Introduction
Augustine Shutte, who wrote one of the first books on Ubuntu—that can roughly be described as African humanism—tells a lovely story about conflict between a group of nuns in a South African convent. Some of the nuns were German, and the rest were African. When an investigator tried to get to the heart of clear conflict between the German and African nuns, she discovered that the Germans thought that a good nun was one who, when all of her community duties were fulfilled, and when she had spent sufficient time in chapel and in prayer, would use her spare time productively, getting useful things done, even if only knitting and sewing. The African nuns did not do this. They spent every spare minute in chatting with one another. Thus, the Germans thought the Africans to be bad nuns, because they saw them as lazy. The African nuns, on the other hand, cherished using their spare time in conversation. They would mostly talk about people and the problems they were experiencing, expressing sympathy and wondering how they might assist. For them, this was the most important thing about the religious life.Footnote 1 Schutte writes: “In all free time they would settle down comfortably to converse, their hands empty, but their hearts and minds full. They saw the German sisters as barbarians, caring only about practical matters and wasting their energies on trivial pursuits.”Footnote 2
This anecdote highlights a distinctive feature of an African worldview, the central importance of community, which is a key notion to be addressed later in this article. However, it also contains an important lesson. One might well ask which group of nuns was morally superior. We suggest that both groups were good in their own way, but they would probably all be better nuns if they learnt from each other. The Germans would be better if they also learnt to value community more, and the Africans would be better if they learnt to appreciate the value of industriousness more. In general, none of us is as smart as all of us, and we can only be enriched in our thinking if we are open to learning from other traditions and cultures.
It is partly for this reason that we assert that our bioethical discourse can only be deepened and enriched by taking seriously the moral perspectives of non-Western traditions. It is clear that, as an academic field, bioethics has been dominated by Western philosophy and moral constructs.Footnote 3 , Footnote 4 It is this fact that was the catalyst for the project that is the focus of this article. At the Steve Biko Center for Bioethics of the University of the Witwatersrand in Johannesburg, South Africa, we teach bioethics to undergraduates and postgraduates in training to become healthcare professionals in most fields of healthcare. We have found that, generally, the teaching of bioethics in Africa is hardly different from that done in Western countries. Many bioethicists have given attention to the special health issues of Africa and to the ethics of research on the continent, but only a handful have considered these issues through the lens of African moral thought. There is a paucity of work that has been done that has asked what a distinctively African moral perspective would entail for our analysis of bioethical issues. As a step toward correcting this, we embarked on a project aimed at incorporating African moral perspectives, values and philosophy into our teaching curriculum, one that is responsive to the specific context of South Africa and seeks to address bioethics issues or dilemmas through the lens of indigenous African thought.
Before describing the details of the project, there is always a risk of being accused of homogenizing, caricaturing, or being reductionist when one makes any claims about African or southern African thought or beliefs. Critics correctly point out that Africa is a large continent with many different tribal, cultural, religious, and language communities, and that it is absurd to suggest that a single African worldview exists. Yet, it is also true that there are some pervasive notions of the moral life that are commonly shared among many of these groups. This is especially the case in southern Africa. It is fair enough to describe such common notions as characteristically African or southern African, in much the same way as we often speak of Western or Asian thought. To claim that, some notion is typically African is not to claim that all Africans share that notion. It is in this sense that we use the terms southern African/African thought and “characteristically” or “saliently” southern African/African in this article.
Since early 2012, this project has informed all curriculum enhancement and development at our Center. Although, in an earlier publication, we address the general need for indigenous bioethicsFootnote 5 and some of those reasons are included here, this paper goes beyond that earlier account to describe why and how we went about the process of indigenizing our teaching and learning curriculum.
Why Embarking on this Project of Curriculum Reform was Necessary: Rationale for Africanizing the Bioethics Agenda
There were five compelling reasons for doing so: (1) Our bioethics discourse stands to be enriched by African thought. (2) It was necessary as a matter of restorative justice to help restore the dignity of indigenous Africans. (3) It is a means to counteract systemic epistemic injustice that denies African moral ideas a voice in global moral conversations. (4) It might promote buy-in to ethical norms and standards expected of professionals. (5) It was a necessary response to increasing calls by students for curriculum reform. The importance of each of these is described below.
Our Bioethics Discourse Stands to be Enriched by African Thought
One of our reasons for thinking this project to be important is that none of us is as smart as all of us. Our bioethics discourse simply stands to be deepened, strengthened and enriched by African thought. It is well-known historically that some of the most creative and enlightening periods in the history of ideas came about at times when different cultures came into engagement with one another. In other academic fields, such as religious studies, theology, sociology, and politics, indigenous African thought has been given serious attention. Yet, this has proven not to be the case in bioethics, and the field can only be the poorer for it.
Godfrey Tangwa, the bioethicist who has done the most to highlight the contribution that African thought can make to bioethics, writes persuasively about how Western bioethics can be enriched by African thought:
It is clearly up to western Bioethics and western systems of thought and practice in general to allow African Bioethics and African culture in general to influence them. If only more westerners could really honestly try to get into the spirit and swing of things African, in the same spirit that many Africans have honestly and enthusiastically got into the spirit and swing of things western, humankind and the entire biological world might stand to reap great benefits. Africans have tried. From western Christianity through western languages and education, to western systems of thought, philosophies and fashions, Africans have honestly and enthusiastically got into the spirit of things western. In the process, Africans have benefitted from western culture and used it to enrich their indigenous cultures. But, unfortunately, in so doing, Africans have neglected some vital aspects of their own indigenous cultures which could, in turn, have helped to humanise and enrich western culture. As there is no possibility of Africans imposing these putative benefits of African culture on westerners through any putative “blackman’s burden” and “decivilising mission”, it is really up to westerners to salvage these cultures for the enrichment of western culture and the benefit of humankind, since western culture is, indisputably, the overwhelmingly dominant culture of our historical epoch.Footnote 6
We agree with Tangwa that bioethics stands to be enriched by being open to the influence of African theorists. There are a number of significant ways in which African ideas may enrich and expand global moral theorizing, filling gaps in Western moral theories.Footnote 7 Some of these ways can be drawn out in relation to the coherentist or foundationalist views of moral justification upon which much moral theorizing depends. Briefly, these views hold that moral beliefs need to be consistent with one another and particularly with powerful, commonly shared, and perhaps even foundational moral intuitions. On this basis, the credibility of a moral claim or theory can be thrown into doubt by showing that it conflicts with another commonly or universally shared moral belief or intuition. For example, many claim that utilitarianism is implausible because it appears to conflict with the strong, widely shared intuition that, other things being equal, I have a stronger duty to save my wife, rather than a stranger.
This reliance on justification by coherence with powerful intuitions suggests at least four significant ways in which neglect of African thought may impoverish western theorizing: First, Western moral ideas and intuitions may not be sufficiently universal, so that the theories that they ground cannot be widely accepted. Second, Africans may have novel moral ideas that, on consideration, are universally attractive and conflict with Western moral theories, necessitating modification or even rejection of those theories. Third, African theories, or theories derived from African beliefs, may better account for widely shared moral beliefs, including those of Western people. Fourth, Africans may have unrecognized means and methods for arriving at significant moral truths that could replace or complement the coherentist method described above.Footnote 8
The neglect of African moral thought in these domains is thus not only undesirable, but also it is potentially damaging to the credibility of bioethics that aims at shared moral judgments. Bioethics and bioethics teaching that encourage attention to African moral concepts thus stand to contribute to richer and more robust moral theories.
It can Help to Restore the Dignity of African People
During the colonial era in Africa, African culture and traditional values were denigrated, looked down upon, despised, and even suppressed. Steve Biko, whose name our bioethics center is proud to bear, was an anti-Apartheid activist and leader of the Black consciousness movement, tortured and killed while in detention. He wrote that, after centuries of oppression, Africans had internalized the view that the oppressor’s view of them as inferior beings; that they had lost their collective self-esteem.
The colonialists … turned to the past of the oppressed people and distorted, disfigured and destroyed it. No longer was reference made to African culture, it became barbarism. Africa was the “dark continent”. Religious practices and customs were… superstition…. No wonder the African child learns to hate his heritage.Footnote 9
His words are a sad indictment of the arrogance of European colonialists. Given how the West robbed Africans of pride in their own heritage in the past, it is imperative now, in a postcolonial Africa, that the people of this continent reclaim their heritage and their pride. One way of contributing to this resurgence is by affirming that there is much in the moral wisdom of the continent, so long regarded as “dark,” that can shed light on what it means to be human and live a morally good life.Footnote 10 Our goal is that our African students will lay claim to their own rich moral tradition, and proudly use it in their reflections on important bioethical issues. Their doing so will also go some way in restoring the dignity of the people of Africa.
It is a Means to Counteract Epistemic Injustice
For Miranda Fricker, epistemic injustice comprises testimonial injustice and hermeneutic injustice.Footnote 11 She refers to Biko’s description that testimonial injustice occurs when a person or groups of people are not believed, or are regarded as less credible, due to a prejudice on the part of the listener. Hermeneutic injustice occurs when language or social structures make it systemically difficult or impossible for people or groups to express their beliefs in a way that will be heard.
Biko attests that both types of injustice were perpetrated in ways that remain sadly prevalent. The worldviews of whole cultures were rejected as barbarism and superstition under colonialism, and systematic separations and inequities continue to limit the opportunities of whole cultures and linguistic groups to contribute to global moral discourse.
By encouraging engagement with African moral concepts and providing theoretical frameworks that enable the expression of ideas that were systematically derided or actively suppressed, our curricula aim to counteract persistent epistemic injustice.
It might Promote Buy-In to Professional Ethical Standards
The right to practice a healthcare profession is predicated on making a sincere promise to adhere to specified moral and professional standards.Footnote 12 However, teaching ethics does not necessarily guarantee ethical students. All we have is the power of persuasion. Our responsibility is to try to convince our students that they ought to keep their promise to uphold the ethical and professional standards they commit to. And this is where teaching African moral values to our students is important.
People are more inclined to buy into the moral precepts they are already familiar with than those that are foreign to them. In writing about his project of surveying environmental ethical thinking across the globe, J. Baird Callicott argues: “A persuasive environmental ethic… cannot be constructed de novo. It must be located in a more general cognitive context, and it must retain continuity with the moral ideas and ideals of the past.”Footnote 13 Thus he embarks on his enterprise to realize the “revival and deliberate construction of environmental ethics from the raw materials of indigenous, traditional, and contemporary cognitive cultures.”Footnote 14 Surely this applies to bioethics, too. It should find its foundation in ethical constructs that are familiar to those engaging in bioethical reasoning. Indigenous and traditional cultural ideas should be put to work to enrich our bioethical reasoning. People more easily own values that are familiar than those that are foreign to them. Cletus Andoh writes that the nurturing of “ethical principles grown from African soil is a necessity for Africa, especially as people in life act in ways that are more consistent with the values they hold.”Footnote 15 Our African students are more likely to be persuaded by moral claims that are based on values that already resonate with them. Appealing to indigenous moral thought is an important way of encouraging our students to accept or buy into the ethical requirements of their profession.
It is a Necessary Response to Increasing Calls by Students for Curriculum Reform
In the years 2015–2016, South African universities and other tertiary education institutions were confronted by a student protest movement that became known as the #FeesMustFall movement. The primary demand made by students was for tuition to be free, along with a very strong second demand for institutions to be “decolonized.” Students rejected institutional cultures and curricula that had their foundations in the Western thought of those who had colonized the continent. What was envisaged was much more than merely the Africanization of the teaching curriculum; it was a total transformation of academic institutions.Footnote 16 Notwithstanding this broader project, a key demand was for curriculum reform, especially a rejection of the hegemony of Western thought and the embracing of African indigenous knowledge, world views and thought. The student activists clearly meant business: classes were disrupted, campuses entrances were closed, buildings and vehicles were set alight, and millions of South African Rands of damage was done to infrastructure. The legacy of the movement is not only that free education was made available to many more poor students; most institutions have now embarked on curriculum reform aimed at Africanizing or decolonizing the academic project.
When the #FeesMustFall protests began in 2015, our Center was already a few years into our project of curriculum reform. However, the demands of students across the country did serve to increase the urgency for us to work harder toward mainstreaming African ethics into our teaching. It also vindicated our original vision, and it continues to serve as catalyst for continuing with the project until our curriculum has been truly Africanized. This is not only necessary because we, as academics think so; it is also necessary because our students are beginning to demand it.
The Three-Step Strategy Employed for Africanizing the Bioethics Curriculum
Step One: Identifying Characteristically African Moral Constructs
Of the many relevant notions and conceptions in African thought and philosophy, the three key ideas that have been included in our curriculum are as follows.
A strong commitment to the value of community
One of the most recognizable features of African philosophical thought is that it is essentially communitarian. Much of the early work done in African philosophy focused on political and economic issues, and often favored communalist or socialist socio-economic systems. Western liberal democracy and capitalism were rejected on the grounds that they were incompatible with traditional African values.Footnote 17 Although it is true that African philosophy, as a whole, has moved on from its exclusively socialist commitments, the belief that African thought remains essentially communitarian is pervasive.
In southern Africa, it is common to use the notion of Ubuntu to describe the central place that community has in accounts of the good life. The philosophy of Ubuntu is often described using the saying, common in many of the languages of sub-Saharan Africa, that “a person is a person through other persons.” Roughly what this means is that it is only possible to become a true and moral human being through relationships with others, or in community.Footnote 18 Western moral theories tend to focus on the individual—perhaps too much so. An African sense of the importance of our embeddedness in communities and families may be a useful corrective.
Morality is essentially about maintaining the right kind of relationships
A second, and related, key ethical notion in African thought is that morality is essentially about maintaining the right kind of relationships. These relationships are ones which are grounded in a sense of a shared or common identity and well-being. In other words, they are based in the idea that we are dependent upon one another and ought to seek the good of others. These relationships are also often described using the term “harmony.” Thaddeus Metz, who has done a great deal of work in developing Ubuntu into a robust and fully-fledged moral theory, likes to describe an African conception of morality as being a “function of communal relationship.”Footnote 19 He describes the kind of communal relationships that are prized as consisting of “identity” (a sense of belonging together) and “solidarity” (caring for one another).Footnote 20 He sees these two elements, taken together, as being similar to what Westerners would describe as friendliness or a relationship of love.
Desmond Tutu writes: “[Ubuntu] speaks to the very essence of being human…. It … means my humanity is caught up, is inextricably bound up, in theirs. We belong in a bundle of life…. Harmony, friendliness, community are great goods. Social harmony is for us… the greatest good.”Footnote 21 Rather than seeking to maximize utility or to fulfill our duties, African thought emphasizes relationships and harmony—injecting some “heart” and caring into moral thought.
In our teaching, we emphasize the importance of maintaining the right quality of relationships in African moral thought, and encourage our students to consider how a relational ethic might entail different conclusions than the more familiar utilitarian or deontological approaches would.
A strong sense of duty to future generations
The third characteristically African notion of morality we have incorporated into our teaching is a strong sense of duty to future generations.Footnote 22 Western philosophers have struggled with complex theoretical problems concerning the very notion that it is possible to have moral obligations towards future generations. They have asked how it can make sense to talk about duties to beings that do not exist yet, whom we can never know, and whose very future existence is contingent upon choices of the now living.Footnote 23 Many in the West have also adopted the attitude that it is up to each generation to find solutions to the problems of its own time, some of which are inevitably a legacy of previous generations. This has led to, at best, a kind of ambivalence in the West as to whether or not we have moral obligations to posterity. John O’Neill describes a:
…temporal myopia that infects modern society. The question of obligations to future generations is posed in terms of abstract obligations to possible future people who are strangers to us. The argument is premised on the lack of a sense of continuity of the present with both the past and the future.Footnote 24
This stands in stark contrast to what African philosopher Kwasi Wiredu writes about moral obligations towards future generations in African thought:
Of all the duties owed to the ancestors none is more imperious than that of husbanding the resources of the land so as to leave it in good shape for posterity. In this moral scheme the rights of the unborn play such a cardinal role that any traditional African would be nonplussed by the debate in Western philosophy as to the existence of such rights. In upshot there is a two-sided concept of stewardship in the management of the environment involving obligations to both ancestors and descendants which motivates environmental carefulness, all things being equal.Footnote 25
Although Wiredu writes in the context of environmental ethical concerns, his defense of strong moral obligations to future generations applies in other contexts, too. In many southern African cultural groups, there is a tradition of honoring ancestors, or the recent dead. It is even believed that these ancestors continue to be present in the world in some sort of spirit form, and that they are able to influence events and people. It is unsurprising that, in such cultures, future generations are naturally also included in the circle of those to whom the present generation should give consideration. There is a sense of there being a duty of gratitude to those who have come before which entails taking the needs of those who are yet to come into account as well.Footnote 26 , Footnote 27 All of this points to a very strong sense of moral obligations to future generations.
Such a position has important implications for ethics. Since continued global warming and climate change will have a severe impact on the health and well-being of future generations, it really matters whether moral obligations to posterity exist or not. It also has implications for gene-editing research and applications, preimplantation diagnosis, and other complex ethical issues. As the African approach directly challenges some typical Western assumptions, this is an example of where African thought may deeply enrich the debate and discourse.
Of course, there are other characteristically African ethical ideas we have not covered here, such as a central place for family relationships, a justification of some degree of partiality, a duty for the rich to assist the poor, and an obligation to show hospitality to strangers. But, these examples of African moral notions are sufficient to demonstrate that Africa has something special to contribute to our bioethical discourse.
Step Two: Mainstreaming African Ethics into our Curriculum
Ernst Wolff suggests that there are two ways of including African philosophy into a curriculum. The first is to offer a whole module dedicated to African thought, and the second is to integrate African thought into all of the courses offered.Footnote 28 Other institutions on the continent have also tried to include African philosophy and thought into their ethics curricula. Typically, they have opted for the first of Wolff’s models, and what this has entailed is little more than dedicating a module or a few individual seminars to African ethics, here and there. This has the effect of making it seem like a quaint and exotic alternative that students might want to consider, assuming they find it interesting.
Our goal was to avoid exceptionalizing African moral thought, but to rather seek to make it an integral part of our students’ exposure to moral theory. That is, we chose the second model described by Wolff. We wanted to mainstream it into the curriculum. Thus, we have sought to teach African morality as just one other moral theory of equal status to deontology, utilitarianism, and so forth. Rather than only offering single lectures on the subject, we have sought to draw on African moral theory as routinely as other moral theories as we engage with important ethical questions right across the curriculum.
For this reason, our curricula incorporate African communitarian approaches to bioethics alongside Western approaches and require our students to reflect on how Ubuntu and African communitarianism might be able to enrich our reasoning on bioethical issues. Our undergraduate students apply these ideas in consideration and presentation of medical ethics case studies, comparing African approaches to more individualistic moral conceptions. Postgraduates increasingly opt to approach significant issues in bioethics through the lens of African moral theory.
Emmanuel Mgqwashu writes that decolonization “will involve conscious, deliberate, non-hypocritical and diligent interest by both black and white academics in indigenous knowledge systems, cultures, peoples and languages. Theories must be generated that are informed by life as it is lived, experienced and understood by local inhabitants.”Footnote 29 It has been our hope that when confronted with a complex moral question, our students will be just as likely to turn to African thought for direction as they will be to turn to the traditional Western theories.
Step Three: A Revised Version of Principlism
Principlism, particularly that espoused by Tom Beauchamp and James Childress in The Principles of Biomedical Ethics,Footnote 30 has been a profoundly influential model for moral decision making in bioethics. This is as true in Africa as anywhere else. Despite the many reservations theorists may have with the approach, the fact is that students in training and practitioners at the coal face find it very helpful when trying to negotiate their way through difficult ethical issues they confront in their day to day experience. We have chosen to acknowledge principlism’s value as something our students easily latch onto, understand and apply. We have also chosen to let it work for us in our attempt to mainstream African morality into our teaching. In a sense we have sought to “piggy-back” on principlism’s success in gaining acceptance by our students. So, what we have done is to devise a new version of principlism, one which is able to reflect some of the more important African ethical notions we are trying to promote.
The four principles are respect for autonomy, beneficence, nonmaleficence and justice. Beauchamp and Childress claim that the four principles carry equal weight. They also assert that they reflect the “common morality,” and consequently, are universal moral principles, acceptable in all cultures and societies.Footnote 31 Of the four principles, beneficence and nonmaleficence are not problematic. African morality shares these moral principles with other traditions. However, the other two principles are of some concern from the perspective of African morality.
Autonomy replaced by respect for persons
Regarding respect for autonomy, communitarians from different parts of the world, including South East Asia, Western Europe, and Africa, have criticized the strong individualist assumptions underlying the principle.Footnote 32 This is evidence enough that Beauchamp and Childress’s claim that the principles have universal validity is questionable. The challenge to the principle from communitarians is that it focuses only on individual choice, neglecting the social dimensions of medical decisionmaking. It does not give sufficient credence to a basic fact of the human experience: namely, that we are social beings and that we exist in communities and relationships with significant others. For this reason, we have proposed replacing the principle of respect for autonomy with that of “respect for persons” (the principle used in the Belmont Report).Footnote 33 “Person” here is understood in the sense intended by the African maxim that “a person is a person through other persons,” indicating our ethical and existential interdependence. In this way, “Respect for persons” is able to encompass the importance of respecting the right of individuals to make decisions about their own bodies and lives while also acknowledging that they might want to do so in consultation with those who are closest to them, and taking their needs into account, too. It conveys respect for a person’s autonomy within the nexus of their important relationships. The change from autonomy to respect for persons draws attention to the African emphasis on community and relationality and away from the idea the people are atomistic individuals. This might entail, for example, a strong moral obligation to support universal healthcare systems and the need for community and not just individual informed consent.
Justice replaced by harmony
The other principle that is problematic, from an African ethical perspective, is justice. Mostly, in principlism, justice has come down to matters of distributive justice and fairness. Now, this is already a relational principle; at the heart of the notion of justice is a sense of fairness in how we relate to one another. But, although important, merely making sure that everyone gets their fair share seems too narrow as a relational principle. Surely there is far more to healthy human relationships than this.
So, in seeking a broader and richer principle to express relationality, we have turned to the African notion of “harmony.” In seeking to promote harmonious relationships, rather than only fairness, it is possible for principlism to acknowledge the importance of making moral choices that make for healthy, affirming, uniting, and other-respecting relationships between people. This reflects an important aspect of African moral thought. What is more, it completely encompasses justice. Harmonious relationships require justice, since unfair distributions create resentment and disharmony. Thus, nothing is lost from the original principle, and much is gained.
As an example of this broader applicability, harmony as a principle is arguably better able to encompass the notion of moral obligations towards future generations. As previously discussed, in the African understanding of relationships between ancestors and descendants, current generations and future generations are all within the circle of moral concern. This means that it is possible to seek harmonious relationships across generational lines, too.
Conclusion
Anecdotal evidence suggests our approaches to Africanization have been successful. Our students often respond with enthusiasm when these ideas are first introduced to them in lectures. And we are gratified that they seem to have embraced, with some pride, the idea that there are ethical notions of value to be found in their own African traditions.
Our project to mainstream African moral concepts into our curriculum in an African university is not just for the benefit of our own students and their patients. Just as the German and African nuns could benefit from learning from each other, the entire global bioethics community can be enriched by taking African moral constructs seriously. Recognizing the importance of community, relationality, and harmony can add something of great value to our global bioethical discourse.
In her 2011 address as president of the International Association of Bioethics (IAB), Nikola Biller-Andorno called for bioethics to seriously begin to view its role through a different lens, one that focuses on enabling “flourishing human relationships.” She wrote:
A good deal of bioethical reasoning is concerned with the autonomous, rational individuals that inhabit sterile theoretical worlds. This perspective seems to neglect utterly what many would say counts most in a fulfilled life, that is flourishing human relationships.Footnote 34
Perhaps African bioethicists could help lead the way to just such a bioethics.
