Systematic review of an African bioethics framework: conception of person-hood and its influence in improving the process of informed consent in health research.

Abstract

Cultural pluralism is vital to the understanding of bioethics in different societies. The principles that guide research ethics decision-making have a cultural basis derived from the west. These principles are drawn from just one worldview out of the many existing worldviews and they are often presented as universal. When these principles are implemented internationally, they are not sufficient to address rising concerns around informed consent. The challenges of implementing these principles in Africa are not an exception. It has been very challenging to obtain genuine informed consent for research, as the procedures of decision-making, in addition to the implementation of community engagement, are always accompanied by the importation of a western ethical philosophy, some of which differs from that of the African people. The western conception of the process of informed consent is premised on the idea of individuality and an abstract self that is not encumbered by culture and society. Culturally embedded semiotic aspects of ethical decision-making are often neglected. A systematic review was conducted on how the African understandings of personhood and community have influenced decision-making in the process of informed consent and community engagement, using keywords to recruit research papers published in English via the HINARI and Google Scholar electronic databases. Among the 322 papers identified, 46 were eligible to be recruited for the study. The results from this study indicate the community plays a critical role in the successful implementation of a truly informed consent. The findings indicate the process of informed consent and decision-making varies with the level of risk and complexity associated with the research, as well as the category of the participants who will be involved in the study. The study recommends that research ethics committees should take into consideration the level of community engagement and the process of informed consent when making a decision on a particular protocol.