There is a ‘catch 22’ situation about applying coercion in psychiatric care. Autonomous choices undeniably are rights of patients. However, emphasizing rights for a mentally-ill patient could jeopardize the chances of the patient receiving care or endanger the public. Conversely, the beneficial effects of coercion are difficult to predict. Thus, applying coercion in psychiatric care requires delicate balancing of individual-rights, individual well-being and public safety, which has not been achieved by current frameworks. Two current frameworks may be distinguished: the civil (...) liberty approach and the Stone model. Both frameworks are restrictive, and not respectful of human dignity. In a civil liberty approach, individuals who are severely mentally-ill but not dangerous would be denied care because they do not meet the dangerousness threshold or because the use of coercion will not lead to rebirthing of autonomy. This is unsatisfactory. Albeit involuntary interventions such as talk therapies, peer-support etc., may not always lead to rebirthing of autonomy or free patients from mental illness; they can however help to maintain the dignity of each mentally ill patient. In place of these frameworks, this study proposes a new ethical framework for applying coercion in psychiatric care that is respectful of human dignity. Specifically, it draws on insights from the African ethico-cultural system by using the Yoruba concept Omo-olu-iwabi to develop this new framework. This way, the study shows that only a more respectful approach for applying coercion in psychiatric care can lead to the careful balancing of the competing interests of individual's rights, individual's well-being and public safety. (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)

This study evaluates the conflict between patient confidentiality and partner notification in sero‐discordant relationships, and argues the thesis that based on a theoretical formulation of Ubuntu, a health provider is obliged to facilitate friendly relationships in which individuals are true subjects and/or objects of communal friendship. In serodiscordant relationships, the health professional can fulfil this obligation by notifying “others” (particularly a partner with whom an HIV positive patient has a “present” and “actual relationship”) of their spouse's HIV seroconversion, since without (...) such relevant information a partner (subject) of an HIV positive patient cannot “appropriately” care for the patient's condition (object). There is a need to move away from the medical traditional emphasis that has for so long put primacy on doctor‐patient confidentiality as is the case with the Health Professions Council of South Africa Guidelines (Booklet 12) which favours patient confidentiality over partner notification. Given empirical evidence to support effectiveness of partner notification amongst sero‐discordant couples, there is thus, a need to focus emphasis on latter. This shift is necessary for achieving the United Nations’ Sustainable Development of Goal of ending HIV/AIDS epidemic by 2030. I proposed in this study that African ethics, specifically Ubuntu, will do a better job than current ethical frameworks at ensuring that partner notification receives more emphasis in the care of serodiscordant couples. If this framework is integrated into ethical guidelines and codes, it would significantly enhance the care of serodiscordant couples, as well as further boost global effort at ending HIV/AIDS epidemic by 2030. (shrink)

This paper demonstrates how ubuntu relational philosophy may be used to ground beneficial coercive care without necessarily violating a patient’s dignity. Specifically, it argues that ubuntu philosophy is a useful theory for developing necessary conditions for determining a patient’s potential dangerousness; setting reasonable limits to the duty to protect; balancing the long-term good of providing unimpeded therapy for patients who need it with the short-term good of protecting at-risk parties; and advancing a framework for future case law and appropriate regulations (...) in the care of psychotherapy patients. Issues regarding the decision to breach medical confidentiality in psychotherapeutic care are ultimately reserved for the courts. Professional assessment might be an important first step in this process, and court rulings govern most aspects of this assessment. However, current case law, especially in the United States, places an unreasonable expectation on psychotherapists to protect all at-risk parties or foresee that a patient intends to follow through on said threats. It has largely failed to guarantee psychotherapy patients unlimited access to care, while potentially inhibiting future honest communication between patients and health professionals and endangering the safety of others. Of these decisions, the two most prominent are the 1976 Tarasoff decision and the 2016 Volk decision. This paper argues for the possibility of grounding good laws in ubuntu African philosophy in a way that protects others from harm and ensures unimpeded access to care without necessarily breaching medical confidentiality. (shrink)

Empirical studies have now established that many patients make clinical decisions based on models other than Anglo American model of truth-telling and patient autonomy. Some scholars also add that current medical ethics frameworks and recent proposals for enhancing communication in health professional-patient relationship have not adequately accommodated these models. In certain clinical contexts where health professional and patients are motivated by significant cultural and religious values, these current frameworks cannot prevent communication breakdown, which can, in turn, jeopardize patient care, cause (...) undue distress to a patient in certain clinical contexts or negatively impact his/her relationship with the community. These empirical studies have now recommended that additional frameworks developed around other models of truth-telling; and which take very seriously significant value-differences which sometimes exist between health professional and patients, as well as patient's cultural/religious values or relational capacities, must be developed. This paper contributes towards the development of one. Specifically, this study proposes a framework for truth-telling developed around African model of truth-telling by drawing insights from the communitarian concept of ootọ́ amongst the Yoruba people of south west Nigeria. I am optimistic that if this model is incorporated into current medical ethics codes and curricula, it will significantly enhance health professional-patient communication. (shrink)

Aim This study is a systematic review that aims to assess how healthcare professionals manage ethical challenges regarding information within the clinical context.Method and Materials We carried out searches in PubMed, Google Scholar and Embase, using two search strings; searches generated 665 hits. After screening, 47 articles relevant to the study aim were selected for review. Seven articles were identified through snowballing, and 18 others were included following a system update in PubMed, bringing the total number of articles reviewed to (...) 72. We used a Q-sort technique for the analysis of identified articles.Findings This study reveals that healthcare professionals around the world generally employ (to varying degrees) four broad strategies to manage different types of challenges regarding information, which can be categorized as challenges related to confidentiality, communication, professional duty, and decision-making. The strategies employed for managing these challenges include resolution, consultation, stalling, and disclosure/concealment.Conclusion There are a variety of strategies which health professionals can adopt to address challenges regarding information management within the clinical context. This insight complements current efforts aimed at enhancing health professional-patient communication. Very few studies have researched the results of employing these various strategies. Future empirical studies are required to address this. (shrink)

This study argues the thesis that a set of guidelines ‐ firmly rooted in a particular interpretation of African moral theory, specifically, Ubuntu – will do a better job than current medical ethics frameworks, in addressing ethical challenges around misattributed parentage within the clinical context. Incidental information such as information with significant personal/health implications raises unique challenges for medical professionals. For example, withholding information of misattributed paternity accidentally discovered in clinical interactions may be seen by a patient as a violation (...) of his/her right‐to‐know. Contrarily, disclosure where a patient has not requested information – or where establishing paternity is not the purpose of clinical visit/interaction – may be taken by the patient as a violation of his/her right ‘not‐to‐know’. Resolving these challenges remain a herculean task. African moral theory contains an under‐emphasized value for addressing such ethical challenges around misattributed parentage in the field of transplant. I seek to contribute this knowledge; and enhance clinician‐patient relationship. This study builds off three completed systematic reviews, which aimed to answer the following questions: “what are the ethical challenges regarding information health professionals face within the clinical contest?” and “what core aspects (or common themes) of Ubuntu can be identified in existing literature describing the same?” In this present study, I applied the definition of Ubuntu which captures the core aspects of the theory in ethical literature on the same, to address ethical issues around unsought information of misattributed parentage in the field of transplant. (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)

Photo ID 279661800 © Sidewaypics|Dreamstime.com ABSTRACT Decolonization is complex, vast, and the subject of an ongoing academic debate. While the many efforts to decolonize or dismantle the vestiges of colonialism that remain are laudable, they can also reinforce what they seek to end. For decolonization to be impactful, it must be done with epistemic and cultural humility, requiring decolonial scholars, project leaders, and well-meaning people to be more sensitive to those impacted by colonization and not regularly included in the discourse. (...) INTRODUCTION Decolonization is complex. To successfully achieve decolonization, projects should incorporate the voices of those subjugated or silenced. Including such voices requires sincerely exploring who has been affected by colonialism or neocolonialism and how, as well as cultural sensitivity. In its basic use, decolonization refers to countries under colonial rule gaining independence or freedom from forms of subjugation. Additionally, scholars use the term to refer to efforts to dismantle neocolonialism and vestiges of colonialism. The process includes de-silencing subjugated voices.[1] I use decolonization in the latter way to refer to countries with technical independence. While arguably colonization ended formally with independence from colonizing powers, neocolonialism is the indirect, informal, and sometimes subtle control of the people, their economy, and political life despite formal independence from colonizing authorities. I conceptualize neocolonialism as a system that involves direct and involuntary control of another’s political, economic, or social life, impacting their worldview and ways of encountering the world. Decolonization may target actions, places, or systems like health care or AI to overcome the ills of colonialism and neocolonialism. It also may target knowledge and require rethinking how people develop their knowledge base. For example, if people grew up seeing an outside colonizer as superior, they would need to change their knowledge of superiority. Decolonization may target power, for example, changing who owns and distributes COVID-19 vaccines and who distributors exclude in the distribution of vaccines. Decolonization could require looking at those disempowered in the distribution process. Additionally, decolonization may target autonomy of persons by freeing people, ensuring human and individual rights, and respecting cultural traditions. Decolonization projects that try to de-silence by including the voices of those affected by colonialism and neocolonialism must examine inclusiveness in the context of the culture of the subrogated individuals. Examples of decolonization projects include making datasets inclusive of diverse peoples and places, returning to traditional food and eating practices, making sure hospitals in developing countries are led by locals and respectful of cultural traditions, returning unethically obtained artefacts or objects. Another project would be laying the groundwork for equality in formerly colonized countries to ensure that business ownership, education, and financial success will flow fairly to those previously victimized by colonization. Summarily, there are many strategies for decolonizing. However, it is worth asking whether the strategies have risks that undermine the goal of decolonization. I. Understanding Decolonization Discourses Many fields, from AI to politics, economics, health care, aviation, and academia, discuss decolonization. The content of the discourse on decolonization depends on the region and field discussing it. Rather than just reporting on decolonization, the discussions may be calls to action. For example, decolonization discourses reflect activism for cognitive justice, such as equal consideration of Indian or African knowledge systems in global health discourses.[2] In politics and political science, some scholars frame decolonization as an anti-western, anti-colonial movement by Africans to emancipate Africa/ns from subjugation or shift the continent to postcolonialism and post-neo-colonialism. This framing walls off non-African participants and may undermine their capacity to benefit the conversation.[3] There are other political scientists who actively support decolonization and see it as a field of activism in support of anyone and countries where colonization harmed people and development.[4] The point is that two ways of conceptualizing decolonization in politics and political science are discernible. One conceptualization is less inclusive since it alienates scholars and professionals from Western, high-income, or developed countries. The other is more inclusive. In humanitarian studies, including philosophy, some decolonization articles and conversations are efforts to end the destructive force of colonization. They focus on either the form, such as ecocide, genocide, and many others, or the geographic location, such as Africa, Asia, Latin America, and Oceania.[5] Finally, the feelings one brings into this conversation can adversely impact how one engages in them and who they listen to or are willing to hear from. For example, anger, rage, bitterness, and hatred are emotions that are not uncommon in spaces of decolonization conversations. Decolonization conversations that originate from a place of negativity risk deepening the psychological state of victimhood and prevent people from disrupting constructively or critically engaging in the conversation.[6] II. Understanding Decolonization Strategies Decolonization strategies mainly aim to de-silence victims of domination or subjugation. People have proposed many strategies for decolonizing. These strategies may be informed by what the target is for decolonization. Decolonization can target power relations in global health. For example, during the COVID-19 pandemic, public health organizations noted the power imbalance in vaccine distribution. Decolonization could involve de-silencing those affected by neocolonialism to bring about a more balanced distribution of power and a more fair distribution of the vaccine. By analyzing who was adversely impacted by the distribution and who ought to wield power, those engaged in decolonizing advocated for positive change and equitable power relations. Equally, when being is the target of decolonization, the language of unlearning or relearning and mental decolonization take centre stage in the decolonization discourse. For example, the quest to decolonize colonized minds aims to demythologize African inferiority and Western superiority. Demythologizing African inferiority enables those engaged in the decolonization discourse to cultivate and foster African agency.[7] Finally, when knowledge production is the target of decolonization, scholars use inclusion and cognitive justice. For example, they try to alter the knowledge that underlies global health ethics.[8] “[D]decolonizing researchers aim to respectfully understand and integrate theory from Other(ed) perspectives, while also critically examining the underlying assumptions that inform their Western research framework.”[9] One common strategy that scholars use in decolonization is inclusion. It is worth asking, does including people who have been subrogated foster decolonization? Whether that is effective depends on whether included people are more heard or whether the strategies to include them create new forms of silencing. III. Inclusion and the Quest to Decolonize Evaluating how effective inclusion is in the quest to de-silence subjugated voices is important. First, inclusive strategies are not neutral. They are epistemically situated. This situatedness constrains meaning-making in different ways: how and what questions are asked, how social roles are constructed, organized or assigned, and who is admitted to the room where these conversations occur.[10] Inclusion strategies may reinforce (unchallenged) assumptions. For example, to address prejudices and stereotypes in global health images, Arsenii Alenichev and his colleagues[11] successfully inverted “one stereotypical global health image” by prompting a generative AI to produce “an image of a traditional Indian or African healer healing a White Child.” Although there were some problems with the image of the White child, this innovation is a significant, useful effort to de-embed or strip global health images of problematic pictures that mythologize White superiority and Black inferiority. Yet it is possible that using categories like traditional Indian or African reinforces unchallenged assumptions, raising key questions regarding how language and words create new stereotypes. It is common to define traditional as non-conventional, unorthodox, and informal. Yet studies continue to reveal that non-scientifically appraised healing approaches in India or Africa are not only effective but also real, meaningful, fundamental, and primary care-seeking behaviours in many communities in these regions.[12] Suppose inclusive strategies are not un-situated. These conversations may be had within the structures, language, and spaces built by or connected to colonialism. The spaces, language, places, and structures in which these conversations occur can limit who can participate and how they participate. Importantly, some conditions are not conducive to participation as equals. The allocated time for the discussion could also constrain how individuals express themselves. It is unclear who is ultimately heard. Furthermore, epistemic situatedness of inclusion can impact decolonization conversations when participants are beneficiaries of, products of, and trained by structures and systems they seek to dismantle. To enhance the decolonization project and its goals, a pressing task is to unveil and question how the circumstances may inhibit activism. If the vestiges of colonialism continue to structure the decolonization discourse invisibly, the vestiges may undermine decolonization. For example, a public health discussion that includes white Western doctors and Western pharmaceutical executives in Africa may have many local Africans at the table but could still effectively devalue their input based on built-in assumptions and biases that are vestiges of colonialism. Second, exclusion and inclusion are also not binary. Individuals may experience exclusion, even while included (the phenomenon called internal exclusion). In other words, inclusion can fail to be substantial or become a means of enhancing optics, “a way of (un)consciously weakening the radical claims being pursued.”[13] For example, in South Africa, many institutions have made significant efforts to diversify their faculties due to the promulgation of the Employment Equity Act 55.[14] The act requires South African institutions to implement employment equity that redresses the history of harmful discrimination in the country. The act further requires transforming departments and institutional administrations. Although many recognize and support the need to transform departments in South Africa, the rhetoric of transformation departs sharply from the lived experiences.[15] This misalignment between the plan and practice is evident in the underrepresentation of black people and females in senior management teams, professorships in many universities and health departments, and positions of power in some South African institutions. Those selected in the transformation of the departments have also complained of being overworked. The burden of extra work undermines their ability to develop agency and voice in the space they now occupy or fulfil key requirements that have implications for their career trajectory.[16] This is called the minority tax. Notably, "the minority tax… is the burden of extra responsibilities [placed] on faculty of colour to achieve diversity and inclusion and contributes to attrition and impedes academic promotion."[17] One challenge for decolonializing projects will be for decolonial scholars and those selected for decolonization objectives to have the humility to decline invitations, requests, roles, and platforms for which they are either unqualified or lack the capacity to fulfil. At its heart, decolonization strategies must empower those included rather than weaken them. Finally, inclusion can lead to a phenomenon known as elite capture.[18] Elite capture occurs when socially advantaged individuals in a group monopolize or exploit activism to their own benefit at the expense of the larger, struggling group. Elite capture weakens decolonization efforts from within, revealing that those likely to benefit from global inclusive efforts are those who fulfil globally constructed standards, those “already present in the room.” There is no better strategy to weaken decolonial movements than weakening the project from within by strategically positioning individuals who share physical properties with the victims of exclusion and silencing but intellectually, behaviourally, psychologically, and emotionally share more common ground with the colonizer. Such insiders may be unaware they are furthering neocolonial conditions rather than decolonizing. In relation to decolonization, particularly in global health, elite capture reveals that those whose voices are loudest in the room are not necessarily those more impacted by colonialism. They may benefit more from reinforcing colonialism. Opportunism weakens meaningful activism from within, preventing good initiatives and strategies from having their intended impact or taking substantive root.[19] This paper cannot do justice to elite capture, but it is worth noting its negative impacts. IV. Improving the Impact of Decolonization To end neo-colonialism, it is important to understand how it manifests and what to do at each level. Beyond the academic discourse, many tangible efforts exist to decolonize through de-silencing. Examples of these efforts include the ME2 movement that seeks to centre the concerns and experiences of sexually abused or harassed victims in the public discourse. At the funding level, many grant-awarding agencies like Wellcome Trust have dedicated huge budgets to studies that help them understand how they may have perpetrated colonialism or neocolonialism and what they can do differently going forward.[20] In South Africa, promulgating the Employment Equity Act 55 was a tangible attempt to entrench decolonization concerns in a country's regulatory framework. Yet, these decolonization efforts could fail to be substantive if they do not reflect cultural sensitivity. Two key components of cultural sensitivity are worth highlighting here: epistemic and cultural humility. Epistemic humility is an intellectual virtue described as knowing one’s limitations and the limitations of the learning methods employed. At its simplest, it is the ability to admit when one is wrong. Cultural humility includes genuine attempts to learn about and embrace other cultures. Epistemic and cultural humility are signs of academic excellence and strength. Epistemic and cultural humility seriously acknowledge how the state of our knowledge, cognitive limitations, experiences, and backgrounds, while constraining us, also invite us to listen, learn, grow, and change. The limitations-owing account of epistemic and cultural humility suggests that “a person who is aware of her cognitive limitations and owns them is much better positioned to achieve such epistemic goods as true beliefs and understanding than someone who… simply has insight into the epistemic status of her beliefs.”[21] Epistemic and cultural humility may help prevent decolonization projects that unintentionally reinforce what they seek to dismantle. Epistemic humility calls on decolonizers to defer tasks for which they are not qualified to suitably qualified persons. Beyond this, humility supports brave scholarship that imagines and reimagines how featuring the same voices, faces, and perspectives possibly introduces new forms of domination or silencing. Cultural knowledge can lead to a more intentional way of seeking out the right people or a more diverse group than those frequently featured in decolonization conversations. This would give others more opportunities to navigate these spaces and should do so in ways that are familiar to them. One ought to be more sensitive to those who would ordinarily not be included in these conversations. Unless we radically and boldly reimagine these discussions, we risk alienating those most negatively impacted by neocolonialism. CONCLUSION Decolonization conversations are complex and the subject of academic debate. The strategies employed to decolonize can harm or help the victims of neo-colonialism. Inclusion of previously silenced individuals may not be enough to overcome the vestiges of colonialism, leading to a false inclusion, where those included feel excluded or contribute in ways reflecting their own biases and circumstances. Inclusion of an elite or people who do not truly represent the subjugated can lead to elite capture. For decolonization strategies to be impactful, for example, in the context of global health, project leaders and participants must engage in conversations employing epistemic and cultural humility. In many ways, epistemic and cultural humility can help us demythologize our assumptions of any cultural superiority or cognitive authority, allowing for diverse voices, cultures, and perspectives to emerge without domination. - [1] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [2] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [3] Anye-Nkwenti Nyamnjoh 2023. Is decolonisation Africanisation? The politics of belonging in the truly African university. Social Dynamics, 1-20. [4] Rianna Oelofsen 2015. Decolonisation of the African mind and intellectual landscape. Phronimon, 16, 130-146. [5] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [6] Pedro Alexis Tabensky 2008. The Postcolonial Heart of African Philosophy. South African Journal of Philosophy, 27, 285-295. [7] Nicholas M. Creary 2012. African Intellectuals and Decolonization, Ohio, Ohio University Press. [8] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [9] Vivetha Thambinathan & Elizabeth Anne Kinsella 2021. Decolonizing Methodologies in Qualitative Research: Creating Spaces for Transformative Praxis. International Journal of Qualitative Methods, 20, 16094069211014766. [10] Abimbola Seye 2023. Knowledge from the global South is in the global South. Journal of Medical Ethics, 49, 337. [11] A. Alenichev, P. Kingori & K. P. Grietens 2023. Reflections before the storm: the AI reproduction of biased imagery in global health visuals. Lancet Glob Health. [12] Jonathan K. Burns & Andrew Tomita 2015. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 867-877. [13] Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso 2023. What type of inclusion does epistemic injustice require? Journal of Medical Ethics, jme-2023-109091. [14] 1998. Employment Equity Act. In: GOVERNMENT, S. A. (ed.) 19370. [15] Dina Zoe Belluigi & Gladman Thondhlana 2019. ‘Why mouth all the pieties?’ Black and women academics’ revelations about discourses of ‘transformation’ at an historically white South African university. Higher Education, 78, 947-963. [16] Juliet Ramohai & Khomotso Marumo 2016. Women in Senior Positions in South African Higher Education: A Reflection on Voice and Agency. 231, 135-157. [17] J. Trejo 2020. The burden of service for faculty of color to achieve diversity and inclusion: the minority tax. Mol Biol Cell, 31, 2752-2754. [18] Olufemi Taiwo 2020. Being-in-the-Room Privilege: Elite Capture and Epistemic Deference. The Philosopher, 108, 7. [19] Margarita Kurbatova & Elena Kagan 2016. Opportunism of University Lecturers As a Way to Adaptate the External Control Activities Strengthening. Journal of Institutional Studies, 8, 116-136. [20] Jeremy Farrar. 2022. An update on Wellcome's anti-racist programme. An update on Wellcome's anti-racist programme [Online]. Available from: https://wellcome.org/news/update-wellcomes-anti-racism-programme [Accessed August 10, 2022 2022]. [21] Katherine Dormandy 2018. Does Epistemic Humility Threaten Religious Beliefs? Journal of Psychology and Theology, 46, 292-304. (shrink)

Bridget Pratt and Jantina de Vries1 have made an insightful contribution to enhancing epistemic justice in global health ethics. Their elaboration details intellectual (external) exclusion—described as non-representation—across three levels, and at its core, proposes inclusion to rectify this. To extend this work, we contend that it is worth probing the nuances and challenges associated with inclusion as a response to epistemic injustice. These include (A) the meaning of inclusion outside binary vocabularies of north and south; (B) the possibility of forms (...) of inclusion that produce exclusion and (C) inclusion as a politics of belonging with intellectual confinement as a possible epistemic harm. How the problem of injustice is described influences the substantive meaning of inclusion. In describing epistemic injustice, north and south (centre and periphery) are used as relational markers of power, inclusion, authority and exclusion. While this binary vocabulary is seductive, it can appear to confer proprietary rights to the concepts, theories and values described as originating in the global north (and south). However, such inscriptions of ownership are not always a correct reading of the problem. Sometimes, the ostensible western-ness and non-western-ness of ideas are taken for granted, particularly …. (shrink)

Bonginkosi Shozi and Donrich Thaldar’s (2023) contribution is relevant to epistemic justice, which involves efforts to develop an inclusive and global bioethics that takes seriously perspectives fr...

Germline gene editing has many applications or uses. This article focuses on specific applications. Specifically, the article draws on a moral norm arising from the thinking about the value of communal relationships in the Afro-communitarian _ubuntu_ philosophy to interrogate key issues that specific applications of germline gene editing – for xeno-transplantation, agriculture and wildlife – raise. The article contends that the application of germline gene editing in these areas is justified to the extent that they foster the capacity to relate (...) with others and to be communed with by others. The article grants that our today’s decisions about germline gene editing will likely affect future humans, but will attempt to justify how this may be ethically permissible. (shrink)

There are concerns that participation in open science will lead to various forms of exploitation – of researchers and scholars in low-income countries and under-resourced institutions. This article defends a contrary thesis and demonstrates the exact ways the underexplored notions of communal relationships, human dignity and social justice – and the normative principles to which they give rise – grounded in African philosophy can usefully address critical concerns regarding exploitation in the sharing of research resources to facilitate open partnership/collaboration and (...) reuse. Further research is required to study the specific roles different institutions can play in facilitating open practice and contribute towards establishing effective structures that can enhance equity and balance unfavourable power asymmetries. (shrink)

There are concerns that participation in open science will lead to various forms of exploitation – of researchers and scholars in low-income countries and under-resourced institutions. This article defends a contrary thesis and demonstrates the exact ways the underexplored notions of communal relationships, human dignity and social justice – and the normative principles to which they give rise – grounded in African philosophy can usefully address critical concerns regarding exploitation in the sharing of research resources to facilitate open partnership/collaboration and (...) reuse. Further research is required to study the specific roles different institutions can play in facilitating open practice and contribute towards establishing effective structures that can enhance equity and balance unfavourable power asymmetries. (shrink)

Bioethics, Volume 36, Issue 3, Page 243-251, March 2022.

This article draws on key normative principles grounded in important values – solidarity, partiality and friendliness – in African philosophy to think critically and deeply about the ethical challenges around returning individual genetic research findings in African genomics research. Precisely, we propose that the normative implication of solidarity, partiality and friendliness is that returning findings should be considered as a gesture of goodwill to participants to the extent that it constitutes acting for their well-being. Concretely, the value of friendliness may (...) imply that one ought to return actionable results to participants even when their preferences regarding feedback are unknown. Notwithstanding, returning individual genetic results will have a cost implication. The cost of feeding back is relevant in the context of African genomics research projects, which are often funded by international sponsors and should be researched further. (shrink)

Bioethics, Volume 35, Issue 7, Page 634-645, September 2021.

Big Data has amplified some challenges in the healthcare context. One significant challenge is how to use healthcare big data in ways that honor individual rights to informed consent or privacy. Careful analysis from diverse backgrounds will be vital in contributing ethical guidelines that can adequately address healthcare Big Data's growing complexities globally. Especially, the study argues that an under-explored African philosophy of Ubuntu can usefully influence big data practices in ways that address this challenge without undermining its benefits. Ubuntu (...) emphasizes harmonious relationships. Harmonious relations entail identifying with one another and exhibiting solidarity to each other. One can identify or exhibit solidarity with others through psychological attitudes such as thinking of oneself as part of a “we” and acting in ways that will more likely improve the quality of life of others. The African relational philosophy of Ubuntu deserves to be given an audience not only for epistemic justice but also because the continued absence of African perspective in the discourse on ethical use of HBD science represents a missed opportunity to enrich ethical thinking about HBD from diverse backgrounds. Research is, however, required to provide greater specificity on how Ubuntu values may be integrated into HBD analytic techniques. (shrink)

There are concerns that participation in open science will lead to various forms of exploitation – of researchers and scholars in low‐income countries and under‐resourced institutions. This article defends a contrary thesis and demonstrates the exact ways the underexplored notions of communal relationships, human dignity and social justice – and the normative principles to which they give rise – grounded in African philosophy can usefully address critical concerns regarding exploitation in the sharing of research resources to facilitate open partnership/collaboration and (...) reuse. Further research is required to study the specific roles different institutions can play in facilitating open practice and contribute towards establishing effective structures that can enhance equity and balance unfavourable power asymmetries. (shrink)

The article argues the thesis that institutions have a prima facie obligation to fund the feedback of individual findings in genomic research conducted on the African continent by drawing arguments from an underexplored Afro-communitarian view of distributive justice and rights of researchers to be aided. Whilst some studies have explored how institutions have a duty to support return as a form of ancillary care or additional foreseeable service in research by mostly appealing to dominant principles and theories in the Global (...) North, this mostly normative study explores this question by appealing to underexplored African philosophy. This is a new way of thinking about institutional responsibility to fund feedback and responds to the call to decolonise health research in Africa. Further studies are required to study how this prima facie obligation will interact with social contexts and an institution’s extant relationships to find an actual duty. The research community should also work out procedures, policies and governance structures to facilitate feedback. In our opinion, though the impacts of feeding back can inform how institutions think about their actual duty, these do not obliterate the binding duty to fund feedback. (shrink)

Anna Wexler and Laura Specker Sullivan (2023) draw on their positionality as Global North early career neuroethics scholars to initiate a meaningful and timely conversation on Translational Neuroet...

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)

This manuscript draws on the moral norms arising from the nuanced accounts of epistemic (in)justice and social identity in relational autonomy to normatively assess and articulate the ethical problems associated with using AI in patient care in light of the Black Box problem. The article also describes how black-boxed AI may be used within the healthcare system. The manuscript highlights what needs to happen to align AI with the moral norms it draws on. Deeper thinking – from other backgrounds other (...) than decolonial scholarship and relational autonomy – about the impact of AI on the human experience needs to be done to appreciate any other barriers that may exist. Future studies can take up this task. (shrink)

Thaddeus Metz’s groundbreaking book A Relational Moral Theory provides a sophisticated moral theory hailing from the Global South. In this book, one of the theses he defends is that biotechnological enhancement is generally morally impermissible. This article, written for a book symposium on A Relational Moral Theory, primarily demonstrates how Metz’s criticisms presented in his book fail to convince. Furthermore, we explore some possible objections from Metzian deontology against enhancement and also show that these do not imply that enhancement is (...) intrinsically wrong. Finally, we showed how Metzian ethics offers good reasons to support rather than oppose enhancement. (shrink)

Current studies of anti/‐natalism have been carried out mainly in the context of western philosophy. In this article, we offer a pro‐natalist view based on Confucian and Afro‐communitarian philosophy (Sino‐African ethics). Grounded in this Sino‐African perspective, we uphold that there is, at least, one reason to believe that not only is it morally permissible to procreate, but also that on some occasions, procreating is what morality prescribes. Specifically, we contend that, from a Sino‐African perspective, procreating sometimes is the best way (...) to fulfil duties of reciprocity and care towards our parents. (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)

In July 2020, the H3Africa Ethics and Community Engagement (E&CE) Working Group organised a webinar with ethics committee members and biomedical researchers from various African institutions throughout the Continent to discuss the issue of whether and how biological samples for scientific research may be accessed by commercial entities when broad consents obtained for the samples are silent. 128 people including Research Ethics Committee members (10), H3Africa researchers (46) including members of the E&CE working group, biomedical researchers not associated with H3Africa (...) (27), representatives from the National Institutes of Health (16) and 10 other participants attended the webinar and shared their views. Several major themes emerged during the webinar, with the topics of broad versus explicit informed consent, defining commercial use, legacy samples and benefit sharing prevailing in the discussion. This report describes the consensus concerns and recommendations raised during the meeting and will be informative for future research on ethical considerations for genomic research in the African research context. (shrink)

This posthumous book represents the first publication of one of the seminars of Cornelius Castoriadis, a renowned and influential figure in twentieth-century thought. A close reading of Plato’s Statesman, it is an exemplary instance of Castoriadis’s pragmatic, pertinent, and discriminating approach to thinking and reading a great work: “I mean really reading it, by respecting it without respecting it, by going into the recesses and details without having decided in advance that everything it contains is coherent, homogeneous, makes sense, (...) and is true.” Castoriadis brings out what he calls The Statesman’s “quirky structure,” with its three digressions, its eight incidental points, and its two definitions, neither of which is deemed good. He does not hesitate to differ with the text, to show that what is, in appearance, secondary is really essential, and that the denunciation of the Sophists accommodates itself quite well to the use of sophistical procedures. Castoriadis shows how The Statesman takes us into the heart of what is distinctive in the late Plato: blending, acceptance of the mixed, of the intermediate. These transcriptions of Cornelius’s afford the reader an opportunity to discover his trenchant, convincing, energetic, provocative, and often droll voice. Here is a hitherto unknown Castoriadis, who reflects as he speaks, collects himself, corrects himself, and doesn’t hesitate to revisit key points. In short, this is Castoriadis’s thinking in action. (shrink)

These remarkable essays include Cornelius Castoriadis's latest contributions to philosophy, political and social theory, classical studies, development theory, cultural criticism, science, and ecology. Examining the "co-birth" in ancient Greece of philosophy and politics, Castoriadis shows how the Greeks' radical questioning of established ideas and institutions gave rise to the "project of autonomy". The "end of philosophy" proclaimed by Postmodernism would mean the end of this project. That end is now hastened by the lethal expansion of technoscience, the waning of (...) political and social conflict, and the resignation of intellectuals who blindly defend Western culture as it is or who merely denounce or "deconstruct" it as it has been. Discussing and criticizing Plato, Aristotle, Leibniz, Kant, Hegel, Weber, Heidegger, and Habermas, the author of The Imaginary Institution of Society and Crossroads in the Labyrinth poses a radical challenge to our inherited philosophy. (shrink)

The integration of biomedical terminologies is indispensable to the process of information integration. When terminologies are linked merely through the alignment of their leaf terms, however, differences in context and ontological structure are ignored. Making use of the SNAP and SPAN ontologies, we show how three reference domain ontologies can be integrated at a higher level, through what we shall call the OBR framework (for: Ontology of Biomedical Reality). OBR is designed to facilitate inference across the boundaries of domain ontologies (...) in anatomy, physiology and pathology. (shrink)

The project of autonomy is not a utopia (1992) -- Why I am no longer a Marxist (1974) -- Imaginary significations (1982) -- Response to Richard Rorty (1995) -- On wars in Europe (1992) -- On the possibility of creating g new form of society (1977) -- What political parties cannot do (1979) -- Present issues for democracy (1986) -- These are bad times (1986) -- Do vanguards exist? (1987) -- What revolution is (1987) -- Neither a historical necessity nor (...) simply an "ethical" exigency: a political and human exigency (1988) -- When the east swings to the west (1989) -- The market, capitalism, and democracy (1990) -- "Democracy" without citizens' participation (1991) -- The Gulf War: setting things straight (1991) -- Gorbachev: neither reform no backtracking (1991) -- On war, religion, and politics (1991) -- Communism, fascism, and emancipation (1991) -- Ecology against the merchants (1992) -- The revolutionary potency of ecology (1992) -- A society adrift (1993) -- On political judgment (1995) -- Neither resignation nor archaism (1995) -- A rising tide of significany? (1996) -- A singular trajectory (1992). (shrink)

As a work of social theory, I would argue that it belongs in a class with the writings of Habermas and Arendt". -- Jay Bernstein, University of Essex This is one of the most original and important works of contemporary European thought.

In this article, we contend that due to their size and emphasis upon addressing external social concerns, the corporate relationship between social enterprises, social awareness and action is more complex than whether or not these organisations engage in corporate social responsibility (CSR). This includes organisations that place less emphasis on CSR as well as other organisations that may be very proficient in CSR initiatives, but are less successful in recording practices. In this context, we identify a number of internal CSR (...) markers that may be applied to measuring the extent to which internal CSR practices are being observed. These considerations may be contrasted with the evidence that community based CSR activities is often well developed in private sector small to medium sized enterprises (SMEs) (Observatory of European SMEs, 2002), a situation which may be replicated in social enterprises especially those that have grown from micro-enterprises embedded in local communities. We place particular emphasis upon the implications for employee management. Underpinning our position is the Aristotelian-informed capabilities approach, a theory of human development and quality of life, developed by Sen (1992; 1999) and Nussbaum (1999) which has been developed further, in an organisational context, (e.g., Cornelius, 2002); Cornelius and Gagnon, 2004; Gagnon and Cornelius, 1999; Vogt, 2005. We contend that the capabilities approach offers additional insights into CSR in social enterprises in general and internal CSR activity in particular. Our article concludes with proposals for future research initiatives and reflections upon social enterprise development from a capabilities perspective. (shrink)

This collection presents a broad and compelling overview of the most recent work by a world-renowned figure in contemporary thought. The book is in four parts: Koinonia, Polis, Psyche, Logos. The opening section begins with a general introduction to the author's views on being, time, creation, and the imaginary institution of society and continues with reflections on the role of the individual psyche in racist thinking and acting. The second part is a critique of those who now belittle and distort (...) the meaning of May 1968 and other movements of the sixties as well as the French Revolution. In part three, Castoriadis shows how psychoanalysis, like politics, can contribute to the project of individual and collective autonomy and challenges Lacan, Foucault, and Derrida, and others in his report on 'The State and Subject Today'. Finally he examines how Aristotle's original aporetic discovery and cover-up of the imagination were repeated by Kant, Freud, Heidegger, and even Merleau-Ponty. (shrink)

In the intellectual confusion prevailing since the demise of Marxism and “marxism”, the attempt is made to define democracy as a matter of pure procedure, explicitly avoiding and condemning any reference to substantive objectives. It can easily be shown, however, that the idea of a purely procedural “democracy” is incoherent and self‐contradictory. No legal system whatsoever and no government can exist in the absence of substantive conditions which cannot be left to chance or to the workings of the “market” but (...) must be posited as objectives of political activity. The confusion results from a deficient understanding of what makes a society and an empty idea of “freedom”. The objective of politics is not happiness, an affair to be left to the individuals, but it certainly is liberty understood as participation in the governance of the polity; it is also the pursuit of the common good, defined as the sum of the prerequisites and facilitations of individual autonomy depending on collective action, and as the realization of commonly agreed collective goals. (shrink)

Improvements in the health capital of citizens are central to the development of countries. By exploiting steep decreases in antiretroviral drug prices and the subsequent increases in antiretroviral therapy (ART) coverage, we test whether the resulting improvements in the health of the population are associated with the prevalence of entrepreneurial activity and whether entrepreneurial activity strengthens the relationship between ART coverage and a country’s development. Drawing on a sample of 87 low- and middle-income countries (2006–2019), we find that a 1% (...) increase in ART coverage is associated with a 1.5% increase in the number of newly registered limited liability firms; however, there is no significant relationship with (male or female) self-employment. Higher ART coverage is particularly associated with development—as proxied by gross domestic product (GDP) per capita and the Human Development Index—in countries with low levels of new business formation and high proportions of self-employment. (shrink)

Recent events have raised concerns about the ethical standards of public and private organisations, with some attention falling on business schools as providers of education and training to managers and senior executives. This paper investigates the nature of, motivation and commitment to, ethics tuition provided by the business schools. Using content analysis of their institutional and home websites, we appraise their corporate identity, level of engagement in socially responsible programmes, degree of social inclusion, and the relationship to their ethics teaching. (...) Based on published research, a schema is developed with corporate identity forming an integral part, to represent the macro-environment, parent institution, the business school and their relationships to ethics education provision. This is validated by our findings. (shrink)

The continuing relevance of Ludwik Fleck’s work, above its status as a classic in science studies, lies in his reflexive conceptualisation of an open epistemology. As early as 1929, in the midst of a broad debate about a ‘crisis’ of science, Fleck offered a socio-historical analysis of the widely assumed crisis in form of an epistemology. He presented his argument, which was in itself an interrogation of the metaphysical foundations of science, as a reflexive and political intervention to this debate. (...) His book of 1935, Genesis and development of a scientific fact, in which he developed the notion of the thought collective, can be read in a similar vein as a functional analysis of science under National Socialism. His traumatic experiences during this period fostered his drive for science, democracy and epistemology. When he returned to the epistemological debate in 1946, he sharpened the presentation of his argument, presenting it rhetorically as an ironic political dialogue. This surprising text unfolds as an epistemological intervention by a participant observer. In this respect, Fleck’s epistemology, combining the historical analysis with reflexive intervention, is still a message in a bottle. (shrink)

This article examines the construction of image recognition algorithms for the classification of plant pathology problems. Rooted in science and technology studies research on the effects of agricultural big data and agricultural algorithms, the study ethnographically examines how algorithms for the recognition of plant pathology are made. To do this, the article looks at the case of a German agtech startup developing image recognition algorithms for an app that aims to help small-scale farmers diagnose plant damages based on digital images (...) of their symptoms. The study posits that the construction of these algorithms can be grasped as a succession of layers, at each of which the startup’s employees carry out different selection practices. It is argued that these practices gradually inscribe a selective recognition of the phenomenon of plant pathology into the algorithms of the app. This selective recognition is reflected in the fact that the emerging algorithms are effective in identifying isolated plant damages on isolated crops, while ignoring most agroecosystem-related actors and relations through which plant damages arise. The article concludes that the app’s selective recognition of plant pathology is likely to perpetuate or even exacerbate the pesticide use of its users. This is because the app’s view of plant pathology as a phenomenon comprised of isolated plant damages on isolated crops is more compatible with the use of chemical pesticides than with approaches to crop protection that strive for a more moderate use of these substances (e.g., integrated pest management, agroecology, organic agriculture). (shrink)

In this posthumous collection of writings, Cornelius Castoriadis (1922-1997) pursues his incisive analysis of modern society, the philosophical basis of our ability to change it, and the points of intersection between his many approaches to this theme. His main philosophical postulate, that the human subject and society are not predetermined, asserts the primacy of creation and the possibility of creative, autonomous activity in every domain. This argument is combined with penetrating political and social criticism, opening numerous avenues of critical (...) thought and action. The book’s wide-ranging topics include the core worldview of ancient Athens, where the idea of self-creation and self-limitation made democracy possible; the wealth of poetic resources; a deconstruction of the so-called rationality of capitalism and of the current conception of democracy, along with a discussion of what a radical, revolutionary project means today; the role of what he calls the radical imagination in the creation of both societal institutions and history; the roots of hate; a psychoanalytic view of human development torn between heteronomy and autonomy; the role of education in forming autonomous individuals; and notions of chaos, space, and number. (shrink)