AFRICAN CULTURE AND MEDICAL ETHICS
Seminar conducted at Department of Surgery,
U.C.H., Ibadan, 26 February 2005
Joseph Kenny, O.P.African culture is said to revolve around the celebration of life. By life is meant not merely physical life, health of tissues and good functioning of the body, but also sharp senses and intellect in the pursuit of truth and goodness in the context of a community. This approximates the American Constitutional phrase, "life, liberty and the pursuit of happiness."
Medicine meets human life by facilitating conception, monitoring gestation and assisting birth. Thereafter it accompanies a person through life primarily by preventive medical care and, when there is need, by treating disease or damage from accidental or other forms of aggression. Finally, medicine meets a person preparing for death, and maybe afterwards by collecting organs for transplant. At every stage procedures have to be considered which require not only a medical but also an ethical, or may we say moral, assessment.
Medical ethics, as any ethics, can have multiple foundations. On the philosophical level, we have to carefully identify and evaluate utilitarian and deontologist approaches on the one hand, which are based on Enlightenment philosophy, particularly Kant, and on the other hand teleological and personalist approaches which older and more perennial roots. The first two approaches are espoused mainly by secular voices, giving rise to the term "medical ethics" in the narrow sense of what is anthropologically acceptable or legal. Teleological or personalist approaches give rise to what can properly be called "medical morals", which considers the intrinsic rightness or wrongness of a procedure, apart from its having legal support or the backing of a certain intelligentia.
Besides these philosophical approaches, we find the voices of Christian churches, Islam and Traditional Religion. The latter determines the cultural bias inherited by people of all religions, while the Christian churches and Islam add a Scriptural reference into the discussion, creating among their adherents a new composite cultural sensitivity and ethical tradition.
On the international scene, the Catholic Church has produced the most detailed and systematic treatises on medical ethics, incorporating Scripture, philosophy, culture and scientific data. Muslims have also entered the arena, and medical ethics has become a major programme in the secular academia.
The ethics of traditional society in Nigeria, coupled with Christian or Islamic norms, has constituted a widely accepted moral standard. While this has been good and has influenced countless individuals and social structures, it has had to coexist with sin. We can say the same of any good ethical system anywhere or any time. We cannot look back, say to pre-colonial Africa, and romanticize about a golden age that never existed. Sin has always been there. But at present the ethical consensus that prevailed in Nigeria has been shaken by two factors:
- The first is the corruption that has spread throughout urban society particularly, led by fraud and embezzlement of resources on the part of political leaders, followed by armed robbery and dishonesty on the lower strata of society, and family breakdown, promiscuity and widespread resort to abortion C all this in spite of lip service to and perhaps nostalgia for traditional norms.
- The second is foreign governments and NGOs which impose or promote population control by any means as a condition for economic assistance. These have used high-pressure advertizement to promote condom use and abortion on demand, and ride roughshod over people's traditional and religious sensibilities.
What we see now is not a conversation between the heirs of African values and proponents of global modernity, which could lead to an evolution of African values, but we see African values being abolished and replaced by imported secular ones. The needed conversation, if it can be launched, should lead to an African concept of modernity and an modern concept of Africanness.
Problems
The problems medical ethics has to face are many.
Conception can be assisted by the timing of copulation or by fertility drugs. It is quite another thing to manufacture babies in vitro or by cloning, whether for implantation, after selecting and expending the rest, or for the purpose of harvesting stem cells. A critique of this practice involves both fundamental principles of respect for life and a consideration of negative consequences. For instance, a fetal stem cell is a wild card. It can develop into anything whatsoever, like a tumor or something totally unintended. Marrow transplant, such as Mr. Alonge of this Department did on my leg, is a different proven sort of stem cell treatment.
There are ways of finding out the sex and the physical condition of a baby in the womb. If the baby does not measure up to expectation, in some places it can face abortion. In India now many young men have to forego marriage because there are not enough marriageable girls to go around, as a result of aborting girls.
African traditional society had no place for abortion, and in some places the guilty would be punished by death. In Nigerian cities today, however, the practice is rampant. When a young girl comes for abortion, there is a need to link her to social services to provide an alternative: a place to have her baby and a way to place it for adoption by a childless couple yearning to have a baby. Unfortunately abortion becomes a profit-orientated industry, as in the U.S., where procedures are provided instantly and without question at any point of the pregnancy in exchange for paying the fee. The providers of such services have no interest in suggesting to the girl an alternative solution. By way of contrast, I refer you to the work Abdul Sattar Edhi is doing in Pakistan.
If a baby scales through to birth, it has a better chance of having its life respected, although we hear of babies here and there tossed onto dust bins or abandoned at places where they can be picked up. Often parents find it difficult to provide adequate feeding, and when sickness does come they cannot afford treatment. It is a major challenge for the medical world to accommodate the problem of indigence. In the U.S. there formerly were charity hospitals run by religious people, but these have been forced out of business by expensive high-tech innovations, mal-practice insurance and the formation of profit-orientated hospital chains. No mercy is shown to those who do not have health insurance and cannot afford to pay. I am only grateful that I am over 65 and can make use of MEDICARE, which pays for about 80% of any medical bills I incur in the U.S.
In this context, we should weigh the merits of government versus private medical provision. Government is usually not very good in managing any business, and we hear the call for privatization as the answer. On the other hand, there must be some form of supervision of private practice and interface between it and community needs.
In Nigeria mal-practice suits are not common, and that ought to make medical treatment more affordable. In any case, the health of patients demands competency on the part of medical personnel. It is malpractice to take a "let my people go" attitude towards medical students who are doing poorly. [Story].
As death approaches, other ethical choices have to be made. Traditional norms do not permit people to suggest that the person is going to die or to start burial arrangements. Yet the dying person on his or her own may raise the question of death. The person has a right to know his condition. He should be free to accept or reject pain-killers that reduce his mental alertness. It is a problem to counsel a person to accept death and perhaps make a will or any other necessary arrangements, including the donation of organs.
Discussion questions
- Discuss the nature of traditional Nigerian ethical norms and their distinctiveness in the face of norms brought in by "globalization".
- Identify African/Nigerian traditional norms affecting medical practice.
- Discuss how these were modified by Christianity or Islam.
- Discuss how these survived and were incorporated in Christian/Muslim society.
- Evaluate their present strength in a changing society.
- Show how traditional norms concur or conflict with norms accepted and exported by Western nations.
- Propose ways of making medical care responsive to social needs.
- The question of indigence
- Other options for abortion applicants
- Preventative medicine education
- Education on how to care for simple things without a doctor
- Careful use of herbal or locally manufactured medicine
REFERENCES
Ashley, Benedict M. & O'Rourke, Kevin, Health care ethics, a theological analysis. St. Louis: The Catholic Health Association of the United States, 3rd ed. 1989.
Varga, Andrew C., The main issues in bioethics. New York: Paulist Press, 1984.
National Conference of Catholic Bishops (U.S.), Documentation on the right to life and abortion. Washington D.C.: United States Catholic Conference Publications Office, I, 1974; II, 1976.
General:
http://www.foresight.org/Nanomedicine/Ethics.html —a vast number of links to texts and sites of all persuasions
http://library.colstate.edu/resources/m_eth.shtml —another large collection of links
Catholic:
http://www.catholiceducation.org/directory /Current_Issues/Medical_Ethics/ —lively discussions of many issues
http://www.catholicculture.org/docs/doc_view.cfm?recnum=2774 —paper by Dianne N. Irving
http://www.ecatholicism.org/category.cfm?Category=15 —important links
Islamic:
http://islam.about.com/library/weekly/aa072700a.htm —brief statements with links
http://www.islamicmedicine.org/ethics.htm —a book of articles on every aspect of medical ethics
http://www.islam usa.com/im1.html —another Islamic textbook, comprising articles by different authors.