Open Journal of Philosophy
2011. Vol.1, No.2, 67-75
Copyright © 2011 SciRes. DOI:10.4236/ojpp.2011.12012
Bioethics and the Challenges to Its Growth in Africa
Cletus T. Andoh
Department of Philosophy, University of Yaounde I, Yaounde, Cameroon.
Received August 24th, 2011; revised September 26th, 2011; accepted October 2nd, 2011.
Bioethics has now become 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 consultations
that privilege all discourse about everyday life issues. It has made exponential progress in addressing moral is-
sues in science, technology and medicine in the world. In spite of this progress, core bioethics issues, approaches
and values are still exclusively Western dominated and largely foreign to most African societies. Although
medical ethics has existed since the time of Hippocrates, in Africa, there is a noted sluggish growth and low
prestige of ethics education as bioethics is not taught in most higher educational systems of learning, low under-
standing of its processes as researchers manifest a general lack of appreciation for bioethics and general igno-
rance characterize those involved in research about ethical practices. This is unfortunate, considering that vari-
ous research that aim at finding solutions to the multiple problems affecting African societies and the need to
address and assess these problems in ethical terms are of crucial importance to Africans. In this work, I argue
that Africa lacks human, institutional, infrastructural capacities and a real African authenticity in bioethics. Ad-
ditionally, African views on bioethics are neither sufficiently developed nor heard. Africans need to confront
these current challenges of bioethics to their lives and communities and to develop African conceptions to in-
corporate African specificities and approaches.
Keywords: Authenticity, African Communitarianism, Ethno-Ethics, Communitarian Bioethics, Professional
Bioethics, Interdisciplinary Research, Biotechnology
The inhuman and degrading treatment inflicted on African
people by other cultures in the course of Africa’s painful his-
tory, especially through colonisation, aggressions and viola-
tions has culminated to the immorality, cruelties and the degra-
dation of African values. These inhuman and maltreatment in-
flicted on Africans constitute a hard blow to human dignity, a
threat to human survival and integrity which is morally con-
demnable, and has develop stigmas and phobias which ethics
rooted in African values and tied to our socio-cultural and tra-
ditional context must address. Also, at this era of contemporary
bioethics and ethical intersection where issues on health re-
search, methods, and researcher responsibility are topical, and
in the wake of diseases where medicine and morality are in
crisis, at a time when questions about screening and conducting
biomedical research (therapy and vaccine trials), health care
practices, access to medical treatment have given rise to ques-
tioning and debates, scientific meetings, debates and discus-
sions on these issues in Africa are still rare.
Meanwhile the African continent and its countries are mark-
ed by huge economic and social challenges, especially in the
field of health. Africa is heavily impacted in poverty and huge
disease burden such as HIV-AIDS and tropical diseases such as
malaria and sleeping sickness that kill millions of Africans
yearly. These diseases pose serious moral challenges for bioe-
thicists to focus on from an African background. Exploitation
in the face of multinational research creates the need for robust
guidance as there is lack of means and mechanisms to enhance
the teaching of bioethics in Africa. Additionally, why is the
field of bioethics not flourishing in Africa? The purpose is to
develop critical thinking in the field of bioethics within Africa
which would require bioethicists from Africa to root their en-
quiries on ethical values in African traditions, to challenge the-
ories using evidence, to be reflexive and be skeptical or critical
of other bioethical values and principles.
Africa need heightened ethical awareness that would enable
Africans suspect or be suspicious of the moral authority and
authenticity of foreign principles and values especially as some
of these values aim to monopolize the field of bioethics and its
discourse. As such the aim of this work is to reform and inform
the moral minimalism of Western bioethics about African val-
ues and principles. Thus by subjecting other principles and
values to theirs to serious scrutiny and questioning, African
bioethicists can produce a rigorous normative analysis of lived
moral experience in Africa and can incorporate African views
and approaches to the current bioethics debates, especially as
African communitarian views are uninfluential in the mains-
tream. Also, is the fact that Western bioethics is not showing
enough concerns for the moral challenges and dilemmas arising
from Africa. As such Africa need to develop its principles and
values based on the existential realities of its people needing
appropriate solutions to problems affecting them. Through ethno-
ethics and professional bioethics, I hereby outline a descriptive
analysis of ethical and moral values as rooted in authentic Af-
rican traditions and cultures that can provide a helpful base or
framework for ethical decision making.
Bioethics in Quest for Authenticity in Africa
Bioethics in quest for authenticity is an attempt to know if it
is possible for bioethics to progress in Africa without the dis-
torting imposition of Western templates, values and principles
or is it possible for Africans to dissociate their traditional Afri-
can thought elements from the superimposition of Western
bioethical categories. In other words, can African bioethics
dismantle the encrustation of foreign values and view the Afri-
can thought materials in their true light rooted on traditional
African values and indigenous heritage? When the question is
asked, why is the field of bioethics not progressing or flourish-
ing in Africa as in other parts of the world. One gets many an-
swers amongst which research in this domain is not funded or
inadequate funding, that is, there are no budgetary allocations
or financing of research in this area.
Furthermore, lack of political will and commitments from
African governments as politicians are not interested in this
kind of research. Due to this lack of motivation, governments in
Africa have not yet established the necessary legislation, insti-
tutions or infrastructures to protect vulnerable persons and to
address bioethical issues. As a result, people are not interested
in bioethics issues since measures are not taken to create a-
wareness on the field in the continent. In addition, many in
Africa consider the field of bioethics a Western discipline or
field of study that deals with issues on High-Tech and ad-
dresses directly issues arising from or related to the use of
High-Tech, health related issues and practice in the West and
modern medicine which does not affect African countries. As
such Africans are not or should not be concerned with such is-
sues. Moreover, it is an expensive field of study that African
countries cannot afford the luxury to sustain.
Many events might have contributed to this (mis) conception
of bioethics in Africa. The first identifiable area of confusion is
with the origin or birth of bioethics. It is a field born out of
scandal (scandal induced phenomenon) and due to new break-
throughs or transformations in medical technologies in the West.
Karori Mbugua makes this clear when he writes that tradition-
ally, bioethics has always been associated with cutting edge
biotechnologies such as in vitro fertilization, organ transplant,
and gene therapy. These technologies are virtually non-existent
in most parts of Africa. The principles of US bioethics which
were formulated to address ethical issues arising from these
advances in medicine cannot therefore be expected to ade-
quately equip African researchers and medical students with the
necessary ethical skills to face the bioethical dilemmas that they
encounter daily (Mbugua, 2009).
Also, among the most powerful triggers for the emergence of
bioethics were a series of public revelations of gross abuses of
human subjects who had been unknowingly coerced into par-
ticipation in dangerous, non-therapeutic research. Bioethics
emergence then was marked by issues about the protection of
human research subjects, autonomy and the rights of patients.
Consequently, all or most ethical codes and guidelines are de-
veloped in response to a problem, crisis or exposure of research
abuse or born in scandal in the Western world. In spite appeals
for universal applicability and validity, initially there were no
African participants or representatives in the deliberations.
Most are exclusively Western dominated and still remain in-
sensitive to non-Western values and moral principles. Many
views confirm principlism as the dominant way of doing bioe-
thics in the United States. It is the mainstream approach, both in
academia, the clinic and in media representations of bioethics.
Tamidayo Ogundiran writes that the growth of bioethics has
been most exponential in North America and Europe and core
bioethics issues, approaches and values are still largely a Wes-
tern phenomenon or western dominated (Tamidayo, 2004). The
fact that Africa is not directly connected or linked to the his-
torical development of the field of bioethics makes people think,
it is exclusively a Western phenomenon.
As a matter of fact there has been a strong impulse to present
Western bioethics, Western culture and ideas, whether optimis-
tic or pessimistic as the only rational and universally valid ones.
Western culture looked in every way like an extraordinarily
successful and exceptionally high culture that if other cultures
and people could read the very words uttered by the great men
of the West, they would be better able to cope with the cultural
crisis that the most advanced thinkers of the time took to be a
fact of contemporary life. It is the super rational culture, that
which is characterized by conformity with reason, adhering to
qualities of thought such as intelligibility, consistency, order,
logical structure, competence, testability, and simplicity. For
instance, Americans consider bioethics to be exclusively their
cultural heritage. Daniel Callahan, one of the pioneers of Ame-
rican bioethics makes reference to this Western domineering
attitude of bioethics: “The more interesting story perhaps con-
cerns the culture of bioethics itself. It is a discipline with some
discernible biases, some unmistakable signs of its heavily Ame-
rican origins, and some long-standing internal struggles I need
to acknowledge its force and cultural bite. It has been accepted
in great part because it is so compatible with American culture,
at least that well-rooted liberal part of the culture that has
looked to law to resolve, or dilute, deep moral disagreements,
and which bends over backwards to allow citizens the widest
range of legal choices and the greatest possible latitude in the
living of a life. Bioethics is often too American, too cul-
ture-conforming, too prone to float along with the tide” (Calla-
han, 1999).
Furthermore, Edmund D. Pellegrino writes that medical scien-
ce and technology, as well as the ethics designed to deal with
its impact, currently are Western in origin. They are deeply in-
grained with three sets of values distinctly Western the values
of empirical science, principle-based ethics, and the democratic
political philosophy. Such values are often alien, and even an-
tipathetic, to many non-Western world views (Pellegrino, 1992).
Many distinguished bioethicists and scholars make allusion to
this domineering Western bioethics. They say that bioethics in
its present form is rooted in and largely dominated by western
culture. The tempo and content of bioethics discourse are
largely influenced by the technological creations of the develo-
ped world. Because of its scientific-cum-technological sophis-
tication and its proselytising character, Western culture, as well
as Western systems of thought and practice, have greatly af-
fected and influenced other cultures, particularly African cul-
ture. But Western cultures, 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 (Tangwa, 1999). Further still,
Godfrey Tangwa characterizes Western culture’s quest for cer-
tainty in the following words: “The obsession with certainty,
and the illusion that may be induced of having achieved it in
many domains of human concern, is what has given the Wes-
tern world its spirit of epistemological over-confidence, an
over-sabi bordering on arrogance, its evangelical and prosely-
tising impulse, its high sense of self-righteousness, that could
easily result in heedless recklessness at the level of practice”
(Tangwa, 2004).
Moreover, though bioethics has come of age in the developed
and some developing countries, it is still largely “foreign” to
most African countries. It is time Africa joined the bioethics
bandwagon. Its relevance and applications to science and re-
search are vital and should not be overlooked. However, bio-
ethics is not exclusively the domain of the West and many ar-
gument accuse this Western dominated approach as a form of
moral imperialism, and an attempt by developed world agencies
to advance their biomedical research agenda at the expense of
the developing countries. Most of the claims that bioethics is
C. T. ANDOH 69
Western is sign of gross neglect to the development of bioethics
and issues outside the western world. It is what some persons
refer to as the field’s deficiencies and blind spots which are
identified as dumped-down teaching formulae, an insensitivity
to cultural differences, and the tendency of American bioethi-
cists to emphasize “individual rights, and rationality” instead of
“community, and common good.” This raises the issue of the
legacy of African approaches to bioethics, while facing the fu-
ture, the purpose, and the place African thought occupy in the
grand bioethics discourse.
In spite the above, the field of bioethics has in the last decade
known some advances in some African countries, especially in
countries of Anglophone Africa where the discipline is expe-
riencing growth. Centers for bioethics can be found in countries
like South Africa, Nigeria, Kenya, Tanzania, Democratic Re-
public of Congo and other countries are expected to follow
these examples. Bioethics education, training and teaching is
experiencing some growth and transformation than ever before,
more due to inputs and contributions brought about by some
African scholars who have undergone some training in Western
institutions and successfully establish partnerships, cooperation
and collaborative networks. However, questionable is how
these centers and their experts are empowered, equipped and
informed on African ethical and bioethics values, given that
they have been trained in foreign values and institutions. As
such, they are not trained to think like Africans. While it is
interesting that there are more centers developing in the field,
what is more challenging and compelling is for these centers
and experts to articulate and span the bioethics discourse rooted
in African ethical principles and values. How they are equipped
to resolve the moral dilemmas of the continent especially as the
values and principles that govern the practice of bioethics are
Western dominated.
The major predominant bioethics ideas, principles and values
are grounded in Western thinking and philosophy not rooted in
African thinking and as such cannot reflect the choices, actions
and decisions Africans make. Munyaradzi Murove succinctly
puts this as he writes that the current discourse on bioethics in
Africa is trapped in Western categories of thought and relies
heavily on Western analytical philosophy. He maintains that an
authentic discourse on bioethics in Africa must take cognizance
of the fact that most Africans rely on traditional medicine for
their health care needs (Murove, 2005). Since the birth of bioe-
thics, Western thinkers have influenced the discussions and
debates, public opinion and public policy and have been strate-
gically staking out territory in a range of bioethical issues. They
are positioned perfectly to frame the discussions, define the vo-
cabulary, create conventions, and, ultimately, forge public po-
licy on bioethical issues, as well as, shaping the way people
should think about issues as they arise in bioethics. Western
bioethicists understand what is at stake in bioethics today than
Africans as they see that driving bioethical debate is critical to
building a society based on their values and their worldviews.
Conversely, bioethics in Africa is poorly funded and narrowly
focused, and lacks unified philosophical framework. Some of
the possible problems that can arise from this situation are that
the reality of an “African” bioethics is problematic due to value
and cultural changes that foreign values introduce. The chal-
lenge is that foreign values might either advocate principles that
clearly cannot capture core aspects of African values and hence
are “too Western”.
A critical scrutiny at the field of bioethics in Africa would
confirm the view that the field is not rooted nor grounded in
African values and traditions but in foreign bodies in the cul-
tural fabric of Africa. In this present context in Africa, one can
easily bemoan the lack of Africanness in African bioethics as
Africanity is undergoing a process of erosion, in the light of
contemporary changes and faced with foreign values. For in-
stance, family solidarity is declining in Africa and our commu-
nal values are being challenged and replaced by foreign ones.
The field of bioethics in Africa lacks a well-defended general
principle grounding particular duties that is informed by such
values and that could be compared to dominant Western theo-
ries such as Hobbesian egoism or Kantian respect for persons
(Metz, 2007). Western values have an overriding and overpo-
wering influence over it African counterpart and is threatening
to destroy these African values. This attitude of assimilating
Western values and ideologies into Africa can give rise to a si-
tuation of self-dehumanization and outright self-subversion bo-
th in terms of dignity and self-esteem. This would consequently
submerge African values into the never-receding tide of ethical
imperialism. An extreme position is that we cannot have a via-
ble existence of the “African” given the overwhelming impact
of alien elements, leading to what is perceived as a collapse of
traditional culture and of traditional ethics (Kigongo, 2009).
This situation causes tension and creates conflicts in the true
African ethical conception and empirical experience as moder-
nity continues to gain a dominating impact on African life.
There is also corresponding decline of the influence of the tra-
dition and, therefore, a decline in its relevance to contemporary
realities. Meanwhile nourished ethical principles grown from
African soil is a necessity for Africa especially as people in life
act in ways that are more consistent with the values they hold,
rather than following any particular bioethical principles. As
such, by African bioethics, it should be understood as thinking
that is rooted and flows from Africa’s innate traditional values.
That is, Africa’s traditional values are quintessential for moral
decision making. These values form the core or fundamental
basis for any ethical deliberation on issues related directly to
Africa. Bioethics in this context is looking for its roots or origin
in African traditional values and it also has to look backward in
the distant past and the present so as to plot the future. However,
one is not trying to down play the importance of Western va-
lues especially as there is need to build collaborative partner-
ships to re-enforce African capacities and institutions. Yet,
there is need for an authentic representation and for Africans to
reclaim their world view if they want to maintain their identity
in the face of change. Therefore, African values should be seen
as more fundamental to the change, that is, as having primary
importance than Western ones.
African perspectives of bioethics points to two different con-
ceptions; bioethics in the sense of sets of moral principles
rooted in culture, and bioethics as an academic discipline. In the
first conception, African bioethics is found in African people’s
culture or world view. This is what might be referred to as
ethno-ethics and consists of a set of shared beliefs, values, cate-
gories, and assumptions that are implicit in the languages, prac-
tices and beliefs of African cultures. The sources of such bioe-
thical principles will include popular sayings, proverbs, maxims,
tales, songs, mythology, folklore and other cultural practices
such as male circumcision, marriage and leadership (Mbugua,
2009). African bioethics in this context revolves around har-
monious coexistence with the cosmos and the promotion, de-
fence and protection of life, including maintaining the integrity
of the human species, protecting the dignity of the person and
protecting nature and diversity. It is rooted in the following
African traditional and cultural values
African Communitarianism or Sense of
Community Life
A major recurrent feature of moral thought in sub-Saharan
Africa is the widespread maxim, “A person is a person through
other persons” or “I am because we are.” The traditional Afri-
can concept Ubuntu “I am because we are. I can only be a per-
son through others” implies that one’s identity as a human be-
ing causally and even metaphysically depends on a community.
Also in a morally grounded prescriptive sense one ought to
support the community. The coinage of African communalism
is of John Mbiti’s famous post-war analysis of African world-
views which says that “What is right is what connects people
together; what separates people is wrong”. John Mbiti further
underscores the important belief and sense of the community
among traditional Africans. In traditional Africa, the individual
does not and cannot exist alone except corporately. He owes
existence to other people, including those of past generations
and his contemporaries. Whatever happens to the individual is
believed to happen to the whole group, and whatever happens
to the whole group happens to the individual. “Whatever hap-
pens to the individual happens to the whole group, and what-
ever happens to the whole group happens to the individual. The
individual can only say: ‘I am, because we are; and since we
are, therefore I am.’ This is a cardinal point in the understand-
ing of the African view of man” (Mbiti, 1992).
Additionally black consciousness leader Steve Biko, in an
essay that explores facets of culture that are widely shared by
Africans: “our action is usually joint community oriented action
rather than the individualism which is the hallmark of the capi-
talist approach” (Biko, 2004). Thaddeus Metz proffers the fol-
lowing moral theory: “an action is right just insofar as it is a
way of living harmoniously or prizing communal relationships,
ones in which people identify with each other and exhibit so-
lidarity with one another; otherwise, an action is wrong” (Metz,
2010). To identify with each other is largely for people to think
of themselves as members of the same group, that is, to con-
ceive of themselves as a “we”, as well as for them to engage in
joint projects, coordinating their behavior to realize shared
Communitarian means pertaining to or characteristic of a co-
mmunity. It is the perspective that recognises both individual
human dignity and the social dimension of being human.
Gboyega A Ogunbanjo and Donna Knapp Bogaert define com-
munitarianism as a model of political organization that stresses
ties of affection, kinship, and a sense of common purpose and
tradition. They further identify two forms of communitarianism
in Africa which are radical and moderate communitarianisms.
Accordingly, radical communitarians in Africa include John
Mbiti and Ifeanyi Menkiti who claim that: 1) the community
defines a person as person (and not some isolated property like
rationality and free will); 2) personhood is acquired (i.e. an
individual’s moral achievements earns him or her the status as a
person, a full member of the community); and 3) personhood is
something at which an individual can fail. Moderate commu-
nalism is promoted by Léopold Sédar Senghor and supported
by contemporary philosophers such as Kwame Gyekye, Kwesi
Wiredu, and Segun Gbadegesin, claim that communitarianism
stresses more on the group than on the individual. It sees
society not as an aggregate but rather as a community of in-
dividuals. Personhood, on this view, is not wholly defined by
membership to a community (Ogunbanjo & van Bogaert, 2005).
In the African perception persons become persons only after
a process of incorporation. Without incorporation into this or
that community, individuals are considered to be mere danglers
to whom the description ‘person’ does not fully apply. How-
ever, the individual is both autonomous and a communal being.
It is recognized that besides being a social being by nature, the
individual also possesses rationality, moral sense, capacity for
virtue, and capacity for free choice. In terms of social structures,
it is argued that authority is located in the leader of a village or
tribe and in the head of the household. In this approach, one
becomes a human being only in a fellowship with the life of
others, that is, the person is viewed as a relational self. Chikezie
Onuoha elucidates on this in the following words: “It is a self
for whom social relationships rather than individualism provide
the basis for moral judgement within the African culture. The
family is the primary social unit and plays a central role in an
individual’s life. In this light, the family is responsible for the
well being of her members especially the aged, sick, disabled
and the unemployed. It has been argued that most African
countries have their moral perspective dominated by their
worldview. Base on this African conception of the relational
self has significant implications for many of the issues in bio-
ethics such as reproductive ethics, human genetics, research
ethics, principles of autonomy, justice, illness, health care, in-
formed conscience, death and dying” (Onuoha, 2007).
On this ground, it is argued that African morality is not nece-
ssarily based on religion or faith, but on the beneficiary values
of collective family and community well-being, without dis-
solving the individual’s character. The community empowers
“personness”. As P J. Nel observes, the term community is in-
clusive of all life (bios): animals, the habitat (the land), flora,
and even the elements. The success of life is found in the ability
to maintain a healthy relationship with all. The community it-
self is more understood as more than the visible community and
includes the ancestors as well as those not yet born. Community
in the African context is the basis for morality in that it guaran-
tees the well-being of both the individual and the community.
The judgment as well as the justification of good and bad (evil)
is not in terms of reason only, but this does not necessarily
mean that it is irrational. The collective input of practice, cus-
tom, ritual, and accompanying narrative textualisation makes
the moral imperative and its justification nearly selfevident
(Nell, 2008). Furthermore, the construction of moral knowledge
in African indigenous communities relates to their mode of un-
derstanding reality and within this reality, the well-being of the
community is the central concern. A visitor to Africa is soon
struck by the frequent use of the first person plural “we”, “ours”
in everyday speech.
Compared to views about healthcare provision and decision
making that stresses autonomy and prioritizes individual right,
the common good receives prominence. Amitai Etzioni makes
it clear that medicine is overwhelmingly non-communitarian in
the sense that it rarely concerns itself with the common good.
The individual patient’s good is at the centre of nearly every
discussion. Moreover, one is hard put to find a bioethicist who
considers him/herself a communitarian. He continues that, tho-
se who do draw on communitarian deliberations do so mainly
to criticize the excessive reliance on the value of autonomy but
typically not to embrace concerns for the common good (Et-
zioni, 2011). Contrary to this view African communitarian ap-
proach regards personal rights such as right to health care in a
communal context. Communitarian bioethics in this light views
the concepts of public health, distributive justice as solidarity or
a collective duty to take care of all citizens, equal access to
C. T. ANDOH 71
health care, involvement of the family in decision-making and
shared consensus about public policies as expressions of this
world-view. The appeal is that it sounds more satisfactory and
humane to live in an organic community rather than alienated in
an aggregate of autonomous individuals.
In a comparative and contrastive context, one important cha-
racteristic that should distinguish African bioethics from Wes-
tern bioethics is that African culture places considerable value
on conformity of the individual to the social group. Western
bioethics focuses on the individual, ignoring the interests of
others who are intimately affected, such as the family and the
community. Westerners view the patient as an individualistic
being and view autonomy as the supreme value, according to
which the patient’s right to personal choice is paramount. This
focus on the individual is based on a philosophy that regards
the self, and only the self, as the end per se. It leans heavily on
Kantian ethics that requires universal norms and an impartial
perspective, which is inattentive to relationships and commu-
nity. Kantianism privileges abstract reasoning over virtue, cha-
racter, and moral emotions. Kantian ethics maintain that the
only way we can morally constitute ourselves is by free and ra-
tional choice.
This view is antithetical to African bioethics which claims
that we morally constitute ourselves not only through free and
rational choice but also through our parents and our community.
African ethics is communalistic in nature and is to be contrasted
with the Western ethical tradition with its emphasis on an indi-
vidual’s sense of self and autonomy of being. As far as Africans
are concerned, the reality of the communal life takes prece-
dence over the reality of individual life histories, whatever
these may be. And this primacy is meant to apply not only on-
tologically, but also in regard to epistemic accessibility. Ifeanyi
Menkiti argues that it is in rootedness in an ongoing human
community that the individual comes to see himself as man,
and it is by first knowing this community as a stubborn perdur-
ing fact of the psychophysical world that the individual also
comes to know himself as a durable, more or less permanent,
fact of this world. After birth the individual goes through the
different rites of incorporation, including those of initiation at
puberty time, before becoming a full person in the eyes of the
community (Menkiti, 2004). In the African view therefore, it is
the community which defines the person as person, not some
isolated static quality of rationality, will, or memory.
These divergent perspective calls for a heightened sensitivity
to this various issues and to the varied explanatory models pa-
tients bring to the clinical encounter as well as in the bioethical
discussions. In a research setting, to obtain informed consent
from patients and research participants in an African setting
without some modification of the principle will prove difficult
as this will require not just the consent of the individual
concerned, but also of the entire community. Consequently, fai-
lure to recognize cultural differences and variations in the un-
derstanding of human dignity, health and disease can lead to
ethical conflicts. Moreover, Ames Dhai makes this clear when
he writes that: “The cultural background of research partici-
pants must be understood with regard to how informed consent
is obtained. Ethical conflict is quite likely to emerge when re-
searchers and participating patients come from different cul-
tures. In Africa a person does not perceive himself or herself as
an individual in his or her own right, but rather as an extension
of a family serving as an intermediary between ancestors and
future generations Because of this perception, an insistence on
first person informed consent in group-orientated cultures is
viewed as morally unacceptable” (Dhai, 2002).
In response to these observations, it is argued that insistence
on first-person informed consent in group-oriented cultures is a
form of medical-ethical imperialism that is morally unaccept-
able (Ijsselmuiden & Faden, 1992). The differences existing
between Western moral thinking and other non Western phi-
losophies must have brought about this. Ethical principles of
Western medicine on informed consent require all adults to be
primary decision makers about their own participation. Amitai
Etzioni elucidates this through the views of some Western au-
thors like Daniel Callahan whom he says quotes Joseph
Fletcher, stating that bioethics is based on “the idea of personal
choice as the highest moral value and the struggle against na-
ture as medicine’s most liberating mission”. Another example
is Ezekiel Emanuel, in his essay on the care of incompetent pa-
tients, points out that the understanding of the ‘best interests’ of
a patient allowed in this individualist vision of healthcare is
based upon the degree of pain a procedure would inflict on that
person. Jeffrey Blustein explains this conception of autonomy
in healthcare, stating, “It rests on a picture of the person as a
separate being, with a distinctive personal point of view and an
interest in being able securely to pursue his or her own concept-
tion of the good”.
However, it should not be seen that African values forbid
individuality, creativity or nonconformity, but it does mean that
some weight in moral thinking is given to whether behavior up-
sets communal norms. In clinical research in an African setting,
where normative decision making is crucial, the leaders and
elders of the community play an important role in the process
of securing informed consent. Researchers must first meet with
leaders and elders of the community to get permission to enter
and interact with community members. It is only when leaders
give assent that researchers can then proceed into broad
discussions with community members that involves defining
what research is, aims or goals of research, risks and benefits of
research to get their consent or refusal to be part of research
project. It is a process that aims at empowering the capacity of
community members about research, risk and benefits, and
build researcher’s capacity in understanding cultural practices,
beliefs, religion and tradition of the community so as to en-
courage trust (Andoh, 2009). Meanwhile in a medicalized
health care situation, the opinion of the head of the family is
very important and for married couples, the husband’s consent
is sought for.
Sense of Good Human Relations
Akan maxim: “It is the human being that counts; I call upon
gold, it answers not; I call upon cloth, it answer not; it is the
human being that counts.” A fundamental unity between the di-
fferent human beings in the community, that is, a unity of hu-
man relationship, underlies traditional African ethics. African
ethics places considerable value on conformity of the individual
to the social group in order to preserve the unity of human re-
lationship. Traditional African metaphysical outlook can be
described as eco-bio-communitarian, implying recognition and
acceptance of interdependence and peaceful co-existence bet-
ween earth, plants, and animals. Within the African traditional
outlook, human beings tend to be more cosmically humble and
therefore not only more respectful of other people but also more
cautious in their attitude to plants, animals, and inanimate
things. Put in short form, they are more disposed toward an
attitude of live and let live (Tangwa, 1999). To commune with
one another, based on communion with God, nature and culture,
is the pillar life-stone in African societies.
Communalism is a fact that flows from human nature. From
the nuclear family via the extended family to the village and
entire kindred, life was seen and lived as one. No one can make
alone. We need one another. Nyasani writes that sociality, pa-
tience, tolerance, sympathy and acceptance are areas in which
the African mind seems to reveal itself in a somewhat dramatic
way. He captures it in the following words: “It reveals itself
through what may rightly be called a congenital trait of social-
bility. It further reveals itself as a virtuous natural endowment
of patience and tolerance. And lastly it manifests itself as a
natural disposition for mutual sympathy and acceptance. These
three areas then appear to serve as important landmarks in the
general description of the phenomenology of the African mind”
(Nyasani, 1997). Human behaviour in Africa is expected to
conform to the value of good human relation and incorporation
to build social harmony.
Sense of the Sacredness of Life
At the centre of traditional African morality is human life
which is a priceless gift. The sacredness of human life and hu-
man worth form the fundamental values and pillar of ethical
thinking in Africa. Ubuntu states that there is intrinsic value to
something about human nature that demands honouring. Afri-
cans recognize the dignity of the human being and, in con-
sequence, hold a deep and unrelenting concern for human wel-
fare and happiness. Recognition of the value of humanity is
intrinsically linked with recognition of the unity of all people,
whether or not they are biologically related. The most important
rule in Bantu ethics and philosophy is that of “blood.” All indi-
viduals descending from the same ancestor are brothers and
sisters: they possess a common ancestral heritage of consangui-
nity. This situation gives them rights and duties. They have the
right to be protected by the whole “family” or, better, lineage.
But they have to avoid anything that could cause evil to anyone
of the group or, most of all, to the group as a whole. It is the
duty of each one to reinforce life for the whole group (Kagabo,
2004). The promotion of life is therefore the determinant prin-
ciple of African traditional morality and this promotion is
guaranteed only in the community. Many renowned African
philosophers like Kwasi Wiredu and Kwame Gyekye conceive
African morality as a form of improving people’s quality of life
(Wiredu, 2004).
African Religiosity or Sense of the Sacred
Goodman Nelson argued that the conditions for distingui-
shing right from wrong the stuff of ethics and the remaking of
world version are not based on comparison with a “world un-
described, undepicted, unperceived” (Goodman,1978). Con-
trary to this view in Africa there is serious interconnectedness
of religion and morality as African cosmogony indicates a di-
vinely destined creation. The attachment to, and worship of
God, forms a dominating part of the African world-view. All
their dealings and lifestyle is impregnated with a vision of the
divine, and all natural reality is explainable in function of the
supernatural reality. Expressions of this pervading religiosity
abound in African languages, arts, proverbs, myths, legends
stories, songs, habits, environment and relationships. Samuel
Imbo says that to understand African religions, one only need
to look as it is actually lived by the ordinary person in the
community. Observe the person busy at work and play, at the
joyous occasions of birth and marriage, and at the sad moments
of war and death. Observe also the interactions of the living
with the dead, for that is where the meaningfulness of life
(Imbo, 2004).
Religion is central in the inculcation, the promotion and rea-
lisation of harmonious inter-relationship among individuals and
the community. African religiosity has in its bosom the belief
that God is; that He is a transcendent Being, and that He is the
all-powerful creator of all that there is, including other super-
natural spirits, gods, ancestors as well as human beings and the
entire material and cosmic creation. God as transcendent high is
revered and worshipped though distantly and often through the
minor deities who are his intermediaries in the governance of
the universe. The belief in deities and ancestral worship is an
important element of African traditional religions. The belief
occupies an important place in the understanding of the role of
the traditional religion in inculcating the ideal of harmonious
living among African peoples. One needs however, to know the
content of the belief to be better able to appreciate how it helps
the people to realise the community ideal of harmonious living.
The ancestors, or the living-dead, as John Mbiti refers to them,
are believed to be disembodied spirits of people who lived up-
right lives here on earth, died “good” and natural death, that is
at ripe old age, and received the acknowledged funerary rites.
The depth of religiosity in the African personality and the
centrality of religion in people’s personal and communal lives
have an equilibrating force for the African. His vision of life is
structured by the divine. It is a deeply spiritual one. This stems
from the fact that man is understood to be a humano-divine
being. He is capable of God, not only in terms of origin, but
also in terms of dependence and sustenance. He may not have
the vision of a blissful union with God in the Christian escha-
tological sense of a face-a-face Visio Beatifica with God at the
end of the individual’s life (Iroegbu, 1994). But the African
knows that God is in charge of everything, his whole life in-
cluded. All true development to the African takes religion as it
basis. The divine is the centre of full success and ultimate en-
richment that all must attune towards. Outside of the Supreme
Being, God, nothing can be and nothing can integrally de-
velop. Consequently outside the divine scheme progress and su-
ccess in any area of human endeavour in an authentic sense is
impossible. The commands of God, the taboos of gods and
deities and all the religious laws that build persons up in dignity
and mutuality are meant to assist people develop as to maintain
equilibrium in all things. This is practicalized through a proper
religious attitude, moral discipline, communal-individual equi-
librium and personal happiness.
Professional or Academic Bioethics
The second conception of African bioethics, that is bioethics
as an academic or professional discipline is a domain in which
Africa is still lagging behind. The current growth of bioethics in
Africa at this level can be characterized as sailing in rough
ocean using archaic technology and one is never sure where one
is or what direction one ought to take. 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 books, jour-
nals, classroom teachings, and conferences in Africa. For in-
stance, in the past years, bioethics has been about finding ar-
guments to support the recommendations to stop, or at least
slow down, take care, beware, meanwhile, Africans are still to
develop the means and mechanisms to enable this kind of as-
sessment. A lot still need to be done to enable the field of bioe-
thics flourish at this level in Africa and to empower the ca-
pacities of bioethicists and institutions to function optimally.
This is true in the light that Africa has very few trained bioethi-
cists, bioethics is not taught in higher institutions of learning
and there is no vibrant culture of bioethical discourse among
C. T. ANDOH 73
philosophers, scientists and medical practitioners. There is a
lack of critical thinking in the field in Africa as no academic
theses are being examined in the field. Karori Mbũgua laments
this as he writes that: “Unfortunately academic bioethics, like
professional philosophy, 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 education even at the certificate level” (Mbũgua,
The future of bioethics in Africa here is bleak as bioethics is
not taught in many higher educational systems of learning.
Africa at this century still lack professionals, experts, professors
of bioethics, the institutions, infrastructures and the critical
mass of African experts to address the current issues of bioe-
thics from typically an African background to bring out African
specificities, approaches and aspects. A careful survey would
reveal that most African governments have not yet taken the
commitment to set up and strengthen ethical and bioethics bod-
ies in their respective countries. Meanwhile, there is need to
create and encourage formal teaching of bioethics in universi-
ties and post university education that deal with research on
human subjects. There is the necessity to put into place pro-
grams of training and teaching on ethics, bioethics and right to
health in all academic and professional programs (health scien-
ces, social and human science and technology). We need to be
reminded that when it comes to ethics, passively allowing so-
mething to happen is morally not different than actively making
it happen. There is need for a radical rethinking and re-inven-
tion of the fields’ nature, purpose, scope, approaches and pri-
orities within Africa. The challenge is that bioethics has to be
practically relevant, that is, the individual reflections of African
bioethicists must primarily be geared towards resolving bioe-
thical dilemmas confronting Africa today such as health care
delivery. In this light, Africa has to develop standards to certify
expertise in clinical ethics, research ethics, and scientific inte-
grity, and to develop codes of ethics governing not only clinical
ethics consultation 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.
Furthermore, interdisciplinary research challenges since bi-
oethics has now evolved to an interdisciplinary field of schola-
rly investigation on every aspect of life, and this transforms it
into a disparate discipline that uses different methods and ap-
proaches. In the bioethics landscape, a whole range of different
disciplines engage with a research question. The field now is
comprised of practitioners from medicine, philosophy, theology,
law, nursing, social psychology, epidemiology, health services
research, medical history, medical anthropology, medical socio-
logy, economics and related fields all working in the field of
bioethics (Sugarman & Sulmasy, 2010). Interdisciplinary re-
search is a challenging and complex field where Africa is still
to introduce and integrate in its programs. Africa is still limited
in terms of approach and methodology in this interdisciplinary
or multidisciplinary nature of the field of bioethics and the
challenges of doing research with different values and research
methodologies. Africa still lacks the technical know-how, hu-
man capacity and sound training in different disciplines which
can make interdisciplinary research more productive and rele-
vant for bioethics in the continent.
Further still, many experts in the international scene have of
late been speculating on the future of bioethics. Some see it fra-
gmenting, some see it ending, some see it on the cusp of prom-
ising new developments that might reinvigorate research and
debate on our field. In these debates African views are dormant
or inexistent while we need African voices to air out the con-
cerns of the continent but it is others who do so for Africa.
Most current challenging issues and vexing problems of bioe-
thics today include the sustainability of the discipline in its
current form to the “expertise” of its practitioners; the legiti-
macy of bioethics in the realms of policymaking; its relation-
ship to philosophy; the purchase of empirical and interdiscipli-
nary method; the relationship of bioethics to the real world;
bioethical understandings of the concept of “health” (and me-
thods of attainment); its agenda, priorities, and inclusiveness ri-
ght up to what might be the overarching question: “What is
bioethics all about?” (Priaulx, 2011) and what should bioethics
become in Africa.
Furthermore, today’s progress in science and technology
offers Africans enormous knowledge and powers but also crea-
tes complex challenges and difficult problems to their humanity.
Meanwhile there are no standards to regulate and guide the
progress and this create the need to reinvigorate standards for
teaching research ethics within Africa. Africa needs to develop
human, institutional and infrastructural capacities to enable it
address optimally the new mega trends in medical technologies
and the bioethical challenges created. Africa needs experts to
combat most ill informed challenges facing the continent in the
face of challenging diseases and limited health facilities. For
instance, there is in many areas mistrust for vaccines to fight
disease that ravage most populations in many countries in
Africa where health indicators are poor, infectious agents are
prevalent and health infrastructure is fragile. Expert can help
make a reasonable assessment of the risks and benefits of
vaccination, rather than distrust based on hearsay, rumors or
shoddy science.
Expert knowledge would assist in the prevention of much
morbidity and mortality in these African countries and can
ensure that good health is integrated into practice as well as
accepted in the hearts and minds of communities. There is need
to train experts who can look for means and methods that work
to enable Africa define it priorities and achieve its goals in
bioethics. Also, to bring in leadership and expertise that would
enable Africa develops its values that may guide policies and
practices on science and technology, as well as identify pitfalls
bioethicists in Africa must avoid. Jude M. Mathooka says that
the time for African institutions to incorporate bioethics in the
curricula is now. The question on whether there is a place of
bioethics in the institutions of higher learning in Africa is also
very appropriate. He writes that: “with the rapid developments
in science, technology and innovations in the world, Africa
institutions should ignore bioethics at their own peril. Teaching
bioethics in institutions of higher learning in Africa will create
awareness that bioethics can be applicable in shaping opera-
tions and encouraging good practices in the increased research
activities, the pros and cons of the introduction of alien produ-
cts; globalisation and the resultant intense inter and intracultural
interactions among human beings; and the emphasis of Science,
Technology and Innovations (ST & I) by governments. All the-
se call for well coordinated ethical approaches” (Mathooko,
If bioethics in Africa has to make for itself a place in the grand
debates that characterize the field in the international scene and
to make a future, bioethicist from the continent ought to take up
the challenges of discussing the politics, practice and intellect-
tual life of the field in Africa. In order that African traditional
and ethical values are not seen as irrelevant for contemporary
society and researchers, there is a serious need for bioethics in
Africa to reclaim and return to the roots of African thinking so
as to reconsolidate a true African authenticity. For bioethics to
be authentically African, Africans must endeavor to root it,
ground and fashion it according to their cultural norms as well
as practical realities. Bioethics in Africa today in this context
needs to be placed in the appropriate historical and social con-
text of the evolution of ideas.
Bioethics need to come to terms with the pressing dilemmas
of the African continent, the challenges that modern science,
technology and medicine creates, its numerous health chal-
lenges, wars and poverty, its difficult fragmented colonial his-
tory and neo-colonial past, and its current situation in the global
economic scene. Bioethics in Africa needs to be responsive and
deal with the immediate problems of current life while not ig-
noring bioethical problems in the Western world emanating
from cutting edge biotechnologies. Biotechnology is the most
explosive field that has raised more challenging social and
moral questions than we can currently answer. Whole new
worlds of issues are arising, with profound implications for
how we think of ourselves and each other as human beings. It is
also creating issues that challenge human imagination as socie-
ties are still ill equipped to understand fully the effects and
implications of biotechnology to daily living so as to control or
regulate it. These issues create serious challenges rooted in
certain shared commonalities and our interconnectedness with
others which Africans need to engage into thoughtful and in
informed debates.
The teaching of ethics and bioethics education in African so-
cieties should be every government’s top priority. Ethics educa-
tion, in fact, may be the ultimate solution to the major problems
facing Africa today. Africa needs to develop properly attuned
ethical theories that offers solution to the pressing dehumaniz-
ing situation affecting the continent and to do that Africans
need to think well ethically. To think well ethically requires th-
ree skills, each of which requires cultivation. The first is know-
ledge of the traditions of ethics, religious and secular, as well as
the formal theories and strategies that historically have been
deployed to analyze ethical issues. The second skill is social
perceptiveness: the capacity to understand our own culture and
the way it has tutored us with certain values and patterns of
thought and behaviour. The third is self-knowledge: the ability
to grasp our biases and proclivities, to resist self-deceit, to note
our moral weaknesses and failings (Callahan, 1999). This im-
plies that Africans need to develop and sustain reflective and
critical perspectives and to engage in meaningful ethical dis-
cussions in science and technology. Till date, the participation
of African countries at the international level in the field of
bioethics has been quite low, due to a lack of awareness at the
policy level, inadequate funding and lack of infrastructures and
resources in this field on the continent.
As such thinking well ethically requires of Africans to build
and sustain their own bioethics institutions that can train, em-
power and enable Africans handle their problems and issues
scientifically. Africans need to emphasize the importance of
multifaceted, intercultural and interdisciplinary dialogue and
education on contemporary bioethics issues. Ethics education in
Africa should begin with reflections on the idea of Africa as the
cradle of human life. This would enable Africans refresh their
faded memories with the moral principles of this continent.
This requires Africans to glance backward to ask questions
about the legacy of African thought in bioethics, to bring out
the true character of African traditional ethics by means of con-
ceptual clarification and reconstruction. Most traditional Afri-
can ethical principles which could be used to build educational
programmes include amongst others: the principle of life as the
greatest gift to humans, respect for life, love for life and pro-
creation, and an understanding of the existence of the person in
the strong living chain of ancestors and the lives which are to
come in the future. The deep religious sense and rich expres-
sions of interiority which are essential for fostering moral va-
lues and principles. The great human resource of young and
energetic people who are capable of education, knowledge, de-
velopment and contextualization of African values in a modern
In addition, a strong sense of solidarity, family and com-
munity life and care for the sick and dying. An ever growing
political awareness and political sense that is capable of chang-
ing the social and economic reasons for the spread of diseases.
A greater thrust for the recognition and promotion of human
rights, freedom and equality (Chummar, 2009). This requires
African governments to build human and institutional capacity
for the implementation of national science and technology stra-
tegies that fully integrate social and ethical concerns. Raising
ethical awareness within the region’s scientific community; rai-
sing public awareness and promoting an open and transparent
ethics debate in African societies and encouraging the active
participation of Africa in shaping the ethics discourse at the
international level. Consequently, African governments need to
reinvigorate standards for teaching research ethics and for the
conduct of research itself, as well as establish robust and trans-
parent procedures for handling allegations of unscientific and
unethical research that does not reflect African values.
The Centre for Bioethics and Human Dignity accommodated
and supported me financially for one month in the United States
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