COVID-19 underscores the important role of Clinical Ethics Committees in Africa

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Exploration of Clinical Ethics Consultation in Uganda: A case study of Uganda Cancer Institute

“…Limitations to formation and access to CESS may range from inadequate knowledge of these mechanisms and processes, misconceptions about ethical consultations by patients and HCPs, power imbalances between HCPs and patients or their families, lack of time, inadequate quali ed ethicists as well as limited resources to establish formal ethics consultations. (13,14) In Uganda, patient care grapples with resource scarcity, disease burden, health-seeking issues, treatment adherence, emotional and psychosocial factors, communication gaps, limited knowledge, and slow medical technology progress. Notably, challenges for cancer patients such as transition to end of life and honoring patient choices are complex and come with moral dilemmas for healthcare providers, patients, and their caregivers in addition to causing distress among HCPs.…”

Fostering public health ethics awareness among medical students through interactive web-based values exchange learning: A cross-sectional study

“…[2,17,18] The coronavirus disease 2019 pandemic has accelerated this newfound interest and demand in the ethics and legalities of healthcare. [2,[19][20][21] Perhaps it reflects the shift in the focus of ethics in clinical practice from patient-centered care to greater-good utilitarianism. [22,23] Some researchers believe that the implementation of effective instructional methods can enhance the quality and uptake of research ethics courses.…”

“…[2,17,18] The coronavirus disease 2019 pandemic has accelerated this newfound interest and demand in the ethics and legalities of healthcare. [2,19–21] Perhaps it reflects the shift in the focus of ethics in clinical practice from patient–centered care to greater-good utilitarianism. [22,23]…”