The evolution of technology, ongoing research and an unending quest for solutions to health issues brought about the concept of bioethics. While the importance of biological research cannot be overemphasized, it is, however, important that these researches are done within the bounds of law, delicately balancing the need to better the medical field and the rights of patients and experimental subjects. To understand bioethics is to value the interplay between ethics, morality, and the continuous evolution of medical practice1.
This article explains bioethics, the difference between Bioethics and Medical Ethics, and Bioethics in Nigeria: Agency, Laws and Evolving Bioethics Issues.
What is Bioethics:
The term "Bioethics" is derived from two Greek words, 'bios – life' and 'ethos – behavior, habit or custom, it simply means the ethics of biological research. Bioethics is an ongoing societal dialogue that strives for and often achieves an actual consensus, this means people's opinions (scientists, patients, researchers and society) matters when considering the concept.
In its multidimensional perspectives, bioethics can address most of the ethical challenges in modern medicine. The primary purpose of bioethics is to ensure that as research deepens and technology advances towards improving life and health, we are cautioned that most noble scientific ends do not necessarily justify every means. The sanctity and sanity of life and dignity of persons must be carefully weighed in experiments and research. As popularly said, "your right ends when the rights of others begin", thus, the right of medical practitioners and researchers to carry out research for the betterment of people does not in any way override the rights of patients or subjects used as experiments to try out or perfect procedures or treatments.
Thus, Bioethics is introduced to address most of the controversial ethical issues emerging from modern medicine and scientific technology and as a response to valid concerns regarding the future of human life or humanity in general. It aims to humanize all scientific research activities with humans, medical education and clinical practices.2
Bioethics V. Medical Ethics
Medical ethics have been around for centuries, focusing on the ethics of the physician-patient relationship. It provides the general duties a physician owes a patient. Medical ethics have always thrived on consent, allowing patients to decide and allow treatments recommended by doctors, Yinka Olomojobi, stated that bioethics on the other hand is concerned with the ethics and implication of new evolutions in biological and medical procedures and the advent and inclusion of technology in treatment.
While medical ethics is concerned with adhering to standards and ethical conduct in medical practice, bioethics tries to provide sufficient answers to pathological, biological and clinical questions and emerging procedures or scientific techniques such as cloning. For most purposes, bioethics is a general category of which medical ethics is a subset.3
Bioethics in Nigeria: Agency, Laws and Evolving Bioethics Issues
Bioethics in Nigeria is still a very tender and has a long way to go. In 2011, Dr. Clement Adebamowo stated that "Examining the bioethics landscape in Nigeria today, it is difficult to imagine how recently it was a barren plain"4.
The Code of Medical ethics has always been the basis to ensure a healthy patient-doctor relationship in Nigeria; however, any deficiency in biomedical ethics and its application can cause ethical issues in dealing with the patients and their families. There is pressing need to eradicate any violation of human dignity, rights and abuse of medical goals while caring for others; this is possible with the applications of biomedical ethics.
In Nigeria, bioethical guidelines, codes and policies that regulate scientific research with human beings exist globally and even to some extent. However, it is still alarming that many cases of human dignity and rights abuse are related to scientific research with human participants.
For example, Nigeria experienced one of the ugly incidents of unethical scientific research with human beings in 1996. Pfizer firm located in Kano, in the northern part of Nigeria, manufactured a 'Trovan' medicine in 1996, and then decided to carry out some studies to determine its effectiveness in treating an epidemic known as meningococcal meningitis. To test the efficacy of its new antibiotic trovafloxacin (Trovan), they carried out an open-label trial in 200 children, half of whom were given trovafloxacin and half the gold standard treatment for meningitis, ceftriaxone. Five (5) of the children given trovafloxacin died, together with six (6) who were given ceftriaxone. Pfizer said that 15000 people died during the epidemic.5 It was discovered that Pfizer obtained neither authorization from the Nigerian government nor informed consent from the parents before giving the unproven drug to the children and infants. A law court in the United States that took up on the adjudication of this matter indicted Pfizer Company for carrying out an illegal and unethical trial of an unregistered drug, that caused liver complications and death of 203 some children Consequently, the Pfizer firm would walk saunter on tight ropes to seek an out-of-court settlement with a considerable sum of $75 million subject to a confidentiality clause. The incident had two effects; it instigated much fear among the people to refuse to participate in other future scientific research, and drew global attention to highlight the importance of ethics review of scientific research in many other developing countries.
The Nigerian health sector is currently and seriously facing significant bioethical challenges that pose a big threat to life, health and the environment. These challenges range from the decisions at the beginning and end of life in the clinical settings, the use of modern scientific equipment to alter the course of life, the issues regarding research with human beings, too much of terrorism, body injuries due to accidents, mental disorders, poverty, high rate of disease outbreaks, morbidity and untimely mortality, amongst others.
The National Biotechnology Development Agency ("NABDA") is the Agency governing bioethics in Nigeria. The Agency has the function of advising on related ethical problems relating to research, development and application of scientific knowledge, formulating recommendations concerning guidelines and legislations, developing tools for standard setting, strengthening co-ordination and contracts among experts and institutions and fostering debate, education and public awareness and engagement in bioethics.6 Thirty-four (34) Bioresource Development Centres (BIODEC) are under the National Biotechnology Development Agency.
The grand norm of all laws in Nigeria is the Nigeria Constitution7 which provides for many rights, including the right to life8 and dignity of person9. The following most important law is the National Health Act 2004; others are – Nigerian National Health Policy (NNHP) 1988, National Agency for Food and Drug Administration and Control (NAFDAC) 1993, and the Code of Medical Ethics in Nigeria (1995).
Some of the evolving issues are cloning, embryo research, stem cells, clinical trials, the notions of euthanasia and physician-assisted suicide, organ harvesting/commercialization and transplant, scientific research with human participants, medical futility, withdrawal and withholding of treatments, palliative care for a dignified end-of-life, genetics, the concept of death and dying, etc.
These issues keep rising, but the Nigerian Health System and Bioethics challenges limit development and success. Some of these challenges are: substandard educational system, inadequate human resources and equipment/instruments, unqualified healthcare workers, ineffective administration and management, poor healthcare financing, ineffective administration and management, the problem of ethnicity and language barriers, amongst others.
Conclusion
One of the significant roles bioethics plays in modern medicine is ensuring that human life, dignity, rights and value are accorded with utmost respect in all biomedical activities. Unethical experiments with humans need to be checked by applying bioethics in the healthcare system to provide quality care, to reduce, or if possible, to eliminate all medical malpractices within the area of clinical medicine and scientific research investigations with human beings. All treatments ought to be within the controlled trial to ensure maximum effectiveness and efficacy of future care of patients. Bioethics still has significant roles to play and will continue to exert enormous influence on the recent evolution of traditional medical ethics.
Recommendation
There is need to establish the need and urgency of applying bioethical principles in places like Nigeria. While constant ethical reviews are highly recommended in modern biomedical scientific research, acknowledgement and respect must be given to different cultural realities in Nigeria without compromising vital moral values. There is a need for constant bioethics training and awareness among medical practitioners and the nation.
Apart from NABDA, a Bioethics Committee should be formed, and this committee will ensure that medical practices and experiments with human beings respect all ethical standards stipulated in the national and international bioethical laws or policies. The committee will also be saddled with the responsibility of ensuring adequate preparation is made towards all experiments, as there is a likelihood that the outcome may be unethical and invalid due to lack of adequate preparation at the beginning of a scientific investigation.
Lastly, more is needed to make laws and policies, strict adherence and implementation are essential. There are many healthcare policies in Nigeria, but the major problem lies in implementing these policies.
Footnotes
1. Health, Bioethics and Globalization, Medical and Health Law, Yinka Olomojoni, page 190
2. A Bioethics Critique of the Healthcare System in Nigeria: Personal Dignity and Human Solidarity, page 296
4. https://www.fic.nih.gov/News/GlobalHealthMatters/nov-dec-2011/Pages/bioethics-nigeria.aspx
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119465/
6. https://nabda.gov.ng/about-us/bioethics/
7. Constitution of the Fedreal Republic of Nigeria 1999 as amended
8. Section 33
9. Section 34
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