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Respect for autonomy and the doctrine of informed consent are considered fundamental pillars of healthcare provision all over the world. However, in the African context, this approach has been criticised for failing to give due attention to traditional values and beliefs. 1,2,3
To investigate this issue, a study has been funded by The MPS Foundation, to explore the compatibility of informed consent and autonomy with African traditional values and beliefs in the context of oral healthcare.
There are currently no empirical studies that explore the experiences, views, and opinions of patients from African communities regarding this compatibility in the context of oral healthcare provision. Hence there is an important gap in the knowledge on this topic which consequently impacts oral healthcare professionals and patients.
This project aims to explore the influence of African traditional values and viewpoints on patients’ decision-making process, as well as its influence on the communication between oral health practitioners and patients. This will assist in establishing culturally sensitive informed consent practices specific to oral healthcare provision, that consider the wishes and the needs of patients from African communities, and that are compatible with their communal values and belief systems.
The doctrine of informed consent is an ethical and legal requirement in oral healthcare in South Africa, as mandated by the Health Professions Council of South Africa.
However, the challenges of relying on such individualism in the process of informed consent when treating patients from African communities are underexplored and may adversely affect the communication between oral healthcare practitioners and patients, as well as negatively impact patients’ decision-making process.
This can, in turn, compromise the quality of care that patients receive. The question then arises, how can autonomy be accommodated in consent processes in oral healthcare provision without overlooking the significance of communal norms and communal relationships in the African context?
The applicability of the principle of respect for autonomy in different cultural contexts has been criticised by several authors. 2,3,4 The principle is rooted in notions of selfhood and individualism which, although significant in Western culture, may not be harmonious with African tradition. As Behrens writes, “on many African accounts this notion of autonomy is problematic”.3
“A pervasive notion is that it is central to the worldview of most Africans that community is prized and that individuals are bound up with their communities”. 3 “Decisions about one’s body and life are, therefore, not to be taken by individuals acting alone, but in engagement with their families and communities”. 3
Behrens suggests that the principle of autonomy should be replaced by the principle of ‘respect for persons’ initially advanced in the Belmont Report, as it is better suited in acknowledging both self-governance as well as social and cultural aspects which are important in the individual’s life and decision-making. 3
In this way, the principle of ‘respect for persons’ is broad enough to allow for the inclusion of a patient’s family members or various other members of the patient’s community in the decision-making process if it is of cultural significance to the patient. 3 Furthermore, Behrens argues that respecting a patient’s relationships is a way of respecting the patient’s autonomy, particularly when that patient’s autonomy is reflected in their community. 3
Lastly, the principle of ‘respect for persons’, is considered to be more fitting with the Ubuntu philosophy prevalent in southern African communities, which underscores the importance of interconnectedness of the community members. 3, 5 The Ubuntu philosophy highlights the significance of shared decision-making and communal care in considering issues related to health and disease. In these African contexts, connection with fellow community members and harmony within the community hold such significance that individualism is perceived in the contexts of the community. 3, 5
This interconnectedness, harmony, care, and involvement that underpins Ubuntu comes to light when a community member is dealing with an illness. 3 It is common practice that the family and community members closest to the patient become involved in assisting the patient to make decisions about the choice of treatment, including advising on the choice of healthcare providers or traditional healers. 3 The care and involvement of the community in dealing with illness underpins the Ubuntu philosophy and belief of interrelatedness best described by this quote from Desmond Tutu: “[Ubuntu] speaks to the very essence of being human, it means my humanity is caught up, is inextricably bound up, in theirs”. 6 “We belong in a bundle of life…. Harmony, friendliness, community are great goods”. “Social harmony is for us… the greatest good”. 6
This important study is funded through The MPS Foundation’s 2023 Grant Programme and is in its very early stages. The study expects to report its answers to the following research questions at the end of the first quarter of 2025:
What is the influence of African traditional values and beliefs on communication and the decision-making process between oral health practitioners and patients?
How effective are current informed consent practices in oral healthcare provision in meeting the needs and expectations of patients from African communities?
How can the informed consent practices in oral healthcare provision be improved to align with African traditional values and beliefs?
The MPS Foundation and Dental Protection will be sharing those findings with members. Further details and updates about the project can be found at www.thempsfoundation.org
References
Chima SC, Akpa-Inyang F. South African Traditional Values and Beliefs Regarding Informed Consent and Limitations of the Principle of Respect for Autonomy in African Communities: A Cross-Cultural Qualitative Study. BMC Medical Ethics. 2021;22(1):1–17.
Walker RL. Respect for rational autonomy. Kennedy Inst Ethics J. 2009;19(4):339–66.
Behrens KG. A critique of the principle of ‘respect for autonomy’, grounded in African thought. Dev World Bioeth. 2018 Jun;18(2):126–34.
Callahan D. Individual good and common good: a communitarian approach to bioethics. Perspect Biol Med. 2003;46(4):496–507.
Metz T. African Values and Human Rights as Two Sides of the Same Coin: Reply to Oyowe. African Human Rights Law Journal. 2014;14(2):306–21.
Tutu D. No Future Without Forgiveness. London: Rider; 2000.