Department of Medicine, Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
BMC Med Ethics. 2021 Sep 25;22(1):131. doi: 10.1186/s12910-021-00696-2.
The COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa.
Twenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses.
Kenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking.
This study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.
COVID-19 大流行使非洲的医疗保健领域长期存在的挑战更加凸显。几个世纪以来，非洲一直存在严重的健康不平等问题，这些问题已经暴露无遗，并引发了复杂的伦理困境。尽管非洲几乎没有临床伦理委员会（CEC），但在 COVID-19 大流行期间，对这些服务的需求确实存在并且有所增加。非洲医疗保健专业人员或生物伦理学家对 CEC 在非洲的作用的看法以前没有得到探讨或记录。在这项研究中，我们旨在探讨这些观点，以及在非洲建立 CEC 所面临的挑战。
来自非洲的 20 名医疗保健专业人员和生物伦理学家参加了这项定性研究，该研究采用了对非洲的主题进行了主题分析，包括：（1）缺乏正式的 CEC 和解决伦理困境；（2）CEC 在 COVID-19 期间的作用；（3）COVID-19 之前提交给 CEC 的伦理困境；（4）对 CEC 的认识不足；（5）缺乏合格的生物伦理学家或临床伦理学家；（6）建立 CEC 的资源有限；（7）对 CEC 产生兴趣和建立网络。
这项研究说明了在非洲 HCP 和生物伦理学家中进行临床伦理教育的重要性，尤其是在 COVID-19 对公共和私人医疗保健系统提出了一系列临床和伦理挑战的情况下。确定的挑战和障碍将为该地区建立 CEC 或临床伦理咨询服务（CES）提供信息。研究结果引发了在非洲建立 CEC 网络的想法。
