INTRODUCTION

Ethics in the practice of medicine was not an alien concept in much of African history (see Chapter 19). Most African traditional healers had closely guarded codes of ethics, which were passed down from one generation to the next. Some of these codes embodied concepts found in the Hippocratic tradition such as confidentiality and privacy. Similarly, bioethics, broadly defined, is not an entirely new notion in Africa. Many African cultures understood the sacred interdependency among the health of individuals, communities, and ecological systems. It was a common belief that the morality of one's actions had consequences, positive or negative, on one's own health, the collective health of the populace, and the environment.

Godfrey Tangwa, an African philosopher–bioethicist asserts that African ethical and metaphysical ideas have over the ages been shaped and colored by its ecological, biological and cultural diversity. He argues that within the African world view, the distinction among plants, animals, and inanimate material, and between the sacred and the profane, matter and spirit, and the communal and the individual is a slim and flexible one. Similarly, metaphysical conceptions, ethics, customs, laws, and taboos form a single continuum (Tangwa 1999, 5).

A discussion of the “emergence” of bioethics in Africa is therefore slightly misleading because bioethics has always been a part of the African way of life. In reality, the emergence refers to the globalization of bioethics (Knowles 2001, 254).

INTRODUCTION

This chapter examines the roles and practices of traditional African healers prior to the introduction of the “modern” scientific world view into the conception and practice of medicine in Africa. To this end, this chapter distinguishes the roles of traditional medical healers in Africa, who mainly dealt with biological causation, from those of diviners, whose work was largely based on metaphysical aspects. This section of the chapter also explores the manner in which traditional healers entered the “profession” and examines the ethical framework within which these healers carried out their work. In addition, this chapter examines the wider role and social standing of the traditional healer in the community. It must be noted that whereas this chapter is essentially a historical account, traditional healers remain active in almost all parts of Africa. This chapter will also discuss the introduction of “modern medicine” in postcolonial Africa and will investigate the immediate conflict between concepts of Western medicine and traditional healing. Of particular concern will be the tension that exists between modern, Western-educated doctors and their traditional counterparts. This chapter considers the question of whether there has been any integration of modern science into the conception and practice of medicine. In conclusion, this essay will briefly examine the doctor–patient and healer–patient relationship in Africa.

THE AFRICAN WORLD VIEW

One cannot talk about a uniform “African World View.” Africa is a continent made up of more than forty-three countries.