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Cited by 68Ethics and bioethics in healthcareEthics in Clinical ResearchAfrican cultural and philosophical studies

South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study

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Akpa-Inyang, Francis, Chima, Sylvester C.·2021·BMC Medical Ethics
DOI 10.1186/s12910-021-00678-4PMC PMC8364064
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Abstract

Background: The Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding informed consent and potential limitations to the principle of respect for autonomy in African communities. Methods: We conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach. Results: Based on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of Ubuntu/Botho and Ukama, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities. Conclusions: We conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities.

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  1. [3]Beauchamp TL Childress JF Principle of biomedical ethics 2013 Oxford Oxford University Press
  2. [10]Murove MF. The Shona concept of Ukama and the process philosophical concept of relatedness, with special reference to the ethical implications of contemporary neo-liberal economic practices. MA dissertation. University of Natal, Pietermaritzburg; 1999.
  3. [16]Chima SC. An investigation of informed consent in clinical practice in South Africa. LLD Thesis. University of South Africa; 2018; uir.unisa.ac.za>handle>thesis_chima_s. https://www.researchgate.net/publication/328459054_An_Investigation_of_Informed_Consent_in_Clinical_Practice_in_South_Africa. Accessed 11 Oct 2020.
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  8. [39]Maqutu TM. African philosophy and Ubuntu: concepts lost in translation. Master of Law dissertation. University of Pretoria, 2018.
  9. [76]Chima SC. Language as a barrier to informed consent and patient communications in South African hospitals—a working paper, in The Asian Conference on Ethics, Religion & Philosophy 2018, 18–22 March, Official Conference Proceedings, Kobe, Japan: The International Academic Forum (IAFOR). p. 67–83. http://papers.iafor.org/wp-content/uploads/conference-proceedings/ACERP/ACERP2018_proceedings.pdf. Accessed 12 Aug 2018.

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Authors
Akpa-Inyang, F., & Chima, S. C.
Affiliations
University of KwaZulu-Natal (ZA)
Corresponding author
Chima, Sylvester C.
ORCID
Venue
BMC Medical Ethics
Publisher
Springer Science and Business Media LLC
Published
2021-08-14
Volume
22
Issue
1
Pages
111-111
ISSN
1472-6939 (ISSN-L)
DOI
10.1186/s12910-021-00678-4
PMC
PMC8364064
OpenAlex
W3193689383
Cited by
67
References
80
Citations by year
2026: 16 · 2025: 13 · 2024: 17 · 2023: 15 · 2022: 5 · 2020: 1
FWCI
8.02
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Ethics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Inyuvesi Yakwazulu-Natali
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
  • Social Sciences › Education › African cultural and philosophical studies
Keywords
informed consent, respect for autonomy, biomedical research ethics, African communities, Ubuntu, relational autonomy, communalism, traditional beliefs, barriers to informed consent
MeSH terms
Bioethics, Cross-Cultural Comparison, Female, Humans, Informed Consent, Male, Morals, Personal Autonomy, Principle-Based Ethics

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