Bioethics Caribebioethicscaribe.org/uploads/3/4/3/0/34300411/... · Bioethics Caribe Volume 2 Number 1 December 2008 4 was designed and circulated to members of the BSEC Executive

Bioethics Caribe Volume 1 Number 1 June 2007 www.bioethicscaribe.org.jm

Bioethics Caribe Newsletter of the Bioethics Society of the EnglishSpeaking

Caribbean

Issue 4 Number 1 December 2010

BSEC Newsletter Winter 2010 Dr. Cheryl Macpherson, PhD

Editor, Bioethics Caribe and President, BSEC Bioethics Department, St. George’s University (SGU), Grenada

CONTENTS

Editors Corner New BSEC Executive Elected in 2010 Presidents Report: 5 th ABM BSEC’s 4th Annual Forum

BSEC Patron’s Message Vice Chancellor’s Message (U of Guyana) Philosophical Reflections on Universal Access to Health Presentations (Abstracts)

Report on BSEC’s 2009 Annual Forum Regional News

BSEC Treasurer Receives Prestigious Teaching Award UNESCO Book includes Chapter on Jamaica’s National Bioethics Committee New IRB at Ross University Landmark BSEC Executive Meeting by Skype

Accomplishments in 2010 by BSEC Members

EDITOR’S CORNER

In 2010 BSEC elected a new Executive Board, upgraded its website, recruited many new members, began work on developing a Caribbean bioethics certificate course, and held its 4 th Annual Forum. These are wonderful accomplishments for such a young society and like youngsters BSEC is growing fast. This issue includes, among other things, presentations on our 4 th Forum and a retrospective report on our 3 rd Forum.

Dr. Derrick Aarons, outgoing BSEC President receiving plaque from Mrs. Shereen DawkinsCox at the 4 th Annual BSEC Forum May 27 28, 2010 in Guyana.

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Bioethics Caribe Volume 2 Number 1 December 2008 www.bioethicscaribe.org.jm

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Readers are directed to the Presidents Report: 5 th ABM herein for more details about BSEC’s growth and accomplishments. These include having a role in providing research ethics guidance to all Chief Medical Officers in the Englishspeaking Caribbean, facilitating the setting up of health care ethics committees, and helping to establish National Bioethics Committees.

BSEC’s website has been upgraded thanks to the Website Coordinator, Mr. Chris Muir, who works tirelessly to establish and maintain an informative and well functioning site. Members are encouraged to visit the site which is more streamlined, join the discussion forum, and submit suggestions for contents to the President and Executive Team.

BSEC elected new officers in June 2010 (listed below). Our new Vice President, Shereen Dawkins Cox (formerly BSEC’s Secretary) will take on the role of Editor of Bioethics Caribe in 2011. We are pleased to note that Shereen’s daughter Apphia turned one year old on October 16 and started walking on her own two days later. We rejoice that Apphia now sleeps through the night. And as she has begun to speak we eagerly await news of her bioethical musings.

NEW BSEC EXECUTIVE ELECTED in 2010

Patron Professor the Honourable Sir George Alleyne President Prof. Cheryl Macpherson Vice President Mrs. Shereen Cox Secretary Ms. Merle Mendonca Treasurer Dr. Grace Charran West Representative Dr. Eileen Boxill North Representative Dr. M. Anthony Frankson SouthEastern Representative Dr. Paul Ricketts NorthEastern Representative Dr. Hamish Mohammed South Representative Dr. Donald Simeon Website Coordinator Mr. Christopher Muir Immediate Past President Dr. Derrick Aarons 20062010

PRESIDENT’S REPORT 5th ANNUAL BUSINESS MEETING Derrick Aarons MB.BS., M.Sc., Ph.D.

Consultant Bioethicist / Palliative Care & Family Physician, Jamaica

A very pleasant afternoon to you all! When our Society was launched into existence on May 19, 2006, I proposed that our Executive should aim to achieve three objectives:

1. A facilitating function that would see us adding new members to our Society, facilitating dialogue about bioethical issues, and facilitating the setting up of research ethics committees to serve the territories within the Caribbean;



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2. An advocacy function that would see us advocating the formulating of ethical policies in health care and research in countries across the Caribbean; and

3. Moulding a form of “ThinkTank” from our membership to provide opinions on bioethical matters

Well I am pleased to report that all these aims have been accomplished under my tenure. We had a founding membership of a little over 40 persons, and this year we have more than doubled that amount with membership in over 12 Caribbean countries.

Our members have taken part in the formation of, and are serving on research ethics committees, and we have provided template manuals for establishing Research Ethics Committees across the Caribbean to all Chief Medical Officers in the Englishspeaking Caribbean, which have included Guidelines for the Contents of Research Protocols. We initially provided communication on bioethical issues via email to members, and then via our interactive website which also has a discussion network for visitors as well as a private forum for BSEC members.

Another objective of our Society was to promote research and publication of ethicsbased information, and this has been accomplished through the holding of four (4) annual Bioethics Forums so far, and the publication of three (3) Bioethics Newsletters, produced annually since 2007.

In furtherance of its Mission Statement, BSEC also developed several regional and international links with various agencies and organizations that work in Bioethics, including the Bioethics Unit of the University of Miami, the Bioethics Unit of the Pan American Health Organization, REDBIOETICA UNESCO, and the European Commission’s SINAPSE.

We have international links also through our six (6) Honorary Members which include world renowned PhilospherBioethicist Prof. Ruth Macklin, Professor of Bioethics, Epidemiology, and Population Health at the Albert Einstein College of Medicine in New York, and PastPresident of the International Association of Bioethics. The outstanding PhysicianPhilosopher Prof. Carl Elliott, Professor of Pediatrics & Bioethics at the Center for Bioethics at the University of Minnesota. Prof. Fernando LolasStepke, who is the Director of the Bioethics Unit for the Pan American Health Organization, Prof. Kenneth Goodman, who is the Director of the Bioethics Unit at the University of Miami, which is one of the Ethics Collaboration Centres for the World Health Organization. Prof. Andres PeraltoCornielle, who is Professor of Bioethics at Cibao Technology University in the Dominican Republic, a Member of the Board of FLACEIS as well as REDBIOETICAUNESCO, and is currently serving a 4year appointment on UNESCO’s International Bioethics Committee. Our 6 th Honorary member is Prof. Daniel Piedra Herrera, who is the Executive Secretary of the Cuban National Bioethics Committee.

Through the work of our website coordinator, Mr. Christopher Muir, our website will soon provide a number of “links of interest” to other institutions, organizations, and sites related to Bioethics.

In my inaugural speech at the launch of BSEC in 2006, I had also stated the aim of facilitating the setting up of health care ethics committees. To this end, a template for establishing such committees



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was designed and circulated to members of the BSEC Executive for their input and discussion, and copies of that template are provided here today.

Our members have also been involved in establishing a National Bioethics Committee in Jamaica, and are currently working to establish a similar committee in Trinidad & Tobago. Further, in an effort to maintain contact with our members and regularly update them, I have been writing quarterly communications where I inform them of happenings since my last communication, as well as things to come.

Shortly after that very successful Bioethics Forum last year in Trinidad & Tobago, entitled “Bioethics Standards: People and the Environment” we applied to the Wellcome Trust in the United Kingdom for an award to assist with our hosting of this year’s Bioethics Forum here in Guyana. That Grant has helped to offset a large part of the costs associated with our Forum today and tomorrow. In this, I must single out our BSEC Regional Representative here in Guyana, Ms. Merle Mendonca, for her outstanding and indefatigable collaborative work done throughout the past year as we prepared for this Forum. Planning for our next BSEC Forum should begin soon, and the new Executive to be elected here today will announce the venue for that forum in due course.

As I now complete my tenure as your President over the past 4 years, time does not permit me thanking all persons who contributed greatly to our accomplishments over the past four years, but I must single out firstly, my greatest support along this very fruitful journey, Prof. Ralph Robinson. It was Ralph who, in late 2005, I gave the initial template I had written for the BSEC Constitution and asked to steer a committee of 8 persons, whose work culminating in the formation and launch of BSEC in May 2006. A couple of our founding members serving on that steering team are present here today, our outstanding legal mind, Dr. Eileen Boxill, and Dr. Anthony Mullings, who is currently serving as the Chairman of the National Bioethics Committee of Jamaica. Also serving on that committee was our VicePresident, Prof. Cheryl Macpherson, who is unavoidably absent today, and Dr. Donald Simeon, our Treasurer who has given us such dedicated service over the past 4 years.

Our Executive meetings over the past 4 years have been held around his jobvisits to Jamaica, and he and I are further bonded by the Constitution, we both will be stepping down from our posts today. I thank him sincerely for his reliability and diligent work over the years. My sincere thanks also to other members of our outgoing Executive, VicePresident Cheryl Macpherson for her support and stellar work on our annual Bioethics Newsletter, Bioethics Caribe, Secretary Shereen DawkinsCox for the high quality of her work despite the presence of baby Appiah in her life, Regional Rep. Eileen Boxill who hosted all our Executive meetings this past year despite the extremely heavy workload she carries in her substantive job, Regional Rep. Tony Frankson who was always present at our Executive meetings with so many ideas and suggestions, first in person, then when his job was transferred to the UWI in the Bahamas, he would do a telephone conference call to participate. Nuff respect Tony.

I must also commend SouthEast and South Regional Reps. Paul Ricketts and Merle Mendonca who, while unable to attend our Executive meetings in Jamaica in person, Paul, like Tony, telephoned in to take part, and Merle was always quick to respond and make suggestions by email. Their ideas and suggestions were invaluable. It was a great team to work with, and I thank you all for your outstanding support in this endeavour.



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Finally, I would like to thank you our members for your support of our work throughout the years. It was a great honour and privilege serving you all and spreading the cause of Bioethics across the Caribbean. And I know we will all pledge our continued support to the new Executive that will be elected here today. Best wishes to you all!

BSEC’s 4 TH ANNUAL FORUM

BSEC’s 4th Forum (May 2728, 2010 in Guyana) was supported in part by a generous grant from the Wellcome Trust. The 2010 theme “An ethical pathway to universal access to health: The role of rights, citizens and science” and the dedication of the host, Ms Merle Mendonca (BSECs newly elected Secretary) generated a remarkable level of involvement of Guyanese health professionals and academicians. Thanks to Merle’s efforts BSEC now has 24 members registered in Guyana.

The 2010 Forum included a training session entitled “Review of BioEthics Standardsetting in the Englishspeaking Caribbean” moderated by BSEC’s West Representative Eileen Boxill, QC. The session included BSEC panelists Derrick Aarons, Donald Simeon, Grace Charran, and special contributors Shamdeo Persaud (CMO of Guyana) and Ray Moseley (Florida Bioethics Network). Merle organized a subsequent meeting of the BSEC Guyana group in September 2010 at which discussion ensued about a proposal to set up a Clinical Ethics Committee.

A survey of delegates found that 96% agreed or strongly agreed that the 2010 Forum addressed important issues in their work and/or studies. The survey indicated that the Forum’s highlights included the presentations on prolonging death: patient rights vs. paternalism (H Seetharahaman) and the clinical ethics paradigm shift (R Moseley). Similarly one delegate described the highlight as the overall emphasis on the role of “ethics in the workplace and the importance of integrating bioethics in all areas at an early stage”.

Left to right: Mrs. Shereen Cox, Dr. Donald Simeon, Dr. M. Anthony Frankson

and Dr. Derrick Aarons.

Audience at BSEC’s 4 th Annual Forum



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BSEC Patrons Message Sir George Alleyne

Chancellor University of the West Indies

Once again I must express my regrets that I cannot be with you on this occasion. My regrets are not only because I will miss the rich exchange which I know will take place about issues that are dear to me, but also I would have liked to be there in person to say thanks to our outgoing President Derrick Aarons. He has been the founder, father and mainstay of the Society. It is not an exaggeration to say that this would not have been possible without his drive, commitment and dedication. We are all grateful to him. It is a tribute to his work that there is a potential successor to whom I offer my very best wishes. I am also pleased to note that the meeting will be held in Guyana.

The topics you will discuss obviously have relevance to all those who are concerned with human behavior and not only those who practice the discipline of medicine. You know as well as I do that the stability of institutions depends in no small measure on the ethical principles that underpin their basic functions and the ethical practices of those who work in them. I am pleased that the topic of standard setting will be addressed and the number of institutions which will be discussed as having a role to play. I have had more recently to be concerned with the ethics of major international health organizations and the role of participating governments in their governance. I wonder sometimes if it could be ever possible in our own Caribbean organizations to introduce the concept of ethical modes of participation.

But I must not attempt to enter into specific discussion in a message which was designed primarily to wish you every success and in particular to express my personal thanks to Derrick. Have a good Forum.

Vice Chancellor’s Welcome Message Lawrence D. Carrington University of Guyana

I am very pleased to be able to welcome all of you who have joined us for this fourth annual forum of the bioethics society of the Englishspeaking Caribbean. Before I was informed of the forum, I was not aware that there was an association in this region that devoted itself to issues of bioethics. I was pleased to learn this because from time to time I am alarmed by some of what I consider to be moral flaws in the activities of enterprises that trade in the medical, pharmaceutical and nutritional commodities that our societies now value. I was also gratified to realize that we do not have to look as far as I thought for guidance on the protocols that we should fashion for our own university’s work in several of the disciplines that need to be guided by ethical principles in respect of human life and well being.

Responsible professionals and academics need to monitor constantly the shifting grayness between what can be done and what it is acceptable to do, between scientific limit and moral boundary. I speak not only of research and experimentation but also of regulatory codes for relationships among professionals, between researcher and subjects of research, between vendors of biological materials and purchasers as well as between states and their citizens. The formulation of policy at national levels



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as well as at the level of recognised regulatory bodies must be informed by the kinds of discussions that you undertake. Equally importantly, the general society needs to understand the issues that you debate so that it can help to determine the boundaries of reasonable policy and legislation.

There is a tendency of the shortsighted in the less developed world to treat topics such as bioethics as if they belong to esoteric high technology environments with little pertinence to us. Countries like ours need more than ever now to abandon that distancing and to recognize that the circumstances of the globe envelop us in a mesh that obliges attention to such matters. Our efforts to achieve the millennium development goals encompass initiatives to reduce infant mortality, improve health and wellbeing and to provide adequate food and potable water supplies for our populations. Inevitably, we have to concern ourselves with policies on the mass administration of vaccines, not merely the already established vaccines against early childhood diseases, but the new ones directed at an increasing range of diseases. We have to have clear positions on how we apply contemporary technology to increasing crop production within our own spheres of concern and control. The issues that related to the genetic modification of food sources are not restricted to wheat and barley; they are also about yams and coconuts, rice and pineapples. They can be about the control of waterlilies just as much as about the treatment of malaria. The challenges of bioethics then are very much challenges of development, challenges that take different shapes in societies with multiple reference points of religions and life philosophies.

Your conference is for me therefore a special opportunity for our resident professionals and students to stretch their minds into the interface between science and society, philosophy and intuition. It is my hope that in so doing you will nurture your sensibilities to favour propriety in your professional lives. I wish you the very best for today’s work. To those of you who have come from other countries, I hope that your experience here in Guyana will encourage you to return and to explore the rich reservoir of research potential of this country.

Philosophical Reflections on Universal Access to Health Derrick Aarons MB.BS., M.Sc., Ph.D.


In reflecting on the subject “Universal Access to Health” – what broadbased perspective may be taken and what ethical theories are germane to this consideration? In fact, the issue begs the question is there a universal access to health? Should there be? What would be the ethical underpinnings of this requirement?

Nina Nikki and Bengt Eriksson, in their paper “Microethics in Action”, proposed that while Biomedical Ethics has been dominated by theoretical discussions based on ethical concepts and analyses of constructed or actual cases, Applied Ethics has often developed from the thought experiments of moral philosophy in order to apply general standards and principles to realistic material. John Abbot Worthley, in “The Ethics of the Ordinary in Health Care”, argues that the ethical dimensions of everyday activities, and the standards, values, and actions on which they rest must be emphasized in order for us to understand the conditions surrounding care giving and health care. Euthanasia, the development of gene technology, and donor organ prioritization are all examples of



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important ethical issues, but they are hardly issues that constitute the reality of most normal caregivers and care recipients. Bioethics has thus adopted a macroperspective and views its task as that of providing general theories and analytical models to serve as subjects for ethical reflection by the professionals.

The cataclysmal events of World War 11 saw the international community articulate the concept of universal human rights. The international right to health and health care has since been articulated in the International Covenant on Economic, Social and Cultural Rights, and other Conventions from the inception of the United Nations – socalled international human rights instruments. The Declaration of AlmaAta (1978), adopted by the International Conference on Primary Health Care, reaffirmed the fundamental human right to health care and called on governments to expeditiously provide primary health care. This advocacy has since accelerated in light of the HIV/AIDS pandemic (a topic to be addressed at the Forum today), women’s health issues (another topic to be addressed today), and gross human rights violations in many parts of the world, but particularly in the Balkans and in Africa. Further, in 2001, the United Nations Human Rights Commission called for an international recognition of an obligation “with regard to the promotion of the right to health”.

National Constitutions that contain a “right to health care”, statutory law, and common law in negligence may also be used to support the right to health and health care. The holder of a right has the capacity to enforce a duty from a person or an institution who has a duty to fulfil that right. A basic tenet of the philosophy of rights is that a right can only exist if there is a preexisting obligation. Consequently, the care of patients is a fundamental responsibility of governments, societies, and health professionals.

Some theorists are critical of the concept of an individual “right to health”, considering it illusory, meaningless, or unattainable in the context of a world of limited resources. This postulation must be considered against the recognition that the determinants of health care are indivisible – that the provision of adequate water, housing and sanitation are as critical to the “health” of individuals as the provision of health care.

Nevertheless, the concept of “human rights” have as their core the recognition that all human beings have an equal moral worth, and that they are the beneficiaries of human rights simply because they are human. It thus sets the standards of behaviour that the international community and individual governments are required to meet.

And so the Universal Declaration of Human Rights states: “Everyone has the right to a standard of living adequate for the health of himself and of his family...” And the International Covenant on Economic, Social and Cultural Rights states – at Article 12.2: The steps to be taken to achieve the realization of this right shall include those necessary for: d) The creation of conditions, which would assure to all medical service and medical attention in the event of sickness. Under the Covenant the express responsibility for the provision of the international right to health lies with the signatory parties – individual governments. The “right” is vested in all human beings the “obligation” is vested in all signatory nations.



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Consequently, as our Bioethics Forum today considers the matter of universal access to health, what are the ethical tenets, social and legal implications, and philosophical considerations to be entertained which underpin this normative paradigm? Ethics has to do with the “ought”. If there is one simple word to define “ethics” – it is the word “ought”. What we ought to do. What we should do!

But before addressing these questions – we have to first have a clear concept of what we mean by the term “health”. Since 1948, the World Health Organization has defined health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity”. Hence, our theme today speaks to the notion of all human beings having access to the means that would facilitate their wholistic existence, that is, a state where they are healthy physically, mentally, and socially. A pipe dream would you say? Well, that’s what normative ethics speaks to setting the standards that we all should aim to achieve. And if at first you don’t succeed try, try and try again! We must try to meet the required standards. But on what ethical grounds would we presume to seek to ensure that all human beings achieve this state of wellbeing? On what basis would the obligation come about and who would have the duty to provide the access and ensure that the access is universal?

According to the ethical theory of the German philosopher Immanuel Kant, an action is good to the extent that it can serve as a universal principle of action for all. The Kantian theory of Deontology thus obligates us to providing care for all at the standard of care we would want for ourselves.

The Harm Principle, as espoused by the Englishman John Stuart Mill, holds that only actions which harm or threaten to harm other people may be coercively prevented. To neglect the wellbeing of others is in fact – doing them harm. Harm may come about through acts of commission as well as through acts of omission.

And what do the dictates of the ethical principles of distributive and egalitarian justice as proposed by the philosopher John Rawls say in this regard? Rawlsian theory pontificates on matters of fairness and equity, and would require that we treat all human beings as equals.

Consequentialist moral theory also comes to bear on this issue. Consequentialism requires that our actions be judged in terms of their consequences, much as its offshoot “the principle of utility” or “Utilitarianism” seeks to maximize happiness.

But are all these ethical theories universally applicable? The question of whether moral values are universally applicable remains the most pertinent and perplexing question for the ethicist. The question is equally relevant whether ethics is defined as an individual response to the question of “how ought I to live or behave” or as mechanisms for ensuring good public practice and in the interaction of individuals and institutions. Can there be a global ethics? Is a global ethics desirable? Would a global ethics be a new form of colonialism, socalled moral neocolonialism, a new form of cultural imperialism with western ethical values at its core? Can the divide between “western” and “non western” ethics be bridged? If so, what type of global ethics should we promote?

Whilst the focus of Western bioethics is at the level of the individual, in other parts of the world bioethical concerns focus on social units. Western bioethics is oriented to principles that elsewhere are articulated primarily in lived moral virtues, the phenomenological world of living experience. For the



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West, bioethics is a framework for thought, a socalled conceptual system. For persons in the East, it is a way of life, an embodied activity of virtue.

This issue illustrates what is called cultural relativism, which states that moral values are culturally dependent and are therefore only applicable in the culture within which they were derived. The presumption is that value frameworks and belief systems are so different that communication on moral matters across diverse communities is impossible and therefore any global agreement or consensus is precluded.

Most international documents on human rights adopt the concept of human dignity, a property common to all human beings as agents as being the grounding for the possession of inalienable rights. Hence, one may argue, all persons have a prima facie claim right to choose to perform certain functions that are “of central importance to a human life”. A full and flourishing human life would include such functions and capabilities as bodily health, imagination, emotion, friendship, and so on. Human rights therefore form a part of morality, and are therefore an important part of the dialogue in bioethical issues.

The issue of human rights however has been criticised for relying too much on a Western individualist concept of the human being, particularly in the case of political rights, and so this has led to the greater inclusion of social and economic rights in the human rights framework. Such rights have been effectively utilised by communities as well as individuals for example, indigenous people succeeding in claiming “land” rights. The dominant form of Western bioethics has been predominantly individualist and principlist focussing on issues of individual choice to the exclusion of social, economic, and communal concerns. Individual consent and confidentiality are linked to the principle of autonomy, rather than being rooted in notions of justice. However, postEnlightenment Western ethics is current under active critique, with the championing of social justice over that of individual choice.

The real answer therefore in bridging the gap for a global ethics is in the work of virtue ethicists. Many of the aspects of morality that belong to the ethics and worldviews of many proponents in countries of the South and nations in the East, that of underscoring the importance of moral virtues embodied in the experience of moral living and as a part of life, are to be found in the field of virtue ethics. Virtue ethics presents a view of moral value and the human being which is most similar to the views of the developing world bioethicists. This will bridge the gap between Western and non Western ethics.

Virtue ethics began with Aristotle and Plato, but the beginning of the virtue ethics movement began in 1958, when Elizabeth Anscombe criticised the two prominent strands of postEnlightenment ethical theory Utilitarianism and Kantianism. She stated that the concepts of obligation and duty, and of what is morally right or wrong, should be jettisoned, and called for moral philosophy to return to issues of moral psychology and human flourishing. Iris Murdoch also challenged the reductionism of post Enlightenment moral theories and advocated a moral theory that placed moral values at the centre of all human living.



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Virtue ethics emphasizes character, habit and virtue, being embedded in everyday life, requiring that we ensure that this morality is an integrated part of lived experience. It can help to bridge the conceptual chiasm between the East and West.

Universally, where are the needs for such ethical practices? One example of the growing need for global ethical regulations, practices, and systems of governance across cultures, communities, and spheres is in the area of “medical tourism”. The term defines the movement of people from one legislative area to another to obtain treatment and procedures which are not available (or less easily available) within the country or state of their origin. It includes “reproductive tourism” which refers to travelling to different spheres of legislation for any reproductive treatment, from Irish women travelling to the UK for abortions, to German couples travelling to Belgium for PreImplantation Genetic Diagnosis and the travelling of relatively rich persons to relatively poor countries for procedures which rely on the exploitation of the poor, for example, organ donation. Connected to this is the trafficking in body parts and materials which are sold by the poor people of the world to “medical merchants” for the benefit of rich persons.

The current existence of medical tourism and the trafficking of medically valuable commodities or persons show that there are different laws in different places that are exploited by those who have the means to access the medical treatments they desire. Clearly wealth is important here, as it is only the wealthy that can effectively exploit the varieties of laws. Only the wealthy can travel to participate in reproductive markets and so can readily evade the constraints in their particular countries. The issues of injustice as well as circumventing national and regional laws strongly suggests the need for global standards or agreements on what is and is not acceptable. This matter could be one point of discussion in tomorrow’s Training Seminar on Bioethics Standardsetting.

And so today as we reflect upon the “Universal access to health”, and recognizing health as “a state of complete physical, mental and social wellbeing” from these examples I have provided it will be clear that health policy legislation will be required in all countries of the world to facilitate the concept of a “Universal Access to Health”.

For our work with the various bioethical issues that affect us in the Caribbean, you can see from this opening presentation that we have many starting points from which we may begin our work. And so I wish you all a very educational and bioethically productive day!

References 1. Nikku N., Ericksson B. “Microethics in action” Bioethics 2006; 20(4); 169179. 2. Widdows H. “Is Global Ethics Moral NeoColonialism? An investigation of the issue in the context of

Bioethics” Bioethics 2007: 21(6); 305315. 3. Anscombe G.E.M. “Modern Moral Philosophy”. In Virtue Ethics 1997 [1958]. Roger Crisp and Michael Slote,

eds. Oxford: Oxford University Press, 2644. 4. Murdoch I. “Vision and Choice in Morality”. In Existentialist and Mystics: Iris Murdoch’s writings on

Philosophy and Literature. 1997 [1956]. P. Conradi, ed. London: Chatto & Windus: 7698. P.87. 5. Carvalho F.L. “Regulation of Clinical Research and Bioethics in Portugal.” Bioethics 2007: 21(5); 290302. 6. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference,

New York, 1922 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.



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7. Farmer P. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, CA & London: University of California Press, 2003, pp402.

8. Fenton E. Genetic Enhancement – A Threat to Human Rights? Bioethics 2008: 22(1); 17.

Forum Presentations (Abstracts)

Ethics and the Contribution of Science to Women’s Health Issues Grace SirjuCharran, PhD.

University of the West Indies, St. Augustine, Trinidad and Tobago

Although scientists in conducting research have operated in the main through the utilitarian and consequentialist paradigm, in which it is understood that all knowledge produced would redound to the improvement of the quality of life for all citizens, past experience has shown that neither “good for the greatest number” (utilitarian) nor the “greatest good” (conseqentialism) has always been achieved. In addition there have been several instances in which scientific discoveries have resulted in “dualuse technology” serving both the military as well as its citizens. Such examples include nuclear energy, and certain chemical and biological organisms which could be used both in warfare as well as in industry.

The recent unprecedented progress made in Genomics since the discovery of DNA has potential for improving the well being of both men and women, it has also raised a number of Ethical and philosophical questions foremost of which is the question of when does life begin. It has also resulted in an upsurge in Eugenics. The allied new technologies e.g. artificial reproductive technologies; genetic testing as well as new developments in brain science have an impact not only women’s health and quality of life but also their status in society. An ethical analysis of these will be undertaken from a feminist perspective.

Prenatal Screening: The Ethical Challenge and a Possible Answer Anthony M.A. Mullings, MB. BS, DGO, DM (O&G), MPH, FACOG

Senior Lecturer – University of the West Indies, Jamaica

Prenatal screening has always been the standard of care in obstetrics. With advances in the understanding of the nature of prenatal problems that might affect the fetus, the level of prenatal screening has changed significantly. The international consensus for example, is that all patients should be offered screening for Down’s syndrome regardless of age or history. It is suggested that all patients should have an “anomaly scan” at gestational age 18 to 20. Genetic prenatal screening is even applied in assisted reproduction centres at the cellular level to attempt to screen for genetic abnormalities. What are the implications for caregivers, patients, and operators of health care facilities of this “intensified” scheme of prenatal screening? Is there a moral question to be answered in relation to the attempt to identify and respond to abnormalities in the fetus? Whose responsibility is it to address these issues? Where does the right of the woman rest and are there fetal rights? It is obvious therefore that the issue of prenatal screening presents several challenges and that these should be constantly reviewed is important and necessary.



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Ethical Issues related to HIV Testing Dr. Donald Simeon, PhD

Caribbean Health Research Council (CHRC), Trinidad

The Caribbean has the second highest HIV infection rates in the world, behind subSaharan Africa. With a prevalence of 1.1%, the rate is approximately twice that of North (0.6%) and Latin (0.5%) America. Within the region, the rate ranges between countries from 0.1% in Cuba to 3.0% in the Bahamas. There are also groups such as men who have sex with men and commercial sex workers that have infection rates of over 10% in some countries. Drivers of the epidemic include poverty, high risk behaviours and stigma and discrimination.

One of the consequences of the latter is that people are unwilling to know their status and are thus deprived of available treatment and also unknowingly expose others to the disease. Public health officials have therefore implemented a number of strategies to increase the rate of testing, especially among mostatrisk populations such as the youth. Since its natural history is known, reliable tests exist and treatment is available, screening for HIV is recommended and is now the primary method for indentifying infected persons. The most common programs include Voluntary Counseling and Testing (VCT), Prevention of Mother to Child Transmission (PMTCT), Provider Initiated Testing and Counseling (PITC). PMTCT has been very effective in reducing infections in children born to HIV+ women and VCT has been a mainstay of National AIDS programs throughout the region.

However, there is potential for ethical abuse when HIV testing is conducted in situations unrelated to public health. One example is in research studies as it is critical that the researchers include appropriate strategies when HIV positive persons are identified, including ensuring that facilities to which they are referred have the capacity to manage the patients. In particular, the practice of anonymous testing is controversial. This approach is attractive as it results in an increased response rate with the researcher having no or reduced responsibility towards those who test positive. However, there is a belief that this approach, used in some surveillance studies, is inappropriate since effective treatment is available and there is a need for HIV positive persons to know their status so that they can take the necessary actions.

Testing is also conducted under other circumstances that have to public health benefits. Indeed, there is great concern that individuals’ rights may be violated when testing is conducted for visas, work permits, food badges, insurance policies, employment, etc. In most cases, these practices are not legal or official. This is clearly an area that needs ethical review and oversight and the establishment of a regional policy regarding testing for HIV.

“Confidentiality and Access to HIV Treatment” Ms. Merle Mendonca, B.Sc.

Guyana Human Rights Association, Guyana

In the Caribbean, stigma surrounding HIV positive status continues to inhibit disclosure of status. Legislative provisions directly addressing confidentiality of HIV–related information by amending



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existing protocols and guidelines are needed to protect information and the right to privacy, or by new legislation directly addressing HIV and AIDS generated concerns.

Although the main focus of attention with respect to HIV/AIDS in the Caribbean as elsewhere, remains medical and technical, the primary drivers of infection are largely political, social and economic. While technical and medical progress in societies with more progressive social attitudes towards the epidemic has led to more relaxed protocols with respect to informed consent requirements for testing, such practices continue to pose high risks for HIV positive persons in the Caribbean.

For this reason the public health dimensions of the struggle against the HIV virus such as combating stigma and discrimination still require vigilance with respect to privacy and confidentiality. A disposition to unquestioningly accept practices from developed societies can place HIV positive persons at risk. The growing tendency in the US, for example, to encourage HIV testing of pregnant mothers as part of routine blood work, if adopted in some Caribbean territories at least, would expose many persons to breaches of confidentiality

Technical progress in the fight against HIV/AIDS is essential, but it is not a substitute for appropriate public health measure in Caribbean societies.

“I Don’t Wanna Wait in Vain”: The Ethical Implications of Unlimited Access and Limited Resources

Ms. Shereen Dawkins –Cox Dip.Pharm, M.Sc. University of Technology, Jamaica

WHO indicates that “good health services are those which deliver effective, safe, good quality, personal and nonpersonal care to those that need it, when needed, and with minimal waste” and “effective health service delivery depends on having some key resources: motivated staff, equipment, information and finance, and adequate drugs” . It is therefore imperative that from time to time, governments examine the quality of health service delivery within their respective countries and note the ethical challenges faced when the criteria as stipulated by WHO are not met. One of the greatest challenges in any Health care system is lack of sufficient resources. It is difficult to estimate “what sufficient resources” entail as one may not always be fully prepared in any economy to handle disasters such as the catastrophic earthquake recently in Haiti. However, the day to day running of any health sector should not be one where individuals are dying because they are not able to receive vital care when needed. One of the commonest cry in some health settings is the waiting time to see receive medical attention. While one may anticipate long waiting times for nonurgent surgeries, the matter of waiting to receive basic medical attention at a clinic or even more importantly, to be triaged in an emergency room is one that may have been overlooked. In an ideal setting, waiting to be triaged or to see an attending physician may be a matter of minutes or a couple hours but when resources are limited, a stroke patient may wait up to 12 hours before receiving any kind of care. Oftentimes, after being attended to by a primary care physician and referred to a specialist, patients would have to be placed on a waiting list for months before getting an appointment. A case considered nonemergency or urgent but important could gradually lead to grievous results. The ethical implications of “long” waiting time especially when there is limited resources would therefore need vital attention.



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Lifesupport Technology to Prolong ‘Death’ – ‘patient rights’ versus ‘paternalism’ Dr. Hariharan Seetharaman, MBBS, MD, FCCM

UWI Anesthesiology and Intensive Care, Trinidad &Tobago

In modern times, all branches of medicine have grown exponentially. Most notably, critical care medicine has developed beyond one’s imagination, heralded by the availability of hightechnology support systems for every failing organ of the human body. In fact, there has been a cultural change and people have started thinking that death is preventable with the help of technology. Because of this ‘death denying’ notion of the society, intensive care unit (ICU) admissions have increased over time and dying on a ventilator has become common in most countries. The Time magazine in 2000 reported that while 70% of Americans wanted to die at home, 75% died in hospitals and at least 30% died in the ICU. In Canada, a survey showed that approximately 70% of the population dies in the hospital and 50% of deaths occur in the ICU. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) trial showed that people do not want to die in a medical institution but if this happens, the relatives face immense financial hardships. There have been widespread myths and misconceptions about the value of cardiopulmonary resuscitation (CPR), which are especially hyped by the television. In fact, in the United States of America, elderly people living in the nursing homes were explained about the stark reality of the outcomes following CPR in order to dissuade them from getting into an ICU. This is because potentially every death could be intervened and life support systems could be used to prolong death, which is ultimately inevitable. In other words, in the modern medical age, death has become more of a ‘process’ rather than an ‘event’. The author’s published research and personal observations have shown that in countries such as Barbados and Trinidad, even when physicians agree to medical futility, lifeprolonging high technology interventions are continued until the inevitable happens.

Education of the society is utmost important in this issue. A patient’s right to refuse treatment is often confused with the right to demand it. Refusal to undergo treatment is a welldefined constitutional right. By the same token, a patient cannot demand a specific intervention just because it is available. It is always the physician’s prerogative to select the appropriate management for an individual patient, although the patient has the right to either refuse or choose from the different modalities of treatment put forward by the physician. Physicians cannot do what nature does not allow, should not do what professional integrity does not allow and cannot hope for miracles to happen.

Currently, in many countries of the Englishspeaking Caribbean, except Trinidad and Tobago, there is no statute that makes provision for discontinuation of lifesupport measures. Although this can be defended in a court because it can be recognized by the common law, many healthcare practitioners do not wish to get entangled in legal proceedings. This most often results in continuation of the life support until the patient eventually dies, consuming a vast amount of resources. In conclusion, the application of lifesupport technology to prolong the process of death in the ICU is inappropriate and there is a role for ‘paternalism’ in these situations.



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Teaching Ethics: Incorporating Ethics into an Undergraduate Science Curriculum Ralph Robinson, PhD and Byron Wilson PhD

University of the West Indies, Jamaica

Strategic Aim #1 of the University of the West Indies’ (UWI) Strategic Plan 20072012 is “To prepare a distinctive UWI graduate for the 21 st century – one who has a regional frame of reference and exemplifies the following attributes: (i) a critical thinker, (ii) a problem solver, (iii) an effective communicator, (iv) knowledgeable and informed, (v) competent, (vi) a leader, (vii) a team player, (viii) ITskilled and literate, (ix) socially and culturally responsive, (x) ethical, (xi) innovative and entrepreneurial, (xii)a lifelong, selfmotivated learner.”

The focus of this paper is the ‘distinguished graduate’, principally achievement thereof in the area of professional ethics. The paper suggests a structure for the introduction and teaching of ethics in non ethicsbased courses. This is particularly relevant to academic Faculties where no formal ethicsbased programs currently exist.

The student learning outputs include: increased sensitivity to ethical issues; increased knowledge relevant to ethical issues; improved student's ethical judgment; and (where practicable) improved student's strength of will (modified from: Center for the Study of Ethics in the Professions, 2009)

Ethical sensitization is paramount and should begin early in the student’s academic experience. Ethical issues related to academic content should be frequently raised in classes (tutorials, lectures, and field or laboratory exercises). Keep it simple for now; there is little need for further discussion apart from statements of outcomes e.g. “….students who plagiarize material will be disciplined severely.” Lengthy casesstudies that necessarily would invoke ethical analytical skills are most probably lost on this audience.

Ethical knowledge logically follows sensitization, and may be introduced in the second semester of 1 st year. At this point, students should be supplied, ideally, with a ‘code of ethics’ e.g. Policy and Code on Research Ethics for the University of the West Indies (in the case of UWI), but lectures, or the use of guest speakers, videos, skits, etc may suffice elsewhere. The intervention at this level is to raise ethical issues in class and assist students to find answers through reference to the code. This should be done regularly. By midsemester, more challenging ethical issues should be raised, discussions facilitated (e.g. how ought you [the student] to handle this?), drawbacks in students' proposals pinpointed, and some standard ways of handling them discussed noting corroboration (or lack thereof) with the code. The semester could be completed by advancing some ‘really hard’ ethical issues (e.g. human biology, or environmental issues); here students should seek opinions and advice from sources (professionals, agencies, literature, etc.) other than the code.

Improvements in ethical reasoning obtain from class discussions that strike a balance between structure and openness. The Seven Step Method for Ethical DecisionMaking (CSEP, 2009) a tested schematic that guides class discussions of a case study could be usefully introduced at this stage. Unstructured sessions boasting moral (e.g. religious) theory won’t work here.



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Ethical judgment may be taught in the 2 nd and also the final year of student academic training by revealing the ethical issues resident in real problems. Discussions, homework assignments, etc., that require judgment and, occasionally, criticism are ideal in this context. Putting the student ‘on the spot’ (as in real life), and role playing are also likely to work here. Always request reasons for any judgment (or criticism) proffered. Any attempt to substitute with didactic style lectures is proscribed. Academic staff are encouraged to develop curricula that require students to solve real problems, but also recognize and decide on attending ethical issues.

Ethical strength of will (good luck with thin one!), unlike the other learning outcomes, cannot be measured directly. Best introduced in the 3 rd (final) year, the most that may be expected is establishing the extent to which members of the professional fraternity agree [on ethical issues] and the expected positive effect this knowledge will have for persons confronting an unethical situation. There is also ample opportunity at this stage to provide information about institutional or professional support, government agency support, etc., or advocacy group which, again, may facilitate a pressured individual to say "no". Finally, instilling the confidence in one’s students to defend their own recommendations should make it easier for them to solicit support within an organization and, having found allies, find it easier to decline where indicated.

Pragmatically, not all academic staff in tertiarylevel institutions will feel comfortable or, for that matter, completely competent to engage this process. There are, however, ample online training opportunities (e.g. University of Miami Ethics Programs) for which free access has been achieved through Memoranda of Understanding with some West Indian tertiarylevel institutions (e.g. UWI), and by which professionals can close such gaps in training.

References 1. Center for the Study of Ethics in the Professions (2009), Illinois Institute of Technology, Chicago, Illinois.

http://ethics.iit.edu/ 2. Policy and Code on Research Ethics for the University of the West Indies (current)

http://www.mona.uwi.edu/fms/ethics/Ethics%20Policy%20&%20Code.pdf 3. University of Miami Ethics Programs (20072009), University of Miami, Miami, Florida

http://www6.miami.edu/ethics/

It’s Time for a Clinical Ethics Paradigm Shift: The Painful Move from a Reactive to a Proactive System

Dr. Ray Moseley, Ph.D Program in Bioethics, Law and Medical Professionalism, University of Florid,a College of Medicine

The clinical ethics process in most hospitals is almost exclusively reactive and/or consists of single point interventions. Primarily this entails rarely used ethics committee consultation services, or having a “singlepoint” activity, such as a patient signing an informed consent form. The evidence is clear that this current approach to clinical ethics is not very effective in resolving clinical ethics problems, and is totally ineffective in preventing them. Consider how few clinical ethics problems in a hospital are actually addressed by ethics consults, and even those that are presented for ethics consultation almost always come too late, after the problem has reached disaster proportions. This assertion is a significant


http://ethics.iit.edu/

http://www.mona.uwi.edu/fms/ethics/Ethics%20Policy%20&%20Code.pdf

http://www6.miami.edu/ethics/


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indictment of the current clinical ethics approach that has developed over the past 25 years, and which is touted by hospitals with every accreditation!

We currently handle clinical ethics problems in the hospital, exactly as adverse medical events were handled 20 years ago, and with the same disastrous results. Then adverse events were rarely reported, and were almost always hidden by a code of silence. They were seen as personal and /or professional failings, which if known to administration would lead to disciplinary action or dismissal and if known to the public would lead to wholesale distrust of the health care system. They were not tracked, categorized or reported.

Consider the paradigm shift that has occurred in how we view and understand adverse events. Now we see them as almost exclusively system problems, addressed by “fixing” the system through a robust and redundant preventative process. Health care professionals have a positive obligation to report, track and to prevent adverse events. If we are to have a meaningful and effective clinical ethics system, it is imperative we embrace a similar paradigm shift and move to a similar systems approach. This presentation outlines such a systems approach.

REPORT ON BSEC’s 2009 ANNUAL FORUM Dr. Donald Simeon, PhD

Caribbean Health Research Council (CHRC), Trinidad

BSEC’s 3rd Annual Bioethics Forum was held at UWI, St. Augustine, in Trinidad and Tobago on June 5, 2009, World Environment Day. Appropriately, the theme was ‘Bioethical Standards: People and the Environment’. With a powerful cast of presenters, it achieved its goal of focusing attention on the relationships between the bioethical considerations and environmental issues faced in the Caribbean. The audience comprised over 70 persons with an interest in bioethics including scientists, other professionals, lay persons and students. The positive feedback from the delegates present was a clear indication of the interest in ethical issues in the Caribbean and the need for additional opportunities to inform and educate the Caribbean population at large on these issues.

There were 15 presentations in addition to a Roundtable Discussion on ‘Establishing National Bioethics Committees’. In the latter, experiences were shared by ethicists from Brazil, Cuba, Jamaica, Trinidad & Tobago and Uruguay on the functions and contributions of their Bioethics Committees. The Forum was of very high standard and the presentations were instructive as well as thought provoking. The audience was moved by Dr. Daniel Piedra Herrera, Executive Secretary of the National Bioethics Committee of Cuba who delivered a powerful feature lecture during the Opening Session entitled ‘Ethics and Bioethics: Change in Morality’.

The Evening Public Lecture, delivered by Dr. Richard D. Schulterbrandt Gragg III, Associate Director & Associate Professor of Environmental Sciences Institute Florida A&M University, was also outstanding. His presentation was entitled ‘Bioethics and the Environment’. Another of the more popular presentations was delivered by Prof. Prof. Ralph Robinson of the UWI, Mona campus on Conservation: an Ethic of Resource Use Allocation, and Protection.



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Evaluation by Delegates Delegates were asked to complete an evaluation form so as to provide feedback, which can guide the hosting of future fora. Evaluation forms were completed by 39 delegates and the results indicate that the delegates were very satisfied with the programme. Indeed, everyone reported that they found the Forum informative and useful. In addition, 38 of the 39 respondents said that it addressed important issues related to their work or studies and that they would attend another Forum.

The delegates were also asked to give general comments on their experience at the Forum. From the 39 questionnaires, 20 respondents identified the most outstanding presentation. Prof. Ralph Robinson received more than twice the votes than any other presenter. To the question “Based on this Forum, I will make changes in my work, professional development, and/or studies” 34 agreed or strongly agreed.

When asked to identify the highlight of the Forum many respondents addressed moral concerns about environmental degradation, for example:

• “The fact, of course that our environment is being devastated at the expense of our comforts and it must be reversed to protect it so we will be safe.”

• “Conservation – the ethical use, allocation and protection of resources.”

Local Organizing Committee The Local Organizing Committee was responsible for planning and fund raising activities that ensured a successful Forum. Meetings were held regularly from June 27, 2008 until the hosting of the Forum. The Committee comprised persons from the Ministry of Health; the University of the West Indies; University of Trinidad and Tobago; Ministry of Foreign Affairs; Ministry of Science, Technology and Tertiary Education; University of the Southern Caribbean; and the Caribbean Health Research Council. They comprised: Dr. Donald T. Simeon (Chair), Dr. Grace SirjuCharran (Cochair), Ms Valerie AlleyneRawlins, Dr. Cheryl Bennet, Dr Dave Chadee, Dr. Clive Dottin, Mr. Carlton Jackman, Ms. Asia Jutla, Dr. Rhonda LynchWatts, Ms. Maureen Manchouck, Ms. Tisha Nickenig, Ms. Karen Rosemin, Dr. Jacqueline Shafe, Ms. Bernadine ThomasMcKain and Mr. Simon Wiltshire.

Sponsors We are grateful for the valuable contributions from:

• Ministry of Science, Technology & Tertiary Education • Alutrint Ltd. • NorthWest Regional Health Authority • Atlantic LNG Ltd. • A.A. Laquis Ltd. • Sandoz Ltd. • BPTT Ltd. • Eastern Regional Health Authority • Nestle Caribbean Ltd • The NorthWest Regional Health Authority • UWI • CHRC



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The main sources of income were from sponsors and the collection of registration fees. Expenditures were for air fare and per diem for presenters as well as lunch and cocktails. After the Forum there was a positive balance of USD 671.

REGIONAL NEWS

The Regional News is developed through readers contributions. It reflects regional activities that pertinent to bioethics and BSEC. Members engage in much work that others would like to know about, learn from, and build upon but are often unaware of the work of our colleagues. To this end we ask BSEC members and others to submit news of their bioethics related activities at any time for the Regional News Section. News may include press releases, editorials, letters, invited presentations, publications, and preliminary research findings. We will consider including information submitted informally in email text. Kindly send your news and accomplishments including recent publications, grants, or invited lectures to [email protected] for the 2011 newsletter.

BSEC and UNESCO – Bioethics Network Derrick Aarons MB.BS., M.Sc., Ph.D.


Immediate Past President of BSEC, Dr. Derrick Aarons, was elected to the Executive Council of RedBioetica UNESCO on November 24, 2010, at the 3 rd International Congress of RedBioetica UNESCO for Latin America & the Caribbean, held on Bogota, Colombia. His presentation to the Congress was entitled “Bioethics and the Environment in the Englishspeaking Caribbean”. Dr. Aarons’ tenure on the Executive will be from 20112013.

RedBioetica UNESCO is a bioethics grouping of all countries in Central America, the Caribbean, and South America, and has specific objectives to promote regional cooperation in bioethics, including bioethics activities, bioethics education, publication, bioethics research, and an increase in bioethics capacity at the national, subregional, and regional levels. As countries of the South, we all encounter particular bioethical issues that require specific cooperation within our regional and subregional context. Dr. Aarons will provide the link between the Englishspeaking Caribbean countries and those of Central and South America in addressing bioethical issues, bioethics education, planning, and bioethics development.

The new President of RedBioetica UNESCO is Prof. Victor Penchaszadeh of Argentina, who replaces Prof. Volnei Garrafa of Brazil (whom many BSEC members met at our 3 rd BSEC Forum in Trinidad & Tobago in June 2009). Prof. Garrafa is currently serving a 3year appointment on the International Bioethics Committee (IBC) of UNESCO.

RedBioetica UNESCO will create a subsection on their website specifically for BSEC. Information from BSEC may be submitted to the RedBioetica UNESCO Portal at www.redbioeticaunesco.org,


mailto:[email protected]

http://www.redbioeticaunesco.org/


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www.redbioeticaedu.com.ar.

Members are invited to promote the existence of this Portal. BSEC members are also invited to submit articles/manuscripts for possible publication in the Revista RedBioetica UNESCO (Journal) – via the Journal Editor, Dr. Luis Justo, at Email:[email protected], http://revista.redbioeticaunesco.org/

The Journal is peerreviewed, and articles in all languages of the Caribbean and Latin America are encouraged.

BSEC’s Treasurer Receives Prestigious Teaching Award Dr. Cheryl Macpherson, PhD

Bioethics Department, St. George’s University, Grenada

Dr. Grace SirjuCharran, BSEC’s newly elected Treasurer, is to be congratulated having received the 2010 UWI/Guardian Life Premium Teaching Award for excellence in Teaching. As a Senior Lecturer and Subject Leader in Biochemistry in the Department of Life Sciences Dr Charran’s commitment to teaching is evident in this honor and in some of the supporting comments stating that Dr Charran:

• Is an extremely dedicated teacher, with a lifetime of experience, devoting herself to individual students

• Clearly warms up when she talks of her courses in Gender Studies and Bioethics where she uses case studies, role play, journal writing, and debates

• Offers a very well coached research project that culminates in a class presentation there is lots of discussion and group work

• Is an excellent allround teacher, with extensive supervision experience, inspiring and respecting students, challenging some of their traditional views about science

• Is very active in Professional Development … especially on Gender in Science

BSEC Honorary Member Prof. Andres Peralta Cornielle of the Dominican Republic with other

members of the Executive Council

Columbia's local organizing committee with newly elected members of the Executive Council of RedBioetica

UNESCO


http://www.redbioetica-edu.com.ar/

mailto:[email protected]

http://revista.redbioeticaunesco.org/


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UNSECO Book Chapter on Jamaica’s National Bioethics Committee

Dr. Cheryl Macpherson, PhD St. George’s University, Grenada

In November 2010 UNESCO announced publication of its new report National Bioethics Committees in Action. This document contains a chapter on Jamaica’s National Bioethics Committee (NBC) written by one of BSEC’s founding members, Dr Anthony Mullings, and is freely available online http://unesdoc.unesco.org/images/0018/001895/189548e.pdf. To paraphrase Dr Mullings’ chapter, governments that establish a National Bioethics Committee do so because they recognize the value and the importance of ethical reflection on evolving technologies and practices in medicine and life sciences.

Jamaica’s NBC is the first in the Englishspeaking Caribbean. Its constitution and rules are structured carefully to support independence. It has its own secretariat, can determine its own work agenda, set its own term limits on membership, and will establish its own evaluation process. The nomination of founding members is based “solely on their expertise and demonstrated interest, without considerations of political or ideological allegiances, was a commendable first step towards ensuring independence”.

NBCs must aim to promote the public good and “ ‘ensure that science delivers what people need and complies with an acceptable ethical consensus (European Commission, 2009)’ ”. The challenge for Jamaica’s NBC, and all others, is to find means of determining what constitutes an acceptable level of consensus about moral issues and to balance these within the competing interests of the democratic pluralist society. To this end Jamaica’s NBC aims to develop strategies to inform and engage the public.

New IRB at Ross University Hamish Mohammed, PhD

Ross University School of Veterinary Medicine, St. Kitts

Dr. Hamish Mohammed, an epidemiologist and assistant professor at the Ross University School of Veterinary Medicine (RUSVM, St. Kitts, West Indies) was recently elected to the Executive of the Bioethics Society of the EnglishSpeaking Caribbean as its Representative for the NorthEastern Caribbean. Currently, most research at RUSVM is conducted on animals and is reviewed by its Institutional Animal Care and Use Committee. To date, research proposals involving human participants have been reviewed by the Institutional Review Board (IRB) of Ross University School of Medicine (Dominica, West Indies). However, as research activities at RUSVM expand, more studies involving human participants are proposed.

To address this need, the RUSVM Research Committee appointed Dr. Mohammed to establish an IRB at RUSVM for the ethical review of all research involving human subjects. This IRB will be registered with the Office of Human Research Protection of the US Department of Health and Human Services, then designated on an application for a Federalwide Assurance with the same body. Once finalized,


http://unesdoc.unesco.org/images/0018/001895/189548e.pdf


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Dr. Mohammed will serve as its founding chairperson. To achieve diverse representation on the IRB an array of professionals from inside and outside RUSVM, including the St. Kitts and Nevis Ministry of Health, is being invited. The aim of these efforts is to maintain a high ethical standard of research involving human subjects conducted at RUSVM.

Landmark BSEC Executive Meeting by Skype Dr. Cheryl Macpherson, PhD St. George’s University, Grenada

Members of BSEC’s Executive Board, like the entire membership, live and work over hundreds of miles distant from each other across the Caribbean region. With no budget designated for meetings the Executive has usually arranged to meet when, by coincidence, there will be a quorum of members in one state. Its Annual Business Meeting has routinely piggybacked on the Annual Forum. The election of the new Executive Board – with even fewer members in any one state than previously necessitated a new approach.

The new Executive successfully attempted to meet via skype on 14 September 2010 at 6 pm EST. The skyped conference call was a new experience for all involved and proved to be both simpler and more complex than was anticipated. It took about 30 minutes of effort to connect all 8 members who called in from at least 6 different Caribbean states and one from England. The agenda had been compiled and circulated prior to the meeting but moving through it after a full workday and without knowing how to set up the call required earnest concentration from all. But business was successfully conducted and having learned how to connect everyone it will be much quicker to do so the next time.

ACCOMPLISHMENTS IN 2010 BY BSEC MEMBERS Aarons, Derrick

Publications • Aarons DE. Template Document: Maintaining high Ethical Standards in Medical Practice in

Dominica. The Ministry of Health &Ross University, Roseau, Dominica, 2010. • Aarons DE. Trust – once lost, cannot be regained! – The Sunday Observer, Jamaica – May 23,

2010 • Aarons DE. The government had better start talking to the Public – The Sunday Observer,

Jamaica – Dec. 6, 2009 • Aarons DE. Bioethics, Health, and the Environment: Some Ethical Concerns in the Caribbean.

Accepted for publication in the Redbiotica/UNESCO Journal • Aarons DE. The Issue of Abortion – Frameworks of Analysis, public morality, and

Legislation. Submitted for publication in the Soc & Econ Studies J

Keynote Addresses • June 2010:Medical Ethics in Clinical Practice – Lessons from around the Caribbean – Ross

University & the Ministry of Health, Dominica



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• May 2010: Philosophical Reflections on Universal Access to Health – 4th Bioethics Forum, Bioethics Society of the Englishspeaking Caribbean – Georgetown, Guyana

• Feb. 2010: Professionalism in Medicine & Challenging Ethical Issues – Annual Conference of the Jamaica Medical Doctors Association

Regional Presentations • Sept. ’10: The Conceptual Framework to making Ethical Decisions – Annual Conference of

the Jamaica Association of Radiologists • July ’10: Regional Model Code of Practice for HIV/AIDS – Annual Conference of the

Regional Nursing Body – Grenada • June ’10: Bioethics Education in the Anglophone Caribbean – Havana, Cuba • June ’10: The National Bioethics Committee of Jamaica & Links across the Englishspeaking

Caribbean – UNESCO Bioethics Conference – Latin America & Carib. • May ’10: Ethical Issues in HIV Testing – PanCaribbean Partnership against HIV/AIDS

(PANCAP) Workshop, Barbados • May ’10: Care & Support of HIV/AIDS Patient – PANCAP Workshop, Barbados • Apr.’10: Medical Codes of Practice – The Annual Meeting of the Chief Medical Officers of

CARICOM Trinidad

Other Activities • Founding Member of the Steering Committee – The SubRegional Bioethics Network of the

Spanish, English, French, and Dutch Caribbean (Redbioetica/UNESCO) • Consultancy Contract to write a Training Module on “The recommitment to Professional

Ethics & the Hippocratic Oath” (PAHO/WHO)

Macpherson, Cheryl

Publications • Macpherson CC. Caribbean Bioethics. Grenada’s New Today Newspaper. December 2010. • Macpherson CC. An ethical imperative to go green. (Letter) Academic Medicine 2010.

(Accepted). • Macpherson CC and Veatch RM. Medical student attitudes about bioethics. Cambridge

Quarterly of Healthcare Ethics. 19(4): 488496. 2010. • Macpherson CC. Public health, bioethics and policy: Protecting our health and environment.

International Public Health Journal 2(4): 0000. 2010. (Invited). • Macpherson CC and Macklin R. Symposium editorial: African perspectives. DWB 10:3033.

2010. • Macpherson CC. A bioethical perspective on Oklahoma’s new abortion law. (Invited).

Women’s Bioethics Project. May 6, 2010. http://womensbioethics.blogspot.com/.



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Invited Presentations • Humanitarian Service Organization (HSO). Gold Humanism Honor Society Biennial

Conference. Dallas, TX. 79 Oct 2010. (Authors: Gifford S, Tepas M, Greathouse M, Kilpatrick M, Shirvani N, and Macpherson C.)

• Bioethics and Business Ethics. Business Ethics Course. Arts and Sciences, St George’s University. 1 Nov 2010.

• Professionalism in Veterinary Medicine. Public Health Course. School of Veterinary Medicine. St George’s University. 24 Sept 2010.

• Caribbean Bioethics. Grenada Medical Association. St. George’s, Grenada. 11 Sept 2010.

Grants• US$ 3000. SGU Small Research Initiative (GSP/SGI/0400). Regional comparisons of hospital

based resources for palliative care in the Caribbean. June 2010.

Mohammed, Hamish

Publications • HP Mohammed, MM. Ramos, A Rivera, et al. TravelAssociated Dengue Infections in the

United States, 1996 to 2005. Journal of Travel Medicine Volume 17, Issue 1, pages 8–14, January/February 2010

• H Mohammed, JS Leichliter, N Schmidt, et al. Does PatientDelivered Partner Treatment Improve Disclosure for Treatable Sexually Transmitted Diseases? AIDS Patient Care and STDs. March 2010, 24(3): 183188.

• H Mohammed, M Ramos, J Armstrong, et al. An Outbreak of Dengue Fever in St. Croix (US Virgin Islands), 2005. 2005. PLoS ONE 5(10): e13729. doi:10.1371/journal.pone.0013729

Presentations • HP Mohammed. Dengue seroprevalence study in a campus community in St. Kitts & Nevis.

CHRC Conference. Trinidad. 2010.

Simeon, Donald

Presentations • An overview of the HIV Epidemic in the Caribbean. The XVIII International AIDS Conference

– Vienna, July 2010. • Enabling a Strong National Research System for Health. The Ministry of Health’s First

National Research Conference. Kingston, November 25, 2010.


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Join BSEC BSEC’s Mission is to increase knowledge and understanding through deliberations about bioethical issues. Membership is open to all who intend to be involved in the discussion of bioethics in the Englishspeaking Caribbean.

Bioethics is an interdisciplinary field (which includes medicine, biology, law, philosophy, religious studies, and the social sciences) that aims to provide moral reflections and guidance in ethical matters related to health care, research, and public policies.

BSEC aims to generate discussion about bioethics, the setting up of research or healthcare ethics committees, and assist formulation of ethical policies in health, biology, biotechnology, health care, and research. Annual dues are US $20.00.

See our website: www.bioethicscaribe.org.jm



Documents

Bioethics Caribebioethicscaribe.org/uploads/3/4/3/0/34300411/... · Bioethics Caribe Volume 2 Number 1 December 2008 4 was designed and circulated to members of the BSEC Executive