scholarly journals 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

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Francis Akpa-Inyang ◽  
Sylvester C. Chima
Keyword(s):  
Informed Consent ◽  
Qualitative Study ◽  
Cultural Values ◽  
Biomedical Research ◽  
Cultural Beliefs ◽  
Individual Autonomy ◽  
Individual Rights ◽  
Moral Philosophies ◽  
Respect For Autonomy ◽  
Communitarian Ethics

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.

scholarly journals Gurus and Griots: Revisiting the research informed consent process in rural African contexts

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Richard Appiah
Keyword(s):  
Informed Consent ◽  
Cultural Values ◽  
Low Income ◽  
Research Process ◽  
Sub Saharan Africa ◽  
Institutional Review Boards ◽  
Individual Autonomy ◽  
Traditional Practices ◽  
Socioeconomically Disadvantaged ◽  
Sub Saharan

Abstract Background Researchers conducting community-based participatory action research (CBPAR) in highly collectivistic and socioeconomically disadvantaged community settings in sub-Saharan Africa are confronted with the distinctive challenge of balancing universal ethical standards with local standards, where traditional customs or beliefs may conflict with regulatory requirements and ethical guidelines underlying the informed consent (IC) process. The unique ethnic, socioeconomic, and cultural diversities in these settings have important implications for the IC process, such as individual decisional autonomy, beneficence, confidentiality, and signing the IC document. Main text Drawing on insights and field observations from conducting CBPARs across several rural, highly communal, low literate, and low-income communities in Ghana, we discuss some theoretical, ethico-cultural, and methodological challenges associated with applying the universal, Western individualistic cultural value-laden IC process in sub-Saharan Africa. By citing field situations, we discuss how local cultural customs and the socioeconomic adversities prevalent in these settings can influence (and disrupt) the information disclosure process, individual decisional authority for consent, and voluntariness. We review the theoretical assumptions of the Declaration of Helsinki’s statement on IC and discuss its limitations as an ultimate guide for the conduct of social science research in the highly communal African context. We argue that the IC process in these settings should include strategies directed at preventing deception and coercion, in addition to ensuring respect for individual autonomy. We urge Universities, research institutions, and institutional review boards in Africa to design and promote the use of context-appropriate ethical IC guidelines that take into consideration both the local customs and traditional practices of the people as well as the scientific principles underpinning the universal IC standards. Conclusion We recommend that, rather than adopt a universal one-size-fits-all IC approach, researchers working in the rural, highly collectivistic, low literate, socioeconomically disadvantaged settings of sub-Saharan Africa should deeply consider the roles and influence of cultural values and traditional practices on the IC and the research process. We encourage researchers to collaborate with target communities and stakeholders in the design and implementation of context-appropriate IC to prevent ethics dumping and safeguard the integrity of the research process.

scholarly journals 新冠瘟疫蔓延時的「知情同意」原則

2020 ◽  
Vol 18 (1) ◽  
pp. 67-88
Author(s):  
Ellen Y. ZHANG
Keyword(s):  
Public Health ◽  
Informed Consent ◽  
Ethical Issues ◽  
Civil Liberties ◽  
Relevant Information ◽  
Common Morality ◽  
Individual Autonomy ◽  
Individual Rights ◽  
Middle Point ◽  
Health Crisis

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文就此次爆發的心冠病毒疸疫，探討中國在對抗疫情過程中所帶出的幾個倫理議題，尤其是如何把握傳染病突發處理中「知情同意」的倫理原則。根據世界衛生組織的規定，「知情同意」意指有行為能力的個體根據充分的相關信息採取行動的主動權，這個行動不能受到強制或謗導。然而在疫情突發時期，知情同意所涵蓋的諸如知情、能力、自願等原則在公共衛生受到挑戰之時也會受到一定的限制。如何在個人自主、個人權利與公共衛生、公共利益之間找到平衡？如何在最低限度的道德言語中找到共同的道德原則，這是疫情中值得探討的倫理議題。本文從世衛《傳染爆發倫理問題指南》出發，對其具 體的倫理原則進行分析，並將其原則放在此次爆發的疫情情境中加以説明，刨析這些原則在具體操作上的困境。作者最後試圖從儒家倫理學的角度闡述如何在東方的「家長主義式干預」和西方的「個體自主式不干預」中找到平衡點，如何在保護公民權利與保證公共衛生中找到平衡點。This paper addresses the question of informed consent during the COVID-19 pandemic. Informed consent is “the process in which a competent individual authorizes a course of action based on sufficient relevant information, without coercion or undue inducement” (WHO, 2016). However, informed consent based on disclosure, capacity, and voluntariness has been seriously challenged during the public health crisis we are facing today. How should we resolve the ethical conflict between individual autonomy and individual rights and public health and public good? How should we attain social consensus through “the minimum grammar” of common morality? In this paper, I first introduce the WHO’s “Guidance for Managing Ethical Issues in Infectious Disease Outbreaks” (2016) and its seven basic principles: justice, beneficence, utility, respect for persons, liberty, reciprocity, and solidarity. I then explain how those principles could face challenges in implementation during the pandemic, as there will always be tensions between individual rights, state interference, and health paternalism. Finally, I explore from a Confucian perspective the possibility of seeking the “middle point” between paternalism and individual autonomy, and between civil liberties and public health.DOWNLOAD HISTORY | This article has been downloaded 26 times in Digital Commons before migrating into this platform.

Two Models of Pluralism and Tolerance

1992 ◽  
Vol 14 (1) ◽  
Author(s):  
Will Kymlicka
Keyword(s):  
Political Theory ◽  
Recent Work ◽  
John Rawls ◽  
Religious Pluralism ◽  
Religious Diversity ◽  
Individual Autonomy ◽  
Individual Rights ◽  
Group Rights ◽  
The Individual ◽  
Social Pluralism

AbstractIn his most recent work, John Rawls argues that political theory must recognize and accomodate the ‘fact of pluralism’, including the fact of religious diversity. He believes that the liberal commitment to individual rights provides the only feasible model for accomodating religious pluralism. In the paper, I discuss a second form of tolerance, based on group rights rather than individual rights. Drawing on historical examples, I argue that this is is also a feasible model for accomodating religious pluralism. While both models ensure tolerance between groups, only the former tolerates individual dissent within groups. To defend the individual rights model, therefore, liberals must appeal not only to the fact of social pluralism, but also to the value of individual autonomy. This may require abandoning Rawls’s belief that liberalism can and should be defended on purely ‘political’, rather than ‘comprehensive’ grounds.

Informed Consent Challenges and Strategies: A Qualitative Study of the Orthodontists’ Perspective

2021 ◽  
Author(s):  
Narjara Conduru Fernandes Moreira ◽  
Louanne Keenan ◽  
Greta Cummings ◽  
Carlos Flores‐Mir
Keyword(s):  
Informed Consent ◽  
Qualitative Study ◽  
Challenges And Strategies

scholarly journals Study the Effect of Culture on Customer Loyalty on the Target Markets for Successful Export

2017 ◽  
Vol 9 (2) ◽  
pp. 148 ◽  
Author(s):  
Farzad Tarhani ◽  
Solmaz Janfadaei
Keyword(s):  
Cultural Values ◽  
Customer Loyalty ◽  
Cultural Beliefs ◽  
Foreign Market ◽  
Structural Equations ◽  
Cultural Dimension ◽  
Target Market ◽  
Validity And Reliability ◽  
Wide Range ◽  
Target Markets

Export deals with a wide range of environmental factors, customers and competitors that are different with the domestic market. That’s why market research and export promotion require management plans and appropriate procedures to their target markets and audiences. Exporter before entering a foreign market requires that by doing the necessary research on the marketrealizethe type of information required and how to collect it from a country other than their country and study about the cultural dimensions.In fact, differences in the environment, cultural, legal, political, economic, financial, geographic, multinational markets, free trade zones and economic agreements include the level of economic development and the risks and major exporter that they should do an investigation to consider the conditions of satisfaction and thus increase customer loyalty.This applied research was done aims to determine the effect of culture on customer loyalty at target markets for successful export using a descriptive method by a questionnaire that its validity and reliability was calculated. To analyze the issue of structural equations and correlation test was used. Based on the results, this study found a relationship between the cultural dimension, cultural beliefs and cultural values and traditions with customer loyalty at target market.

scholarly journals Changing Neighborhoods and Residents’ Health Perceptions: The Heart Healthy Hoods Qualitative Study

2018 ◽  
Vol 15 (8) ◽  
pp. 1617 ◽  
Author(s):  
Paloma Conde ◽  
Marta Gutiérrez ◽  
María Sandín ◽  
Julia Díez ◽  
Luisa Borrell ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cultural Values ◽  
Health Perceptions ◽  
Social Changes ◽  
Structured Interviews ◽  
Positive Health ◽  
Family Responsibilities ◽  
Economic Changes ◽  
Positive Effects ◽  
Constant Change

Cities, and therefore neighborhoods, are under constant change. Neighborhood changes may affect residents’ health in multiple ways. The Heart Healthy Hoods (HHH) project studies the association between neighborhood and residents’ health. Focusing on a middle–low-socioeconomic neighborhood in Madrid (Spain), our aim was to describe qualitatively its residents’ perceptions on the urban changes and their impacts on health. We designed a qualitative study using 16 semi-structured interviews including adult residents and professionals living or working in the area. Firstly, we described the perceived main social and neighborhood changes. Secondly, we studied how these neighborhood changes connected to residents’ health perceptions. Perceived major social changes were new demographic composition, new socio–cultural values and economic changes. Residents’ negative health perceptions were the reduction of social relationships, increase of stress and labor precariousness. Positive health perceptions were the creation of supportive links, assimilation of self-care activities and the change in traditional roles. Neighborhood changes yielded both negative and positive effects on residents’ health. These effects would be the result of the interrelation of different elements such as the existence or absence of social ties, family responsibilities, time availability, economic resources and access and awareness to health-promoting programs. These qualitative research results provide important insight into crafting urban health policies that may ultimately improve health outcomes in communities undergoing change.

scholarly journals Practice of informed consent in Guangdong, China: a qualitative study from the perspective of in-hospital patients

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e020658 ◽  
Author(s):  
Ni Gong ◽  
Yinhua Zhou ◽  
Yu Cheng ◽  
Xiaoqiong Chen ◽  
Xuting Li ◽  
...  
Keyword(s):  
Informed Consent ◽  
Qualitative Study ◽  
Medical Information ◽  
Medical Knowledge ◽  
Information Provision ◽  
Clinical Decision ◽  
Clinical Settings ◽  
Clinical Practices ◽  
Informed Consent Form ◽  
Hospital Patients

ObjectiveThis study aimed to investigate the practice of informed consent in China from the perspective of patients.DesignA qualitative study using in-depth interviews with in-hospital patients focusing on personal experience with informed consent.SettingGuangdong Province, China.Participants71 in-hospital patients in rehabilitation after surgical operations were included.ResultsMedical information is not actively conveyed by doctors nor effectively received by patients. Without complete and understandable information, patients are unable to make an autonomous clinical decision but must sign an informed consent form following the doctor’s medical arrangement. Three barriers to accessing medical information by patients were identified: (1) medical information received by patients was insufficient to support their decision-making, (2) patients lacked medical knowledge to understand the perceptions of doctors and (3) patient–doctor interactions were insufficient in clinical settings.ConclusionsInformed consent is implemented as an administrative procedure at the hospital level in China. However, it has not been embedded in doctors’ clinical practices because, from the perspective of patients, doctors do not fulfil the obligation of medical information provision. As a result, the informed part of informed consent was neglected by individual doctors in China. Reforming medical education, monitoring the process of informed consent in clinical settings and redesigning medical institutional arrangements are pathways to restoring the practice of informed consent and patient-centred models in China.

scholarly journals Informed Consent in the U.S. Indigenous Peoples Context: A Systematic Literature Review 

2021 ◽  
Author(s):  
Tasha Gross ◽  
Clarita Lefthand-Begay
Keyword(s):  
Informed Consent ◽  
Literature Review ◽  
Cultural Values ◽  
Systematic Literature Review ◽  
Human Subjects ◽  
The United States ◽  
Inclusion Criteria ◽  
Research Practices ◽  
The Individual ◽  
The U.S

Abstract BACKGROUND: Tribal communities in the United States (U.S.) have a long history of subjection to unethical and exploitive medical and research practices. Today, many Tribal nations are establishing procedures in order to protect themselves from further harm and to advance culturally informed research practices. These procedures are also meant to ensure that their communities benefit from research conducted within their communities. Informed consent is a key element in protecting human subjects, but it may not be sufficient in the tribal context, as its conception is rooted in Western understandings of protection. Specifically, the informed consent emphasizes the individual, rather than the community as a whole, which is just as important in the context of conducting research with Native communities.METHODS: We conduct a systematic literature review to answer two related questions: How is informed consent being conceived of by U.S. tribes? And how is informed consent being required by U.S. tribes? Our inclusion criteria include articles focusing on informed consent within the U.S. tribal context, written in English in 2010-2020. Articles that did not fit our inclusion criteria were excluded. Two reviewers independently reviewed and coded 30 peer-reviewed articles by using content analysis and, in an iterative process, agreed on emerging codes and themes. RESULTS: A number of themes arise in the selected literature, including the conception of informed consent as a process, its operation at various levels (individual, collective, and government-to-government), possible alternatives to informed consent, and the need for specificity about ownership of samples and data, benefits and/or risks, and the methods and procedures that researchers use in the course of study.CONCLUSIONS: Our key results point to a need for clear and transparent information for prospective research participants and for consent forms and processes to include the collective, as well as the individual. This will better align with the cultural values and political standing of sovereign tribes in the U.S.

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