WHO provides common platform to countries to find common solutions to bioethics issues-Abha Saxena


 Bioethics conference at CBEC

WHO provides common platform to countries to find
common solutions to bioethics issues-Abha Saxena

Each country should prepare its National Bioethics Profile- Susan Vize

Developing world is a victim of economic exploitation- Adib Rizvi

KARACHI: WHO is providing leadership, shaping research agenda, defining norms and standards, articulating ethics and evidence based policy options in its programme of Global Health Ethics? This was stated by Dr. Abha Saxena from WHO while speaking on the WHO strategy on Global Bioethics collaboration at the three day International Bioethics Collaborative Conference organized by Centre of Biomedical Ethics and Culture, Sindh Institute of Urology and Transplantation at Karachi from April 18-20, 2017. The conference was organized by CBEC in collaboration with Center for Bioethics and Medical Humanities, Universities Gajah Mada Indonesia.

Ethics, Dr. Abha Saxena further stated has always been central to WHO and it was in 2002 that a separate unit of Research Ethics was created.  Its objective is to allow countries to come to common platform and find common solutions.  It has four staff members and two important components i.e. Public Health and Research Ethics. We have six regional focal points and most of the interns come from the developing countries for training.  They have to find their own resources. They come for PhD or Masters programme. There are also six weeks to three months courses wherein they work on some specific projects. He also talked about the Public Health Ethics consultative Group which incorporates ethics in technical guidelines. We are working on staff capacity strengthening besides development of drugs and vaccines. All these projects go through ethical review. Ethics Review Committee meets once a month and during 2014, it approved one hundred proposals. Our future plans include working on healthy aging and antimicrobial resistance. He also referred to Global Ethics Forum held in Berlin Germany where eighty Ethics Committees from all over the world were present. We also organized a Regional Summit and hopefully CBEC will be designated as one of the WHO Collaborating Center in the field of Bioethics, he remarked.

Dr. Ahmed Mandil from WHO EMRO talked about supporting Bioethics in the EMRO/WHO Region. He pointed out that IMEMR the regional Index Medicus has included seven hundred journals from the region representing twenty two countries.  He also talked about e Health and m Heath initiatives by WHO. Ethical Review Committee approves research grants for different projects. We also provide small grants for some public health projects. There are forty four WHO collaborating centers in the world of which four are in Pakistan and CBEC will be the 5th WHO Collaborating Center functioning in Pakistan, he added.

He also shared the results of Bioethics Survey in the region which consisted of fifty one questions. It showed that   84.5% of the institutions, countries have Ethics Committees but they have limited training facilities, unclear Terms of Reference, insufficient resources. There is gap between policy and practices, low level of bioethics education, illiteracy among patients besides lack of regulations on sensitive issues. WHO, he said, has recommended capacity building of healthcare providers, allotting resources for bioethics, input by civil society and other key stake holders. He also mentioned about the Regional Summit on Bioethics recently held at Muscat in Oman.

Ms Susan Vize from UNESCO Bangkok Thailand spoke about enhancing bioethics globally and the UNESCO strategy.  Bioethics, she said, was about values which vary according to culture, age and overtime. It is not possible to respect every principle but it is useful to seek many views. In some cases the patient may die but in certain cases the patient may be saved but has a very poor quality of life. We refer all such cases to ethics committees for decisions. She also talked about global, regional and national standards and pointed out that social responsibility is an ethical issue.  She also talked about the International Bioethics Committee and opined that each country should prepare National Bioethics Profile. We in the UNESCO do some ethics education, give advice on bioethics curriculum, and organize ethics training courses for teachers. She suggested that each country should develop its own case studies for teaching which will be much better. She also referred to the Global Ethics Observatory which gives lot of useful information which is available on UNESCO website.

Earlier Prof. Adib Hassan Rizvi from SIUT in his welcome address said that developing world is a victim of economic exploitation. We have two words, one is the first world with 20% population which has 80% of the world’s resources while the other world has 80% population but just 20% of world resources. Pakistan spends less than 1% of its GDP on Health, 85% of our population is deprived of modern healthcare, 50% live below the poverty line. Hence under such circumstances health becomes a luxury which many cannot afford. He then talked about the development of SIUT which had undergone transformation from a Urology ward to a Comprehensive Healthcare set up. Hence, we needed moral and ethical guidelines to keep pace with the modern world. That is why we established this CBEC at SIUT which has so far produced seventy seven graduates from Pakistan, Sri Lanka and Kenya.

In the second session Prof. Farhat Moazam Chairperson of CBEC discussed the challenges in Developing the first Center of Bioethics in Pakistan. She discussed in detail the ground realities, existional challenges, logistic challenges, programme development challenges. Minorities, she opined, are ignored or abused by Muslim society. We in Pakistan has a very polarized society. While in the West bioethics got birth due to campaign against the physicians, in Pakistan it was the physicians who introduced bioethics. It is said that we kill more people due to unethical practices. There have been revolution in interventional procedures, biotechnology and flourishing of the private health sector in Pakistan. We have seen gender selection using IVF. NBC was formed in Pakistan about ten years ago.  SIUT and CBEC was willing to support, help and cooperate with other institutions to promote bioethics in Pakistan, she added.

Dr. Aamir Jafary from CBEC discussed the CBEC programme making bioethics relevant. He pointed out that we wish to make the programme attractive.  Previously there was no institutional funding for bioethics and there was dearth of locally available faculty. Hence, we had to teach our teachers how to teach our students. He also talked about appropriate evaluation of Diploma and Masters programme as well as certificate course. So far six people have done Masters Course, 71 have earned Diploma in Bioethics and twenty students have attended the certificate course organized by CBEC.  We have now an alumni of seventy seven, have one hundred three publications and organized numerous workshops all over the country. We also undertake continuous evaluation besides having external review of our programme.

Dr. Shahid Shamim from Saudi Arabia talked about Evaluating Bioethics, Challenges and Strategies. He also talked about tools for assessment. Students, he said, are now more knowledgeable hence the job of teachers has become a bit difficult. He laid stress on motivation for learning, career implications, quality of care, and cost of assessment. He was of the view that it is the assessment which drives effective learning. He also referred to assessment in the middle of the course, feedback, scores, grades which take lot of time of the faculty. He suggested that one should use both tools for assessment of learning and assessment for learning. Ethics is an art, we should provide torch bearers of bioethics. Assessment, Dr. Shahid Shamim said should be of competency. He also referred to learning outcomes and teaching methodology, work based assessment and presentations.