Theoretical Medicine and Bioethics

, Volume 38, Issue 2, pp 111–126 | Cite as

Ancillary care obligations in light of an African bioethic: from entrustment to communion

  • Thaddeus MetzEmail author


Henry Richardson recently published the first book ever devoted to ancillary care obligations, which roughly concern what medical researchers are morally required to provide to participants beyond what safety requires. In it, Richardson notes that he is presenting the ‘only fully elaborated view out there’ on this topic, which he calls the ‘partial-entrustment model’. In this article, I provide a new theory of ancillary care obligations, one that is grounded on ideals of communion salient in the African philosophical tradition and that is intended to rival and surpass Richardson’s model, which is a function of Western considerations of autonomy. I argue that the relational approach of the former has several virtues in comparison to the basic individualism of the latter.


African bioethic Ancillary care Autonomy Clinical trials Communion Partial-entrustment model Relationality Research ethics 



For oral comments on a talk based on this research, I thank participants at the Conference on Giving a Voice to African Thought in Medical Research Ethics hosted by the University of the Witwatersrand Steve Biko Centre for Bioethics in 2015. For written comments on a previous draft, I am grateful to Kevin Behrens, Henry Richardson, and an anonymous referee for Theoretical Medicine and Bioethics. Research for this article has been supported financially by the South African National Research Foundation (NRF), and any opinion, findings, conclusions, or recommendations expressed in it are those of the author, with the NRF not accepting any liability in regard thereto.


  1. 1.
    Richardson, H. 2012. Moral entanglements: The ancillary-care obligations of medical researchers. Oxford: Oxford University Press.CrossRefGoogle Scholar
  2. 2.
    Metz, T. 2010. African and western moral theories in a bioethical context. Developing World Bioethics 10 (1): 49–58.CrossRefGoogle Scholar
  3. 3.
    Metz, T. 2010. An African theory of bioethics: Reply to Macpherson and Macklin. Developing World Bioethics 10 (3): 158–163.CrossRefGoogle Scholar
  4. 4.
    Slack, C., et al. 2005. Provision of HIV treatment in HIV preventive vaccine trials: A developing country perspective. Social Science and Medicine 60 (6): 1197–1208.CrossRefGoogle Scholar
  5. 5.
    Stobie, M., and C. Slack. 2010. Treatment needs in HIV prevention trials: Using beneficence to clarify sponsor-investigator responsibilities. Developing World Bioethics 10 (3): 150–157.CrossRefGoogle Scholar
  6. 6.
    Gyekye, K. 2010. African ethics. Stanford Encyclopedia of Philosophy, ed. E. Zalta. Accessed March 1, 2017.
  7. 7.
    Bujo, B. 1997. The ethical dimension of community. Trans. C.N. Nganda. Nairobi: Paulines Publications.Google Scholar
  8. 8.
    Kasenene, P. 1998. Religious ethics in Africa. Kampala: Fountain Publishers.Google Scholar
  9. 9.
    Tutu, D. 1999. No future without forgiveness. New York: Random House.Google Scholar
  10. 10.
    Gyekye, K. 2004. Beyond cultures: Ghanaian philosophical studies, III. Washington, D.C.: The Council for Research in Values and Philosophy.Google Scholar
  11. 11.
    Iroegbu, P. 2005. Beginning, purpose and end of life. In Kpim of morality ethics, ed. P. Iroegbu and A. Echekwube, 440–445. Ibadan: Heinemann Educational Books.Google Scholar
  12. 12.
    Mokgoro, Y. 1998. Ubuntu and the law in South Africa. Potchefstroom Electronic Law Journal 1 (1):15–26. Accessed March 1, 2017.
  13. 13.
    Masolo, D.A. 2010. Self and community in a changing world. Bloomington: Indiana University Press.Google Scholar
  14. 14.
    Metz, T. 2007. Toward an African moral theory. Journal of Political Philosophy 15 (3): 321–341. Revised version in 2017. Themes, issues and problems in African philosophy, ed. I. Ukpokolo, 97–119. London: Palgrave Macmillan.Google Scholar
  15. 15.
    Metz, T. 2016. An African theory of social justice: Relationship as the ground of rights, resources and recognition. In Distributive justice debates in political and social thought: Perspectives on finding a fair share, ed. C. Boisen and M.C. Murray, 171–190. New York: Routledge.Google Scholar
  16. 16.
    Metz, T. 2013. The Western ethic of care or an Afro-communitarian ethic? Finding the right relational morality. Journal of Global Ethics 9 (1): 77–92.CrossRefGoogle Scholar
  17. 17.
    Appiah, A. 1998. Ethical systems, African. In Routledge encyclopedia of philosophy, ed. E. Craig. London: Routledge.Google Scholar
  18. 18.
    Olson, N. 2016. Medical researchers’ ancillary care obligations: The relationship-based approach. Bioethics 30 (5): 317–324.CrossRefGoogle Scholar
  19. 19.
    Singer, P. 1972. Famine, affluence, and morality. Philosophy & Public Affairs 1 (3): 229–243.Google Scholar
  20. 20.
    Richardson, H., and L. Belsky. 2004. The ancillary-care responsibilities of medical researchers. Hastings Center Report 34 (1): 25–33.CrossRefGoogle Scholar
  21. 21.
    Richardson, H. 2015. Correspondence with the author, December 6.Google Scholar
  22. 22.
    Wertheimer, A. 2010. Rethinking the ethics of clinical research. Oxford: Oxford University Press.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Philosophy DepartmentUniversity of JohannesburgAuckland ParkSouth Africa

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