African ethical theories tend to hold that moral agents ought to be partial, in the sense that they should favour members of their family or close community. This is considered an advantage over the impartiality of many Western moral theories, which are regarded as having counterintuitive implications, such as the idea that it is unethical to save a family member before a stranger. The partiality of African ethics is thought to be particularly valuable in the context of bioethics. Thaddeus Metz, (...) in particular, argues that his African-derived theory best accounts for a number of plausible intuitions, such as the intuition that health care practitioners ought to be biased towards the patients for whom they are directly responsible. In this article, I claim that the plausible intuitions drawn on in favour of partiality can be satisfactorily explained on the basis of impartial moral theories. Moreover, I argue that blanket acceptance of partiality has problematic consequences for distributive justice in resource allocation in biomedical contexts. By contrast, impartial theories can justify plausible instances of partiality whilst avoiding the pitfalls of fully partial moral theories. Although this provides grounds for abandoning partiality in principle, I claim that this finding should not be seen as damaging to African medical ethics. Instead, it prompts investigation of underexplored possibilities of impartial African moral theories. To demonstrate the value of this direction, I sketch some novel and attractive conceptions that combine impartiality with elements of African ethics. (shrink)

It has become increasingly common to point out that African morality is under-represented in ethical theorizing. However, it is less common to find arguments that this under-representation is unjustified. This latter claim tends to be simply assumed. In this paper I draw together arguments for this claim. In doing so, I make the case that the relative lack of attention paid to African moral ideas conflicts with epistemic and ethical values. In order to correct these shortcomings, moral theorists, broadly construed (...) as including descriptive and normative disciplines, have a duty to engage with and actively explore African moral ideas. I claim that Moral Foundations Theory is well suited to a descriptive exploratory project, and could provide a significant contribution to normative, African-derived moral theories that could be epistemically and ethically superior to their Western counterparts. (shrink)

In this paper, I argue that the ‘modified youngest first’ principle provides a morally appropriate criterion for making decisions regarding the distribution of scarce medical resources, and that it is morally preferable to the simple ‘youngest first’ principle. Based on the complete lives system's goal of maximizing complete lives rather than individual life episodes, I argue that essential to the value we see in complete lives is the first person value attributed by the experiencer of that life. For a life (...) to be ‘complete’ or ‘incomplete,’ the subject of that life must be able to understand the concept of a complete life, to have started goals and projects, and to know what it would be for that life to be complete. As the very young are not able to do this, it can reasonably be said that their characteristically human lives have not yet begun, giving those accepting a complete lives approach good reason to accept the modified youngest first principle over a simple ‘youngest first’ approach. (shrink)

Prestigious University is a large, private educational institution with a medical school, a university hospital, a law school, and graduate and undergraduate colleges all on a single campus. In the face of the Covid‐19 pandemic, students were told during spring break to return to campus only briefly to retrieve their belongings. Classes then went online. On March 23, 2020, the faculty, students, and staff were emailed the following by the university's director of infection control and public health: We have become (...) aware that a Prestigious University staff member has tested positive for the virus that causes Covid‐19. The individual, who was last on campus on March 16, is now in isolation at their permanent residence and is doing well clinically. The university has already identified those members of our community who may have been in close contact with this individual, and we are working to notify them. Further, this individual's local health department has a protocol for identifying people who have been in direct contact with anyone testing positive for Covid‐19 (such as this Prestigious University staff member) so that they can self‐quarantine and watch for COVID‐19 symptoms for a period of 14 days from their last contact with the infected individual.A professor in the Philosophy Department has asked the ethicists at the medical school whether such contact tracing suffices. “Don't the members of the community deserve to know who this is? Isn't there a mandate to identify this person in order to maximize public health benefits and slow the spread of this deadly virus?”. (shrink)

In this article I articulate and defend an African moral theory, i.e., a basic and general principle grounding all particular duties that is informed by sub-Saharan values commonly associated with talk of "ubuntu" and cognate terms that signify personhood or humanness. The favoured interpretation of ubuntu (as of 2007) is the principle that an action is right insofar as it respects harmonious relationships, ones in which people identify with, and exhibit solidarity toward, one another. I maintain that this is the (...) most defensible moral theory with an African pedigree at the time, and that it should be developed further with an eye to rivalling dominant Western theories such as utilitarianism and Kantianism. (NB: a mildly revised version, avoiding some typos and phrases that invite misinterpretation, appeared as a chapter in Isaac Ukpokolo, ed., _Themes, Issues and Problems in African Philosophy_ London: Palgrave Macmillan, 2017, pp. 97-119.). (shrink)

The dominant conceptions of moral status in the English-speaking literature are either holist or individualist, neither of which accounts well for widespread judgments that: animals and humans both have moral status that is of the same kind but different in degree; even a severely mentally incapacitated human being has a greater moral status than an animal with identical internal properties; and a newborn infant has a greater moral status than a mid-to-late stage foetus. Holists accord no moral status to any (...) of these beings, assigning it only to groups to which they belong, while individualists such as welfarists grant an equal moral status to humans and many animals, and Kantians accord no moral status either to animals or severely mentally incapacitated humans. I argue that an underexplored, modal-relational perspective does a better job of accounting for degrees of moral status. According to modal-relationalism, something has moral status insofar as it capable of having a certain causal or intensional connection with another being. I articulate a novel instance of modal-relationalism grounded in salient sub-Saharan moral views, roughly according to which the greater a being's capacity to be part of a communal relationship with us, the greater its moral status. I then demonstrate that this new, African-based theory entails and plausibly explains the above judgments, among others, in a unified way. (shrink)

Henry Richardson has recently published the first book ever devoted to ancillary care obligations, which roughly concern what medical researchers are morally required to provide to participants beyond what safety requires. In it Richardson notes that he has presented the ‘only fully elaborated view out there’ on this topic, which he calls the ‘partial-entrustment model’. In this article, I provide a new theory of ancillary care obligations, one that is grounded on ideals of communion salient in the African philosophical tradition (...) and is intended to rival and surpass Richardson’s model, which is a function of Western considerations of autonomy. I argue that the relational approach of the former has several virtues in comparison to the basic individualism of the latter. (shrink)

Is age discrimination ethically objectionable? One puzzle is that we sometimes assume that the target of both age discrimination and ageism must be older people, yet in poorer nations, older people are generally shown more respect. This article explores the ethical question. It looks first at ethical arguments favoring age discrimination toward younger people in low‐income, less industrialized countries of the global South, using sub‐Saharan Africa as an illustration. It contrasts these with arguments favoring age discrimination toward older people in (...) high‐income, more industrialized countries of the global North, particularly the United States and United Kingdom. Finally, it considers what role, if any, differences in life expectancy, infant and child mortality, and prospects for healthy lives should play in the moral embrace of a particular view by a community. It argues that there can be reasons to favor different types of discrimination in different parts of the world. (shrink)

How should healthcare systems prepare to care for growing numbers and proportions of older people? Older people generally suffer worse health than younger people do. Should societies take steps to reduce age-related health inequalities? Some express concern that doing so would increase age-related inequalities in healthcare. This paper addresses this debate by presenting an argument in support of three principles for distributing scarce resources between age groups; framing these principles of age group justice in terms of life stages; and indicating (...) policy implications that merit further attention in light of rapidly aging societies. (shrink)

Resistance to rationing health care to the elderly is enormous. This article lays out the need for rationing, based on projections of Medicare expenditure in the near future, and the judgment of policy experts that there will be no technological breakthrough that might lower costs. Various forms of rationing possibilities are discussed as well as cultural and political obstacles to needed reform. Some general principles for thinking about health care for the elderly are presented.

For well over 20 years I have been arguing that someday we will have to ration health care for the elderly. I got started in the mid-1980s when I served on an Office of Technology Assessment panel to assess the likely impact on elderly health care costs of emergent, increasingly expensive medical technologies. They would, the panel concluded, raise some serious problems for the future of Medicare. The panel did not take up what might be done about those costs, but (...) I decided to think about that question and wrote a book called, Setting Limits: Medical Goals in an Aging Society. (shrink)