Ethically challenging or controversial medical procedures have prompted increasing requests for the exercise of conscientious objection, and caused concerns about how and when it should be practised. This paper clarifies definitions, especially with regard to discrimination, and explores the restrictions, duties, and practical limitations, in order to suggest criteria for its practice. It also argues that a conscientious refusal to treat, where there is therapeutic doubt, is a valid form of conscientious objection. An email survey sent to General Practitioners (GPs), (...) explored the adherence to the suggested criteria, and assessed the outcomes, in terms of acceptability, impact, and difficulties experienced by the GPs, their colleagues and their patients. The results demonstrate high acceptability of conscientious objection, and better outcomes when the suggested criteria are adhered to. The GPs would support education to improve the practice of conscientious objection to a professional level, which could further improve outcomes and acceptability. (shrink)

The response to feeding needs in advanced dementia patients is a subject of ethical inquiry. Advanced dementia is the debilitating result of a range of neurodegenerative diseases. As this terminal illness progresses, patients develop mild to severe dysphagia that can make swallowing difficult. Of the two available options, artificial tube feeding or oral hand feeding, an estimated one-third of these patients will receive artificial tube feeding. However, observational studies have failed to validate the clinical benefits of tube feeding. Ethics of (...) care, the feminist philosophical perspective, and Ubuntu philosophy offer arguments for the choice of oral hand-feeding as a preferrable first option by caregivers as far as possible. These moral theories acknowledge that human beings can be dependent for long periods, mostly early and later years of life. Both views reflect an approach that draws people into a system of interdependent caring relationships. They encourage hand feeding as a way of exhibiting solidarity and respecting human dignity even at the end of life. (shrink)

This paper problematizes the concept of individual autonomy in the on-going project of attempting to understand and construct global principles of bioethics. We argue that autonomy as it is commonly defined and interpreted, and the emphasis that is placed on it, presupposes an individualistic concept of the self, family, and community that arises out of a Euro-Western liberal tradition and that is often in tension with various non-Western perspectives. We conclude that a more globally dialogical approach to bioethics is required.

In this study, I explore the challenges that ideological hegemonies of personhood imbibed by nurses and other healthcare workers could pose for the nursing profession, particularly in terms of inhibiting the acknowledgment of difference. Dominant or hegemonic conceptions of personhood in particular spaces often consist of self‐contained ideas and essentialist ontologies and normativity of what it means to be a person, lack of which results in the denial of personhood and the othering as non‐person or sub‐person. The other as the (...) residue of such self‐contained notions of personhood is most often denied the quality of care that the one who fits within such conceptions enjoy. For nurses and other healthcare workers to overcome such exclusionary tendencies in healthcare, they must overcome hegemonies and ideological dominance and be more open to alternative viewpoints and theories of personhood. I develop these lines of thought by focusing on the rich ideological traditions of Continental and African philosophies showing how exclusion takes place within these traditions based on conceptions of personhood and how such exclusion on the basis of difference impacts negatively on healthcare. I conclude by highlighting the need to go beyond hegemonic philosophies of personhood by decolonizing and demasculinizing healthcare, thereby allowing difference to flourish in an ecology of medical knowledge. (shrink)

To date, existing studies on paltering argue the thesis that paltering is never ethically justifiable; it is akin to deception, since one uses truthful statements with an intention to deceive. This study contends the above essential description and rather argues the thesis: it is a hasty generalisation to conclude that just because paltering has been employed in some fields such as the fields of negotiation and politics to deceive, it is therefore synonymous with deception. Specifically, I show in this study (...) that paltering does not necessarily imply deception, and is distinct from lying. And following a particular interpretation of a moral theory from the global South – ubuntu – paltering is a justified (as well as ethically acceptable) non-disclosure strategy when truthful disclosure would harm one’s relational capacity or jeopardise social cohesion. I am optimistic that this study makes a conceptual contribution to ethical literature on paltering, and introduces fresh perspective to the same by showing how an African moral theory may be used to evaluate paltering. (shrink)

This study adopts a heuristic technique to argue the thesis that a set of norms rooted in the African philosophy of Ubuntu can usefully supplement current research guidelines for dealing with incidental findings discovered in genomic research. The consensus regarding incidental findings is that there is an ethical obligation to return individual genetic incidental findings that meet the threshold of analytic and clinical validity, have clinical utility, and are actionable, provided that research contributors have not opted out from receiving such (...) information. This study outlines the hurdles that may hinder the integration of this consensus in mainstream clinical practice, and shows how an ethical theory from the global south may be used to address the same. This will advance the field of ethical, legal and social issues of personalized medicine by providing exposure to the under-represented African perspective on the ethical, legal, and social issues of genomics. (shrink)

Secular arguments for equal and exclusively human worth generally tend to follow one of two strategies. One, which has recently gained renewed attention because of a novel argument by S. Matthew Liao, aims to directly ground worth in an intrinsic property that all humans have in common, whereas the other concedes that there is no morally relevant intrinsic difference between all humans and all other animals, and instead appeals to the membership of all humans in a special kind. In this (...) article, I argue that both strategies necessitate drawing a line that is both arbitrary and implausibly opens a moral gulf between individuals whose difference from one another in terms of empirical reality is entirely unremarkable, providing reasons to reject them that go beyond the standard objections in the literature. I conclude that, if all humans are to be included in the community of equals, we must lay to rest the idea that we can do so without also including a wide range of non-human animals. (shrink)

Carrying out research on brains is important for medical advances in various diseases. However, such research ought not be carried out on human brains because the benefits do not outweigh the potential risks. A possible alternative is the use of brain surrogates. Nevertheless, some scholars who uphold a threshold account of moral status suggest the possibility that, with technological advances in the near future, more advanced brain surrogates will have very similar features to humans. This may suffice for these having (...) the same moral status as humans, and as a result, the situation may have implications for brain research, indeed, leading to the implication that this ought also not to be carried out upon brain surrogates. In this article, we present a relational approach to moral status which upholds that brain surrogates do not have the same moral status as human beings. Hence, brain research ought not be rejected on the grounds of equality of moral status between humans and brain surrogates. (shrink)

There appears to be a conflict between global bioethical principles and the local understanding and application of these principles, but this conflict has misleadingly been characterized through the east–west dichotomy. This dichotomy portrays bioethical principles as western and as alien to non-western cultures. In this paper, I present reasons to reject the east–west dichotomy. Using the discussion around the principle of informed consent as an example, I propose that while bioethical values are common, bioethical governance must display a certain flexibility (...) akin to Aristotle’s metaphor about the Lesbian rule. Such flexibility combined with a deeper understanding of the lived experiences of bioethical subjects might lead to the purging of tensions between global and local, giving us Glocal Bioethics. (shrink)

Although many bioethicists have given attention to the special health issues of Africa and to the ethics of research on the continent, only a handful have considered these issues through the lens of African moral thought. The question has been for the most part neglected as to what a distinctively African moral perspective would be for the analysis and teaching of bioethics issues. To address the oversight, the authors of this paper describe embarking on a project aimed at incorporating African (...) moral perspective, values and philosophy into a teaching curriculum. The authors clarify the rationale for the project and discuss the strategies employed in Africanizing the bioethics curriculum. (shrink)

For the more than a decade, I have advanced an account of what makes persons, animals, and other beings entitled to moral treatment for their own sake that is informed by characteristically African ideas about dignity, a great chain of being, and community. Roughly according to this account, a being has a greater moral status, the more it is capable of communing (as a subject) or of us communing with it (as an object). I have mainly argued that this characteristically (...) African and relational approach to moral status is a better account than salient Western approaches, especially individualist views associated with utilitarianism and Kantianism. Over the years, several commentators have raised criticisms of my approach, including that it objectionably: entails that we may rightly dominate mentally incapacitated human beings; prioritizes mentally incapacitated human beings over animals with similar cognitive abilities without sufficient justification; entails that intelligent aliens lack moral status; cannot make sense of our duties towards the dead; and is unable to account for the standing of species as distinct from their members. In this chapter I provide a comprehensive response to these and related objections, defending the initial account as an attractive way to understand what makes a being matter morally for non-instrumental reasons. (shrink)