African Traditional Medicine: Autonomy and Informed Consent

217 Pages·2014·2.169 MB·English

by  Peter Ikechukwu Osuji (auth.)

Advancing Global Bioethics
Volume 3
Series Editors
Bert Gordijn
Dublin City University
Dublin
Ireland
Henk A.M.J. ten Have
St. Vincent’s Health Centre
Duquesne University
Pittsburgh
USA
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Peter Ikechukwu Osuji
African Traditional
Medicine: Autonomy
and Informed Consent
1 3
Peter Ikechukwu Osuji
Center for Healthcare Ethics
Duquesne University
Pittsburgh
Pennsylvania
USA
ISSN 2212-652X ISSN 2212-6538 (electronic)
ISBN 978-3-319-05890-0 ISBN 978-3-319-05891-7 (eBook)
DOI 10.1007/978-3-319-05891-7
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To my late parents Elizabeth and Leonard
Osuji for their loving care,
and
to all practitioners of African traditional
medicine and African bioethicists.
v
Peter Osuji. African Traditional Medicine: Autonomy and Informed Consent
This fascinating study engages a challenging exploration of African traditional
medicine interpreted in a manner that astutely coalesces with the western focus
on autonomy and informed consent from a relational perspective. By providing
an enlightening explanation of the community-focused culture that undergirds the
interpersonal practice of African traditional medicine, the analysis constructively
compares it with the widely respected discourse on ethics of care in bioethics. In
addition to the rich tapestry in the normative analysis, the text presents practical
guidance for healthcare ethics committees in African hospitals, integrating their
practices with relational autonomy in informed consent that characterizes African
traditional medicine. This carefully researched and clearly written book sheds much
needed light on the emerging debate on global bioethics whereby traditional cul-
tures can be illuminating and instructive for the development of healthcare in a
worldwide context.
Professor Gerard Magill, PhD, Vernon F. Gallagher Chair,
Center for Healthcare Ethics, Duquesne University, Pittsburgh, USA
vii
Preface
The Western liberal approach to informed consent defines autonomy as an inde-
pendent choice or decision made by an individual as the final authority in medical
decision-making. This approach is so dominant that one can fail to see the merits of
other traditional and cultural perspectives. This book considers another approach to
informed consent -that of communal culture of Africa, a process used in African tra-
ditional medicine (ATM) wherein patients make medical decisions and give consent
in consultation with the members of their community and the ATM doctor. Often,
but not necessarily, the final consent rests on the consensus reached in consultation
with the group rather than on that by the individual patient alone.
I argue that the ATM form of consent constitutes legitimate informed consent
based on the concept of relational autonomy, commonly called relational autonomy
in informed consent (RAIC) in this book. To interpret and enlighten the signifi-
cance of the ATM approach to RAIC, the analysis in this book examines the ethics
of care movement in Western bioethics which also advocates a relational approach
to informed consent. This movement presents a concept of persons as relational
beings who are socially embedded, thereby interpreting patient autonomy in their
relationships with others. This movement provides the hermeneutic to enlighten the
significance of the ATM approach as a legitimate model of RAIC.
By comparing ethics of care approach with that of ATM to RAIC, this book
further provides a relational approach to informed consent in order to inform the
restrictive emphasis on individual autonomy practiced in Western bioethics, all with
a view towards fostering current discourse on global bioethics. This work also pro-
vides an applied example of the contribution of ATM’s RAIC approach to ethics
committees in Africa, focusing in particular, on the decision-making process for
patient informed consent.
This book is distinct insofar as it focuses on informed consent in ATM, employs
ethics of care as a hermeneutic to interpret ATM, advocates integrated model of
healthcare ethics committees in ATM. Because ATM forms a large portion of the
healthcare systems in Africa, therefore, ATM and its practices should receive more
attention in bioethics in the present global era.
ix
Acknowledgement
First and foremost, I am also deeply indebted to Gerald Magill, PhD, Henk ten Have
PhD, and Fr. E. Uzukwu, C.S.Sp., PhD who offered invaluable advice and helped
to bring this work into being. To Margaret Mary Vojtko, R. N., who proofread the
entire work right I remain forever thankful.
I am also greatly indebted to Munyaradzi Felix Murove, PhD of South Africa.
Even though we did not know each other, he took time to offer invaluable advice
and encouragement when I contacted him at the beginning of this work. Thank you
for your love for academics as well as your expression of solidarity.
Finally, to Frs. S. Ogbonna C.S.Sp., Oliver Iwuchukwu C.S.Sp., and Ype de
Jong, to Linda Donovan, and Sr. Mary Agatha Ozah, PhD, who offered invaluable
suggestions and helped to look up references in various stages of the journey, I
remain ever grateful.
xi
Contents
1 Introduction: Informed Consent in a Communal Culture ....................... 1
1.1 Dominant Cultural Perspectives of Informed Consent ......................... 2
1.2 Informed Consent in a Communal Culture ........................................... 3
1.3 Focusing on ATM .................................................................................. 4
1.4 Scope of the Study ................................................................................ 5
1.5 Focusing on Ethics of Care ................................................................... 6
1.6 Focusing on Ethics Committees ............................................................ 7
References ...................................................................................................... 7
2 Historical Context of the Western Bioethics Approach to Autonomy ..... 9
2.1 History and Origin of Informed Consent .............................................. 9
2.1.1 Legal Origin .............................................................................. 11
2.1.2 Bioethical Origin ....................................................................... 15
2.1.3 Reaction Against Paternalism ................................................... 17
2.2 A utonomy and Informed Consent ......................................................... 19
2.2.1 Meaning of Autonomy .............................................................. 19
2.2.2 Informed Consent and the Principle of Respect for Autonomy .... 21
2.2.3 Autonomy and Trust .................................................................. 27
2.3 The Concept of Person and Autonomy ................................................. 30
2.3.1 Individual Independence ........................................................... 34
2.3.2 Reason as Opposed to Emotion ................................................. 37
2.3.3 Individual Patient Rights ........................................................... 41
2.3.4 Individual Autonomy ................................................................ 43
2.3.5 Subjective Conception of the Good .......................................... 46
2.4 Summary ............................................................................................... 48
References ...................................................................................................... 49
3 Systematic Analysis of Ethics of Care ........................................................ 53
3.1 T he History and Origin of Ethics of Care ............................................. 53
3.1.1 Feminist Movement and Some Male Voices ............................. 54
3.1.2 Ethics of Care and Alternative Feminist Moral Theories .......... 56
xiii