Vision

Why strengthen bioethics capacity in the DR Congo, Francophone Africa, or low-income countries in general?

In 1999, the Fogarty International Center (FIC) initiated the first meeting of the Global Forum for Bioethics in Research in Bethesda, Maryland. One of the main conclusions of this meeting was that there were few existing training programs on research ethics specifically catering for investigators from the developing world.

In response to this need, FIC announced in 2000 its International Bioethics Education and Career Development Award, which in part aims to ‘support the advanced training of developing country professionals who can assume the roles of bioethicists involved in the ethical review of clinical trial design in research and clinical investigation in their countries.’ As of 2005, 18 FIC bioethics programs have been established around the world. Our collaborative project is one of them.

FIC’s mission to strengthen bioethics globally has embraced by some, but has also met with criticism. The two most prominent criticisms are:

Bioethics as wasteful luxury item

Some have argued that bioethics capacity is not a developing world priority, and the financial and human resources could be better spent on securing assess to food and clean water, distributing vaccines, or strengthening health infrastructure. According to this view, it is unjustified – perhaps even unethical – to devote resources to bioethical capacity building in countries marked by poverty, civil conflict and where people are dying from treatable diseases.

Bioethics as covert neo-colonialism

Some suspect the globalization of bioethics capacity is ultimately an attempt by developed world agencies to facilitate their biomedical research priorities and projects in the developing world, and thereby further extend the power of more privileged societies. How can institutional review boards (IRBs) in the developing world retain their independence if their members have been trained in research ethics at powerful developed world institutions? If developing country professionals need bioethics training, and the training takes place in at developed world institutions, how can they avoid absorbing foreign ideologies, values and normative frameworks, and imposing them back at home? Ultimately, aren’t developing country professionals being trained to promote the global research interests of the developed world?

We believe these criticisms are important should be be part of a self-reflective, honest and ongoing discussion. They challenge us to reflect on the broader significance of the recent movement to globalize bioethics capacity, and the place of our own project within that movement.

• Is bioethics a wasteful luxury in the Democratic Republic of Congo and Francophone Africa?

• Is the movement to strengthen bioethics capacity in developing countries a form of neo-colonialism?

Further readings on these issues:

Benatar, SR and Singer, P. (2000) A new look at international research ethics. BMJ 321: 824-826.

Chadwick, R. and Schuklenk, U. (2004) Bioethical Colonialism? Developing World Bioethics 18 (5): iii-iv.

Ogundiran, OT. (2004) Enhancing the African Bioethics Initiative. BMC Medical Education (4):21.

Benatar SR, Daar AS, and Singer, P. (2005) Global health challenges: the need for an expanded discourse on bioethics. PLoS Med (2)7:e143 [link].

Benatar SR and Singer, P. (2001) Beyond Helsinki: A vision for global health. BMJ 322 (7289): 747-748.