BMJ No 7102 Volume 315 Letters Saturday 26 July 1997
Informed consentOther societies have different concepts of autonomy
Editor,
There is a disturbing undertone of cultural imperialism in
the debate about informed consent. It shows itself most starkly in the
tacit assumption that the whole world shares the same philosophical
meanings as those that underpin our own shaky Judaeo-Christian-liberal
ethic. That this is far from so is vividly illustrated in the very
different concepts of autonomy held by different societies. In many
traditional African cultures, and certainly in Bantu culture, the
individual does not take his or her autonomy from 'cogito, ergo
sum' ('I think, therefore I am'), as in the West, but from
'sumus, ergo sum' ('we are, therefore I am')-membership of an
intensely important group that enhances the individual. In many parts
of Africa it is simply not possible, especially for women, to make
important decisions without reference to the group; any clinician or
researcher who believes that a 'yes' given by a terrified and
lonely patient, in or out of a hospital bed, amounts to anything
approaching informed consent is either naive or a knave. Add to this
the very real social difficulty in ever saying 'no' and thus
threatening a relationship and you have the perfect situation for doing
anything you like.
Tim Cullinan
Head
Community Health Department,
University of Malawi,
Private Bag
360,
Chichiri,
Blantyre 3,
Malawi
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