Is 'decolonisation' a legitimate and appropriate value in biomedical research and teaching?

This article investigates the claim that decolonisation is an appropriate and legitimate value in the process of current-day biomedical research, particularly in Africa. Can we expect that the nature and effects of the decolonisation of research will be comparable and similar for all scientific disciplines (obviously including the biomedical disciplines), or does the claim to significant differences between the 'natural'and 'human' sciences have notable implications for our understanding of both the nature and the effects of decolonisation, as well as for our understanding of the biomedical disciplines themselves? In this article I firstly analyse the notion of decolonisation . Secondly, I investigate the legitimacy of holding and maintaining a conceptual difference between the natural and the human sciences. I do this in conversation with Charles Taylor and Jürgen Habermas, who have produced invaluable contributions in this regard. Thirdly, I apply these insights to the question as to whethethedecolonialist project (the general legitimacy of which I accept) is equally applicable to both the natural and the human sciencesin their traditional formats. Finally, I discuss the relevance of this debate for both the nature of the biomedical sciences and the question as to the extent to which the biomedical sciences can and ought to be successfully decolonised ­ a question that is answered in the affirmative

Injection risks and HIV transmission in the Republic of South Africa.

The sexualization of the HIV epidemic in South Africa has been used as evidence that unsafe medical injections are of minimal importance to transmission in Africa, because the country was thought to be free of unsafe injection risks. More recent observation reveals routine failures in infection control in South African maternity and paediatric wards and in public dental clinics. In one province at least one medical injection in five is administered with a used needle or syringe. Over 25% of new HIV infections identified in South African adults using the BED IgG capture enzyme immunoassay in 2005 were in individuals reporting they had not been sexually active in the past 12 months. Immunization injections received at public health facilities are associated with HIV infections in children, many of whom may have passed HIV to their mothers during breastfeeding. South Africa is one of few countries in sub-Saharan Africa not using auto-disable (non-reusable) syringes for all immunizations. Using resource scarcity as justification for needle reuse is ethically indefensible, as injection safety is a readily achievable goal.

Medical futility and end-of-life care.

Acceptance of the concept of medical futility facilitates a paradigm shift from curative to palliative medicine, accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process. This should not be looked upon as abandoning the patient but rather as providing the patient and family with an opportunity to come to terms with the dying process. It also does not entail withdrawal or passivity on the part of the health care professional. In addition to medical skills, the treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored.

Separation-survivability--the elusive moral cut-off point?

Act 92 of 1996, the Choice on Termination of Pregnancy Act, seeks to promote female autonomy. The Act makes no reference to the nature of the abortus--implying its moral insignificance. Utilitarian arguments on the value of life strongly support this position. Utilitarians argue that neither belonging to the human species, nor possession of the potential to develop into a person, is a significant intrinsic characteristic in determining the value of life. For them the entrance requirement to any conception of moral significance is sentience--the ability to suffer. Full moral significance is only accorded to 'persons'. A person is someone who has attained a sufficient level of self-awareness to have an interest in the continuance of its existence. This develops some time after birth. 'Conservatives' argue for conception as the moral cut-off point after which termination is morally unacceptable; 'liberals' hold that there is no such prenatal point. Both of these notions are problematic, as is the notion of sentience. We argue that separation-survivability is the only morally acceptable cut-off point, based on four premises, viz. (i) a particular notion of potentiality; (ii) the inextricable, mutual relationship between human beings and their world (without either, the other cannot exist); (iii) the moral correspondence of the viable fetus and the neonate; and (iv) the moral unacceptability of infanticide. We support a graded position on the value of prenatal human life, and a 'moderate' stance on termination--that notwithstanding possessing some moral significance, other arguments may trump this up to the point of separation-survivability. This seriously problematises 'partial birth' abortion, and the utilitarian argument on the value of life.