Clinical Ethics Committees in Africa : lost in the shadow of RECs/IRBs?
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Clinical Ethics Committees (CECs) are well established at healthcare institutions in resource-rich countries.
However, there is limited information on established CECs in resource poor countries, especially in Africa. This
study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage
the establishment of CECs or Clinical Ethics Consultation Services (CESs) on the continent.
Methods: A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare
professionals and bioethicists in Africa. Data were subjected to descriptive analysis and Fischer’s exact test was
applied to determine associations. Texts from the open-ended questions were thematically analysed.
Results: In total 109 participants from 37 African countries completed the survey in December 2019. A significant
association was found between participants’ bioethics qualification or training and involvement in clinical ethics
(p = 0.005). All participants were familiar with Research Ethics Committees (RECs), and initially conflated RECs with
CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their
institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of
CECs. However, the majority of participants (81.7%) were interested in establishing CECs. Participants listed assistance
required in establishing CECs including funding, resources, capacity building and collaboration with other known
CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa.
Conclusions: This study provides a first look into CECs in Africa and found very few formal CECs on the continent
indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals
and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study
served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders
from the global north support capacity development in research ethics and establish RECs to approve the research
they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their
role in improving the quality of health care in Africa is sorely needed.
Keywords: Clinical ethics committees, Clinical ethics consultation service, Africa, Developing countries, Ethics,
Clinical ethics, Dilemma
Description
CITATION: Moodley, K., et al. 2020. Clinical Ethics Committees in Africa : lost in the shadow of RECs/IRBs?. BMC Medical Ethics, 21:115, doi:10.1186/s12910-020-00559-2.
The original publication is available at https://bmcmedethics.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
The original publication is available at https://bmcmedethics.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
Keywords
Clinical ethics -- Committees, Consulting services, Developing countries, Health care personnel -- Ethics
Citation
Moodley, K., et al. 2020. Clinical Ethics Committees in Africa : lost in the shadow of RECs/IRBs?. BMC Medical Ethics, 21:115, doi:10.1186/s12910-020-00559-2