An African Perspective on Advance Directives

ABSTRACT

Advance directives, a form of oral or written statement in which people declare their treatment preferences in the event that they lose decision-making capacity, are known to exist in various cultures of the world. Existing studies on advance directives in Western medical tradition place great emphasis on individual autonomy to the neglect of communal and other associative ties characteristic of the practice in African tradition. This study, therefore, interrogated the practice of advance directives with a view to bringing to the fore an African perspective – consensus advance directives – represented in Igbo tradition, which is communal in nature. The study adopted, as framework, Menkiti’s notion of the human person which states that the individual is defined by reference to his environing community.  Ten relevant texts in Bioethics, especially  Meilaender’s Bioethics (BI), Kuhse and Singer’s A Companion to Bioethics (ACB), Beauchamp’s Contemporary Issues in Bioethics (CIB) and six on African thought,  particularly, Nwala’s Igbo Philosophy (IP),  Menkiti’s Person and Community in African Traditional Thought (PCAT) and Metuh’s African Religions in Western Schemes (ARWCS) were purposively selected. These texts dealt extensively with advance directives and the idea of personhood. Conceptual analysis was used to clarify key terms like advance directives, personhood and community. Critical method was employed in interrogating existing debates on advance directives which emphasised individual autonomy, freedom and choice. Reconstructive method was used to evolve an autochthonous African perspective, herein referred to as ‗consensus advance directives. Texts on Bioethics revealed that Western culture places emphasis on the autonomy of individual persons, perceived as ‗liberty and ‗right-claim’ holders (BI and ACB). This personalistic conception of the human person is an expression of the Western humanistic tradition, which places premium on atomistic individualism (ACB and CIB). The individual reserves the right to self-determination, and in case of debilitating disease, the liberty to choose the type of healthcare and medical treatment in consonance with his personal convictions, values and beliefs (BI and CIB). Texts on African thought showed that the individual is defined by reference to his environing community, and in case of medical treatment, people need consensus of the community in arriving at a holistic healthcare decision (IP). This is substantiated by proverbs and aphorisms in Igbo thought such as Umunna bu ike (community is strength), oria ofu onye bu oria ikwu na ibe (a kinsman’s sickness is sickness on the patrilineage) and nwanna ibi dara na egosiya umunnaya (one with a diseased scrotum first shows it to his kinsmen). Critical intervention revealed that among the Igbo, decisions concerning the individual’s health are taken not without the participatory knowledge and input of the kin group. The centrality of the community in the individual’s wellbeing, further indicated the place of ‗consensus advance directives’ among the Igbo. The individual in Igbo culture achieves healthcare goals and other aspirations through the fraternal relationship that community affords. Therefore, the African perspective on advance directives as represented in Igbo thought is consensual in nature.