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"It is very difficult in this business if you want to have a good conscience": pharmaceutical governance and on-the-ground ethical labour in Ghana

Hampshire, Kate; Mariwah, Simon; Amoako-Sakyi, Daniel; Hamill, Heather

"It is very difficult in this business if you want to have a good conscience": pharmaceutical governance and on-the-ground ethical labour in Ghana Thumbnail


Authors

Simon Mariwah

Daniel Amoako-Sakyi

Heather Hamill



Abstract

The governance of pharmaceutical medicines entails complex ethical decisions that should, in theory, be the responsibility of democratically accountable government agencies. However, in many Low- and Middle-Income Countries (LMICs), regulatory and health systems constraints mean that many people still lack access to safe, appropriate and affordable medication, posing significant ethical challenges for those working on the “front line”. Drawing on 18 months of fieldwork in Ghana, we present three detailed case studies of individuals in this position: an urban retail pharmacist, a rural over-the-counter medicine retailer, and a local inspector. Through these case studies, we consider the significant burden of “ethical labour” borne by those operating “on the ground”, who navigate complex moral, legal and business imperatives in real time and with very real consequences for those they serve. The paper ends with a reflection on the tensions between abstract, generalised ethical frameworks based on high-level principles, and a pragmatic, contingent ethics-in-practice that foregrounds immediate individual needs – a tension rooted in the gap between the theory and the reality of pharmaceutical governance that shifts the burden of ethical labour downwards and perpetuates long-term public health risks.

Citation

Hampshire, K., Mariwah, S., Amoako-Sakyi, D., & Hamill, H. (2022). "It is very difficult in this business if you want to have a good conscience": pharmaceutical governance and on-the-ground ethical labour in Ghana. Global Bioethics, 33(1), 103 - 121. https://doi.org/10.1080/11287462.2022.2103899

Journal Article Type Article
Acceptance Date Dec 17, 2021
Online Publication Date Jul 26, 2022
Publication Date 2022-07
Deposit Date Aug 1, 2022
Publicly Available Date Aug 1, 2022
Journal Global Bioethics
Print ISSN 1128-7462
Electronic ISSN 1591-7398
Publisher Taylor and Francis Group
Peer Reviewed Peer Reviewed
Volume 33
Issue 1
Pages 103 - 121
DOI https://doi.org/10.1080/11287462.2022.2103899

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