Ike Iyioke has multidisciplinary degrees/certificates in philosophy, international relations, and journalism. He also has transdisciplinary research/teaching interests in ethics of healthcare, environmental health, and multicultural studies. Currently, he is engaged in projects dealing with population health, health services research, the cross- cultural components of bioethics, and health policy. The issues of social determinants, health disparities, unequal medical treatment, and implicit bias also are foregrounded. Previously, he has explored questions pertaining to moral philosophy, specifically research subject/participant selection; biomedical research partnerships between Africa & the West; environmental science and public policy; environmental justice/racism; and morality in primitive cultures.
What is your work about?
This book is an attempt to explore the ethics of public health, specifically, ethical issues with clinical trials; it is also a reflection of the wider area, and research interest forays I make in the broad field of bioethics. In it, I aim to re-conceptualize responsibility in clinical trials with the insight of the African notion of self. I strive to complement scholarly literature dealing with cross-cultural biomedical ethics, and emphasize the African perspective which is rare or even non-existent in many cases. It has become obvious that the assumptions implicit in the Western framework that makes claim to universal validity about research ethics are not shared by non-Western cultures. If not reined in, the concern seems to be that the Euro-American approach is bound to globalize a less than global view of the world and reality. In other words, the mainstream research ethics which is grounded on principlism is itself inherently linked to Western individualistic notions of personhood, whereas the rest of the world, particularly Africa, sees the person not as an isolated individual, but as a part of the community who is embedded in kinship, group, community and the environment. While opposing individualism (a Euro-American mantra), the African perspective stresses communitarianism. By definition, the communalist philosophical view point instantly recognizes that ethical issues with biomedical studies are far more broad-based than the four principles of autonomy, beneficence, non-maleficence, and justice. In other words, there is need to establish a higher tier of ethical principles to cater for research ethics protection at the level of communities as well as the physical environmental level.
How are notions of community in African philosophy different from those found in Western ethics? How do you balance protection for individuals with protections for the community and environment?
Some critics of communalism (e.g., Paulin Hountondji and Uwaezuoke Obioha in “Radical communitarian idea of the human person in African Philosophical Thought: A critique”) have expressed the same concern. They reject communalism on the basis that its emphasis on conformity, consensus, custom, loyalty and solidarity makes it constrictive of the individual liberty. However, they fail to see the import of the communitarian argument which is well articulated by Leopold Senghor (in On African Socialism) that the African communalism was founded on dialogue and reciprocity [and that] the group had priority over the individual without crushing him, but allowing him to blossom as a person. It is by recognizing the humanity of others that one realizes the fullness of his/her own humanness. As we shall see in the next segment, the African person is distinctively infused in the African conception of the community and of the world writ large. It is a point also made by Jensen and Gaie, namely that while Western notions of self tend to draw us inward ‘centripetally’, the African notion of self draws us ‘centrifugally’ outward in relation to other people, the natural world, and the social environment (see “African communalism and public health policies: the relevance of indigenous concepts of personal identity to HIV/AIDS policies in Botswana”). And to be clear communalism is not the same as ‘group think.’
What topics do you discuss in the work, and why do you discuss them?
This book presents a tripartite thesis: ‘responsibility’, ‘clinical trials,’ and ‘personhood’ (specifically, the African notion of personhood). The challenge was to harmoniously blend these seemingly disparate themes (full-fledge concepts in their own rights), to justify why it makes sense to analyze them together for my purpose. The study structure and rationale therefore was cognizant of the need to establish the intersectional standpoints and the confluence between the three arms of the project .
With the philosophical dimension of ‘African personhood’ as a third panel to the equilibrium, I wish to provide a perspective of what responsibility can mean in an African context and then apply that understanding to biomedical clinical trials with human subjects. The overall analysis therefore follows through as the trifecta themes of responsibility, clinical trials, and African personhood, come to a full circle
Which of your insights or conclusions do you find most exciting?
The formulation of what I have referred to as the ‘BEC Principle’ excites me the most. Bio-eco-communalism, or BEC, like the concept of one-in-all, refers to the inseparability of the individual within his/her community and the environment. I have used it to argue that when clinical trials (much of which are currently conceived in the Global North) involve other cultures (particularly Africa – in the Global South, where many of the trials are often offshored to), there is need to frame and apply some additional considerations. The status quo (Principles of Research Ethics) is deficient in multicultural settings because of its over emphasis on individualism. As I have articulated in the book, the philosophical/cultural significance of the person in the African setting differs markedly from the Western perspective. I therefore see my suggestion to re-conceptualize responsibility from an understanding of the African perspective as a landmark point at which to address myriad publica health issues one of which responsibility in clinical trials in one; and to provide a path to head off unnecessary philosophical, cultural and ideological tensions that are still lurking ahead.
The crux of my re-conceptualizing project is as follows: when communalist principle (personhood within the context of the community and his milieu) is applied to the public health sphere, at least two outcomes are immediately discernible. One, because of the interconnectedness and interrelatedness of human persons (and indeed of everything else in nature) whatever happens to the individual happens to the community in which he belongs. The individual is integrally located and anchored in a mesh of relationships within the family, village and clan (living and dead), all of whom are primordial sources of that person’s physical, psychic, emotional, and spiritual existence – wellbeing or otherwise. By implication, if you are responsible for one, you are responsible for all (at least in some degree hence, I view it as a one-in-all paradigm or BEC). Research ethics is right, just, proper, and culturally sensitive so long as it expresses respect for communal relationships in which people both identify with each other and exhibit solidarity with each other.
Two, because of this communal disposition, it follows that almost every issue with the individual is correspondingly regarded as a communal affair, sometimes to the point that the family (or community) has a stake in becoming aware of another’s illness/wellbeing and having a role in the decisions regarding their treatment or upkeep — a phenomenon that conflicts with the Euro-American proclivity to individual right to confidentiality. This comparative analysis should be a teaching moment for researchers, clinicians, bioethicists, students and academics as they confront the African perspectives on morality.
I can imagine privacy advocates being concerned about the idea that the community should be aware of and/or involved in individual medical decisions. How do you address this concern?
How nice. But no; obsession over privacy was never part of African thought. It’s only now with the age of the social media that ‘privacy’ is beginning to be a buzz. Even that is not typical with the dominant trend in African social life. It’s normal for families and even village heads to weigh in on the individual’s wellbeing. The saying, “it takes a village to raise a child” has quite a significant meaning in African culture and philosophy. The individual is integrally located and anchored in a mesh of relationships within the family, village and clan (living and dead), and the environment; all of whom are primordial sources of that person’s physical, psychic, and spiritual wellbeing. This is particularly true of relatives or significant others, whose closeness may generate a host of contraposing attributes such as pride or envy, excitement or malice, likeness or hostility, love or rancor; and the capacity to harm or help through the harnessing of the shades of energy residing in the beings within the individual’s sphere.
Same could be said about many cultures of the world (for example in Asia). But it is a factuality that has proved too hard for a Euro-American to wrap their mind around. On the surface of it, this attribute may be viewed only negatively or as a potential downside. However, doing so does not represent the total picture. Casting a wider perspective would reveal the overarching reality that African societies are organized around the requirements of duty and obligation to the larger community (as opposed to Western individualism which is shaped by Kant, Bentham and Mill ideologies).
How have readers responded?
If my experience at the recent “Author Meets Critics” session, 2019 APA Eastern Conference in NY is any measure, I feel pretty happy with my work. It was a moment I felt that I actually communicated something tangible. Not that all the panelists were 100 percent in sync – and that would be impossible to find among philosophers – but the overall assessment and verdict were very good. A major criticism from one of the panelists was that I focused ONLY on the African continent, hence I was parochial and excluding of the African thought in the diaspora. However, another panelist quickly interjected on my behalf, calling it out as a non-sequitur. Afterall, the scope of the book is clearly on the title. Overall, I plan to use all the comments and observations to make improvements in the second edition which I’m already prepping for.
How is your work relevant to the contemporary world? How is your work relevant to historical ideas? What effect do you hope your work will have?
The perspective that I advance in my book is not entirely novel. However, I have provided it some historical currency and made it relevant to the contemporary mind. For instance, I see the African ‘self’ (vital force) as a being that is hooked on a grid. The energy that he generates serves his individual needs, but it is also shared with other forces around him. But as the need arises, he supplements his individual energy as well with those of other elemental forces. In other words, existing as a power point in an interconnected network, he is a generator, a supplier as well as a consumer of the voltage energy of the distribution network. The African ‘person’ is capable of these interpersonal dynamisms due to his elemental attributes of being a vital force who is imbued and animated with a vital principle and above all, is anchored in the communal operations of other forces. As such, he is a force in the hierarchy of forces, habitually in intimate consanguinity with other forces above and below him. Therefore, the fulfillment of his life is predicated on the support of other forces (humans, spirits, the biota, etc.). As a consequence, consideration for the community of other forces is always in the mix whenever ethical, juridical, ontological, epistemological, and other decisions are made. It is upon this platform that my reconceptualization stands.
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