Bioethics in Tanzania: Legal and Ethical Concerns in Medical Care and Research in Relation to the HIV/AIDS Epidemic

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This article examines bioethics in Tanzania, particularly in relation to the HIV/AIDS epidemic for the following reasons: First, not only is HIV/AIDS the most alarming health problem in most parts of Africa, but the complexity of issues involved in medical and research ethics (codes of conduct and standard guidelines, conflicting rights and responsibilities, and issues of distributive justice) clearly illustrates the various levels of problems that bioethics—more precisely, both professional medical ethics and research ethics—faces in a poor, developing country. The article defends uniformity in the general, international bioethical guidelines but calls for wider discussion in their applicability in different economic and social conditions by claiming that in the present debates the issues of distributive justice, culture, and individual professional judgment have been tangled together in a manner that tends to justify double standards in practice. To avoid this confusion there is a need to find a more coherent approach to bioethics that brings together the normative requirements set by international guidelines, national policy planning, social ethics, and professional medical ethics.I thank particularly Dr. Louis Mlingi, Tanzanian Occupational Health Service, and Dr. Pekka Nokso-Koivisto, Tanzanian Occupational Health Service and the Nordic Clinic, for their insightful views and for sharing their personal experiences in the issues of medical ethics in Tanzania in relation to their participation in our development ethics project funded by the Finnish Academy of Science 2000–2003. Some of the empirical examples are collected from our medical and healthcare ethics training in Lindi, Southern Tanzania with the Finnish funded Professional and Civic Ethics Project (CPEP), 2003. In addition I am grateful to professor Zul Premji, Muhimbili University College of Health Sciences, Dar es Salaam, for his advise on research ethics in Tanzania.