Colonialism, Biko and AIDS: Reflections on the principle of beneficence in South African medical ethics

Braude, Hillel D.

doi:10.1016/j.socscimed.2009.03.019

Cited by 9 publications

(7 citation statements)

References 22 publications

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“…In traditional medicine, however, where diagnosis and treatment are primarily understood in social terms, a perceived threat can be addressed collectively. The suspicion of witchcraft or malevolent ancestral spirits, for example, can serve to examine and re‐establish relations with others (Evans‐Pritchard 1976; Allen 2007; Braude 2009). In the case of an HIV infection, it may help to relocate guilt from the individual to external forces, allowing the affected person to re‐integrate into the community.…”

Section: Synthesis and Discussion: Line Of Argument Synthesismentioning

confidence: 99%

Patient‐reported barriers and drivers of adherence to antiretrovirals in sub‐Saharan Africa: a meta‐ethnography

Merten

Kenter

Mckenzie

et al. 2010

Tropical Med Int Health

146

143

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This meta-ethnography aims at providing a synthesis and an interpretation of the findings of recent social science research on the questions of retention in antiretroviral therapy (ART) programmes in sub-Saharan Africa (SSA). The literature reviewed comprises ethnographic studies of the barriers to adherence to ART in various cultural settings. The results show that the quality of services, treatment-related costs, as well as the need to maintain social support networks - which can be negatively affected by HIV-related stigma - are important barriers to adherence. In addition, they show how African concepts of personhood are incompatible with the way services are conceived and delivered, targeting the individual. In SSA, individuals must balance physical health with social integrity, which is sometimes achieved by referring to traditional medicine. The ability of local concepts of illness to address social relations in addition to health, together with a historically grounded distrust in Western medicine, explains why traditional medicine is still widely used as an alternative to ART.

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Section: Synthesis and Discussion: Line Of Argument Synthesismentioning

confidence: 99%

Patient‐reported barriers and drivers of adherence to antiretrovirals in sub‐Saharan Africa: a meta‐ethnography

Merten

Kenter

Mckenzie

et al. 2010

Tropical Med Int Health

146

143

View full text Add to dashboard Cite

show abstract

“…For medical ethicists, the story of how government-employed district surgeons Ivor Lang and Benjamin Tucker 1 neglected to diagnose or treat the obvious injuries Biko received during the course of his detention forms a case study with an obvious lesson: all medical practitioners, even those operating under the most repressive states, must remain committed to the needs of their patients above all other political or social concerns. By offering what is intended as a clear distinction between the categories of ‘medicine’ and ‘politics,’ these arguments reaffirm the principal of beneficence by contrasting the theoretical principles that all practitioners are meant to uphold with the actual actions of Lang and Tucker (Braude, 2009).…”

Section: Introductionmentioning

confidence: 98%

The Possibility of Care: Medical Ethics and the Death of Steve Biko

Bucher

2012

Journal of Asian and African Studies

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This article analyzes the debates surrounding the inadequate medical care reportedly offered to Steve Biko during the final weeks of his life in 1977. For the past three decades, medical ethicists have used the so-called ‘Biko Case’ to define the ethical obligations of medical practitioners who operate under systems of authoritarian rule. This evaluation of Biko’s death has reduced the history of apartheid to a narrative of political repression. This article argues that this process of clarifying ethical medical practices through a contrast with repressive power fails to account for the ways in which medical care itself acts as a form of power. In other words, a narrow focus on the effects of repressive power provides an insufficient strategy for evaluating both the history of Steve Biko’s death and of apartheid power more broadly.

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“…The often impossible decisions needing to be made by health professionals managing children with HIV infection with scarce resources has led to a change in emphasis in medical ethics away from autonomy and beneficence to social justice. It is the sheer scale of the epidemic that has made justice such an important ethical issue in Africa because, in spite of the availability of lower cost ARVs in recent years, there is a logistical impossibility of treating all HIV patients with these drugs, even when indicated by current evidence 4 …”

Section: Introductionmentioning

confidence: 99%

“…It is the sheer scale of the epidemic that has made justice such an important ethical issue in Africa because, in spite of the availability of lower cost ARVs in recent years, there is a logistical impossibility of treating all HIV patients with these drugs, even when indicated by current evidence. 4 The ethical debates on HIV have focused mainly upon research, perhaps to the relative neglect of clinical practice issues in Africa. Since the author is based as a paediatrician in the Southern African region, where the consequences of acquired immunodeficiency syndrome (AIDS) are at its worst, this paper will also attempt to focus on the clinical realities of child health in this region from both a scientific and ethical perspective, trying to avoid any accusation of Western ethical pontificating by an armchair academic.…”

Section: Introductionmentioning

confidence: 99%

Science and ethics of human immunodeficiency virus/acquired immunodeficiency syndrome controversies in Africa

Brewster

2011

J Paediatrics Child Health

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Abstract:The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in Africa has raised important ethical issues for both researchers and clinicians. The most notorious controversy has been related to the zidovudine (AZT) trials in Africa in the late 1990s, in which the control groups were given a placebo rather than an effective drug to prevent vertical transmission. This raised concerns in the sponsoring country about exploitation of subjects, injustice and an ethical double standard between donor countries and resource-poor settings. However, the real double standard is between clinical practice standards in Western versus African countries, which must be addressed as part of the increasing global inequity of wealth both between countries and also within countries. There are important limitations to ethical declarations, principles and guidelines on their own without contextual ethical reasoning. The focus on research ethics with the HIV epidemic has led to a relative neglect of ethical issues in clinical practice. Although the scientific advances in HIV/AIDS have changed the ethical issues since the 1990s, there has also been progress in the bioethics of HIV/AIDS in terms of ethical review capability by local committees as well as in exposure to ethical issues by clinicians and researchers in Africa. However, serious concerns remain about the overregulation of research by bureaucratic agencies which could discourage African research on specifically African health issues. There is also a need for African academic institutions and researchers to progressively improve their research capacity with the assistance of research funders and donor agencies.

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Colonialism, Biko and AIDS: Reflections on the principle of beneficence in South African medical ethics

Cited by 9 publications

References 22 publications

Patient‐reported barriers and drivers of adherence to antiretrovirals in sub‐Saharan Africa: a meta‐ethnography

Patient‐reported barriers and drivers of adherence to antiretrovirals in sub‐Saharan Africa: a meta‐ethnography

The Possibility of Care: Medical Ethics and the Death of Steve Biko

Science and ethics of human immunodeficiency virus/acquired immunodeficiency syndrome controversies in Africa

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