Public health decisions made by the state involve considerable disagreements on the course of actions, uncertainties, and compromises that arise from moral tensions between the demands of civil liberties and the goals of public health. With such complex decisions, it can be extremely difficult to arrive at and justify the best option. In this article, we propose an ethical decision-making framework based on the philosophy of Ubuntu and argue that in sub-Saharan African settings, this approach provides attractive alternative conventions of (...) moral decision-making and a useful language for understanding moral reasoning and ethics. Through its emphasis on humanity, compassion, and social responsibility, Ubuntu (“I am because we are”) has the potential to facilitate solutions to and avert conflicts between individual rights and public health. The use of Ubuntu shifts the moral reasoning and ethics of decision-making from a field of philosophy shaped by the global north, to the everyday values, decision-making, and consequent practices of people in much of Africa. Using examples of Ebola, pandemic influenza, and tuberculosis, we illustrate how Ubuntu can be applied to tackle conflicting ethical problems in public health and medicine. (shrink)

Ethical problems are addressed in various ways within countries in planning for and response to pandemic influenza. Here we report on a qualitative study, in which 46 policymakers in Malawi and Ghana were interviewed on how they identified and resolved ethical problems. The study results revealed that ethical problems involving conflicts of values and choices were raised in reference to the extent and role of resources and nature of public health interventions, including the extent and processes of decision making, reasoning, (...) and justification. There is a need for an ethical framework within pandemic preparedness plans to resolve and avert these problems. (shrink)