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The last 10 years of Bioethics in the English-speaking Caribbean - An Overview By Dr. Derrick Aarons - Physician - Bioethicist © Dr. Derrick Aarons 2004 Introduction:

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the last 10 years of bioethics in the english speaking caribbean an overview

The last 10 years of Bioethics in the English-speaking Caribbean - An Overview

By Dr. Derrick Aarons - Physician - Bioethicist

© Dr. Derrick Aarons 2004

introduction
Introduction:
  • The English-speaking Caribbean comprise 18 politically independent as well as British-dependent countries where English is the first language. These are: Antigua & Barbuda, Anguilla, The Bahamas, Barbados, Belize, Bermuda, British Virgin Islands, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Montserrat, St. Kitts-Nevis, St. Lucia, St. Vincent & the Grenadines, Trinidad & Tobago, and The Turks & Caicos Islands.
introduction3
Introduction:
  • Together, these countries have a total population of 6 million people.
  • Currently, there are 3 medical schools affiliated with the University of the West Indies (Jamaica, Barbados, and Trinidad), and 3 off-shore medical schools affiliated with the United States.
10 years ago
10 years ago….
  • Health professionals in the English-speaking Caribbean were first introduced to the concepts and substance of Bioethics at the 1st Caribbean Workshop on “Health Care, Law & Ethics”which was hosted in Barbados, April 13-16, 1993.
10 years ago6
10 years ago….
  • Attendees included representatives from PAHO/WHO, the University of the West Indies, Chief Medical Officers for some Caribbean Islands, Medical Council representatives, doctors, nurses, and persons in health administration.
10 years ago7
10 years ago….
  • Topics presented included:

- Health Care Law as an Academic Discipline

- Medical Ethics – Caribbean Issues and Perspectives

10 years ago8
10 years ago….
  • Topics presented:

- Patient Rights

- Legal rights and responsibilities of the health professional

- Contemporary medico-legal issues

10 years ago9
10 years ago….
  • Topics presented:

- Medical Research

- Fitness to practice: Doctor and the Law

- AIDS and ethical issues: suicide, euthanasia and confidentiality

10 years ago10
10 years ago….
  • Topics presented:

- PAHO: Inter-American Network of Health Legislation

- Termination of Pregnancy issues and practice

10 years ago11
10 years ago….
  • Topics presented:

- Setting up Clinical Ethical Committees

- Teaching Ethics and Law

- Coordination of regional councils

10 years ago12
10 years ago….

With the resulting increased sensitivity to the issues discussed, attendees at the workshop were urged to implement certain recommendations in the future:

- The Faculty of Medical Sciences should include a formal course on Bioethics

10 years ago13
10 years ago….

Recommendations for the future:

- Plan for PAHO to fund the establishment of a Centre on Health Law at a regional level

10 years ago14
10 years ago….
  • Recommendations for the future:

- More teaching of Ethics to medical and nursing students

- Establish a Caribbean Medical Council

7 years ago
7 years ago….
  • In April 1997, PAHO’s Caribbean Program Coordinator convened the 1st sub-regional meeting on Bioethics.
  • In attendance were several Chief Medical Officers from across the Caribbean;
7 years ago16
7 years ago….
  • .. and representatives from the University of the West Indies and the Caribbean Health Research Council (CHRC).
  • At this meeting: Clinical ethics, ethics and health legislation, and bioethics in public health were identified as important priorities.
since then
Since then….
  • A growing awareness of bioethical issues has been permeating the English-speaking Caribbean
  • In 1999, Trinidad & Tobago, Haiti, and the Bahamas were selected as sites for HIV vaccine trials
since then18
Since then….
  • More recently, Jamaica has been identified as the next site in the Caribbean for HIV vaccine trial.
  • Consequent to such developments, health professionals as well as lay persons have been questioning the ethics of vaccine trials in particular and health research in general.
since then19
Since then….
  • In the Caribbean, not all investigators have access to a research ethics committee, and communities have not had the opportunity to debate and reach consensus on ethical issues arising from research involving human participants.
bioethics the last 5 years
Bioethics: The last 5 years...
  • Consequently, at the 44th Caribbean Health Research Council (CHRC) scientific meeting in April 1999, a symposium was held on “Bioethics in the Caribbean”at which Dr. Fernando Lolas, Director of the PAHO/ WHO Regional Program presented an overview of the program.
bioethics the last 5 years21
Bioethics: The last 5 years...
  • The meeting agreed to:

- Convene a sub-regional workshop on Bioethics

- Develop a proposal for a training program in research ethics for the Caribbean

bioethics the last 5 years22
Bioethics: The last 5 years...
  • The meeting agreed to:

- Present a draft of this training program to the workshop, which – after input from the workshop participants, would be submitted for major funding.

workshop
Workshop:
  • Workshop on Ethics in Health Care and Research in the Caribbean – 23-25th Feb., 2000 – Port of Spain, Trinidad.
  • 46 participants representing a range of disciplines and interests from across the Caribbean were in attendance. These persons were in positions to make substantial contributions to clinical, public health, and research ethics.
workshop24
Workshop:
  • Distinguished experts contributing to the workshop included:

Dr. Derrick Aarons, Bioethicist, UWI, Jamaica

Dr. James Drane, Clinical Ethicist, Edinboro University, Pennsylvania

Dr. Christine Grady, Head – Section of Human Subjects Research, NIH, USA

workshop25
Workshop:
  • Distinguished experts contributing to the workshop included:

Prof. Alice Herb, Asst. Clinical Professor – Family Practice, State University of New York Health Science Centre

Dr. Fernando Lolas, Director – PAHO/WHO Regional Program on Bioethics

workshop26
Workshop:
  • Distinguished experts contributing to the workshop included:

Prof. Ruth Macklin, Professor of Bioethics, Albert Einstein College of Medicine, N.Y.

Dr. F. Zacharias, Program Coordinator on AIDS & Sexually Transmitted Diseases, PAHO

workshop27
Workshop:
  • Themes:

- Ethical Issues in Health Care and Public Health in the Caribbean

- Models of Clinical Ethics Committees

- Research Ethics Committees

- Caribbean Ethics Network

- Training in Health Care Ethics

workshop28
Workshop:
  • Workshop Conclusions:

- The Caribbean has an inadequate number of persons who have received training in research ethics

- Too few ethical review committees in the Caribbean

- An urgent need exists to provide such training in the Caribbean

2 nd workshop
2nd Workshop:
  • Workshop on Ethics in Human Subjects Research in the Caribbean – 12-14th Feb., 2001 – Port of Spain, Trinidad.
  • 50 participants were provided intensive training in human subjects research ethics. Included were members of research ethics committees from the English-speaking Caribbean, the Netherland Antilles and Haiti;
2 nd workshop30
2nd Workshop:
  • …Individuals with skills or interests in research ethics in the sub-region, including the fields of clinical and public health medicine, academia, non-government organizations, and active researchers in the Caribbean.
2 nd workshop31
2nd Workshop:
  • Faculty included:

Dr. Derrick Aarons, Bioethicist, UWI, Jamaica

Dr. Francis Crawley, Ethicist, European Forum for Good Clinical Practice, Belgium

Dr. Jose Esparza, tutor of 2-day training workshop in research ethics for UNAIDS

2 nd workshop32
2nd Workshop:
  • Faculty included:

Dr. Fernando Lolas, Director – PAHO/WHO Regional Program on Bioethics

Prof. Ruth Macklin, Professor of Bioethics, Albert Einstein College of Medicine, N.Y.

2 nd workshop33
2nd Workshop:
  • Themes:

- Fundamentals of Human Subjects Research Ethics

- Status of Ethical Review in the Caribbean

- Establishment of Ethical Review Committee

2 nd workshop34
2nd Workshop:
  • Themes:

- Application of Basic Ethical Principles

- Research in Developing Countries: Standards of Care

- Standard Operating Procedures

- Establishing a Forum for Ethics discussion in Caribbean Countries: Caribbean Ethics Network

bioethics the last 5 years35
Bioethics: The last 5 years...
  • In 1999, a survey was conducted on the existence of Research Ethics Committees (RECs) across the 18 English-speaking Caribbean countries. 8 countries had such committees (with 1 country having 4 committees). At that time, these 11 RECs reviewed an average of 10 research protocols each year (with the numbers ranging from 1 to 25).
bioethics the last 5 years36
Bioethics: The last 5 years...
  • However, only 4 countries had a research ethics committee that was accessible to all research investigators regardless of their institutional affiliation.
  • Only 6 of these 11 RECs had a member with any training in research ethics. Further, of the 8 countries that had no REC, 7 believed that there was a need for one.
bioethics the last 5 years37
Bioethics: The last 5 years...
  • Also in 1999, 5 countries in the English-speaking Caribbean were represented at the UNAIDS Workshop on Research Ethics held in Brazil. The workshop was sponsored for countries who were or may become involved in research on the HIV/AIDS vaccine, and invitees comprised members of research ethics committees and specialists who might be involved in the HIV vaccine research.
bioethics the last 5 years38
Bioethics: The last 5 years...
  • Subsequent to these developments, in 1999, an Ethics Committee Handbook was written for the Faculty of Medical Sciences, UWI, in Jamaica .
  • During 1999 and 2000, the Faculty of Medical Sciences, UWI, in Trinidad and Jamaica developed and distributed Guidelines for the conduct of research with human subjects to all their departments.
bioethics the last 5 years39
Bioethics: The last 5 years...
  • In 2000, as a part of its health reform and re-structuring program, the Ministry of Health in Jamaica established an Advisory Panel of Ethics & Medico-Legal Affairs.
  • This Panel, in 2001,developed Guidelines for the conduct of research with human subjects across the island.
bioethics the last 5 years40
Bioethics: The last 5 years...
  • In 2003, the Panel conducted a Research Ethics Seminar for all Medical Officers of Health in charge of the parishes across Jamaica. These officers are now the first reviewers of research protocols across the island, with multi-center studies and proposed research involving more than minimal risk being referred to the Advisory Panel in the Ministry of Health.
bioethics the last 5 years41
Bioethics: The last 5 years...
  • The Panel has also developed Guidelines for the establishment of Clinical Ethics Committees in hospitals across Jamaica. However, these committees have not yet been established.
simultaneous with all this
Simultaneous with all this…

There has been an expanding interest in ethics and ethical standards:

  • 1 week of activities on Medical Ethics hosted by St. Vincent & the Grenadines in the eastern Caribbean (1996)
  • Ethical dilemmas in the management of terminally ill patients – Annual Conference, Jamaica Anaesthetist Assn. (1997)
simultaneous with all this43
Simultaneous with all this…

There has been an expanding interest in ethics and standards:

  • Ethical Issues in the treatment of HIV-positive Mother to prevent Mother-to-child transmission – a training workshop, Ministry of Health, Jamaica (1999).
simultaneous with all this44
Simultaneous with all this…

There has been an expanding interest in ethics and standards:

  • Bioethics: A new frontier – a Challenge for Policy-making, Law & Jurisprudence - A distinguished lecture to High Court Judges, Resident Magistrates, and Attorneys-at-Law in the Jamaican Justice System (1999)
simultaneous with all this45
Simultaneous with all this…

There has been an expanding interest in ethics and standards:

  • Genes and their impact: Social, Ethical, Moral & Religious Issues – Annual Conference of the Scientific Research Council of Jamaica (2000).
  • The 10th Annual Research Day of Activities, UWI, Jamaica, was on Research Ethics (2001).
simultaneous with all this46
Simultaneous with all this…

There has been an expanding interest in ethics and standards:

  • Human Cloning – The General Assembly of the Jamaica Baptist Union (2002).
simultaneous with all this47
Simultaneous with all this…

There has been an expanding interest in ethics and standards:

  • Medical Ethics & the Doctor-Patient Relationship Course established in the M.Sc. (Family Medicine), UWI, Jamaica (2001), and in the Family Medicine Diploma program in Trinidad (2000).
bioethics the last few years
Bioethics: The last few years…

Expanding interest in ethics and standards:

  • The annual conference of the Medical Association of Jamaica includes at least one topic on ethics (clinical or medical).
  • The West Indian Medical Journal (WIMJ) published an Editorial on the Role of the Health Care Ethics Consultant (1997).
bioethics the last few years49
Bioethics: The last few years…

Expanding interest in ethics and standards:

  • Since then, its has published a series on Bioethics:

- Issues in Bioethics: Teaching Medical Ethics to health professionals

- Issues in Bioethics: Ethics and Professional Responsibilities

- Issues in Bioethics: Teaching Research Ethics

bioethics the last few years50
Bioethics: The last few years…

Expanding interest in ethics and standards:

  • The Caribbean Health Research Council (CHRC) has included a chapter on Research Ethics in its Research Skills Workshop Manual (2003).
  • Radio interviews on many bioethical issues, e.g. cloning, in-utero diagnosis of diseases, euthanasia & physician-assisted suicide, ethical dilemma in harvesting semen from a deceased man for impregnation, etc.
in closing52
In Closing…
  • Emergent problems in the English-speaking Caribbean:

- Financing a decent minimum standard of health care for all the people in Caribbean

- Ethical issues in HIV/AIDS – access to care and discrimination in the society

- The financial impactof care for AIDS patients, as well as crime, violence & injury on scarce resources

in closing53
In Closing…
  • Emergent problems in the English-speaking Caribbean:

- The need for local research into the long-term safety of alternative medicine products being widely used across the Caribbean

in closing54
In Closing…
  • Emergent problems in the English-speaking Caribbean:

- Access to ethical review for all proposed research across the Caribbean

- Access across the Caribbean to advice in health care ethics