[Abanda Tueche]

Thank you Marisa for your the point you are making in question 3 especially when you talk of a “common morality”. Meeting people from different cultures, origins, socio-economic classes, religions/belief systems, etc. can be a big piece in International medical practice. Sometimes, it is just about understanding where one or another person has placed it. But it is not easy. And this is why we have to be reflective.

[Abanda Tueche]

I get your point Julie, when you say that the mandates put in place during the pandemic impacted all aspects of our lives and that made room for a feeling of unethical decisions due to people’s rights being violated. I find it difficult achieving the respect of all people’s rights in situations like the pandemic. Mandates must be put in place to reduce the spread, protect vulnerable and ensure prioritisation of the most needful. There is a call to everyone to demonstrate high levels of responsibilities, and that is a duty. I feel emphasising on people’s rights while we don’t actually stress on their duties is an imbalance and a threat to the non-containment of the spread of disease in these situations. I hope we learn our lessons.

[Abanda Tueche]

C.J. I agree with you that integrating both ethics (virtue and quandary) gives us more room for morally correct decisions in our fast evolving society.

[Abanda Tueche]

Question #1: How would you evaluate the place of the three quandary-focused theories – utilitarianism, Kantianism and rights theory juxtaposed to the place of virtue ethics in our present medical education system and health system?
The transition from a focus on cultivating virtues among healthcare workforce (academia, students, leaders, Doctors, Nurses, etc.) to a problem-solving approach in medical ethics reflects a recognition that, while virtues are essential, ethical decision-making in complex medical situations requires more systematic and analytical methods to ensure the best possible outcomes for patients and society. This is important as the society in which we live is fast evolving. However, quandary-focused theories originate from Western philosophical traditions and may not fully align with the cultural values and belief systems prevalent in Africa. The heavy reliance on individual rights and autonomy, which is prominent in these theories, might not resonate with more communal and family-centric cultural norms in some African societies.
People want to know if healthcare workers take the immunizations they advise to public. If they actually eat the foods/diet they say are good and don’t eat what they say are bad. They want to know how many sexual partners the Doctor/Nurse has, and if a health leader has children out of their marriage and it happens to be known, the impact on the practitioners practice is highly negative.
In resource-limited settings, it might be difficult to fully implement these theories, especially when difficult trade-offs need to be made due to limited resources.
I think that we are progressively integrating and applying quandary-focused theories, but African societies are still highly tight to virtues in ethical decisions.

Question #2: In Dr. Sulmasy’s NY Daily News editorial refers to several of the ethical theories presented in B&Cs textbook. Sulmasy insists on some while rejecting others. Analyze his admonitions to the people and health-care workers of NYC during the epidemic found in his editorial.
My take on this piece is that during a pandemic, the utilitarian and Kantian components of the quandary-focused theories should be prioritized. Dr. Sulmasy’s NY Daily News editorial strongly recommends we get ethically prepared for the next pandemic from the lessons learned from this one. There is an important threat to the “common good” if people inflate individualism and autonomy as they may expose others and contribute to spreading the deadly virus.

Question #3: How might the B@C concept of reflective equilibrium function in an international medical context? What additional factors might need to be taken into consideration in making ethical judgments?
Reflective equilibrium is a method of ethical reasoning that seeks to find coherence and consistency among moral principles, considered moral judgments, and relevant background theories. It involves a process of constant reflection and adjustment to achieve a balanced and justified ethical position. Some factors we can consider include:
– Cultural Sensitivity: as different cultures and societies may have distinct ethical values and norms. healthcare professionals must engage in a process of understanding and respecting these diverse perspectives.
– Navigating Legal systems: Reflective equilibrium allows medical practitioners to harmonize their ethical decisions with varying legal and ethical requirements, finding common ground and overarching moral principles
– Resource Allocation: where resources may be limited or unevenly distributed, reflective equilibrium can assist in balancing the ethical considerations of utility (maximizing benefits for the greatest number) with concerns of justice and fairness.

[Abanda Tueche]

Thank you for your point Julie. I appreciate your comments and agree that we had important (sometimes scary) points during our last class). But these are eye opener. These conversations seem so important to me as we are made aware of the injustices happening.
On your patient who travelled to Central America on a “win-win” deal, I think the same. This is the direct opposite of what we read in the article where poor and vulnerable people were exploited, I would say even primarily because they were poor and vulnerable.
We must think of the poor, the vulnerable, the disabled, the strangers (people coming not living in the areas they are receiving care), etc. depending on what you have at scale for minorities in your context. We must think about these populations, support them, protect them.

[Abanda Tueche]

Question #1: Our society has recently seen much angst over past and persisting injustices, manifesting as inequities and disparities in multiple arenas, including health care. Do you see this as evidence that justice is increasingly seen as the pivot on which all other principles turn? Do you think that in bioethics justice deserves this place, in the sense that it is rights-oriented, practical and prudential? Why or why not?

There are concrete examples that I have in mind, which shows how ethical principles have been applied practically, considering the availability of healthcare resources, cost-effectiveness, and the feasibility of implementing interventions or policies. Mobile technology has been utilized in Ghana to improve access to healthcare services. The mobile health (mHealth) initiative in the country has been implemented to improve healthcare access and delivery. Through mobile phones, individuals can access health information, receive reminders for medication, and even consult with healthcare professionals remotely. This practical approach leverages the widespread use of mobile phones to overcome barriers to healthcare access in remote or underserved areas.

Political influences, corruption, and competing priorities can affect resource allocation and healthcare policies and delivery. I saw a concrete one during the covid-19 pandemic: 2 highly specialized medical centers were kept out of the treatment plans while they could have helped save lives and reduce congested centers apparently for political reasons. Justioce was clearly not applied in this strategy.

Question #2: Which among the theories identified by B&C do you think is most operative in our present health care system in the US? With which one do you resonate most and why?

Capabilities theories of justice is one of the 2 recent theories of justice that focus on the concept of human capabilities or functioning as central to justice and well-being. Justice involves ensuring that individuals have the necessary capabilities to live a dignified and fulfilling life. These can include basic needs like good health, education, shelter, nutrition, and security, as well as higher-order capabilities like participating in social and political life, having meaningful relationships, and pursuing personal goals.
I resonate with this theory because I see in Ghana how the government is implementing a good package for basic health needs for all individuals as well as higher-order capabilities that could be associated to physical and mental healthcare delivery. In many hospitals, various services (fast-tracking for quick consultations, complementary examination, etc. catering services, etc.) are offered in case the patient can pay. These are offered without reducing the quality of care offered to all.

Question #3: Principles of Biomedical Ethics, Chapter 7, writes of seeing theories of justice globally or seeing them as “statist” or only locally-applying (p 276 in 7th edition and p 297 in 8th edition). The disparities in the application of theories of justice at a global level are pointed out in the assigned article, which presents the realities of global reproductive tourism, reproductive trafficking, and human organ trafficking. What are some ways in which, in our increasingly globalized world, issues of more equitable application of justice can be ensured in the arenas discussed in the article? What principles need to be greater emphasized at a global level for this to happen?

In our increasingly globalized world, addressing issues of more equitable application of justice in the arenas of global reproductive tourism, reproductive trafficking, and human organ trafficking requires concerted efforts and a focus on key principles. Here are some ways to ensure greater equity and justice in these areas:

• Effective collaboration among nations is essential to tackle these complex issues. Governments, international organizations, and civil society groups should work together to develop and enforce comprehensive legal frameworks and protocols.

• Emphasizing a human rights-based approach is crucial. This includes recognizing and protecting the rights of individuals involved in reproductive tourism, reproductive trafficking, and organ trafficking, such as the right to autonomy, bodily integrity, and freedom from exploitation.

• Establishing clear ethical guidelines and regulations is necessary to govern these practices. International bodies, such as the World Health Organization (WHO) and the United Nations (UN), should develop and disseminate guidelines for the responsible and ethical conduct of reproductive procedures and organ transplantation.

• Support for Vulnerable Populations: Prioritizing support for vulnerable populations, such as potential donors, recipients, surrogate mothers, and victims of trafficking, is crucial. This includes providing comprehensive healthcare, legal support, and social services to ensure their well-being and protect their rights.

• Targeting Demand and Root Causes: Addressing the root causes of reproductive and organ trafficking is vital. Efforts should focus not only on criminalizing the perpetrators but also on addressing the demand for these services and tackling socioeconomic factors that contribute to the exploitation of vulnerable individuals.

• Providing comprehensive support and rehabilitation services to victims of reproductive and organ trafficking is essential. This includes medical care, psychological support, legal aid, and socioeconomic reintegration programs to help survivors rebuild their lives.

[Abanda Tueche]

Question #1: Principles of Biomedical Ethics, Chapter 6, states that “principles of beneficence are not sufficiently broad or foundational, in our account, that they determine or justify all other principles” (p.203 in 7th edition and 218 in 8th edition). Do you agree or disagree? How might one’s view of “the good” lead to differing conclusions about the prioritization of the principles?
The principle of beneficence is the duty to do good and to promote well-being. It is one of the four principles of biomedical ethics, along with non-maleficence, autonomy, and justice. One’s view of “the good” can lead to differing conclusions about the prioritization of the principles because different people have different ideas about what constitutes “good” and “well-being.” And so while beneficence is an ethical principle that needs to be observed and practiced, I feel it can be tricky depending on how we see “the Good”, and our understanding of what constitutes a good outcome. Utilitarian perspectives may prioritize overall well-being, rights-based perspectives may prioritize autonomy and individual rights, and virtue ethics perspectives may prioritize justice and fairness. Each perspective offers a distinct lens through which ethical decisions can be evaluated, resulting in differing conclusions about how principles should be prioritized in specific situations.

Question #2: A middle-aged, wealthy, highly-educated female patient comes to you asking for a unilateral left mastectomy in order to improve her golf swing. The breast size is not excessive and there are otherwise no indications for this procedure. Using principles studied this far (autonomy, nonmaleficence, beneficence) and Pellegrino’s suggestions on making moral choices based on a four-fold understanding of the patient’s good, how would you process this request ethically? Having processed the request, what would you say to this patient?

PROCESSING THE REQUEST:
– Autonomy: the patient has expressed her desire for a unilateral left mastectomy to improve her golf swing. It is important to respect her autonomy and take her request seriously. However, it is equally important to ensure that her decision is well-informed and based on a thorough understanding of the risks, benefits, and alternatives.
– Nonmaleficience: We are reviewing the request to do a surgical procedure which is not medically needed and would not bring any health benefit. Surgical procedures involve risks such as infection, bleeding, anesthesia complications, and potential psychological and emotional consequences. Therefore, the potential harm should be carefully considered and weighed against the anticipated benefits.
– Beneficience: While the patient believes that the mastectomy will improve her golf swing, it is important to assess whether this procedure will truly enhance her overall well-being and quality of life. A comprehensive evaluation of the patient’s physical and mental health should be conducted to identify any underlying issues that may be influencing her decision. Additionally, alternative interventions, such as physical therapy, exercises, or coaching, should be explored to achieve her desired goals without resorting to a surgical procedure.
– Pellegrino’s Four-Fold Understanding: it is crucial to consider all the patient’s dimensions (biological, psychosocial, individual, and relational dimensions) to make an ethically sound decision. While the patient may believe that improving her golf swing is in her best interest, it is necessary to assess the impact of the surgery on her overall well-being, body image, self-esteem, and relationships. A thorough evaluation should include discussions about her motivations, expectations, and the potential consequences of the procedure.

MY REPLY TO HER:
In discussing your request for a unilateral left mastectomy to improve your golf swing, I want to acknowledge and respect your autonomy in making decisions about your body and health. I value having an open and honest conversations about your goals and desires. However, I also have an ethical responsibility to consider your well-being and the potential risks and benefits associated with such a procedure.
While I understand that improving your golf swing is important to you, it is essential to avoid causing harm. Surgery, including mastectomy, carries inherent risks such as infection, bleeding, and potential psychological and emotional consequences. In the absence of a medical indication or significant health benefits, it is crucial to carefully evaluate the potential harm that could arise from such a procedure.
I would like to explore with you alternative interventions that may help you achieve your desired goals without having surgery. Physical therapy, targeted exercises, or working with a golf coach could be potential options worth considering. These alternatives would allow us to promote your well-being and enhance your golf performance without subjecting you to the risks associated with surgery.
I take this opportunity to suggest to have a comprehensive evaluation of your overall health, including discussions about your motivations and expectations. This assessment will help us understand the potential impact of the surgery on your body image, self-esteem, and relationships, as well as consider any underlying issues that may be influencing your decision.
I encourage you to take the time to consider the information provided and explore alternative interventions that may achieve your goals while minimizing potential harm.

[Abanda Tueche]

Hello Julie.
Thank you for your post “responding to peers” inspired by our conversation in class last Thursday. Fascinating conversation. John’s example is one of many examples we see as communities develop and are opening to other practitioners coming from different countries, religions, cultures, etc.
An anthropological approach is important to identify and understand that people in communities take traditional showers and other bathing technics (for “good luck”, protection, removing impure spirits, etc.) prior to important events like receiving surgery. Ethnoethics recognizes and respects the use of traditional healing practices in certain cultures. As healthcare providers, we must navigate the integration of Western medicine with traditional healing methods, working collaboratively with traditional healers and respecting the cultural beliefs and practices associated with these forms of care, without jeopardizing the safety of patients as you mentioned.

[Abanda Tueche]

Question #1:In the chapter on Nonmaleficence, Principles of Biomedical Ethics by Beauchamp and Childress presents a view of the goals of medicine as broader than the maintenance of health and the restoration to health, which Kass posits as the telos of medicine. B&C call this an “unduly narrow way of thinking about what the physician has to offer the patient” (p.185, in 7th edition). Instead, they find physician-assisted death as consistent with the principles of autonomy and beneficence. How might Kass’s more traditional telos and B&C’s more contemporary one be perceived in a developing world context such as Kenya, among the Maasai?
When examining the differing perspectives of Kass’s traditional telos of medicine and B&C’s contemporary viewpoint within the context of the Maasai community in Kenya, I think specific points arise to show the Maasai’s cultural identity and healthcare needs pertinent to understand in answering this question.
The Maasai community has a rich cultural heritage deeply rooted in their traditional way of life, which centers around herding livestock and maintaining a strong connection to the land. The Maasai place great value on physical strength, vitality, and the preservation of health as essential elements of their cultural identity. Kass’s traditional telos of medicine, focusing on the maintenance and restoration of health, may resonate with the Maasai’s cultural values. Their emphasis on robust health aligns with the Maasai’s perception of medicine as a means to address physical ailments and enable individuals to fully participate in their cultural practices and responsibilities. The Maasai may perceive medicine as a vital tool to ensure the well-being and continuity of their community. However, it is essential to recognize that the Maasai also possess their own traditional healing practices deeply intertwined with their cultural beliefs and rituals. These practices often involve herbal remedies, spiritual ceremonies, and the involvement of traditional healers. Therefore, integrating Western medical approaches that prioritize disease treatment and prevention into the existing Maasai healthcare framework requires cultural sensitivity and an understanding of the Maasai’s holistic approach to health and well-being.
B&C’s contemporary perspective, emphasizing autonomy and beneficence, may present challenges in the Maasai context. The Maasai traditionally value communal decision-making, with extended family and community members having a significant influence on individual choices. The concept of individual autonomy, as understood in Western bioethics, may not align directly with the Maasai’s collective decision-making processes.
Furthermore, the acceptance of physician-assisted death, proposed by B&C, may conflict with the Maasai’s cultural beliefs that emphasize the sanctity of life and the interconnectedness of individuals within their community. The introduction of this concept would require careful consideration, taking into account the cultural and religious complexities involved and ensuring that healthcare practices are aligned with the Maasai’s cultural values.
In a developing world context such as the Maasai community, finding a balance between the traditional telos of medicine and the contemporary perspective becomes crucial. It requires an approach that respects and integrates the Maasai’s cultural beliefs, practices, and community decision-making while also addressing their evolving healthcare needs. Efforts should be made to involve Maasai community leaders, traditional healers, and healthcare providers in a dialogue that explores how Western medical practices can be integrated in a manner that respects the Maasai’s cultural values and complements their traditional healing practices. This collaborative approach would ensure that healthcare interventions are culturally sensitive, ethically sound, and relevant to the Maasai community’s unique context.

Question #2: The Kenyan authors of the article assigned find the principlism of B&C’s classic text inadequate for a full understanding of ethical decision-making in their context. What is the anthropological approach? Is it relevant for any context or just for “special” ones, such as working among tribal people such as the Maasai?
The anthropological approach is a way of studying human societies and cultures that emphasizes the importance of understanding a culture from the perspective of its own members. The anthropological approach focuses on solving bioethical issues by use of local societal norms and cultural perspectives.
The anthropological approach is relevant for any context in which it is important to understand the cultural context of human behavior. This includes working among tribal people, but it also includes working in any other setting where people from different cultures interact. For example: a hospital, a school, or a workplace. This approach is particularly valuable in settings where there is a risk of cultural misunderstanding. By understanding the cultural context of human behavior, anthropologists can help to bridge cultural gaps and promote cross-cultural understanding.

[Abanda Tueche]

Question #1: Edmund Pellegrino points out that historically, until the 1950s, beneficence was the first among the principles in ethical medical practice. In the 1960s, it came to be seen as paternalistic and autonomy came to be first, eclipsing all other moral principles. Though Beauchamp and Childress respond to other’s criticism of the idea of autonomy as first among the four principles in bioethics (p99 and 143), what do you think of the place of autonomy in the actual practice of medicine in the US? For those who have worked internationally, how weighty has autonomy played a role in your experience?
In developing countries where I have practiced, the principle of autonomy in medical practice may have different manifestations and challenges compared to more developed regions like the US. The extent to which autonomy is recognized and respected can vary based on cultural, social, economic, and institutional factors.
I would like to share an example about cultural and social factors: In some cultures in Cameroon and Ghana, communal decision-making and family involvement in healthcare decisions are highly valued. Family members, like elders and/or close relatives, are often consulted and actively participate in discussions about diagnosis, treatment options, and care plans. The patient cannot take a decision without their consult, as individuals agree they are not alone and belong to a whole. The collective wisdom and input of the family are valued in ensuring the best outcome for the patient. Individual autonomy may be less emphasized compared to collective decision-making. Respect for autonomy in medical practice needs to be understood in the context of cultural norms and values.

Question #2: Beauchamp and Childress speak predominantly of patient autonomy in their chapter. Pellegrino writes of the doctor/patient relationship, indeed any ethical relationship, as having two autonomies flowing bilaterally between the parties. Pellegrino also writes of the necessity of a healthy interplay of beneficence and autonomy in the doctor/patient relationship. What do you think of Pellegrino’s critique of his perceived imbalance in modern medicine and his reassertion of the prioritization of beneficence?
Can Doctors be considered trusteed advisors prioritizing patients well-being in healthcare systems where you have more primes and earnings if you ask more lab tests, imaging tests, etc. even if they are not required? Can patients be autonomous in healthcare delivery when they are not participating in healthcare decision-making, or even want to participate in the decision-making process (As they consider a 3rd part – Doctors, family, the gods, etc. – have more insight of their well-being)? Well I think we need to work on each patient individually to achieve this balance. Different cultures and societies may prioritize autonomy differently, and some patients may place a higher value on their individual autonomy than the expertise of healthcare professionals. Emphasizing autonomy over beneficence in such cases can be seen as respecting diverse values and cultural perspectives. I think with every patient, we need to make a case. I also wish healthcare professionals, ethicists, and policymakers could assess the extent to which beneficence and autonomy are balanced in the doctor-patient relationship more often, to identify areas for improvement or intervention to promote ethical and patient-centered care.

Question #3: How might Sanders perceive the place of autonomy in an African-American context vs a Euro-American one?
I would agree with Marisa that Cheryl J. Sanders perceived autonomy as central in both contexts since she perceived priority in delivering healthcare in a fair, equitable and with human dignity. The task is the same in both cultures.

[Abanda Tueche]

Question #1: In chapter 5, Beauchamp and Childress (B&C) present five theories of moral status, with a critique of each. Critique each theory on your own. In your thinking, which theory/theories has/have the greatest coherence?
The following are the 5 theories described in the chapter:
– THEORY BASED ON HUMAN PROPERTIES:
This theory suggests that moral status is determined by being a member of the human species. According to this view, all human beings possess inherent moral worth and deserve moral consideration. This theory fails to consider other relevant factors beyond species membership, such as individual capabilities or characteristics e.g. when considering the moral status of non-human primates used in medical research. If moral status is solely based on being a member of the human species, it would imply that non-human primates have no inherent moral worth, which many find problematic.

– THEORY BASED ON COGNITIVE PROPERTIES:
This theory suggests that moral status is determined by cognitive abilities such as rationality, self-awareness, and the capacity for moral reasoning. It asserts that beings with higher cognitive capacities have greater moral status. The theory however excludes individuals with severe cognitive impairments or those who lack certain cognitive abilities (like infants who may not have some abilities or lack developed moral reasoning), leading to potential discrimination and neglect of vulnerable populations.

– THEORY BASED ON MORAL AGENCY:
This theory argues that moral status is determined by the capacity to act morally and make moral choices. Beings who can understand and follow moral principles have higher moral status. This theory overlooks those who are temporarily or permanently incapable of moral agency, such as individuals in comatose states or those with severe cognitive impairments.

– THEORY BASED ON SENTIENCE:
This theory posits that moral status is based on the capacity to experience pleasure, pain, and other subjective states. Beings capable of sentience, such as animals, deserve moral consideration. It however, does not account for variations in cognitive abilities, relationships, or other relevant factors that may influence moral status. Insects are sentient beings capable of experiencing pain and pleasure, yet many people do not grant them the same moral consideration as animals with higher cognitive capacities, highlighting the limitations of a theory solely based on sentience.

– THEORY BASED ON RELATIONSHIPS:
This theory proposes that moral status is determined by the relationships and interactions between beings. Moral consideration is extended based on the degree of moral significance and mutual obligations within these relationships. I think the theory may prioritize certain relationships over others, potentially leading to the exclusion or devaluation of certain individuals or groups who do not have established relationships. An example to critique this theory could be the moral status of strangers or individuals outside of our immediate social circles. If moral status is solely based on relationships, it may neglect the moral consideration owed to those we have no direct relationship with, potentially undermining principles of justice and fairness.

None of the theories on its own is adequate. I however think that the theory based on human properties is the most coherent.

Question #2: Do you agree or disagree with B&C’s inclination against using the language of “person”, “personhood” and “respect for persons” in bioethical discussion (pp 67-68, 7th ed)? Is it a term we should discard and with what could it be replaced?
B&C make the choice of not engaging in the concept of “personhood”; it is indeed a subject of ongoing debate in philosophy, ethics, and various fields. Like most members of the forum (CJ, Marisa, Natan… just to name a few), I disagree with them. We need to be equipped to make the courageous move to mention (or not mention) the terms “person(s)”, “personhood” and call for the “respect of persons” depending on the specific philosophical perspectives and ethical framework in which we may be dealing/operating. Factors to consider are biological, genetical, cognitive, moral, relational, sentience, etc.

Question #3: In light of Englehart’s critique of moral pluralism, do you think moral status is undermined by moral pluralism?
There seems to be a majority as well here: Yes, I do think that when we have many different moral values and principles, it becomes challenging to determine which ones should take priority in specific situations. For me, there is a real challenge of not being consistent, and so seem fair in one situation and unfair in another.

Question #4: In B&Cs chapter on the Professional-Patient Relationship, they note that, in the case of epidemics, care for the sick has often been considered praiseworthy and virtuous, but not obligatory? (p 325, 7th ed). Do you consider this to be so? In light of the NEJM article, is the embrace of some degree of risk in caring for the sick inherent to the practice of being in a healing profession?
The ethical obligations of healthcare workers are immense. Regrettably, during the first months of the pandemic, many healthcare workers in developing countries like Ghana did not act in the best interest of the patients they were seeing, especially those presenting covid-like symptoms. The governance of facilities and other technical leads did not ensure appropriate distribution of resources to ensure equitable but appropriate care. For months, countries did not have the appropriate PPE; so healthcare personnel want to act for the best interest of the patients, but not at the detriment to their own safety. I think we need to ensure a balance between the ethical considerations of prioritizing patient care, ensuring healthcare professionals’ safety, and preserving public health.

[Abanda Tueche]

Question #1: Do you agree with Beauchamp and Childress that there is a common, universal morality upon which contemporary bioethics can be built? Why or why not?
Bioethics deals with ethical questions related to medicine and biology. These subjects deal with many complex issues like abortion or genetic engineering. These topics have different viewpoints influenced by various beliefs, cultures, values, etc. Because of all these differences, it is difficult to establish one moral framework that everyone agrees on in bioethics. However, bioethicists try to have meaningful discussions, consider different perspectives, and think about important principles like autonomy, beneficence, non-maleficence, and justice to make ethical decisions. So, to answer your question, and like the majority in the forum, there is no simple, universally accepted moral framework for bioethics because people have different opinions based on their beliefs and ethical theories they follow.

Question #2: What do you think of Englehardt’s critique of Beauchamp and Childress’s position and of his argument that morality itself is deflated in a morally pluralistic world and that morality and bioethics degenerate into biopolitics?
Englehardt has different ideas about how we should make moral decisions in the field of bioethics. He criticizes the approach of Beauchamp and Childress, who believe in using general moral principles to guide our choices. Englehardt thinks that when people have different opinions about what is right or wrong, it makes it hard to have one clear answer. He also says that when moral disagreements become part of politics, it can be unfair because powerful people can influence the decisions.
But not everyone agrees with Englehardt. Some people think that having different opinions about what is right or wrong doesn’t mean that there is no right answer. They believe that we should listen to different ideas and try to understand each other.

Question #3: Is the de-emphasis on virtues in our contemporary culture, which Beauchamp and Childress lament, a result of what Engelhardt calls the groundlessness of contemporary morality?
Yes, according to Engelhardt, the de-emphasis on virtues in contemporary culture is a result of what he calls the “groundlessness” of contemporary morality. He argues that in a morally pluralistic world, where there are diverse and conflicting moral perspectives, the concept of objective morality becomes uncertain or “groundless.” I would rather say there are changing societal values, cultural shifts, or different philosophical perspectives, and not that morality is groundless.

Question #4: African-American ethicist Cheryl Sanders offers her critique of B&C’s principlism from an African-American perspective, noting significant cultural values more characteristic of African-Americans which she contrasts with dominant European-American ones that prevail in B&Cs book. Comment on these values and how they might inform a view of “common morality”?
Cheryl Sanders’ article clearly highlights that when people come from different cultures with different beliefs, it is challenging to have one set of values that everyone accepts. She highlights that African-American culture may have different values (e.x. theistic, humanistic, spiritual, etc. all converging to a holistic being contrasting with the individualistic values of the Western world) that are important to consider in the dominant European-American ones. This clearly shows that it is difficult to have a “common morality,” i.e., a set of values that everyone agrees on.
Instead of trying to find one “common morality,” it is better to respect and understand the values of different cultures. By doing this, we can have discussions that include diverse perspectives and learn from each other. It helps us develop a broader understanding of what is right and wrong, taking into account different cultural beliefs.

[Abanda Tueche]

Hello everyone.
My name is Amanda Tueche and I am also taking this course (despite not being able to join at the first class) and I am excited about joining you in the next class. Here are my contributions to the forum:
1. Your healthcare experience
I am Medical Doctor and I have been serving through the United Nations as a Primary Healthcare Physician for over 10 years now first in Rwanda and now in Ghana. Prior to this, I worked as a medical officer in a District hospital of my hometown Yaoundé in Cameroon.

2. Why you are taking this course
I wish to strengthen my professional competences around issues related to ethics, particularly my ethical decision-making skills, critical to my day to day work. Furthermore, one of my expectations for this course is the be aware of the ethical challenges in the global health arena as well as how I can cultivate and promote cultural sensitivity while delivering healthcare.

3. What are your future plans
Well, I am passionate about education and learning and so I am considering teaching. I also plan to conduct research.

[Abanda Tueche]

Question #1:
In your opinion, how should health leaders respond when government leaders make statements detrimental to the health of the public?

During epidemics, governments can be stuck in denial, bias, avoidance, self-interest, etc. putting citizens at risk of suffering and even dying, particularly the most vulnerable like the poor, the disabled, persons in specific communities or other minorities.

This can pose problems of human rights, accountability, and even social justice, particularly in developing communities, nations or even continents.

When the government takes such positions, it is important for health leaders to respond by speaking out publicly against such positions, strategies, or statements. Dr. Denis Mukwege, a Congolese gynecologist and human rights activist, spoke out against the inadequate response of the Democratic Republic of Congo’s government to the Ebola epidemic in the country. He called for increased investment in public health infrastructure and addressing the underlying social and economic factors that contributed to the disease’s spread.

Health leaders can also use data to battle against misinformation and infodemics (frequent in epidemics) by sharing accurate data and research. Dr. John Nkengasong (a Cameroonian virologist and the Director of the Africa Centers for Disease Control and Prevention) has been a vocal advocate for accurate and evidence-based information during the COVID-19 pandemic. He has shared data and research related to the virus and has worked to counter misinformation related to COVID-19 in Africa.

Health leaders can advocate for health policies and/or interventions that prioritize and focus on public health, even in the face of opposition from government leaders, and use their influence to promote policies that respect human rights or promote social justice. During the H1N1 influenza pandemic, Dr. Margaret Chan, former Director-General of the World Health Organization (WHO), advocated for increased investment in vaccine research and development, as well as for policies to promote vaccine distribution and uptake.

Health leaders can also build partnerships with advocacy groups and other stakeholders to raise awareness and advocate for the rights of people affected by the epidemic, as seen with the ACT UP and the Treatment Action Campaign during the HIV/AIDS epidemic.

Question #2:
Explain the role of one recent social movement to prevent or end epidemics.

I think The Black Lives Matter movement has helped prevent or end epidemics. While the movement primarily focuses on addressing systemic racism and police violence, it has also highlighted the ways in which inequality and social determinants of health can contribute to the spread of disease by drawing attention to the impacts of systemic racism and inequalities on marginalized communities, including higher rates of infection and death among Black and Latinx communities during the COVID-19 pandemic. The movement has highlighted the importance of addressing social and economic factors that contribute to the spread of disease, such as poverty, lack of healthcare access, and discrimination. Greater social and economic justice can help prevent and address the spread of epidemics.

[Abanda Tueche]

Question #1:
Highlight at least two mistakes recently observed by nations regarding international cooperation for COVID-19 pandemic control.

Two mistakes recently observed by nations regarding international cooperation for COVID-19 pandemic control are:
1. The lack of equity in vaccine distribution: Despite efforts by various international organizations including the UN and COVAX, there have been persistent inequities in access to vaccines. Many low-income countries received far fewer doses than developed nations. This has led to a situation where the virus continued to spread in some parts of the world, leading to new variants and prolonging the pandemic.

2. Politicization of COVID-19 response: The politicization of COVID-19 has hindered international cooperation, with some leaders exploiting the pandemic for political gain or to deflect blame for their own failures. This has resulted in a lack of trust between countries and an inability to effectively control the pandemic. Some countries have even actively worked against each other, spreading misinformation, and engaging in trade wars that have made it difficult to distribute necessary medical supplies and vaccines.

Question #2:
What principles should guide international cooperation for the purpose of controlling future pandemics?

Transparency: Transparency involves sharing information about outbreaks in a timely and open manner. This includes data on the spread of disease and information regarding the efficacy and safety of medical countermeasures. Moreover, it is important to involve communities in decision-making processes and ensure they have access to information about the benefits and risks of different interventions.

Equity: Equity should be at the heart of any efforts to control future pandemics. This means ensuring that everyone, regardless of their location, socioeconomic status, or other factors, has equal access to medical countermeasures and other resources. Equity also means involving low- and middle-income countries in decision-making processes and ensuring that they have an equal say in how resources are allocated.

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