part of undergraduate and graduate teaching programs
taught around the globe, in Africa, bioethics education and
training programs in high schools, undergraduate and graduate
levels are still lacking. Within Africa, bioethics is still seen as a
new discipline and by nature interdisciplinary, and many of
those to teach it still lack the training in the didactic approaches
of the field.
In most African countries and educational system, the field is
still considered new and bioethics education is underfunded and
lacks national standards. This has constrained African govern-
ment’s capacity to introduce the teaching and sustenance of the
discipline in school curricula. There is lack of resources for the
academic formation of bioethicists. The various teaching activi-
ties are not coordinated, and there is a need for competent
teachers and suitable teaching material. Bioethics education is
given lip service but not substance as bioethics courses are
often meager in content. This constitutes a serious barrier to the
implementation, emergence and teaching of bioethics in schools
and since the field is fairly new and remains underfunded, less
effort has been expended in developing programs.
Furthermore, bioethics as an academic or professional disci-
pline is a domain in which Africa is still lagging behind. Africa
has very few trained bioethicists, bioethics is not taught in
higher institutions of learning and there is no vibrant culture of
bioethical discourse among philosophers, scientists and medical
practitioners. There is a lack of critical thinking in the field in
Africa as no academic dissertations or theses are being exam-
ined in the field. Karori Mbũgua laments this as he writes that:
“Unfortunately academic bioethics, like professional philoso-
phy, is still largely foreign in most African countries. Indeed,
despite the rapid growth of bioethics research centers especially
in Europe and North America, there are still relatively few
places in Africa where one can obtain formal bioethics educa-
tion even at the certificate level”(Mbũgua, 2009). The field’s
development in this area has been very sluggish as bioethics is
not yet an escalating tradition of thought and talk by ways of
teachings in classrooms, publications in typically African jour-
nals and conferences in Africa.
Consequently, there are no academic resources to enable Af-
rican students learn how to identify ethical issues and to discuss
them productively with others. At both the high schools and
college levels there exists no major teaching tools and programs
to stimulate the moral imagination of students or help students
recognize moral issues. Most African students still lack the
means and methods to understand what kinds of questions can
be raised by this or that dilemma? Who are the participants in
the dilemma? What are the points of conflict? What things have
to be considered in making a choice? Who is affected by the
decisions? What ethical problems does the decision seem to
raise? There are no guides to help students analyze key moral
concepts and principles, to help students deal effectively with
moral ambiguity and disagreement so as to stimulate students’
sense of responsibility, virtue and obligation.
The implication is for the African community welfare and
well-being. If Africans are not taught the importance of bio-
ethics issues for their community, they may easily be exploited,
their legal rights of self determination may be disregarded, and
their experience of health care will be less than optimal. The
risk is that bioethics may come to be viewed as marginal and
therefore expendable (Moore, 1996). A careful survey would
reveal that most African governments have not yet taken the
commitment to set up and strengthen ethical standards and
bioethics bodies in their respective countries. Meanwhile, there
is need to create and encourage formal teaching of bioethics in
universities and post university education that deal with re-
search on human subjects. The need to provide an excellent
environment for discussion of the principles behind moral rea-
soning and to create an ethical learning climate, which can help
undergraduates acquire tools to address ethical issues in profes-
sional life. Creating an ethical learning climate requires cultural
change and paying serious attention to role modeling in the
learning environment and implementing policies and processes
to ensure a learning climate conducive to ethical development.
There is the necessity to put into place programs of training and
teaching on ethics, bioethics and right to health in all academic
and professional programs (health sciences, social and human
science and technology).
The future of bioethics in Africa is bleak as bioethics is not
taught in many higher educational systems of learning. Africa
in this century still lacks professionals, experts, professors of
bioethics, the institutions, infrastructures and the critical mass
of African experts to address the current issues of bioethics
Open Access 513
from typically an African background to bring out African
specificities and approaches. The implication that this has on
the teaching of bioethics within the continent is that Africans
lack the capacities, skills and strategies to recognize ethical
issues, lack moral imagination, cannot use analytical skills and
would not develop a sense of moral obligation and responsibil-
ity to confront the new challenges in science, technology and
medicine. Also, lack of these skills means that they lack the
ethical capacities to identify dilemmas or to understand di-
lemma situation and how to explore the ethical values and con-
cepts that explain why the dilemma is a dilemma.
Meanwhile, in most Western countries, bioethics gained le-
gitimacy since the early 1970s and there has been an increasing
trend of bioethics centers becoming academic departments. The
professionalization of bioethics has taken it from the academic
margins to the center, and with this development has come all
of the trappings of traditional academics, such as tenure, degree
programs, professional conferences, and academic journals.
Additionally, beginning in the 1980s, departments of bioethics,
depending on their configuration, offer traditional undergradu-
ate or graduate courses, undergraduate majors or concentrations,
graduate degrees (usually master’s degrees), undergraduate
medical school ethics training, and/or residency ethics training.
In spite these developments, in Africa, bioethics is not yet a
legitimate discipline as no concrete steps have been taken to
institute the teaching of bioethics in institutions of learning and
no major attempts to shape the identity of bioethics vis-a-vis
other disciplines, for example, medical ethics which has occu-
pied centre stage of medical practice. Despite greater acquaint-
ance with bioethics as an academic discipline and the recogni-
tion of bioethics as an autonomous discipline, most African
universities have not yet include the teaching of bioethics
courses in their undergraduate and post-graduate curricula. In
addition, no concrete measures and efforts have been under-
taken for the creation of research centers destined exclusively
to conduct research in bioethics in African countries. The ab-
sence of research centers in bioethics implies that researchers
have no avenues or structures to group themselves around
common topics and for discussions with new researchers. Cur-
rently, there are very limited platforms for bioethicists to inter-
act and share ideas and best practices.
The most fundamental and complex challenge to the teaching
of bioethics in Africa revolves around understanding the nature
and the varieties of bioethics. The fact that bioethics in Africa
is a discipline without a well-defined subject matter that could
pass the muster of serious critical academic evaluation. There is
still a lingering uncertainty about its purpose and value. Ed-
mund Pellegrino summarizes it in the following questions: How
much of “bioethics” is biology, how much is ethics, and how
much is in the domain of the humanities or social sciences?
How do the many disciplines that now claim a role in moral
deliberation relate to each other? Where does philosophical
ethics fit in the expansive visions of bioethics that are now
fashionable? Is it merely one discipline among many, or can it
make some claim to the role of primusinter pares? If bioethics
is, indeed, an interdisciplinary exercise, how inclusive and how
diversified should bioethics be? How much of bioethics should
be ethics? (Pellegrino, 2002).
The field has no dominant methodology, no master theory or
its own ethical principles since it has borrowed pieces from
philosophy, theology, fragments of law and social sciences.
Furthermore, it is argued that: Still, many students, and even
some of those who have graduate degrees in the specific disci-
plines that contribute to bioethics, remain unclear just what
“bioethics” means, what bioethicists do, how one prepares for
practice in the field, and the value of the profession (Miller,
Fletcher, & Humber, 2003). Yet, it continues to be understood,
taught and applied as principlism, and its experts continue to
flood the halls of health care facilities, courts, congress and
government departments and agencies in most central countries.
Bioethical expertise is widely sought in the framing of public
and institutional policy. Bioethicists regularly provide testi-
mony as expert witnesses in courts of law. They present them-
selves as experts of moral rationality and principles of moral
probity, including permissible standards of evidence and infer-
ence (Peppin & Cherry, 2005).
Furthermore, bioethics as John D. Arras indicates is not a
unitary “discipline” with its own distinctive methods and cre-
dentialing institutions. Bioethics is not a monolithic entity or
activity as there are varieties of bioethics. There is clinical bio-
ethics, which amounts to the deployment of bioethical concepts,
values and methods within the domain of the hospital or clinic.
There is policy-oriented bioethics where the bioethicist cum
policy analyst is called upon to assist in the formulation of
policies that will affect large numbers of people. There is bio-
ethics as a theoretical pursuit mostly in the academy, where
within the academic domain the relationship between philoso-
phical-religious theory and bioethics are explicitly discussed
(Arras, 2003).
Discussions in a clinical bioethics setting often revolves
around philosophically charged subjects, such as informed
consent, competency, the right to refuse life-sustaining treat-
ments, and so on; but the discussions themselves are rarely
explicitly philosophical. Effective ethics training here is done
during medical school and residency training. Medical students
and doctors are trained to address effectively the disclosure of
bad news, informed consent, confidentiality, dishonesty, re-
search ethics, end-of-life care, resource allocation and the like,
the doctor must recognize situations as an ethical dilemma;
possess the relevant knowledge of norms, laws and policies;
analyze how this knowledge applies to the situation at hand;
and demonstrate the skills needed to communicate and negoti-
ate this situation in practice (Singer, 2003).
At a time when the concerns of science and society are in-
creasingly intermingled and when much scientific research
occurs without ethically informed or effective regulations, Af-
ricans can hardly afford not to pay attention to these questions.
To hope that someone will solve these very real problems for us
is to abandon our lives and destiny at the doorstep of harm. It is
our responsibility to choose wisely in our use of promising
technologies. We need to be reminded that when it comes to
ethics, passively allowing something to happen is morally not
different than actively making it happen. There is a need for a
radical rethinking and re-invention of the fields’ nature, pur-
pose, scope, approaches and priorities within Africa. The chal-
lenge is that bioethics has to be practically relevant, that is, the
individual reflections of African bioethicists must primarily be
geared towards resolving bioethical dilemmas confronting Af-
rica today. Also, much still needs to be done to inspire and
motivate bioethics teachers in their work, and to enter deeper
into the issues of how best to teach bioethics. In this light, Af-
rica has to develop standards to certify expertise in clinical
ethics, research ethics, and scientific integrity, and to develop
codes of ethics governing not only clinical ethics consultation
Open Access
but the full range of bioethical activities. The strengthening of
bioethics education and research and the raising of public
awareness of bioethical issues in Africa must be given priority.
Appropriate structures for deliberation and action on bioethical
issues must also be put in place.
However, there have been global efforts to strengthen and
enhance bioethics capacity in Africa. Research ethics training
programs have successfully been initiated by the US Fogarty
Bioethics Training Program, African Malaria Network Trust
(AMANET), the European and Developing Countries Clinical
Trials Partnerships, the UK Welcome Trust, have been building
capacity in Africa. Yet, the major challenge is for African gov-
ernments to initiate their own bioethics courses and teaching
programs in their respective countries and institutions. Till date,
no major efforts have been undertaken to introduce the teaching
of bioethics in African institutions by Africans themselves, as
such, more efforts are required to raise awareness on issues and
trends in bioethics. The need to create awareness on issues
concerning responsible conduct of research and develop capac-
ity for training of academic faculty, clinicians, researchers,
government health ministry officials, NGOs, the media, tradi-
tional leaders and community representatives. More efforts are
required towards increasing continent-wide awareness about
ethical issues in biomedical practice and research through ethics
conferences, workshops, national bioethics conferences, the
public media and Non-Governmental Organizations (NGOs)
(Tamidayo, 2004).
There is need to train experts who can look for means and
methods that work to enable Africa define her priorities and
achieve her goals in bioethics. Also, to bring in leadership and
expertise that would enable Africa develops her values that may
guide policies and practices in science and technology, as well
as identify pitfalls bioethicists in Africa must avoid. The major
challenge is that nothing concrete is done by African govern-
ments to confront the reality of these existential dilemmas that
threaten the development and teaching of bioethics in Africa. It
seems African governments are still “turning a blind eye” to the
development and the implementation of strategies to enhance
the teaching of bioethics in Africa. The phrase “to turn a blind
eye” means to deliberately refuse to acknowledge something
that one knows to be true (Cheshire, 2011).
When human condition and prospects face challenges from
scientific undertakings, when ethical principles are improper for
Africa, when the means and methods to teach or introduce the
teaching of bioethics are insufficient, when Africa lacks experts
and trained professionals, when Africa lacks the human, institu-
tional and infrastructural capacities in bioethics, turning a blind
eye to these issues that constitute the major challenges to the
progress of bioethics is tantamount to destruction. Many of the
issues that characterize the development of bioethics today
concern efforts to avoid turning a blind eye to the new mega-
trends and breakthroughs in science, technology and medicine.
The relevance of bioethics to Africa is of cardinal importance
and ignoring it would ultimately lead to disaster.
Bioethics is one of the most flourishing disciplines in the
world and there has been an increasing demand for the intro-
duction and teaching of bioethics courses in schools and uni-
versities. However, although the list of immoral research is
increasing and problems created are outpacing ethical decision
making, bioethics education is not yet flourishing in Africa.
The major challenge today is the institution of the teaching of
bioethics in African universities and the legitimation of the
discipline as a scholarly field of learning, which constitutes an
urgent moral imperative for African governments. Bioethics
education becomes a moral imperative for Africa as long as
new scientific breakthroughs create complex moral challenges
and moral dilemmas to their lives, well-being and welfare. The
necessity to develop bioethics programs and initiate its teaching
at the undergraduate and graduate levels in universities of Af-
rica is of utmost urgency as this would train and empower a
critical mass of African experts who can navigate moral vul-
nerabilities and remain morally intact, evaluate and confront the
dilemmas created by the new wave of scientific research.
As such, effective bioethics education and teaching in Africa
would consist of looking for means and methods that empower
capacities of communities in African countries to understand
the challenges of research (risks and benefits) and to respond
positively to these challenges to their lives. Also, there is a need
to re-enforce and strengthen the capacities of Research Ethics
Committees to function optimally. It consists of building re-
search institutions in universities, high schools and professional
centers to train and empower future experts, professionals and
leaders to empower a critical mass of African intellectuals. It
encourages the publication of books and developing of African
journals of bioethics that encourage the publication of ideas and
issues on African bioethics specificities, approaches and pecu-
liarities. There is a need to encourage the organization of con-
ferences, seminars, workshops that train capacities and ex-
change of ideas on moral views and that stimulate academic
discussions. It develops solid partnerships with other bioethics
institution, organization, structures and nations. Moreover, edu-
cating the public is also critically important as we must redis-
cover the values of bioethics and re-learn the importance of the
intellectual and scientific thought that is central to the best
practice of bioethics.
Andoh, C. (2011). Bioethics and the challenges to its growth in Africa.
Open Journal of Philosophy, 2, 67-75.
Arras, J. (2003). The owl and the caduceus: Does bioethics need phi-
losophy? In F. G. Miller, J. C. Fletcher, & J. M. Humber (Eds.), The
nature and prospect of bioethics: Interdisciplinary perspectives. To-
towa, NJ: Humana Press Inc.
Ashcroft, R., Parker, M., Verkerk, M., & Widdershoven, G. (2005).
Philosophical introduction: Case analysis in clinical ethics. In R.
Ashcroft, A. Lucassen, M. Parker, M. Verkerk, & G. Widdershoven
(Eds.), Case analysis in clinical ethics (p. 1). Cambridge: Cambridge
University Press.
Baker, R. (2009). In defense of bioethics. Journal of Law, Medicine &
Ethics, 83-92.
Braddock, C. (2010). Empirical methods in bioethics: A cautionary tale.
Annals of Internal Medicine, 152, 396-397.
Cheshire, W. (2011). Turning a BLIND Eye: An ethical assessment.
Ethics and Medicine, An International Journal of Bioethics, 27, 1.
Coggon, J. (2011). On Method and resolution in philosophical bioethics.
Cambridge Quarterly of Healthcare Ethics, 20, 159-163.
Emmerich, N. (2011). Literature, history and the humanization of bio-
ethics. Bioethics, 25, 112-118.
Fins, J. (2010). The humanities and the future of bioethics education.
Open Access 515
Open Access
Cambridge Quarterly of Healthcare Ethics, 19, 518-521.
Gesang, B. (2010). Are moral philosophers moral experts? Bioethics,
24, 153-159.
Haimes, E. (2006). What can the social sciences contribute to the study
of ethics? Theoretical, empirical and substantive considerations. In C.
Rehmann-Sutter, M. Düwell, & D. Mieth (Eds.), Bioethics in cultural
contexts (Vol. 28, pp. 275-298). The Netherlands: Springer.
Harwood, K. (2004-2005). Essays on teaching excellence. Toward the
Best in the Academy. Teaching Bioethics through Participation and
Policy-Making, 16.
Holm, S., & Jonas, M. (2004). Engaging the world: The use of empiri-
cal research in bioethics and the regulation of biotechnology. Am-
sterdam: IOS Press.
Itai, K., Asai, A., Tsuchiya, Y., Onishi, M., & Kosugi, S. (2006). How
do bioethics teachers in Japan cope with ethical disagreement among
healthcare university students in the classroom? A survey on educa-
tors in charge. Journal of Medical Ethics, 32, 303-308.
Kohlberg, L. (1981). Essays on moral development. Vol. I: The phi-
losophy of moral development. New York: Harper & Row.
Liaschenko, J., Oguz, N., & Brunnquell, D. (2006). Critique of the
“tragic case” method in ethics education. Journal of Medical Ethics,
32, 672-677.
Macer, D. (2008). Moral games for teaching bioethics. UNESCO Chair
in Bioethics, Haifa, Isreal.
Mbũgua, K. (2009). Is there an African Bioethics? Eubios Journal of
Asian and Internation al Bioethics, 19, 4.
McCullough, L. (2011). Was bioethics founded on historical and con-
ceptual mistakes about medical paternalism? Bioethics, 25, 66-74.
Memeyer, R. (2002). What conception of moral truth works in bioethics?
Journal of Medicine and Phil os op h y, 27, 403-416.
Miller, F., Fletcher, J., & Humber J. (2003). The nature and prospect of
bioethics: Interdisciplinary perspectives. Totowa, NJ: Humana Press
Moore, J. (1996). Bioethics programs’ future uncertain. Modern Health-
care, 26, 20.
Murray, S., & Holmes, D. (2009). Critical interventions in the ethics of
healthcare. Challenging the Principle of Autonomy in Bioethics.
England: Ashgate Publishing Limited.
Myser, C. (2001). How bioethics is being taught: A critical review. In
H. Kuhse and P. Singer (Eds.), A companion to bioethics (p. 485).
Oxford: Blackwell Publishing.
Pellegrino, E. (2002). Bioethics as an interdisciplinary enterprise:
Where does ethics fit in the mosaic of disciplines? In R. A. Carson,
& C. R. Burns (Eds.), Philosophy of medicine and bioethics a
twenty-year retrospective and critical appraisal (Vol. 50). Dordrecht:
Kluwer Academic Publishers.
Peppin, J., & Cherry, M. (2005). The annals of bioethics. Regional
perspectives in bioethics. Lisse: Swets & Zeitlinger Publishers.
Pickering, M. (2008). Research methods for cultural studies (p. 5).
Edinburgh: Edinburgh University Press.
Priaulx, N. (2011). Vorsprungdurch technik: On biotechnology, bio-
ethics, and its beneficiaries. Cambridge Quarterly of Healthcare
Ethics, 20, 174-184.
Rasmussen, L. (2005). Ethics expertise: History, contemporary per-
spectives, and applications (p. 3). Dordrecht: Springer.
Rehmann-Sutter, C., Düwell, M., & Mieth, D. (2006). Bioethics in
cultural contexts (p. 2). Dordrecht: Springer.
Renee, F. (1999). Is medical education asking too much of bioethics.
Schaller, B. (2008). Understanding bioethics and the law: The promises
and perils of the brave new world of biotechnology. Westport: Prae-
ger Publishers.
Singer, P. (1972). Moral experts. Analysis, 32, 115-117.
Singer, P. (2003). Strengthening the role of ethics in medical education.
Canadian Medical Association Journal, 168, 854-855.
Sugarman, J., & Sulmasy, D. (2010). Methods in medical ethics (p. 3).
Washington DC: Georgetown University Press.
Sugarman, J., & Sulmasy, D. (2010). Methods in medical ethics (p. 6).
Washington DC: Georgetown University Press.
Tamidayo, O. (2004). Enhancing the African bioethics initiative. BMC
Medical Education, 4, 21.
Taylor, H., Chandros Hull, S., & Kass, N. (2010). Qualitative methods.
In J. Sugarman, & D. Sulmasy (Eds.), Methods in medical ethics (p.
193). Washington DC: Georgetown University Press.
Turrens, J. (2005). Teaching research integrity and bioethics to science
undergraduates. Cell Biology Education, 4, 334.
Velasquez, M. et al. (2009). A framework for thinking ethically in
issues. Ethics, 1.