BeOnline ® Journal of the Center for Bioethics and Research

A Systematic Review of the Management of Incidental Findings in Genomic Research

Cornelius Olukunle Ewuoso — Mon, 21 Nov 2016 00:00:00 +0000

Information empowerment has been the greatest gain of genomics, yet it also poses serious threat to its survival, especially when the information is incidental. There may be an emerging consensus that actionable incidental findings be returned. But this has not been supported by any systematic review. Future directions are equally missing. These are significant gaps.

To fill these gaps, an online search on PubMed and Genetics in Medicine website was conducted between 20^th of August to 23^rd of October, 2013; combining certain filters and phrases, such as â€˜return incidental findingsâ€™. Â 19 articles were selected from an avalanche of result, and reviewed. The review confirms a majority support for return of clinically actionable findings (68.42%). The result also shows that the support represents views of Northern Americans (USA 84.2% and Canada 15.8%). Critical contributions of Africans, Asians and Europeans are missing in this discourse. I recommended studies in this direction.

The Ethics of Ebola Trial Drugs: to give or not to give?

Ebunoluwa Olufemi Oduwole, Kazeem Ademola Fayemi — Mon, 21 Nov 2016 00:00:00 +0000

The 2014 outbreak of Ebola viral disease in some West African countries, which later spread to the USA and Spain, has continued to be a subject of global public health debate. While there are no yet registered vaccines or drugs on Ebola as they are at different clinical trial phases, moral questions of bioethical significance are emerging. This paper, through a normative and critical approach, focuses on the question of whether it is ethical to give any experimental drugs to Ebola victims in Africa or not. Given the global panic and deadly contagious nature of Ebola, this paper argues on three major compassionate grounds that it is ethical to use experimental drugs on the dying African victims of Ebola. Besides respecting patients and family consent in the intervention process, this paper argues that the use of Ebola trial drugs on West African population will be ethical if it does not violate the fundamental principles of transparency and integrity in human research ethics. Using Kantian ethical framework of universality as a basis for moral action, the paper establishes further that giving trial vaccines on compassionate grounds in the face of Ebola outbreak is ethical. It is only when such drugs are discriminately administered on non-principled bases that it raises more probing moral questions in the current global Ebola scourge.

Advance Directive in End of Life Decision

Ayodele Samuel Jegede, Olufunke Olufunsho Adegoke — Mon, 21 Nov 2016 00:00:00 +0000

Increased capacity of health care professionals, armed with improved medical technologies, to sustain life even when there is no hope of recovery has created more need for decision making than ever. With the advancement in medical technology the question of when to let patients die is a subject of debate among physicians, philosophers and theologians â€“ â€œthe dilemma of modern medicineâ€ what men value is closely connected with how they view the universe, with their â€œWeltanschauungâ€ which affects biomedical field because. Value as perceived in the field enters mightily into decision-making and influence things how people make decisions. End-of-life decision making is value laden arising from the norms and values of society. In Africa, little is known about end-of-life decision making within the context of bioethics. Hence, it is difficult to understand what role ethics committees have played. This paper examines the ethnomethological perspective of this issue in a rapidly expanding bioethical global age

Methodology: The study utilized an anthropological approach to documenting contemporary issues in end-of-life decision making in Yoruba culture of Nigeria. Specifically, it aimed at examining the concept of death, cultural beliefs about end-of-life decision making, factor influencing end-of-life decision making and the role of ethics committees in end-of-life decision making. Thirty In-depth Interviews were conducted among young and adult male and female in two selected Yoruba communities. Content analytical approach was used for data analysis.

Result: In Yoruba culture, death is socially constructed being interpreted as â€œIkuâ€ (meaning: end of existence). It has spiritual, physical and social significance. Hierarchy of authority is the basis of implementing traditional advance directive. Socialization, gender, form of marriage, property, patriarchy, religious belief and tradition are the major considerations in end-of-life decision making. Education, public engagement, resource allocation and advocacy are important roles for ethics committees.

Conclusion: Further research into end-of-life decision making strategies will illuminate the diversity of cultural practices about end-of-life decision making and strengthen clinical practice.Â

Decolonizing Bioethics in Africa

Ademola Kazeem Fayemi, Olawunmi Macaulay-Adeyelure — Mon, 21 Nov 2016 00:00:00 +0000

The global spread of bioethics from its North-American and European provenance to non-Western societies is currently raising some concerns. Part of the concern has to do with whether or not the exportation of bioethics in its full Western sense to developing non-Western states is an instance of ethical imperialism. This paper attempts an exploration of this debate in the context of bioethics in sub-Saharan Africa. Rather than conceding that bioethics has a colonial agenda in Africa, this paper defends the position that the current bioethics trend in sub-Saharan Africa is an unintended imperialistic project. It argues that its colonizing character is not entirely a product of the Western programmed goals of training and institution building; rather, it is a structural consequence of many receptive African minds and institutions. Though bioethics in Africa is turning out as a colonizing project, one serious implication of such trend, if unchecked urgently, is that bioethicsâ€™ invaluable relevance to Africa is being incapacitated. This paper, therefore, attempts a decolonizing trajectory of bioethics in Africa. Contrary to the pretense of â€˜African bioethics,â€™ which some African scholars are now defending, this paper through the logic of decolonization makes case for â€˜healthcare ethicsâ€™ in Africa. In such logic, the principle of existential needs is prioritized over the principle of identity and authenticity that define African voice in bioethics. Â Â