African approaches to an enriched ethics of person-centred health practice
Abstract‘Person-centred ethics’, containing ‘person’ in the singular, may suggest a commitment to individualism. This paper, however, argues that a person-centred ethic need not be trapped in an a priori commitment to liberal individualism or communitarianism, should one draw on two related core African insights on 1) putting people first and 2) respect for diversity. “Batho pele” is a Sesotho expression that means “people first”. It is closely connected to the rich concept of “ubuntu”, translated incompletely as “in existence with and through others”. It champions both the person and groups of persons by virtue of an interconnectedness expressed, for example, in the isiZulu maxim “Unmuntu Ngumuntu Ngabantu”, translated as “I am because you are, and you are because we are”.Putting people first in the ethics of health care has to account for diversity, for diversity is an inevitable characteristic both among individual persons and groups of people. To account for diversity in not merely a general way, the diversity specific to both particular persons and between groups of people in a particular situation and context needs to be taken seriously. Accounting for diversity in this way guided by the ethics “people first” and “ubuntu”, requires a process of shared decision making in which all relevant values, including potential individualist and communitarian values, are taken up in a substantive communicative process that creates in partnership person and people-specific decisions for that very situation, context, and time – a process captured in the African concept of an “indaba”.
Third Geneva Conference on Person-Centered Medicine: Conceptual Perspectives