Kevin Gary Behrens

Although many bioethicists have given attention to the special health issues of Africa and to the ethics of research on the continent, only a handful have considered these issues through the lens of African moral thought. The question has been for the most part neglected as to what a distinctively African moral perspective would be for the analysis and teaching of bioethics issues. To address the oversight, the authors of this paper describe embarking on a project aimed at incorporating African moral perspective, values and philosophy into a teaching curriculum. The authors clarify the rationale for the project and discuss the strategies employed in Africanizing the bioethics curriculum.

Background Surgery for intersex infants should be delayed until individuals are able to decide for themselves, except where it is a medical necessity. In an ideal world, this single principle would suffice and such surgeries could be totally prohibited. Unfortunately, the world is not perfect, and, in some places, intersex neonates are at risk of being abandoned, mutilated or even killed. As long as intersex persons are at such high risk in some places, any ethical guidelines for intersex surgeries will need to take these extreme risks of harm into account. Main text I therefore argue for five basic principles that ought to inform ethics guidelines for surgical interventions in intersex children, specifically in contexts in which such children are at risk of significant harm. What I set out to come up with is a set of principles that do not completely prohibit surgery, but only allow it where a strong case can be made for its necessity, in the best interests of the child, and where there is some kind of oversight to prevent misuse. The first principle is that interventions as drastic as these surgeries should only be performed when there is strong evidence that they are beneficial and not harmful. The second principle is that in surgeries should normally only be performed in cases of true medical necessity. Principle three is that surgeries should normally be delayed until such time as the intersex person is mature enough to assent to treatment or decide against it. Principle four is that the conventional ethical requirements regarding truth telling apply equally to intersex children as to anyone else. The final principle is that where physicians or parents think that surgery is in the best interests of the child, the burden of proof lies with them. Conclusion It is hoped that these principles might help medical teams and parents make better decisions about intersex surgeries on children, and they would make such surgeries very rare indeed, if they happen at all.

African ethical theories tend to hold that moral agents ought to be partial, in the sense that they should favour members of their family or close community. This is considered an advantage over the impartiality of many Western moral theories, which are regarded as having counterintuitive implications, such as the idea that it is unethical to save a family member before a stranger. The partiality of African ethics is thought to be particularly valuable in the context of bioethics. Thaddeus Metz, in particular, argues that his African-derived theory best accounts for a number of plausible intuitions, such as the intuition that health care practitioners ought to be biased towards the patients for whom they are directly responsible. In this article, I claim that the plausible intuitions drawn on in favour of partiality can be satisfactorily explained on the basis of impartial moral theories. Moreover, I argue that blanket acceptance of partiality has problematic consequences for distributive justice in resource allocation in biomedical contexts. By contrast, impartial theories can justify plausible instances of partiality whilst avoiding the pitfalls of fully partial moral theories. Although this provides grounds for abandoning partiality in principle, I claim that this finding should not be seen as damaging to African medical ethics. Instead, it prompts investigation of underexplored possibilities of impartial African moral theories. To demonstrate the value of this direction, I sketch some novel and attractive conceptions that combine impartiality with elements of African ethics.

I give an account how the principle of ‘respect for autonomy’ dominates the field of bioethics, and how it came to triumph over its competitors, ‘respect for persons’ and ‘respect for free power of choice’. I argue that ‘respect for autonomy’ is unsatisfactory as a basic principle of bioethics because it is grounded in too individualistic a worldview, citing concerns of African theorists and other communitarians who claim that the principle fails to acknowledge the fundamental importance of understanding persons within the nexus of their communal relationships. I defend the claim that ‘respect for persons’ is a more appropriate principle, as it is able to acknowledge both individual decision making and the essential relationality of persons. I acknowledge that my preference for ‘respect for persons’ is problematic because of the important debate around the definition of ‘personhood’ in bioethics discourse. Relying on Thaddeus Metz's conception of moral status, I propose a relational definition of personhood that distinguishes between persons with agency and persons without agency, arguing that we have different moral obligations to these distinct categories of persons. I claim that this conception of personhood is better able to accommodate our moral intuitions than conventional approaches, and that it is able to do so without being speciesist or question-begging.

I address the question: ‘Are acts of the ritual slaughter of animals, of the kind recently engaged in by the Yengeni family, morally justifiable?’ Using the Yengeni incident as a springboard for my discussion, I focus on the moral question of the relative weight of two competing ethical claims. I weigh the claim that we have an obligation not to cause animals pain without good reason against the claim by cultures that traditional practices, such as the one under discussion, are morally justifiable on the basis of the moral goods obtained through cultural identification and participation. I attempt to show that claims justifying practices on the basis of culture are not strong enough to outweigh the prima facie wrong of causing non-human animals unnecessary pain

There is a pervasive presumption that African thought is inherently anthropocentric and has little to contribute to environmental ethics. Against this view, a promising African environmentalism can be be found in a belief in a fundamental interrelatedness between natural objects. What establishes moral considerability on this African view is that entities are part of the interconnected web of life. This position accords moral standing to all living things, groups of living things, as well as inanimate natural entities. This view is not only plausible, but also theoretically appealing

The Children’s Act and its associated regulations allow for virginity tests to be performed on male and female children over the age of 16. This is subject to a number of legislated conditions, including that informed consent should be obtained. In this article I argue that, whilst it is important that the right to social and cultural practice be protected in South Africa, virginity testing is a practice that cannot be morally justified. Firstly, I defend the claim that the practice is inherently unjust. At least some of those subjected to the tests will inevitably experience the undesirable consequences of a false test result. The practice is also discriminatory as it typically and unjustly targets girl children, since boys are far less commonly tested. I argue further that the practice perpetuates a harmful patriarchal social order. Finally, I contend that any attempts to justify this legislation are fatally flawed, because it is fundamentally irrational, since there is no reliable means of testing for virginity

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves

Given the importance of being able to account for moral obligations towards future generations, especially in the light of the problem of global climate change, I argue that there are under-appreciated notions in African thought that are able to significantly contribute to the on-going discourse with respect to inter-generational moral obligations. I identify two related African notions, both springing from the prominent belief that ancestors who have died ? but continue to have a presence ? are entitled to respect, which upon secular refinement are promising in terms of grounding a claim that we do have moral obligations to future generations. These conceptions are that the environment is a communal resource, shared across generations, and that the present generation should express gratitude to its predecessors for preserving the environment on its behalf, by emulating its predecessors and preserving the environment for future generations. I argue that these two conceptions present plausible grounds for thinking that we have moral obligations to posterity, partly because they go some way towards overcoming some of the theoretical concerns generally associated with the notion of moral obligations towards unidentifiable, contingent future persons