In 1998, a famous Russian scientist who is currently the directors of the Institute named after Kurchatov, Mikhail Kovalchuk, proposed his own version of uniting together these four fields of knowledge. In 2011, in his article named "Convergence of sciences and technologies is a breakthrough into the future," he gave both conceptual basics and serious arguments supporting the convergence of NANO-BIO-INFO-COGNO (NBIC). It is important that when compared with pure technological solutions of the NBIC technologies future development forecast, he includes humanitarian sciences in this process. According to Kovalcuk, the main objective of today's post-industrial stage of development of the society is reproduction of systems of live nature. The first stage is combining technological possibilities of modern microelectronics with achievements in studies of live nature (nano-biotechnologies). This means creating hybrid anthropomorphic technical systems of bionic type. The second stage is the integration of nano-biosensor platforms created at the first stage, that is, the development of technologies of atomic-molecular design and self-organization on the basis of atoms and

of NBIC technologies would become the basis of a new technological structure [49].

bioorganic molecules, the result of which are biorobotic technical systems [50].

Another factor that makes the notion of bioethics preferable is the NBIC technologies convergence, which represents a mutual interaction of information technologies, biotechnologies,

**4. Conclusion: Global trends to global bioethics**

raw materials, and other recourses.

Starting from 2009, the Institute of Philosophy of Russian Academy of Sciences publishes "Work books in bioethics" dedicated to its different branches; in 2010, it started to publish international e-journal "Medical anthropology and bioethics" [43].

In Kazan (Republic of Tatarstan), professor of philosophy Nezhmetdinova obtained the grant to develop a course of bioethics for students in 1994. This course passed attestation by the University of New York, and in 1996, it was approved and supported by the University of Kent (Great Britain). This program became the basis for the course in biomedical ethics, when Nezhmetdinova started lecturing it to students of the medical university by the initiative of Professor Albitskiy. At that time, it was regarded as something exotic. In the following 3 years, it became possible to prove the livability of this field and to "capture" the wider public, and the independent chair of biomedical ethics and medical law with the course in the history of medicine was established in 1998, which was the first to be developed in Russia. As the desire to study the new scientific field was enormous and there was no methodological support, a textbook "The law and medicine: bioethical foundations" was written in 1998 [44], and bioethical issues became part of scientific research work of the staff, doctoral students, and degreeseeking applicants of the chair. In 2000, Nezhmetdinova and Guryleva developed legal and regulatory documents, and with the support of the rector of the Kazan Medical University, Professor Amirov organized an ethical committee with local functions. Three years later, due to the growth of multicenter clinical studies and the appearance of legal regulatory actions, namely the law of the Russian Health Ministry "On approval of Rules of clinical practice in Russian Federation," there appeared the necessity to organize a Regional Ethical Committee (Regional Committee of ethical issues in clinical drug trials under the Ministry of Healthcare of the Republic of Tatarstan). This situation was an exception rather than a rule for Russia. There was a disastrous lack of knowledge, but the Kazan school of bioethics has the great stroke of luck. Since 2002, the topical nuts-and-bolts course was organized with the support of UNESCO for ethical committees of the post-soviet countries, and representatives of the Kazan school Nezhmetdinova and Guryleva took an active part in conferences and workshops, first as trainees and then as full participants of discussions. The Forum of committees in ethics of the CIS member-countries organized by Kubar enabled the whole commonwealth to take a common stand in issues of ethics of clinical studies and to think about legal aspects not only of clinical trials but also about medical practice as is evidenced by such model laws as "On protection of human rights and dignity in biomedical studies in the CIS member-countries" and "On ethical-legal protection and safety of genetic medical studies in the CIS membercountries" passed by the Inter-Parliamentary Assembly of the CIS countries.

One can say about the birth of a new research area of agrobioethics developed by the initiative of Nezhmetdinova [45]. This is due to global challenges and bio-technologization of economy [46]. Agrobioethics is understood as a mechanism of social control and regulation of new "material viability" in bioeconomics [47, 48]. Agrobioethics represents a new approach to the solution of ethical dilemmas, which can arise in everyday practice of using new technologies in agriculture. It is an experience of solving disputes, inter-personal and social communication for solving controversies both between producers and customers and between the state and the civil society [45, 46].

## **4. Conclusion: Global trends to global bioethics**

lens of Orthodoxy. The basic rights stated and listed in the Universal Declaration of Human Rights (1948, the UN) [42] are unconditional, and the difficulty arises when the list of these rights grows unlimitedly and such rights as "reproductive rights" and "sexual rights" become attached to it. Their real nature lies in willfulness and seeking to change the human nature itself with inevitably fatal consequences for it. Bioethics is the knowledge, the task of which is to protect human life from possible kinds of "artificial" and "invented" rights on changing one's

Starting from 2009, the Institute of Philosophy of Russian Academy of Sciences publishes "Work books in bioethics" dedicated to its different branches; in 2010, it started to publish

In Kazan (Republic of Tatarstan), professor of philosophy Nezhmetdinova obtained the grant to develop a course of bioethics for students in 1994. This course passed attestation by the University of New York, and in 1996, it was approved and supported by the University of Kent (Great Britain). This program became the basis for the course in biomedical ethics, when Nezhmetdinova started lecturing it to students of the medical university by the initiative of Professor Albitskiy. At that time, it was regarded as something exotic. In the following 3 years, it became possible to prove the livability of this field and to "capture" the wider public, and the independent chair of biomedical ethics and medical law with the course in the history of medicine was established in 1998, which was the first to be developed in Russia. As the desire to study the new scientific field was enormous and there was no methodological support, a textbook "The law and medicine: bioethical foundations" was written in 1998 [44], and bioethical issues became part of scientific research work of the staff, doctoral students, and degreeseeking applicants of the chair. In 2000, Nezhmetdinova and Guryleva developed legal and regulatory documents, and with the support of the rector of the Kazan Medical University, Professor Amirov organized an ethical committee with local functions. Three years later, due to the growth of multicenter clinical studies and the appearance of legal regulatory actions, namely the law of the Russian Health Ministry "On approval of Rules of clinical practice in Russian Federation," there appeared the necessity to organize a Regional Ethical Committee (Regional Committee of ethical issues in clinical drug trials under the Ministry of Healthcare of the Republic of Tatarstan). This situation was an exception rather than a rule for Russia. There was a disastrous lack of knowledge, but the Kazan school of bioethics has the great stroke of luck. Since 2002, the topical nuts-and-bolts course was organized with the support of UNESCO for ethical committees of the post-soviet countries, and representatives of the Kazan school Nezhmetdinova and Guryleva took an active part in conferences and workshops, first as trainees and then as full participants of discussions. The Forum of committees in ethics of the CIS member-countries organized by Kubar enabled the whole commonwealth to take a common stand in issues of ethics of clinical studies and to think about legal aspects not only of clinical trials but also about medical practice as is evidenced by such model laws as "On protection of human rights and dignity in biomedical studies in the CIS member-countries" and "On ethical-legal protection and safety of genetic medical studies in the CIS member-

nature, on the denial of moral laws protecting the nature, society, and human life.

countries" passed by the Inter-Parliamentary Assembly of the CIS countries.

One can say about the birth of a new research area of agrobioethics developed by the initiative of Nezhmetdinova [45]. This is due to global challenges and bio-technologization of economy [46].

international e-journal "Medical anthropology and bioethics" [43].

110 Reflections on Bioethics

Global challenges and strategic and social-economic priorities of the future of the humankind have made it necessary to fasten the study, forecast and development of means which should promote sustainable development, provide population safety and quality of life, protect ecology, and improve the rational use of nature. Currently developed countries are starting the formation of a new technological base of economic systems based on the use of the latest achievements in biotechnologies, information science, and nanotechnologies including agriculture, medicine, veterinary, ecology, and other spheres. This will make it possible for the humankind to solve four main problems it is facing today—food supply, quality of health care, degradation of environment, and problems connected with the exhaustion of power, raw materials, and other recourses.

On the one hand, we are contemporaries of the global problems that need urgent solution as we are talking about the future of the humankind. On the other hand, we witness or directly participate in scientific fundamental cutting-edge achievements which make it possible to change fundamentals of being on the level of life and artificial matter or their synthesis. In 2002, the National Scientific Fund of the USA and the American Ministry of Economy using forecasts of scientists prepared and published a well-known Report on Convergent technologies NBIC (NBIC: N—nano, B—bio, I—infor и C—cogno). It stressed out that the convergence of NBIC technologies would become the basis of a new technological structure [49].

In 1998, a famous Russian scientist who is currently the directors of the Institute named after Kurchatov, Mikhail Kovalchuk, proposed his own version of uniting together these four fields of knowledge. In 2011, in his article named "Convergence of sciences and technologies is a breakthrough into the future," he gave both conceptual basics and serious arguments supporting the convergence of NANO-BIO-INFO-COGNO (NBIC). It is important that when compared with pure technological solutions of the NBIC technologies future development forecast, he includes humanitarian sciences in this process. According to Kovalcuk, the main objective of today's post-industrial stage of development of the society is reproduction of systems of live nature. The first stage is combining technological possibilities of modern microelectronics with achievements in studies of live nature (nano-biotechnologies). This means creating hybrid anthropomorphic technical systems of bionic type. The second stage is the integration of nano-biosensor platforms created at the first stage, that is, the development of technologies of atomic-molecular design and self-organization on the basis of atoms and bioorganic molecules, the result of which are biorobotic technical systems [50].

Another factor that makes the notion of bioethics preferable is the NBIC technologies convergence, which represents a mutual interaction of information technologies, biotechnologies, nanotechnologies, and cognitive science. The term was introduced in 2002 by Mikhail Roko and William Bainbridge, the authors of the most important for today's work in this direction, the report "Converging Technologies for Improving Human Performance 1" prepared in 2002 in the WTEC [51]. NBIC convergence has not only huge scientific and technological importance. Technological possibilities appearing during the NBIC convergence inevitably will cause serious cultural, philosophical, and social disturbances.  It is quite possible that from the certainty based on everyday experience, the humankind has to move to understanding that in the real world there are no clear boundaries between many phenomena, which were previously considered to be of dual nature. First of all, due to recent research, the traditional difference between live and inanimate loses its meaning. In the same way, the difference between a rational system possessing mind and free will and rigidly programmed system is gradually fading. Already today, live beings are created "artificially" with the help of gene engineering. One of these days, it will become possible to create complex live beings (also with the help of nanotechnologies from separate molecular-size elements.) In addition to broadening the boundaries of human creativity, this will also mean the transformation of our understanding of life and death. All this is in the center of bioethical discourse.

and nanotechnological communities refer, are mainly based on principles and approaches developed within the secular liberal bioethics. At the same time, positions of religious concepts, in particular of modern Christian social doctrines, are barely reflected in official international, state, and professional documents even though the substantial part of the society keeps Christian or Muslim ethical norms. The religious understanding of the world first of all is based on the creative mission of God. It is in the creation of all the living: life, a man, the nature. Modern NBIC technologies undermine the belief in creationism. Hence, a necessity arises in both the new interpretation of sacred books and the development of religious ethics. Speaking about technological challenges, modern researchers and scientists cannot help but use the chance to express their anxiety and call to vigilance. Analyzing characterizing traits of the modern society (using the American one as an example), an American scientist Nesbitt

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 113

The last 25 years of the twentieth century and the beginning of the twenty-first century gave rise to such a specific phenomenon which the German sociologist Ulrich Beck named "other modern" or "the society of risk" [56]. And we think that he quite correctly stressed the change of the meaning and use of the notion "risk" which from the category of the personal area only

Second, if the previous century risk was considered to be a result of insufficient development of technologies and scientific knowledge, today risk appears where there is redundancy of technological and scientific progress [57]. This emerges the following questions: "Should we worry about this or leave it to the discretion of scientists-technologists? If we should then are there any humanitarian practices providing our bodily safety and fundamental basics of

In the Kazan school of bioethics, great attention is paid to the applied nature of bioethics. Updating of applied ethics seems quite natural in this respect. Here, we should remember the meaning given to ethics by classics of antique philosophy Plato and Aristotle. For Plato, ethics being the structural part of philosophic knowledge should teach the art of life. He thought that this was the real and highest possible good for a man [58]. While distinguishing theoretical and applied levels of the philosophical knowledge system, Aristotle also defined their aims as the truth and the good. He included ethics, politics, and economy into applied philosophy, thus emphasizing that ethics was the applied philosophy and so philosophical foundation of ethics is definitive in its character [59]. Judging from all said above, it is possible to make the following assumption: when this or that scientific discipline claims to be bioethics

in interdisciplinary discussions, its philosophical origin is logical and crucial.

calls it the Zone Poisoned by Technology, where

**1.** We feel fear about technology and worship it.

**3.** We take violence as a norm of life.

moves to the global level.

nature?"

**4.** We love technology as children love toys.

**5.** Our life has become estranged and erratic [55].

**2.** We are unable to tell reality from fantasy any more.

Also, today we witness futuristic or manifesting scenarios of the development of the human society. In his presentation made already in the autumn of 2010 at the scientific conference "Future talk" in Vienna, which discussed technologies of the future, a futurologist and trans humanist Raymond Kurzweil [52] spoke about fantastic possibilities that could become quite real: in the nearest 20 years, the humankind would be able to make the so-called "reserve copy of a brain," which would contain records of all reminiscences; a person will be able to look though his or her past which will be projected into his eyes: special nano-robots regulating the health of human being will be implanted into his blood system; in the 30s of the current century, the computer will prove existence of the artificial intellect, and it will be able to understand human words as a man does and will be able to pass the Turing test; the implantation of a special chip into the brain which will create virtual reality of "complete submersion" will become feasible; by 2040, a human body will be able to transform into any form which will also be made of a huge number of nano-robots, and all internal organs will be replaced by cybernetic devices. In conclusion, Kurzweil forecasts the coming of the complete "technological singularity" by 2045, the result of which will be turning the Earth into a single gigantic computer, and gradually this process will involve the whole of Universe [53].

In 2011, the "Project 2045" was developed in Russia, and a Manifesto of a strategic public movement "Russia 2045" was published. The Manifesto proclaims the demand for creating a new ideological paradigm for the necessity of "using breakthrough technologies for improvement the man himself and not only his habitat. We think that it is possible and necessary to eliminate aging and even death, to overcome fundamental limits of physical and psychological abilities, defined by restrictions of a biological body" [54].

The appearance of new options of the humankind future can form new moral Decalogues. They differ substantially from Biblical, Muslim, and other confessional variants of ethical codes. Currently, most official documents in bioethics, to which professional medical, biological, and nanotechnological communities refer, are mainly based on principles and approaches developed within the secular liberal bioethics. At the same time, positions of religious concepts, in particular of modern Christian social doctrines, are barely reflected in official international, state, and professional documents even though the substantial part of the society keeps Christian or Muslim ethical norms. The religious understanding of the world first of all is based on the creative mission of God. It is in the creation of all the living: life, a man, the nature. Modern NBIC technologies undermine the belief in creationism. Hence, a necessity arises in both the new interpretation of sacred books and the development of religious ethics.

Speaking about technological challenges, modern researchers and scientists cannot help but use the chance to express their anxiety and call to vigilance. Analyzing characterizing traits of the modern society (using the American one as an example), an American scientist Nesbitt calls it the Zone Poisoned by Technology, where

nanotechnologies, and cognitive science. The term was introduced in 2002 by Mikhail Roko and William Bainbridge, the authors of the most important for today's work in this direction, the report "Converging Technologies for Improving Human Performance 1" prepared in 2002 in the WTEC [51]. NBIC convergence has not only huge scientific and technological importance. Technological possibilities appearing during the NBIC convergence inevitably will cause serious cultural, philosophical, and social disturbances.  It is quite possible that from the certainty based on everyday experience, the humankind has to move to understanding that in the real world there are no clear boundaries between many phenomena, which were previously considered to be of dual nature. First of all, due to recent research, the traditional difference between live and inanimate loses its meaning. In the same way, the difference between a rational system possessing mind and free will and rigidly programmed system is gradually fading. Already today, live beings are created "artificially" with the help of gene engineering. One of these days, it will become possible to create complex live beings (also with the help of nanotechnologies from separate molecular-size elements.) In addition to broadening the boundaries of human creativity, this will also mean the transformation of our understanding of life and death. All this

Also, today we witness futuristic or manifesting scenarios of the development of the human society. In his presentation made already in the autumn of 2010 at the scientific conference "Future talk" in Vienna, which discussed technologies of the future, a futurologist and trans humanist Raymond Kurzweil [52] spoke about fantastic possibilities that could become quite real: in the nearest 20 years, the humankind would be able to make the so-called "reserve copy of a brain," which would contain records of all reminiscences; a person will be able to look though his or her past which will be projected into his eyes: special nano-robots regulating the health of human being will be implanted into his blood system; in the 30s of the current century, the computer will prove existence of the artificial intellect, and it will be able to understand human words as a man does and will be able to pass the Turing test; the implantation of a special chip into the brain which will create virtual reality of "complete submersion" will become feasible; by 2040, a human body will be able to transform into any form which will also be made of a huge number of nano-robots, and all internal organs will be replaced by cybernetic devices. In conclusion, Kurzweil forecasts the coming of the complete "technological singularity" by 2045, the result of which will be turning the Earth into a single gigantic

computer, and gradually this process will involve the whole of Universe [53].

cal abilities, defined by restrictions of a biological body" [54].

In 2011, the "Project 2045" was developed in Russia, and a Manifesto of a strategic public movement "Russia 2045" was published. The Manifesto proclaims the demand for creating a new ideological paradigm for the necessity of "using breakthrough technologies for improvement the man himself and not only his habitat. We think that it is possible and necessary to eliminate aging and even death, to overcome fundamental limits of physical and psychologi-

The appearance of new options of the humankind future can form new moral Decalogues. They differ substantially from Biblical, Muslim, and other confessional variants of ethical codes. Currently, most official documents in bioethics, to which professional medical, biological,

is in the center of bioethical discourse.

112 Reflections on Bioethics

The last 25 years of the twentieth century and the beginning of the twenty-first century gave rise to such a specific phenomenon which the German sociologist Ulrich Beck named "other modern" or "the society of risk" [56]. And we think that he quite correctly stressed the change of the meaning and use of the notion "risk" which from the category of the personal area only moves to the global level.

Second, if the previous century risk was considered to be a result of insufficient development of technologies and scientific knowledge, today risk appears where there is redundancy of technological and scientific progress [57]. This emerges the following questions: "Should we worry about this or leave it to the discretion of scientists-technologists? If we should then are there any humanitarian practices providing our bodily safety and fundamental basics of nature?"

In the Kazan school of bioethics, great attention is paid to the applied nature of bioethics. Updating of applied ethics seems quite natural in this respect. Here, we should remember the meaning given to ethics by classics of antique philosophy Plato and Aristotle. For Plato, ethics being the structural part of philosophic knowledge should teach the art of life. He thought that this was the real and highest possible good for a man [58]. While distinguishing theoretical and applied levels of the philosophical knowledge system, Aristotle also defined their aims as the truth and the good. He included ethics, politics, and economy into applied philosophy, thus emphasizing that ethics was the applied philosophy and so philosophical foundation of ethics is definitive in its character [59]. Judging from all said above, it is possible to make the following assumption: when this or that scientific discipline claims to be bioethics in interdisciplinary discussions, its philosophical origin is logical and crucial.

"*In the framework of applied ethics, the theoretical analysis, public discourse and direct morally responsible decision-making merge together and become a content of a real practice organized correctly. It is a special form of theorization. Theorization directly integrated into the life process, a kind of theorization in the terms of life."* (italics by F.N.) [60]. As a consequence, the interpretation of the meaning of the adjective "applied" related to the noun "ethics" gains a special meaning. In this respect, the view point of Bakshtanovskiy and Samogonov, which states that what it involves is first of all the integration of both sides of ethics—both moral practice and ethical knowledge into the field of reflection about the nature of the applied ethics, seems most trustworthy and well reasoned. This finds its reflection in ethical know-how for the interaction of two sides of applied ethics (rational analysis of moral choice situations, ethical design and modeling, ethical expertise and consulting, etc.). And further, the meaning of the word "applied" used with the noun "ethics" is considered as a supplement understood as a process of moral creative art, concretization procedure, an *act of a moral choice* (italics by F.N.) The concept of these authors considers the modus Vivendi of the applied ethics to be the moral choice, and the applied ethics is defined as "regulatory and value subsystems concretizing moral (business ethics, ethics of journalism, bioethics and etc.) and the theory of concretizing of moral, project-oriented knowledge" [61].

Here, we can speak about concrete types of bioethics, institutionalization of which we witness today, such as biomedical ethics, agrobioethics, sports bioethics, ecological bioethics and global bioethics, scientific bioethics, and so on. The peculiarity of biological aspects of regulatory and value subsystems on this level is the frequent use of the complementarity principle, which presupposes combination of elements of professional codes and regulatory acts with principles of bioethics on a case-by-case basis rather than consistently [64]. **3.** Practical or clinical bioethics is a concrete bioethical expertise or visualization of a problem, which demands to make moral choice right here and now in the situation that (as a rule) is not supported by previous experience in medicine or any other sphere of human activity

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 115

This is translated into bioethical know-how. Examples of these solutions form a bank of bioethical casuistry which becomes a practical and methodological basis of project-oriented "advanced knowledge" that provides research of and transforming influence on "small

The level of clinical bioethics represents the brightest from of "bioethical feasibility." It is here that the identification of bioethical problem and its detection take place. Tischenko emphasizes that "visualization, detection (from the bottom to the top) of the real moral order is a prerequisite of correction, moral healing both of a separate human being and the society in the whole. Bioethics in particular is trying to solve this problem in modern biomedicine by clarifying the essence of relations between moral entities, existing in it, and proposing ways

Speaking about the clinical level of bioethics, it is necessary to emphasize that it is influenced by the American tradition, including the US legislative system as it is based on precedence which does not allow mandatory and generally binding nature and compulsoriness of legal norm and the law. In this case, the question arises as to whether bioethical casuistry is compulsory and valuable. Suffice it to recall the legislative mess with the right to organize ethical committees in the Russian Federation, beginning with the possibility to organize them which first appeared due to the Article 16 of the federal law "On foundations of public health protection in Russian Federation," which was later withdrawn and did not appear in the last federal law "On foundation of public health protection in Russian Federation" passed in 2011 [67]. These three levels of bioethics are closely interconnected. Within the bioethical discourse, the theoretical analysis, public discourse, and direct making of a morally responsible decision fuse together and become the subject matter of a real practice that is properly organized. We would like to point that it is a special form of theorizing which is included into the process of

**1.** Being the interdisciplinary field of knowledge by its birth, bioethics leans toward philosophy by its content's "specific gravity" and reflects results of global social changes affecting

**2.** The subject of bioethics as a new scientific discipline is search, definition of principles, and criteria of moral attitude to all the living, and as a social technology—evaluation and

regulatory-value systems" [65].

life and a special form of responsible decision making.

choice of the moral criteria for the living.

Based on the above, it is possible to make the following conclusions:

the ultimate foundations of man, nature, and the society.

of their arrangement" [66].

A number of researchers divide bioethics into three levels—theoretical, practical, and applied. In particular, philosopher Sedova gives the following explanation:

"Theoretical bioethics is a combination of knowledge about attitude of man to all the living represented in the form of an axiological discourse.

Practical bioethics is the institutionally shaped standardizing regulation and value expertise of the attitude of man to all life forms. Corresponding standards are documented in the form of oaths, charters and declarations, which are not legally binding in their essence.

Applied bioethics is the description of concrete situation of human behavior related to the living" [62].

At the same time, based on the definition of bioethics as a search, assessment, and choice of a criterion of moral attitude to all the living [63], the following definition to these three levels can be proposed:

**1.** The theoretical level is an interdisciplinary and complex analysis of ethical and axiological aspects in theory and practice of various kinds of human activity with respect to the living

In this case, we can speak about concepts and theories (e.g., humanism, utilitarianism, deontology, etc.), which shape and define the moral attitude of a man to the living in historical-cultural and social context. Here, we can lay emphasis on the peculiarities of recurrence and non-recurrence of moral decision making as an axial principle depending on existing technological possibilities of live systems transformation.

**2.** The applied level is bioethical aspects of regulatory and value subsystems of concrete types of activities (medicine, science, politics, sport, agriculture, etc.), which are controlled and regulated by professional codes and moral commandments, laws and regulatory acts, which include those lens of the public discourse.

Here, we can speak about concrete types of bioethics, institutionalization of which we witness today, such as biomedical ethics, agrobioethics, sports bioethics, ecological bioethics and global bioethics, scientific bioethics, and so on. The peculiarity of biological aspects of regulatory and value subsystems on this level is the frequent use of the complementarity principle, which presupposes combination of elements of professional codes and regulatory acts with principles of bioethics on a case-by-case basis rather than consistently [64].

"*In the framework of applied ethics, the theoretical analysis, public discourse and direct morally responsible decision-making merge together and become a content of a real practice organized correctly. It is a special form of theorization. Theorization directly integrated into the life process, a kind of theorization in the terms of life."* (italics by F.N.) [60]. As a consequence, the interpretation of the meaning of the adjective "applied" related to the noun "ethics" gains a special meaning. In this respect, the view point of Bakshtanovskiy and Samogonov, which states that what it involves is first of all the integration of both sides of ethics—both moral practice and ethical knowledge into the field of reflection about the nature of the applied ethics, seems most trustworthy and well reasoned. This finds its reflection in ethical know-how for the interaction of two sides of applied ethics (rational analysis of moral choice situations, ethical design and modeling, ethical expertise and consulting, etc.). And further, the meaning of the word "applied" used with the noun "ethics" is considered as a supplement understood as a process of moral creative art, concretization procedure, an *act of a moral choice* (italics by F.N.) The concept of these authors considers the modus Vivendi of the applied ethics to be the moral choice, and the applied ethics is defined as "regulatory and value subsystems concretizing moral (business ethics, ethics of journalism, bioethics and etc.) and the theory of concretizing of moral, project-oriented

A number of researchers divide bioethics into three levels—theoretical, practical, and applied.

"Theoretical bioethics is a combination of knowledge about attitude of man to all the living

Practical bioethics is the institutionally shaped standardizing regulation and value expertise of the attitude of man to all life forms. Corresponding standards are documented in the form

Applied bioethics is the description of concrete situation of human behavior related to the

At the same time, based on the definition of bioethics as a search, assessment, and choice of a criterion of moral attitude to all the living [63], the following definition to these three levels

**1.** The theoretical level is an interdisciplinary and complex analysis of ethical and axiological aspects in theory and practice of various kinds of human activity with respect to the

In this case, we can speak about concepts and theories (e.g., humanism, utilitarianism, deontology, etc.), which shape and define the moral attitude of a man to the living in historical-cultural and social context. Here, we can lay emphasis on the peculiarities of recurrence and non-recurrence of moral decision making as an axial principle depending

**2.** The applied level is bioethical aspects of regulatory and value subsystems of concrete types of activities (medicine, science, politics, sport, agriculture, etc.), which are controlled and regulated by professional codes and moral commandments, laws and regulatory acts,

of oaths, charters and declarations, which are not legally binding in their essence.

on existing technological possibilities of live systems transformation.

which include those lens of the public discourse.

In particular, philosopher Sedova gives the following explanation:

represented in the form of an axiological discourse.

knowledge" [61].

114 Reflections on Bioethics

living" [62].

living

can be proposed:

**3.** Practical or clinical bioethics is a concrete bioethical expertise or visualization of a problem, which demands to make moral choice right here and now in the situation that (as a rule) is not supported by previous experience in medicine or any other sphere of human activity

This is translated into bioethical know-how. Examples of these solutions form a bank of bioethical casuistry which becomes a practical and methodological basis of project-oriented "advanced knowledge" that provides research of and transforming influence on "small regulatory-value systems" [65].

The level of clinical bioethics represents the brightest from of "bioethical feasibility." It is here that the identification of bioethical problem and its detection take place. Tischenko emphasizes that "visualization, detection (from the bottom to the top) of the real moral order is a prerequisite of correction, moral healing both of a separate human being and the society in the whole. Bioethics in particular is trying to solve this problem in modern biomedicine by clarifying the essence of relations between moral entities, existing in it, and proposing ways of their arrangement" [66].

Speaking about the clinical level of bioethics, it is necessary to emphasize that it is influenced by the American tradition, including the US legislative system as it is based on precedence which does not allow mandatory and generally binding nature and compulsoriness of legal norm and the law. In this case, the question arises as to whether bioethical casuistry is compulsory and valuable. Suffice it to recall the legislative mess with the right to organize ethical committees in the Russian Federation, beginning with the possibility to organize them which first appeared due to the Article 16 of the federal law "On foundations of public health protection in Russian Federation," which was later withdrawn and did not appear in the last federal law "On foundation of public health protection in Russian Federation" passed in 2011 [67].

These three levels of bioethics are closely interconnected. Within the bioethical discourse, the theoretical analysis, public discourse, and direct making of a morally responsible decision fuse together and become the subject matter of a real practice that is properly organized. We would like to point that it is a special form of theorizing which is included into the process of life and a special form of responsible decision making.

Based on the above, it is possible to make the following conclusions:

**3.** Bioethics is a new type of scientific knowledge which is based on procedures and methods of "advanced experience" when the theoretical analysis and gaining new knowledge, public discussion, and practical moral decision making take place simultaneously.

**Author details**

**References**

Nezhmetdinova Farida Tansykovna\* and Guryleva Marina Yuryevna

Kazan State Agrarian University, Member of the International Society of Clinical Bioethics,

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 117

[1] Potter VR. Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice-Hall; 1971. 340 p [2] Callahan D. Bioethics as a discipline. In: Reich WT, editor-in-chief. Encyclopedia of

[4] Potter VR. Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice-Hall; 1971. p. 48 [5] Potter VR. Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice-Hall; 1971. p. 67

[8] Hellegers A. Bioethics center formed. Chemical and Engineering News. Oct 11, 1971. p. 7

[9] Reich WT, editor-in-chief. Encyclopedia of Bioethics 1978. Vol. V1-5. NY; 1995. p. 324 [10] Reich WT. The word "Bioethics": Its birth and the legacies of those who shaped it. Кennedy Institute of Ethics Journal (The Johns Hopkins University Press). 1994;**4**:329 [11] Reich WT. Introduction. In: Reich WT, editor-in-chief. Encyclopedia of Bioethics. Vol.

[14] Reich WT. Introduction. In: Reich WT, editor-in-chief. Encyclopedia of Bioethics. V1-5.

[15] Daniel Callahan. Bioethics as a discipline. In: Reich WT, editor-in-chief. Encyclopedia of

[16] Engelhart Jr HT. The Foundation of Bioethics. Oxford University Press. 1986, 1996. 446 р [17] Tom L, Beauchamp JL, Childress JF. Principles of Biomedical Ethics. Oxford University

[18] Engelhart Jr HT. The Foundation of Bioethics. Oxford University Press; 1996. p. 3

[6] Reich WT, editor-in-chief. Encyclopedia of Bioethics 1978. Vol. V1. NY; 1995. 322 p

[7] Potter VR. Global Bioethics. Michigan State University Press; 1988. p. 72

[12] Potter VR. Global Bioethics. Michigan State University Press; 1988. pp. 74-77

[13] Potter VR. Global Bioethics. Michigan State University Press; 1988. p. 78

[3] Sass H-M. Postscript/Fritz Jar. Essays in Bioethics 1924-1948. 2013. pp. 126-129

\*Address all correspondence to<EMAIL_ADDRESS>
Bioethics. Vol. V1 . NY; 1995. p. 248

V1-5. NY; 1995. p. XXI

NY; 1995. p. XXI

Press; 1994. 378 p

Bioethics. Vol. 1. NY; 1995. pp. 247-248

National and Local Ethical Committee, Kazan, Russia

**4.** Considering the place and role of bioethics in the conditions of global changes, one can see that its social-regulatory status, the aim of which is to prevent negative consequences of breakthrough technologies, becomes evident.

The present rector of the Kazan State Medical University Professor Sozinov has been the head of the chair of biomedical ethics and medical law since 2003. Due to his efforts, it has become the first in the country among chairs of educational institutions providing teaching bioethics together with legal foundations of health, study of patients' rights, and their implementation in modern conditions as well as rights, responsibilities, and protection of medical workers themselves. The following events were organized in Kazan: the workshop in ethics of clinical trials for members of ethical committees and researchers, the conference in ethics and law, the first Russian congress "Bioethics and human rights," the workshop of the Forum of committees in ethics of the CIS member-countries, the international research and practice conference under the auspices of UNESCO "Gender equality and bioethics," and numerous round tables in ethical and legal issues of health care and medical science within large medical forums. Since 2003, Professor Sozinov has been the head of the Regional Committee in Ethics, and starting from 2006, he is the member of the Russian Committee in Bioethics under the Commission of the Russian Federation for UNESCO and since 2007—the head of the Forum of committees in ethics of the CIS member-countries. Professor Sozinov also is a member of the Managing Council of "The Strategic Initiative for Developing Capacity in Ethical Review (CIDCER)" of the World Health Organization (WHO). The study of ethical-legal problems arising in different fields of medicine (pulmonology, infectious diseases, dentistry, orthopedics and traumatology, obstetrics and gynecology, pediatrics, etc.) is the main scientific direction of the chair.

Today, a great number of books and articles are published, and conferences and symposia are held every year. Significant in this respect is the Encyclopedia of global bioethics which was recently published under the editorship of philosopher Henk Ten Hava and which contains 358 articles by more than 400 authors [66, 68].

In the present time, Kazan studies in the field of bioethics have a comprehensive and interdisciplinary character and cover different fields of medicine and biology, sport, food, and ecological safety. In the recent years, we witness broadening of the discourse in the field of bioethics, and there are studies related to the philosophical analysis of consequences of breakthrough technologies implementation for the solution of global problems.

## **Acknowledgements**

The authors want to thank ANO "Kazan open University of talents 2.0" (ANO "KOUT 2.0") for supporting our publication.

## **Author details**

**3.** Bioethics is a new type of scientific knowledge which is based on procedures and methods of "advanced experience" when the theoretical analysis and gaining new knowledge, pub-

**4.** Considering the place and role of bioethics in the conditions of global changes, one can see that its social-regulatory status, the aim of which is to prevent negative consequences of

The present rector of the Kazan State Medical University Professor Sozinov has been the head of the chair of biomedical ethics and medical law since 2003. Due to his efforts, it has become the first in the country among chairs of educational institutions providing teaching bioethics together with legal foundations of health, study of patients' rights, and their implementation in modern conditions as well as rights, responsibilities, and protection of medical workers themselves. The following events were organized in Kazan: the workshop in ethics of clinical trials for members of ethical committees and researchers, the conference in ethics and law, the first Russian congress "Bioethics and human rights," the workshop of the Forum of committees in ethics of the CIS member-countries, the international research and practice conference under the auspices of UNESCO "Gender equality and bioethics," and numerous round tables in ethical and legal issues of health care and medical science within large medical forums. Since 2003, Professor Sozinov has been the head of the Regional Committee in Ethics, and starting from 2006, he is the member of the Russian Committee in Bioethics under the Commission of the Russian Federation for UNESCO and since 2007—the head of the Forum of committees in ethics of the CIS member-countries. Professor Sozinov also is a member of the Managing Council of "The Strategic Initiative for Developing Capacity in Ethical Review (CIDCER)" of the World Health Organization (WHO). The study of ethical-legal problems arising in different fields of medicine (pulmonology, infectious diseases, dentistry, orthopedics and traumatology, obstetrics and gynecology, pediatrics, etc.) is the main scientific direc-

Today, a great number of books and articles are published, and conferences and symposia are held every year. Significant in this respect is the Encyclopedia of global bioethics which was recently published under the editorship of philosopher Henk Ten Hava and which contains

In the present time, Kazan studies in the field of bioethics have a comprehensive and interdisciplinary character and cover different fields of medicine and biology, sport, food, and ecological safety. In the recent years, we witness broadening of the discourse in the field of bioethics, and there are studies related to the philosophical analysis of consequences of break-

The authors want to thank ANO "Kazan open University of talents 2.0" (ANO "KOUT 2.0")

through technologies implementation for the solution of global problems.

lic discussion, and practical moral decision making take place simultaneously.

breakthrough technologies, becomes evident.

tion of the chair.

116 Reflections on Bioethics

**Acknowledgements**

for supporting our publication.

358 articles by more than 400 authors [66, 68].

Nezhmetdinova Farida Tansykovna\* and Guryleva Marina Yuryevna

\*Address all correspondence to<EMAIL_ADDRESS>
Kazan State Agrarian University, Member of the International Society of Clinical Bioethics, National and Local Ethical Committee, Kazan, Russia

#### **References**

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**Bioethics and Technology**

**Bioethics and Technology**

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2016. p. XXXVI, 3030. ISBN: 978-3-319-09482-3

**Chapter 7**

**Provisional chapter**

**Marching for 3D Printing: Its Potential to Promoting**

**Marching for 3D Printing: Its Potential to Promoting**

Technology has the capacity for helping African citizens realize their basic rights. The recent introduction of the disruptive technology—3D printing—has the potential to impact millions of lives through a variety of revolutionary medical solutions, including surgery and the treatment of intractable health conditions. As the technology progresses, so does the practical enjoyment of health rights. This chapter argues that the human rights-based approach to 3D printing technology can be helpful in focusing discussions and actions on health well-being and security for individuals in Africa. Having first analyzed the impact of the technology in revolutionizing healthcare, the chapter provides an overview of the complex health challenges this young continent is faced with. Further, it also explores the most relevant African regional laws and standards, guidelines and policy initiatives requiring African governments to use technologies that can advance the human right to health. It concludes that the healthcare agenda of African countries needs to be better integrated and coordinated to ensure that the technologies have a positive impact on health rights. It further concludes that the African Union Commission should promote the researching and utilization of this technology in the implementation

of national health policies and strategies of African countries.

**Keywords:** 3D printing, access to healthcare, Africa, human rights, technology

Relatively new in its adoption, 3D printing technology is a rapidly expanding method of manufacturing that has found numerous applications in areas such as automotive, aerospace and defense industries [19]. 3D or three-dimensional object printing is an additive manufacturing process that creates a physical object from a digital design. It is a set of processes in

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.75649

**Access to Healthcare in Africa**

**Access to Healthcare in Africa**

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.75649

Solomon Tekle Abegaz

Solomon Tekle Abegaz

**Abstract**

**1. Introduction**

#### **Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa**

DOI: 10.5772/intechopen.75649

Solomon Tekle Abegaz Solomon Tekle Abegaz

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.75649

#### **Abstract**

Technology has the capacity for helping African citizens realize their basic rights. The recent introduction of the disruptive technology—3D printing—has the potential to impact millions of lives through a variety of revolutionary medical solutions, including surgery and the treatment of intractable health conditions. As the technology progresses, so does the practical enjoyment of health rights. This chapter argues that the human rights-based approach to 3D printing technology can be helpful in focusing discussions and actions on health well-being and security for individuals in Africa. Having first analyzed the impact of the technology in revolutionizing healthcare, the chapter provides an overview of the complex health challenges this young continent is faced with. Further, it also explores the most relevant African regional laws and standards, guidelines and policy initiatives requiring African governments to use technologies that can advance the human right to health. It concludes that the healthcare agenda of African countries needs to be better integrated and coordinated to ensure that the technologies have a positive impact on health rights. It further concludes that the African Union Commission should promote the researching and utilization of this technology in the implementation of national health policies and strategies of African countries.

**Keywords:** 3D printing, access to healthcare, Africa, human rights, technology

## **1. Introduction**

Relatively new in its adoption, 3D printing technology is a rapidly expanding method of manufacturing that has found numerous applications in areas such as automotive, aerospace and defense industries [19]. 3D or three-dimensional object printing is an additive manufacturing process that creates a physical object from a digital design. It is a set of processes in

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

which material is joined or solidified under computer control to create a three-dimensional object, with material being added together. 3D Printing is used in both rapid prototyping and additive manufacturing [13]. In the realm of health, the introduction of the disruptive technology—3D printing—has the potential to impact on millions of lives through a variety of revolutionary medical solutions including surgery and the treatment of otherwise difficult health conditions. The application of technology in the area of health is wide ranging. 3D printing can help generate a part of the human body that is an accurate replicate of a patient's own structure. Experts have developed 3D printed skin for burn victims and airway splints for babies. Also, 3D printed models made of different materials representing bone, organs and soft tissue are produced in a single print procedure. 3D printers are also playing significant roles in improving the success rates of stages, but first tests are looking promising in a variety of areas, operations and for crafting amazing artifacts. Many 3D printed medical solutions are still in their experimental stage.

medical application, section three assesses the situation of access to healthcare as a challenge in Africa and the African countries' obligation to create conditions which would assure to all medical services and medical attention in the event of sickness of their needy population. Capitalizing on the State obligation to make healthcare available and accessible, section four and five are allocated for the discussion on the essentials of utilizing the benefits of 3D technology as a human right to address access to healthcare gaps in Africa. Finally, the chapter

Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa

http://dx.doi.org/10.5772/intechopen.75649

125

To do this research, the writer reviewed the scholarly literature, reports, technology-focused websites, human rights law and relevant organizational statements. The chapter relies heavily on elaborations given by relevant United Nations (UN) treaty bodies to identify substantive rights of access to healthcare and the obligation they entail against African governments that signed relevant human rights treaties. The sources for institutional statements are the primary websites of UN agencies and treaty bodies, major government bi-lateral organizations and international Non-Governmental Organizations (NGOs) working actively in health. The overall objective is to promote the capitalization of the technology by informing the African governments and people of Africa, disseminating information, educating people and popularizing the subject so people can claivm the benefit of the technology. It is hoped that the work will eventually lead to leveraging 3D printing as a driving force in Africa's health rights'

**2. Evolution of 3D technology and its utilization in the healthcare**

Undoubtedly, technology can be utilized to disrupt or promote human security. Technology can facilitate repression through censorship of expression, block or filter access to information, monitor online activity and more effectively and efficiently control populations than in the pre-digital world [35]. Equally, it can also be innovatively, creatively and very effectively used to sensitize communities regarding issues that require advocacy, promotion and protec-

An example of innovative technology that recently emerged with many benefits for human security is 3D printing. The modern history of 3D printing dates back to the 1980s when Charles Hull invented the stereo-lithography apparatus (SLA) Printer around 1987 [24]. Since then, there is an ever-growing list of astounding accomplishments using 3D printing. In 2004 and 2005, a Chinese company WinSun developed a 3D printing spray nozzle and automatic material feeding systems. Three years later, in 2008, they printed an actual wall for a building [27]. In 2015 WinSun printed a five-storey residential apartment building [27]. But they did not stop there. To top off this feat, they also built a 3D printed 1100 square meter villa that came complete with internal and external decorations. Today, the technology is expanding rapidly; almost every week new printers and printing materials offering novel possibilities as well as excfiting new applications appear [19]. In the case of Dubai-based construction firm Cazza Technologies, the company's large robotic 3D printers already allow them to construct architecturally complex buildings at unprecedented speeds. All of the essential structural

closes by concluding the entire discussion.

safeguards.

tion, such as health rights [18].

Despite the revolution being brought about by technology in the medical sector together with some developments seen on the continent concerning the application of technology in general [13, 14, 15], access to healthcare remains a huge challenge in Africa. The continent is confronted with an increased demand beyond the treatment of AIDS, malaria and other communicable diseases to address the non-communicable ones such as heart attacks and cancers. There are a variety of illnesses throughout the continent—half the population still lacks adequate health services. According to researches, fewer than 50% of Africans have access to modern health facilities [16]. Further, many African countries spend less than 10% of their Gross Domestic Product (GDP) on healthcare. This is in contradiction with African governments' political commitment they made to allocating 15% of their GDP to the health sector pursuant to the Abuja Declaration of 2001. Only very few African countries have implemented this objective [17]. Africa is faced with a dearth of trained healthcare professionals as many of them prefer to live and work in places like the USA and Europe.

In order to address the challenges of access to healthcare to their needy populations, African States have assumed several obligations under regional human rights treaties and non-binding political commitments. These norms and standards obligate States Parties to those treaties and declarations, *inter alia*, to fulfill the right of access to healthcare—a duty is placed on States to actively implement the right. There are several ways in which access to healthcare will be enjoyed, such as through adoption of cost-effective technologies. As the technology progresses, so does the practical enjoyment of health rights. African countries have to embrace technology to close the healthcare gap, thereby performing their heath rights' obligation to their people in accordance with agreed regional human right norms and standards.

Due to the relatively new introduction of the 3D printing, the link between this technology, the human right to healthcare and the obligation of States has not been fully explored. This chapter therefore seeks to critically examine whether the human rights-based approach to 3D printing can be helpful in focusing discussions and actions on health well-being and security of individuals in Africa. The chapter is structured into six sections. Preceded by a brief introduction about 3D printing, health and human rights obligations to healthcare in general in section one, section two describes the 3D technology and its application with a focus on its medical application, section three assesses the situation of access to healthcare as a challenge in Africa and the African countries' obligation to create conditions which would assure to all medical services and medical attention in the event of sickness of their needy population. Capitalizing on the State obligation to make healthcare available and accessible, section four and five are allocated for the discussion on the essentials of utilizing the benefits of 3D technology as a human right to address access to healthcare gaps in Africa. Finally, the chapter closes by concluding the entire discussion.

which material is joined or solidified under computer control to create a three-dimensional object, with material being added together. 3D Printing is used in both rapid prototyping and additive manufacturing [13]. In the realm of health, the introduction of the disruptive technology—3D printing—has the potential to impact on millions of lives through a variety of revolutionary medical solutions including surgery and the treatment of otherwise difficult health conditions. The application of technology in the area of health is wide ranging. 3D printing can help generate a part of the human body that is an accurate replicate of a patient's own structure. Experts have developed 3D printed skin for burn victims and airway splints for babies. Also, 3D printed models made of different materials representing bone, organs and soft tissue are produced in a single print procedure. 3D printers are also playing significant roles in improving the success rates of stages, but first tests are looking promising in a variety of areas, operations and for crafting amazing artifacts. Many 3D printed medical solutions are

Despite the revolution being brought about by technology in the medical sector together with some developments seen on the continent concerning the application of technology in general [13, 14, 15], access to healthcare remains a huge challenge in Africa. The continent is confronted with an increased demand beyond the treatment of AIDS, malaria and other communicable diseases to address the non-communicable ones such as heart attacks and cancers. There are a variety of illnesses throughout the continent—half the population still lacks adequate health services. According to researches, fewer than 50% of Africans have access to modern health facilities [16]. Further, many African countries spend less than 10% of their Gross Domestic Product (GDP) on healthcare. This is in contradiction with African governments' political commitment they made to allocating 15% of their GDP to the health sector pursuant to the Abuja Declaration of 2001. Only very few African countries have implemented this objective [17]. Africa is faced with a dearth of trained healthcare professionals as many of them prefer

In order to address the challenges of access to healthcare to their needy populations, African States have assumed several obligations under regional human rights treaties and non-binding political commitments. These norms and standards obligate States Parties to those treaties and declarations, *inter alia*, to fulfill the right of access to healthcare—a duty is placed on States to actively implement the right. There are several ways in which access to healthcare will be enjoyed, such as through adoption of cost-effective technologies. As the technology progresses, so does the practical enjoyment of health rights. African countries have to embrace technology to close the healthcare gap, thereby performing their heath rights' obligation to

Due to the relatively new introduction of the 3D printing, the link between this technology, the human right to healthcare and the obligation of States has not been fully explored. This chapter therefore seeks to critically examine whether the human rights-based approach to 3D printing can be helpful in focusing discussions and actions on health well-being and security of individuals in Africa. The chapter is structured into six sections. Preceded by a brief introduction about 3D printing, health and human rights obligations to healthcare in general in section one, section two describes the 3D technology and its application with a focus on its

their people in accordance with agreed regional human right norms and standards.

still in their experimental stage.

124 Reflections on Bioethics

to live and work in places like the USA and Europe.

To do this research, the writer reviewed the scholarly literature, reports, technology-focused websites, human rights law and relevant organizational statements. The chapter relies heavily on elaborations given by relevant United Nations (UN) treaty bodies to identify substantive rights of access to healthcare and the obligation they entail against African governments that signed relevant human rights treaties. The sources for institutional statements are the primary websites of UN agencies and treaty bodies, major government bi-lateral organizations and international Non-Governmental Organizations (NGOs) working actively in health. The overall objective is to promote the capitalization of the technology by informing the African governments and people of Africa, disseminating information, educating people and popularizing the subject so people can claivm the benefit of the technology. It is hoped that the work will eventually lead to leveraging 3D printing as a driving force in Africa's health rights' safeguards.

## **2. Evolution of 3D technology and its utilization in the healthcare**

Undoubtedly, technology can be utilized to disrupt or promote human security. Technology can facilitate repression through censorship of expression, block or filter access to information, monitor online activity and more effectively and efficiently control populations than in the pre-digital world [35]. Equally, it can also be innovatively, creatively and very effectively used to sensitize communities regarding issues that require advocacy, promotion and protection, such as health rights [18].

An example of innovative technology that recently emerged with many benefits for human security is 3D printing. The modern history of 3D printing dates back to the 1980s when Charles Hull invented the stereo-lithography apparatus (SLA) Printer around 1987 [24]. Since then, there is an ever-growing list of astounding accomplishments using 3D printing. In 2004 and 2005, a Chinese company WinSun developed a 3D printing spray nozzle and automatic material feeding systems. Three years later, in 2008, they printed an actual wall for a building [27]. In 2015 WinSun printed a five-storey residential apartment building [27]. But they did not stop there. To top off this feat, they also built a 3D printed 1100 square meter villa that came complete with internal and external decorations. Today, the technology is expanding rapidly; almost every week new printers and printing materials offering novel possibilities as well as excfiting new applications appear [19]. In the case of Dubai-based construction firm Cazza Technologies, the company's large robotic 3D printers already allow them to construct architecturally complex buildings at unprecedented speeds. All of the essential structural components for tall buildings, including reinforcements with steer rebar, can be 3D printed using this technology [20]. The leading countries in the world immersed with this technology are the USA followed by the United Kingdom and New Zealand.

reason, patients in Sub-Saharan *Africa, thus have* very *limited* or no access to *healthcare* clinics and basic *health. The section that follows gives an overview of some of the challenges of healthcare*

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Not all things in Africa are going bad, despite that it is considered as a backward or dark continent. There are initiatives in the health sector that are moving in the right way. A large number of African countries, such as Senegal, Ghana, Gabon, Cote d'Ivoire, Kenya and Benin, have begun to work at setting up various types of universal medical insurance coverage in an effort to reduce social inequalities. In addition, international solidarity (Global fund, Gates Foundation, etc.) and pressures from civil society have made possible a number of successes against diseases such as onchocerciasis (river blindness), polio, human immune-deficiency virus and tuberculosis. Here, mention must be made of the 300 or so medical doctors trained at the School of Medicine in Dakar (Senegal) by French professionals between 1918 and 1950, who made a major contribution to the almost complete eradication of the epidemic and endemic diseases that took a heavy toll on West African peoples, such as trypanosomiasis (sleeping sickness), plague, yellow fever and smallpox [30]. As a result, Africa's healthcare

Despite the efforts made in improving the healthcare systems by African countries, enormous challenges exist within this sector. Unfortunately, preventable deaths of children under five remain very high in Sub-Saharan *Africa* due to poor *access* to timely and quality *healthcare* interventions [28]. While child mortality rates have plummeted since the 1990s, evidence shows that progress on its reduction in most developing countries has witnessed a widening *gap* as well as a concentration of 'under-five' deaths in the most deprived communities [28]. Eighty-three per cent of the highest number of people in rural areas who are not covered by essential *healthcare* services is in *Africa*. However, it is not only rural Africa that the center of access to healthcare is a challenge. It seems even those who lead Africa are not in a different position. It is not uncommon to see many African leaders and government officials traveling to get their medical treatment abroad. Ian Taylor has observed that from 2000 to 2012, 10 African heads of states who have died from natural causes had been receiving medical care abroad and except 2, the rest have died abroad while receiving treatment [29]. This demonstrates that African leaders lack confidence in their own country's healthcare systems. A failure to invest in national healthcare systems in Africa, which ultimately will lead to extreme shortages of healthcare facilities, goods and professional personnel, is the potential cause of

Another unfortunate fact in Africa is it bears one-quarter of the global disease burden, yet has only 2% of the world's doctors. While medical professionals in neuron-related diseases are in demand, whether in the area of neurosurgeons, or neurologists, or neuroradiologists, there is not a single facility in all of sub-Saharan Africa (except South Africa) dedicated to diseases of the nervous system on the level of the criteria followed in the countries of the northern hemisphere [30]. Unfortunately, the ratio of neurosurgeon/capita in sub-Saharan

**3. Challenges to healthcare in Africa: An overview**

coverage to the rural population has grown exponentially.

*service in the region.*

the problem.

Coming to the medical application of the technology, this is rapidly creating new ways by which the medical industry can enhance our lives and save billions of dollars in healthcare costs. As highlighted in the introductory section, the additive manufacturing applications within the medical community are diverse. It is recognized that medical uses for 3D printing, both actual and potential, will bring revolutionary changes [21]. They can be organized into several broad categories including: creation of customized prosthetics, implants and anatomical models, tissue and organ fabrication, manufacturing of specialty surgical instruments, pharmaceutical research regarding drug fabrication, dosage forms, delivery and discovery as well as manufacturing medical devices [24]. Concerning implantation, researchers are now using 3D printers to cheaply create medical devices that can be directly implanted into the human body. Doctors have fashioned 3D-printed splints to help children with rare breathing disorders and have successfully implanted a 3D-printed titanium sternum and ribs into a cancer patient [23]. Benefits provided by application of 3D printing in medicine include not only the customization and personalization of medical products, drugs and equipment but also cost-effectiveness, increased productivity, the democratization of design and manufacturing and enhanced collaboration. The technology enables quick, cost-effective development of new medical devices as well as customized end-use products that improve the delivery and results of a patient's care [26].

In terms of its cost, except in recent years, the average cost of a 3D printer was floating around the \$50k mark, but due to consumerism and an increase in demand and subsequently production, one can now purchase a respectable 3D printer for the substantially lower cost of \$1800 [27]. If that is still too expensive for our pockets, there is even a \$49 3D printer available for pre-order on Kick starter [27]. Despite the seeming affordability of the technology in some areas, it is the majority of the Western world that embraces the benefits of advanced technology, with Sub-Saharan Africa still working to provide for the most basic needs such as adequate healthcare, food and sanitation. Healthcare development without an eye toward improving technological capacities is likely to further hamper Sub-Saharan Africa's overall well-being [1].

Whereas 3D technology is not an end in itself, its effective usage empowers people and communities to become self-sufficient in meeting their basic needs and reach their full potential. The 3D technology has several connected advantages for the continent Africa, ranging from the provision of an impetus to the democratization process and good governance; facilitating Africa's integration into the new information society by use of its cultural diversity as a leverage; helpful tools for a wide range of applications such as remote sensing and environmental, agricultural and infra-structural planning. While technology in general and 3D printing in particular offers several of these possibilities to promote healthcare and the overall the development of the African region, there is limited influence of technology in healthcare. The deprivation of technology in general prevents individuals in certain parts of the world, for instance in the countries making up Sub-Saharan Africa, from realizing certain fundamental, internationally recognized rights, such as the right to health [1]. Partly for this reason, patients in Sub-Saharan *Africa, thus have* very *limited* or no access to *healthcare* clinics and basic *health. The section that follows gives an overview of some of the challenges of healthcare service in the region.*

## **3. Challenges to healthcare in Africa: An overview**

components for tall buildings, including reinforcements with steer rebar, can be 3D printed using this technology [20]. The leading countries in the world immersed with this technology

Coming to the medical application of the technology, this is rapidly creating new ways by which the medical industry can enhance our lives and save billions of dollars in healthcare costs. As highlighted in the introductory section, the additive manufacturing applications within the medical community are diverse. It is recognized that medical uses for 3D printing, both actual and potential, will bring revolutionary changes [21]. They can be organized into several broad categories including: creation of customized prosthetics, implants and anatomical models, tissue and organ fabrication, manufacturing of specialty surgical instruments, pharmaceutical research regarding drug fabrication, dosage forms, delivery and discovery as well as manufacturing medical devices [24]. Concerning implantation, researchers are now using 3D printers to cheaply create medical devices that can be directly implanted into the human body. Doctors have fashioned 3D-printed splints to help children with rare breathing disorders and have successfully implanted a 3D-printed titanium sternum and ribs into a cancer patient [23]. Benefits provided by application of 3D printing in medicine include not only the customization and personalization of medical products, drugs and equipment but also cost-effectiveness, increased productivity, the democratization of design and manufacturing and enhanced collaboration. The technology enables quick, cost-effective development of new medical devices as well as customized end-use products that improve the delivery and

In terms of its cost, except in recent years, the average cost of a 3D printer was floating around the \$50k mark, but due to consumerism and an increase in demand and subsequently production, one can now purchase a respectable 3D printer for the substantially lower cost of \$1800 [27]. If that is still too expensive for our pockets, there is even a \$49 3D printer available for pre-order on Kick starter [27]. Despite the seeming affordability of the technology in some areas, it is the majority of the Western world that embraces the benefits of advanced technology, with Sub-Saharan Africa still working to provide for the most basic needs such as adequate healthcare, food and sanitation. Healthcare development without an eye toward improving technological capacities is likely to further hamper Sub-Saharan Africa's overall

Whereas 3D technology is not an end in itself, its effective usage empowers people and communities to become self-sufficient in meeting their basic needs and reach their full potential. The 3D technology has several connected advantages for the continent Africa, ranging from the provision of an impetus to the democratization process and good governance; facilitating Africa's integration into the new information society by use of its cultural diversity as a leverage; helpful tools for a wide range of applications such as remote sensing and environmental, agricultural and infra-structural planning. While technology in general and 3D printing in particular offers several of these possibilities to promote healthcare and the overall the development of the African region, there is limited influence of technology in healthcare. The deprivation of technology in general prevents individuals in certain parts of the world, for instance in the countries making up Sub-Saharan Africa, from realizing certain fundamental, internationally recognized rights, such as the right to health [1]. Partly for this

are the USA followed by the United Kingdom and New Zealand.

results of a patient's care [26].

well-being [1].

126 Reflections on Bioethics

Not all things in Africa are going bad, despite that it is considered as a backward or dark continent. There are initiatives in the health sector that are moving in the right way. A large number of African countries, such as Senegal, Ghana, Gabon, Cote d'Ivoire, Kenya and Benin, have begun to work at setting up various types of universal medical insurance coverage in an effort to reduce social inequalities. In addition, international solidarity (Global fund, Gates Foundation, etc.) and pressures from civil society have made possible a number of successes against diseases such as onchocerciasis (river blindness), polio, human immune-deficiency virus and tuberculosis. Here, mention must be made of the 300 or so medical doctors trained at the School of Medicine in Dakar (Senegal) by French professionals between 1918 and 1950, who made a major contribution to the almost complete eradication of the epidemic and endemic diseases that took a heavy toll on West African peoples, such as trypanosomiasis (sleeping sickness), plague, yellow fever and smallpox [30]. As a result, Africa's healthcare coverage to the rural population has grown exponentially.

Despite the efforts made in improving the healthcare systems by African countries, enormous challenges exist within this sector. Unfortunately, preventable deaths of children under five remain very high in Sub-Saharan *Africa* due to poor *access* to timely and quality *healthcare* interventions [28]. While child mortality rates have plummeted since the 1990s, evidence shows that progress on its reduction in most developing countries has witnessed a widening *gap* as well as a concentration of 'under-five' deaths in the most deprived communities [28]. Eighty-three per cent of the highest number of people in rural areas who are not covered by essential *healthcare* services is in *Africa*. However, it is not only rural Africa that the center of access to healthcare is a challenge. It seems even those who lead Africa are not in a different position. It is not uncommon to see many African leaders and government officials traveling to get their medical treatment abroad. Ian Taylor has observed that from 2000 to 2012, 10 African heads of states who have died from natural causes had been receiving medical care abroad and except 2, the rest have died abroad while receiving treatment [29]. This demonstrates that African leaders lack confidence in their own country's healthcare systems. A failure to invest in national healthcare systems in Africa, which ultimately will lead to extreme shortages of healthcare facilities, goods and professional personnel, is the potential cause of the problem.

Another unfortunate fact in Africa is it bears one-quarter of the global disease burden, yet has only 2% of the world's doctors. While medical professionals in neuron-related diseases are in demand, whether in the area of neurosurgeons, or neurologists, or neuroradiologists, there is not a single facility in all of sub-Saharan Africa (except South Africa) dedicated to diseases of the nervous system on the level of the criteria followed in the countries of the northern hemisphere [30]. Unfortunately, the ratio of neurosurgeon/capita in sub-Saharan is 1/3,000,000 while it is 1:200,000 in the northern hemisphere. On the other hand, in medical imaging, sub-Saharan Africa's ration is 1 MRI/25 million inhabitants, while it is 25 MRIs/ one million inhabitants in the northern hemisphere [30]. Life expectancy in Africa is 15 years lower than the global average because the continent has to deal with the significant burden of epidemics without the infrastructure to fight them. The continent is, according to the Gates Foundation, a mix of new and persistent healthcare challenges [30].

(CEDAW) [32]; the 1989 Convention on the Rights of the Child (CRC) [11] and the Convention on the Rights of Persons with Disabilities [33] stipulate that the right to health is to be enjoyed by everyone without discrimination. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation [12] and policies and at international conferences. In this way, the right in question has also been proclaimed by resolution 1989/11 of the Commission on Human Rights, the Vienna Declaration and Program of Action of 1993, the Millennium Development Goals (MDGs) and the Sustainable

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Parallel to global human rights treaties, regional human rights conventions, including the 1996 European Social Charter (as revised) [31], the 1999 Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social And Cultural Rights [7], the 1981 African Charter on Human and People's Rights (also known as the "Banjul Charter") [10], as well as the African Charter on the Rights and Welfare of the Child [9] uphold that the right to access to healthcare is a fundamental human right that needs to be respected, promoted and fulfilled. Every State has ratified at least one international human rights treaty recognizing the right to health. Thus, they have the obligation to respect, protect and fulfill the

The incorporation of health as a human right in the various global and regional treaties implies that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services. Again, the human right to healthcare means that hospitals, clinics, medicines and doctors' services must be accessible, available, acceptable and of good quality for everyone on an equitable basis, where and when needed [3]. Except those obligations that have immediate effect, (i.e., States' immediate obligation in relation to the right to health are that they have to guarantee that the right will be exercised without discrimination of any kind and the obligation to take steps toward the full realization of the right) [3], States have the obligation to progressively realize the right to health over a period of time. Meaning that, States' parties that have ratified a treaty which incorporates the right to health have a specific and continuing obligation to move as expeditiously and effectively as possible toward the full realization of the right. The realization of their obligation may be pursued through numerous, complementary approaches, such as the formulation of health policies or the implementation of health programs, or the adoption of specific legal instruments [3]. This chapter focuses and suggests the African States' obligation to adopt programs aimed at ensuring their healthcare—needy population enjoys the benefits of the 3D

Development Goals (SDGs).

right to healthcare to their needy populations.

technology and its application for the realization of the right.

**healthcare**

**5. The obligation to benefit 3D technology in realizing access to**

The link between the right to enjoy the benefits of scientific progress and other human rights, notably the right to health, has been underscored. Scientific and technological advancement are crucial in health development and poverty reduction. According to Yvonne Donders, the

Researchers predict that non-communicable diseases such as diabetes, cancer and cardiovascular disease will overtake communicable and nutritional diseases by 2030. Right now communicable diseases such as malaria, pneumonia, Ebola, HIV/AIDS and even leprosy have a negative effect on continental growth [30]. It was in view of addressing the physical and mental challenges that disease or ill-health might bring about to humans that human rights laws promised the right of everyone to the highest attainable standard of physical and mental health, which includes *access* to all medical services.

## **4. Access to healthcare as a human right in Africa**

The African continent is faced with a myriad of human rights challenges—"surveillance, privacy laws, threats, imprisonment, intimidation and killings have been happening across the continent, lending to the assertion that regional institutions with a human rights mandate are largely failing to protect the victims" [18]. However, human rights interests in Africa are not limited to the protection from unlawful detention, freedom from censorship of opinion and arbitrary killings. Equally, human rights are also about the ability to enjoy a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health [3]. True, ensuring a healthy life is the spindle upon which a person's whole personality and well-being depend. To be without healthcare is a frightening prospect, for death is the inevitable consequence [29]. Access to healthcare helps people identify and seize opportunities to grow and develop and to better their lives and those of their families and communities. It also facilitates an individual's participation in society, in the economy, in government and in the development process itself.

Human rights lay standards, norms and principles—they aim to ensure human well-being. Focusing on the right to health, it is one of the fundamental human rights enshrined in the leading and binding human rights documents, including the Constitution of World Health Organization (WHO), 1946, where health is defined as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" [2]. The preamble further states that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living [8]. Again, the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) [5]; the 1969 International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) [34]; the 1975 Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) [32]; the 1989 Convention on the Rights of the Child (CRC) [11] and the Convention on the Rights of Persons with Disabilities [33] stipulate that the right to health is to be enjoyed by everyone without discrimination. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation [12] and policies and at international conferences. In this way, the right in question has also been proclaimed by resolution 1989/11 of the Commission on Human Rights, the Vienna Declaration and Program of Action of 1993, the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs).

is 1/3,000,000 while it is 1:200,000 in the northern hemisphere. On the other hand, in medical imaging, sub-Saharan Africa's ration is 1 MRI/25 million inhabitants, while it is 25 MRIs/ one million inhabitants in the northern hemisphere [30]. Life expectancy in Africa is 15 years lower than the global average because the continent has to deal with the significant burden of epidemics without the infrastructure to fight them. The continent is, according to the Gates

Researchers predict that non-communicable diseases such as diabetes, cancer and cardiovascular disease will overtake communicable and nutritional diseases by 2030. Right now communicable diseases such as malaria, pneumonia, Ebola, HIV/AIDS and even leprosy have a negative effect on continental growth [30]. It was in view of addressing the physical and mental challenges that disease or ill-health might bring about to humans that human rights laws promised the right of everyone to the highest attainable standard of physical and mental

The African continent is faced with a myriad of human rights challenges—"surveillance, privacy laws, threats, imprisonment, intimidation and killings have been happening across the continent, lending to the assertion that regional institutions with a human rights mandate are largely failing to protect the victims" [18]. However, human rights interests in Africa are not limited to the protection from unlawful detention, freedom from censorship of opinion and arbitrary killings. Equally, human rights are also about the ability to enjoy a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health [3]. True, ensuring a healthy life is the spindle upon which a person's whole personality and well-being depend. To be without healthcare is a frightening prospect, for death is the inevitable consequence [29]. Access to healthcare helps people identify and seize opportunities to grow and develop and to better their lives and those of their families and communities. It also facilitates an individual's participation in society, in the economy, in

Human rights lay standards, norms and principles—they aim to ensure human well-being. Focusing on the right to health, it is one of the fundamental human rights enshrined in the leading and binding human rights documents, including the Constitution of World Health Organization (WHO), 1946, where health is defined as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" [2]. The preamble further states that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living [8]. Again, the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) [5]; the 1969 International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) [34]; the 1975 Convention on the Elimination of All Forms of Discrimination Against Women

Foundation, a mix of new and persistent healthcare challenges [30].

health, which includes *access* to all medical services.

128 Reflections on Bioethics

government and in the development process itself.

**4. Access to healthcare as a human right in Africa**

Parallel to global human rights treaties, regional human rights conventions, including the 1996 European Social Charter (as revised) [31], the 1999 Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social And Cultural Rights [7], the 1981 African Charter on Human and People's Rights (also known as the "Banjul Charter") [10], as well as the African Charter on the Rights and Welfare of the Child [9] uphold that the right to access to healthcare is a fundamental human right that needs to be respected, promoted and fulfilled. Every State has ratified at least one international human rights treaty recognizing the right to health. Thus, they have the obligation to respect, protect and fulfill the right to healthcare to their needy populations.

The incorporation of health as a human right in the various global and regional treaties implies that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services. Again, the human right to healthcare means that hospitals, clinics, medicines and doctors' services must be accessible, available, acceptable and of good quality for everyone on an equitable basis, where and when needed [3]. Except those obligations that have immediate effect, (i.e., States' immediate obligation in relation to the right to health are that they have to guarantee that the right will be exercised without discrimination of any kind and the obligation to take steps toward the full realization of the right) [3], States have the obligation to progressively realize the right to health over a period of time. Meaning that, States' parties that have ratified a treaty which incorporates the right to health have a specific and continuing obligation to move as expeditiously and effectively as possible toward the full realization of the right. The realization of their obligation may be pursued through numerous, complementary approaches, such as the formulation of health policies or the implementation of health programs, or the adoption of specific legal instruments [3]. This chapter focuses and suggests the African States' obligation to adopt programs aimed at ensuring their healthcare—needy population enjoys the benefits of the 3D technology and its application for the realization of the right.

## **5. The obligation to benefit 3D technology in realizing access to healthcare**

The link between the right to enjoy the benefits of scientific progress and other human rights, notably the right to health, has been underscored. Scientific and technological advancement are crucial in health development and poverty reduction. According to Yvonne Donders, the right of individuals to enjoy the benefits of scientific advancement implies the right of access to scientific and technological advancement. In this regard, the African States adoption of the Universal Declaration of Human Rights (UDHR) and ICESCR that guarantee the right to enjoy the benefits of scientific progress and its applications is a step in the right direction [5, 8]. The African States' obligation to healthcare moves further to ratifying global and regional treaties. Equally, they have the responsibility for incorporating into their domestic legal and policy framework an individual's right to enjoy the benefits of the 3D technology (which is a result of advancement or practical application of science) progress and its applications in the area of health. This emanates not only because the enjoyment of benefits of science and its application is a fundamental right, but also the realization of the right to healthcare imposed an obligation on the part of the States to make administrative, financial, educational, social and other measures, including judicial remedies [4].

Using the foregoing mandate, the Commission has made several efforts to promote the realization of the right to healthcare on the continent. For instance, the Commission adopted Resolution 141 (Access to Health and Needed Medicines in Africa) following advocacy by the Human Rights and Access to Medicines Clinical Group, a collaboration of the Centre for Human Rights at the University of Pretoria and the Washington College of Law at American University. In its resolution the Commission states that "access to needed medicines is a fundamental component of the right to health and that States Parties to the African Charter have an obligation to provide

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In the same vein, the Commission can use a wide range of promotional activities, including dissemination of information, making recommendations on the gaps in access to healthcare on the continent and the need to critically study and design strategies for the application of

Increasingly, African governments express their commitment to the defense of human and peoples' rights of access to healthcare on the continent by issuing various norms and standards as well as setting up various institutions relating to human rights protection and promotion on the continent. Among the various norms included are article 16 of the African Charter on Human and Peoples' Rights, article 14 of the African Charter on Human and Peoples' Rights, Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa, article 14 of the African Charter on the Rights and Welfare of the Child,

Regrettably, in spite of these lofty ideas, the daily lives of Africans do not always manifest the concrete benefits of these initiatives. Africa remains beset, as it were, by gaps in implementing healthcare rights caused by factors such as socio-economic and political problems, corruption, poverty, armed conflicts and the abuse of individuals' fundamental rights. More remains to be done in order to translate the benefits of human rights protection and promotion into the daily healthy lives of the peoples of Africa. To address the challenges, African States must focus on building better healthcare infrastructures. Africa's existing promotional activities need to be catapulted by amalgamating 3D technology in implementation. This needs to hap-

To better adopt the technology, the African Commission should urge African States to guarantee the full scope of access needed to 3D technical applications in medicine. There is a need for developing a communication strategy aimed at strengthening the Commission's corporate identity and the positioning of its activities in the area of advancing medical care. Such a strategy should build and maintain creative and effective communication partnerships, particularly with the technologically developed world; promote 3D technology usage; ensure responsiveness to the rapidly changing 3D technology and environments and advocate for media

3D technology for the progressive realization of the right through available resources.

where appropriate needed medicines, or facilitate access to them" [6].

**6. Conclusion**

pen in a flawless manner.

as well as article 16 the African Youth Charter.

In implementing the right to enjoy the benefits of scientific progress and thereby to foster healthcare services, States are under an obligation to invest, to the maximum possible, in scientific and technological advancement and share the benefits. Against this background, the development of vaccines and medicines against widespread diseases has done much to improve life expectancy. In the same way, science and research in the field of information technology, including mobile telephones, the internet and satellite television, have accelerated the flow of information throughout the world, which has proven particularly beneficial to developing countries. It is thus submitted that African States have the obligation to invest, to the maximum possibility, in 3D technological advancement and share the benefits to promote access to healthcare services. International co-operation and solidarity are equally crucial in this regard for African countries to discharge their obligation. This is especially important for ensuring availability of resources from the international community when resources are scarce within African States.

#### **5.1. Africa Union Commission: Its mandate to promote healthcare in Africa**

The *African* Charter on Human and Peoples' *Rights* is the foremost African legal instrument intended to protect and *promote* human rights and basic freedoms on the continent. As noted previously, the right to healthcare is protected under article 16 of this instrument. In addition, the Charter also crafts mechanisms of promoting the spectrum of rights enshrined there. The African Commission on Human and Peoples' Rights (hereinafter "the African Commission or the Commission") is a mechanism designed to promote human rights [10], including the right of access to healthcare in the region. The Commission is composed of 11 members chosen from among African personalities of the highest reputation, known for their high morality, integrity, impartiality and competence in matters of human and peoples' rights. In particular, the Commission's promotional mandate includes [10]:

*To collect documents, undertake studies and research on African problems in the field of human and peoples' rights, organize seminars, symposia and conferences, disseminate information, encourage national and local institutions concerned with human and peoples' rights, and, should the case arise, give its views or make recommendations to governments;….*

Using the foregoing mandate, the Commission has made several efforts to promote the realization of the right to healthcare on the continent. For instance, the Commission adopted Resolution 141 (Access to Health and Needed Medicines in Africa) following advocacy by the Human Rights and Access to Medicines Clinical Group, a collaboration of the Centre for Human Rights at the University of Pretoria and the Washington College of Law at American University. In its resolution the Commission states that "access to needed medicines is a fundamental component of the right to health and that States Parties to the African Charter have an obligation to provide where appropriate needed medicines, or facilitate access to them" [6].

In the same vein, the Commission can use a wide range of promotional activities, including dissemination of information, making recommendations on the gaps in access to healthcare on the continent and the need to critically study and design strategies for the application of 3D technology for the progressive realization of the right through available resources.

## **6. Conclusion**

right of individuals to enjoy the benefits of scientific advancement implies the right of access to scientific and technological advancement. In this regard, the African States adoption of the Universal Declaration of Human Rights (UDHR) and ICESCR that guarantee the right to enjoy the benefits of scientific progress and its applications is a step in the right direction [5, 8]. The African States' obligation to healthcare moves further to ratifying global and regional treaties. Equally, they have the responsibility for incorporating into their domestic legal and policy framework an individual's right to enjoy the benefits of the 3D technology (which is a result of advancement or practical application of science) progress and its applications in the area of health. This emanates not only because the enjoyment of benefits of science and its application is a fundamental right, but also the realization of the right to healthcare imposed an obligation on the part of the States to make administrative, financial, educational, social

In implementing the right to enjoy the benefits of scientific progress and thereby to foster healthcare services, States are under an obligation to invest, to the maximum possible, in scientific and technological advancement and share the benefits. Against this background, the development of vaccines and medicines against widespread diseases has done much to improve life expectancy. In the same way, science and research in the field of information technology, including mobile telephones, the internet and satellite television, have accelerated the flow of information throughout the world, which has proven particularly beneficial to developing countries. It is thus submitted that African States have the obligation to invest, to the maximum possibility, in 3D technological advancement and share the benefits to promote access to healthcare services. International co-operation and solidarity are equally crucial in this regard for African countries to discharge their obligation. This is especially important for ensuring availability of resources from the international community when

**5.1. Africa Union Commission: Its mandate to promote healthcare in Africa**

The *African* Charter on Human and Peoples' *Rights* is the foremost African legal instrument intended to protect and *promote* human rights and basic freedoms on the continent. As noted previously, the right to healthcare is protected under article 16 of this instrument. In addition, the Charter also crafts mechanisms of promoting the spectrum of rights enshrined there. The African Commission on Human and Peoples' Rights (hereinafter "the African Commission or the Commission") is a mechanism designed to promote human rights [10], including the right of access to healthcare in the region. The Commission is composed of 11 members chosen from among African personalities of the highest reputation, known for their high morality, integrity, impartiality and competence in matters of human and peoples' rights. In particular,

*To collect documents, undertake studies and research on African problems in the field of human and peoples' rights, organize seminars, symposia and conferences, disseminate information, encourage national and local institutions concerned with human and peoples' rights, and, should the case arise, give*

and other measures, including judicial remedies [4].

130 Reflections on Bioethics

resources are scarce within African States.

the Commission's promotional mandate includes [10]:

*its views or make recommendations to governments;….*

Increasingly, African governments express their commitment to the defense of human and peoples' rights of access to healthcare on the continent by issuing various norms and standards as well as setting up various institutions relating to human rights protection and promotion on the continent. Among the various norms included are article 16 of the African Charter on Human and Peoples' Rights, article 14 of the African Charter on Human and Peoples' Rights, Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa, article 14 of the African Charter on the Rights and Welfare of the Child, as well as article 16 the African Youth Charter.

Regrettably, in spite of these lofty ideas, the daily lives of Africans do not always manifest the concrete benefits of these initiatives. Africa remains beset, as it were, by gaps in implementing healthcare rights caused by factors such as socio-economic and political problems, corruption, poverty, armed conflicts and the abuse of individuals' fundamental rights. More remains to be done in order to translate the benefits of human rights protection and promotion into the daily healthy lives of the peoples of Africa. To address the challenges, African States must focus on building better healthcare infrastructures. Africa's existing promotional activities need to be catapulted by amalgamating 3D technology in implementation. This needs to happen in a flawless manner.

To better adopt the technology, the African Commission should urge African States to guarantee the full scope of access needed to 3D technical applications in medicine. There is a need for developing a communication strategy aimed at strengthening the Commission's corporate identity and the positioning of its activities in the area of advancing medical care. Such a strategy should build and maintain creative and effective communication partnerships, particularly with the technologically developed world; promote 3D technology usage; ensure responsiveness to the rapidly changing 3D technology and environments and advocate for media liberalization and deregulation to ensure a more central, dynamic and effective contribution of communication to the work of the Commission. Driven by technological convergence, it is here argued that the concentrated use of 3D technology can bring unprecedented comparative advantages to the continent. The knowledge-based economy of the future will depend more and more on the effective use of this technology. Rapid advances in technology coupled with the low-cost of acquiring 3D technology tools are opening new windows of opportunity for Africa to accelerate access to healthcare services. The 3D printing revolution can accelerate Africa's goals in the right to health, fostering intra-regional trade, integration into the global economy, as well as realizing its security needs. This must be reinforced by African governments' political will to improving knowledge, skills and resources and creating collaboration and consensus among key stakeholders.

[4] UN Committee on Economic, Social and Cultural Rights. General comment no. 3. The Nature of States Parties' Obligations. Article 2 of the Covenant. 14 December 1990.

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[5] UN General Assembly, International Covenant On Economic, Social and Cultural

[6] The African Commission on Human and Peoples' Rights. Resolution on Access to Health

[7] Organization of American States (OAS). Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights. November 16,

[8] UN General Assembly, Universal Declaration of Human Rights. December 10, 1948. 217

[9] Organization of African Unity (OAU). African Charter on the Rights and Welfare of the

[10] OAU. African Charter on Human and Peoples' Rights ("Banjul Charter"). June 27, 1981.

[11] UN General Assembly Convention on the Rights of the Child. November 20, 1989.

[13] Christopher B. 3D printing: Third edition. CreateSpace Independent Publishing

[14] 3D Hubs. What is 3D printing?: The definitive guide to additive manufacturing [Internet]. Available from: https://www.3dhubs.com/what-is-3d-printing [Accessed December 25,

[15] Wikipedia. 3D printing [Internet]. Available from: http://en.wikipedia.org/wiki/3D\_

[16] Lily BC. Taking on the Challenges of Health Care in Africa [Internet]. June 16, 2015. Available from: https://www.gsb.stanford.edu/insights/taking-challenges-health-care-

[17] World Health Organization (WTO). The Abuja Declaration: Ten years on [Internet]. Available from: http://www.who.int/healthsystems/publications/Abuja10.pdf [Accessed

[18] Eliot N. The Use of Information and Communications Technology (ICTs) in Human Rights Promotion: A Case Study of the African Commission on Human and Peoples'

[19] Helena D. Applications of 3D printing in healthcare. Polish Journal of Thoracic and

Rights [Thesis]. Msida MSD 2080, Malta: University of Malta; 2015

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and Needed Medicines in Africa. November 24, 2008

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[12] Constitution of the Republic of South Africa. 1996

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