Does the South African government have a duty to fund influenza vaccination of adults 65 years and older?

In this paper, we draw on the thinking about solidarity, reciprocity and distributive justice grounded in Afro-communitarian ethics from the Global South to argue for institutions, particularly the South African (SA) government, have a prima facie duty to foster influenza vaccine uptake for adults 65 years and older. Although we focus specifically on the South African government to defend our position, we believe that our argument extends to all governments. Notably, these duties are that the SA government ought to make influenza vaccines freely available for the older adult in both the public and private health facilities, provided financial allocation and their extant relationships allow for this. Further, the SA government has a duty to improve influenza vaccine procurement and availability in the country, preferably through increasing manufacturing capabilities. This paper is intrinsically valuable to promote epistemic justice, thereby contributing toward the decolonization of the global healthcare system. Moreover, this project has social significance in contributing to mitigation efforts against future public health challenges associated with population aging in resource-limited developing African nations, wherein the impact of population transition will be felt most.

Epistemic (in)justice, social identity and the Black Box problem in patient care.

This manuscript draws on the moral norms arising from the nuanced accounts of epistemic (in)justice and social identity in relational autonomy to normatively assess and articulate the ethical problems associated with using AI in patient care in light of the Black Box problem. The article also describes how black-boxed AI may be used within the healthcare system. The manuscript highlights what needs to happen to align AI with the moral norms it draws on. Deeper thinking - from other backgrounds other than decolonial scholarship and relational autonomy - about the impact of AI on the human experience needs to be done to appreciate any other barriers that may exist. Future studies can take up this task.

A Sino-African perspective and the morality of procreation.

Current studies of anti/-natalism have been carried out mainly in the context of western philosophy. In this article, we offer a pro-natalist view based on Confucian and Afro-communitarian philosophy (Sino-African ethics). Grounded in this Sino-African perspective, we uphold that there is, at least, one reason to believe that not only is it morally permissible to procreate, but also that on some occasions, procreating is what morality prescribes. Specifically, we contend that, from a Sino-African perspective, procreating sometimes is the best way to fulfil duties of reciprocity and care towards our parents.

Webinar report: stakeholder perspectives on informed consent for the use of genomic data by commercial entities.

In July 2020, the H3Africa Ethics and Community Engagement (E&CE) Working Group organised a webinar with ethics committee members and biomedical researchers from various African institutions throughout the Continent to discuss the issue of whether and how biological samples for scientific research may be accessed by commercial entities when broad consents obtained for the samples are silent. 128 people including Research Ethics Committee members (10), H3Africa researchers (46) including members of the E&CE working group, biomedical researchers not associated with H3Africa (27), representatives from the National Institutes of Health (16) and 10 other participants attended the webinar and shared their views. Several major themes emerged during the webinar, with the topics of broad versus explicit informed consent, defining commercial use, legacy samples and benefit sharing prevailing in the discussion. This report describes the consensus concerns and recommendations raised during the meeting and will be informative for future research on ethical considerations for genomic research in the African research context.

Addressing exploitation and inequities in open science: A relational perspective.

There are concerns that participation in open science will lead to various forms of exploitation - of researchers and scholars in low-income countries and under-resourced institutions. This article defends a contrary thesis and demonstrates the exact ways the underexplored notions of communal relationships, human dignity and social justice - and the normative principles to which they give rise - grounded in African philosophy can usefully address critical concerns regarding exploitation in the sharing of research resources to facilitate open partnership/collaboration and reuse. Further research is required to study the specific roles different institutions can play in facilitating open practice and contribute towards establishing effective structures that can enhance equity and balance unfavourable power asymmetries.

Decolonial health literature can increase our thinking about ethics dumping.

This article draws on the underexplored or novel accounts of inclusion and the moral accounts of decolonization in African health decolonial literature to increase our understanding of how ethics dumping manifests in health research partnerships, and what more ought to be done to eliminate this phenomenon. African decolonial health literature proposes "inclusion that matters" - conceptualized as substantial, respectful and deep engagement with African agency - as a solution to end domination or mitigate the "appearance" of inclusion. Based on this supposition, the harm of ethics dumping - and I demonstrate how - is that it fails to engage the agency of Africans, and listen to or echo their voices in health and health research collaborations on the continent, or research collaborations that have significant implications for them. This account of inclusion can usefully increase our thinking about ethics dumping, which is ultimately and in several ways a failure to practice responsible science. Research is required to increase our understanding of what could reasonably constitute responsible science from a variety of perspectives.

Rethinking benefit sharing in collaborative human genetic research from an Afrocommunitarian perspective.

This article draws on reflections about humanness, friendliness and partiality, in the writings of Afro-communitarians to develop principles for thinking critically about why benefit sharing, what may count as benefits within the context of human research in Africa and the limits of the obligation of benefit sharing. Suppose the thinking about humanness, friendliness, and partiality in Afro-communitarianism were the foundation of human genetic research in Africa, then, individuals who have contributed to research or borne its burden would benefit from its rewards. This is even more important if participants have pressing needs that researchers and/or research institutions can help ease. A failure to aid sample contributors and data providers in need when researchers and research institutions can-as well as an indifference to the serious needs of contributors-are failures to exhibit friendliness in the relevant ways. Finally, though providing benefits to contributors can be an important way of showing humanity to them, nonetheless, this obligation is not absolute and may be limited by the stronger obligation of shared experience-to advance science. Studies are still required to inquire how well these norms will work in practice and inform regulatory and legal frameworks.

Epistemic justice, African values and feedback of findings in African genomics research.

This article draws on key normative principles grounded in important values - solidarity, partiality and friendliness - in African philosophy to think critically and deeply about the ethical challenges around returning individual genetic research findings in African genomics research. Precisely, we propose that the normative implication of solidarity, partiality and friendliness is that returning findings should be considered as a gesture of goodwill to participants to the extent that it constitutes acting for their well-being. Concretely, the value of friendliness may imply that one ought to return actionable results to participants even when their preferences regarding feedback are unknown. Notwithstanding, returning individual genetic results will have a cost implication. The cost of feeding back is relevant in the context of African genomics research projects, which are often funded by international sponsors and should be researched further.

Should institutions fund the feedback of individual findings in genomic research?

The article argues the thesis that institutions have a prima facie obligation to fund the feedback of individual findings in genomic research conducted on the African continent by drawing arguments from an underexplored Afro-communitarian view of distributive justice and rights of researchers to be aided. Whilst some studies have explored how institutions have a duty to support return as a form of ancillary care or additional foreseeable service in research by mostly appealing to dominant principles and theories in the Global North, this mostly normative study explores this question by appealing to underexplored African philosophy. This is a new way of thinking about institutional responsibility to fund feedback and responds to the call to decolonise health research in Africa. Further studies are required to study how this prima facie obligation will interact with social contexts and an institution's extant relationships to find an actual duty. The research community should also work out procedures, policies and governance structures to facilitate feedback. In our opinion, though the impacts of feeding back can inform how institutions think about their actual duty, these do not obliterate the binding duty to fund feedback.

Managing feeding needs in advanced dementia: perspectives from ethics of care and ubuntu philosophy.

The response to feeding needs in advanced dementia patients is a subject of ethical inquiry. Advanced dementia is the debilitating result of a range of neurodegenerative diseases. As this terminal illness progresses, patients develop mild to severe dysphagia that can make swallowing difficult. Of the two available options, artificial tube feeding or oral hand feeding, an estimated one-third of these patients will receive artificial tube feeding. However, observational studies have failed to validate the clinical benefits of tube feeding. Ethics of care, the feminist philosophical perspective, and Ubuntu philosophy offer arguments for the choice of oral hand-feeding as a preferrable first option by caregivers as far as possible. These moral theories acknowledge that human beings can be dependent for long periods, mostly early and later years of life. Both views reflect an approach that draws people into a system of interdependent caring relationships. They encourage hand feeding as a way of exhibiting solidarity and respecting human dignity even at the end of life.

Racism without racists and consequentialist life-maximizing approaches to triaging.

Consequentialist life-maximizing approaches to triaging prescribe that everyone ought to have an equal chance of living a typical lifespan, through the saving more life-years (or saving most lives) principle, which emphasizes the youngest-first principle and in some cases a lottery approach, often at the expense of the old and the sick. Although this approach has already been criticized by several bioethicists, this article provides a different kind of criticism to the life-cycle viewpoint, one that has not yet been explored at length; namely, we contend that the life-maximizing approach entails a form of racism without racists in its attitude towards Black people. More specifically, we contend that by neglecting the idea that current societies are not post-racial, it privileges White individuals and disadvantages Black people in the triaging process, curtails equal opportunities for Black people, reinforces white normativity, and neglects African culture. We end the article by pointing towards an Afro-communitarian relational triaging approach that does not face the same difficulties as consequentialist life-maximizing approaches do.

Patient confidentiality, the duty to protect, and psychotherapeutic care: perspectives from the philosophy of ubuntu.

This paper demonstrates how ubuntu relational philosophy may be used to ground beneficial coercive care without necessarily violating a patient's dignity. Specifically, it argues that ubuntu philosophy is a useful theory for developing necessary conditions for determining a patient's potential dangerousness; setting reasonable limits to the duty to protect; balancing the long-term good of providing unimpeded therapy for patients who need it with the short-term good of protecting at-risk parties; and advancing a framework for future case law and appropriate regulations in the care of psychotherapy patients. Issues regarding the decision to breach medical confidentiality in psychotherapeutic care are ultimately reserved for the courts. Professional assessment might be an important first step in this process, and court rulings govern most aspects of this assessment. However, current case law, especially in the United States, places an unreasonable expectation on psychotherapists to protect all at-risk parties or foresee that a patient intends to follow through on said threats. It has largely failed to guarantee psychotherapy patients unlimited access to care, while potentially inhibiting future honest communication between patients and health professionals and endangering the safety of others. Of these decisions, the two most prominent are the 1976 Tarasoff decision and the 2016 Volk decision. This paper argues for the possibility of grounding good laws in ubuntu African philosophy in a way that protects others from harm and ensures unimpeded access to care without necessarily breaching medical confidentiality.

Transhumanism and African humanism: How to pursue the transhumanist vision without jeopardizing humanity.

African humanism should be considered more in the theoretical discussion on transhumanism. Using an underexplored humanistic philosophy of Ubuntu, this article shows how the perspective from the global south provides guidelines for pursuing transhumanism without jeopardizing humanism. It argues that heuristics from African (Ubuntu) humanism can serve transhumanist goals. While transhumanism has attracted severe criticisms from bio-conservatives, this article counterargues some salient objections. Drawing on an Ubuntu understanding of humanism, this article posits that the transhumanist vision of the posthuman does not threaten our humanity. Ubuntu humanism is shown to be supportive of transhumanism and can plausibly serve as a guide to protecting transhumanist trajectories from potential abuses. This article concludes that the embedded values of African humanism deserve to be taken seriously in galvanizing global trust in transhuman futures.

An African Relational Approach to Healthcare and Big Data Challenges.

Big Data has amplified some challenges in the healthcare context. One significant challenge is how to use healthcare big data (HBD) in ways that honor individual rights to informed consent or privacy. Careful analysis from diverse backgrounds will be vital in contributing ethical guidelines that can adequately address healthcare Big Data's growing complexities globally. Especially, the study argues that an under-explored African philosophy of Ubuntu can usefully influence big data practices in ways that address this challenge without undermining its benefits. Ubuntu emphasizes harmonious relationships. Harmonious relations entail identifying with one another and exhibiting solidarity to each other. One can identify or exhibit solidarity with others through psychological attitudes such as thinking of oneself as part of a "we" and acting in ways that will more likely improve the quality of life of others. The African relational philosophy of Ubuntu deserves to be given an audience not only for epistemic justice but also because the continued absence of African perspective in the discourse on ethical use of HBD science represents a missed opportunity to enrich ethical thinking about HBD from diverse backgrounds. Research is, however, required to provide greater specificity on how Ubuntu values may be integrated into HBD analytic techniques.

How do healthcare professionals respond to ethical challenges regarding information management? A review of empirical studies.

AIM: This study is a systematic review that aims to assess how healthcare professionals manage ethical challenges regarding information within the clinical context. METHOD AND MATERIALS: We carried out searches in PubMed, Google Scholar and Embase, using two search strings; searches generated 665 hits. After screening, 47 articles relevant to the study aim were selected for review. Seven articles were identified through snowballing, and 18 others were included following a system update in PubMed, bringing the total number of articles reviewed to 72. We used a Q-sort technique for the analysis of identified articles. FINDINGS: This study reveals that healthcare professionals around the world generally employ (to varying degrees) four broad strategies to manage different types of challenges regarding information, which can be categorized as challenges related to confidentiality, communication, professional duty, and decision-making. The strategies employed for managing these challenges include resolution, consultation, stalling, and disclosure/concealment. CONCLUSION: There are a variety of strategies which health professionals can adopt to address challenges regarding information management within the clinical context. This insight complements current efforts aimed at enhancing health professional-patient communication. Very few studies have researched the results of employing these various strategies. Future empirical studies are required to address this. ABBREVIATIONS: CIOMS: Council of International Organization of Medical Sciences; WHO: World Health Organization; AMA: American Medical Association; WMA: World Medical Association; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; ISCO: International Standard Classification of Occupations; ILO: International Labour Office; SPSS: The Statistical Package for the Social Sciences.