Must we remain blind to the need for clinical ethics support services in Africa? Eyes on Nigeria.

Hospitals and healthcare workers in Africa, and Nigeria specifically, are increasingly being confronted by complex situations, in which decision-making becomes more troublesome in the presence of conflicting goals, values, and preferences among the respective stakeholders. Given that all healthcare decision-making requires ethical considerations, and there is a noted absence or paucity of documentation of institutionalized mechanisms for addressing any associated concern or dilemma in Nigeria, it is thus unclear how most hospitals, healthcare workers, and the public handle the ethical dimensions of patients' care and hospital practice, while also generating possibilities for improvement in care quality. This paper is an attempt to heighten awareness of the need for clinical ethics support services (CESS) in Nigeria and encourage thought, reflection and dialogue over the issues raised. The authors, drawing from their experiences as practicing bioethicists and health care professionals, as well as findings from an unpublished exploratory qualitative study and a review of literature, posit that Nigeria is ripe for the formalization of CESS, especially at the tertiary level of care. Based on the identified bioethics manpower capacity and societal utilization of the existing telecommunication infrastructure in Nigeria, we propose the establishment of a homegrown and socially responsive pilot initiative in which, on-site hospital ethics support services, as well as a web/portal-based or online component will be accessible to all interested healthcare professionals/students, patients, bioethicists, and members of the public. Though the evidence for the effectiveness and impact of CESS and related services on the quality and outcome of care has remained relatively weak and there is no single existing CESS model that has been comprehensively proven to be beneficial to healthcare practice in all settings, we argue that the establishment of formal and homegrown CESS should be of top priority in Nigeria, and Africa generally.