PAHO Forum on Bioethics, Public Health, and Health Policy PERSPECTIVES AND EXPERIENCES FROM JAMAICA...

PAHO Forum on Bioethics,PAHO Forum on Bioethics,Public Health, and Health PolicyPublic Health, and Health Policy

PERSPECTIVES AND EXPERIENCES FROM JAMAICA

Dr. Derrick Aarons MD, PhD

Consultant Bioethicist / Palliative Care & Family Physician

Ethical considerations of public health issues include:

The rights and responsibilities of health care personnel, researchers, patients and research participants, communities, and governments

The determination of which ethical theories are most appropriate for the particular situation:

- Deontological theories

- Utilitarian theories

- Principles of beneficence, non-maleficence, autonomy, and justice


Bioethics in Jamaica:

1991: Formal lectures to medical students in medical

ethics began at the Medical Faculty, University of the

West Indies, Mona, Jamaica

1991: Ethics Committee established by the Medical

Association of Jamaica

1994: Topics such as euthanasia and abortion were

added to the lecture series to medical students



1997: UWI/UHWI Research Ethics Committee

recommenced reviewing protocols for research with

human subjects at the University. The Committee

was chaired by the Dean of the Faculty of Medical

Sciences, with representation from the various

departments in medicine, the hospital lawyer, 2

representatives from the lay public (including a

member of the clergy), and a Bioethicist.



1999: An Ethics Committee Handbook was written

for the Faculty of Medical Sciences, UWI, in Jamaica

2000: The Faculty of Medical Sciences, Mona, UWI,

Jamaica developed and distributed Guidelines for

the conduct of research with human subjects to all

their departments.



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.

2001: The Panel developed Guidelines for the

conduct of research with human subjects across the

island of Jamaica.



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, but multi-centre studies and proposed

research involving more than minimal risk should be

referred to the Advisory Panel in the Ministry of

Health for evaluation.



The Advisory Panel has also developed Guidelines for

the establishment of Clinical Ethics (Health Care

Ethics) Committees in hospitals across Jamaica.

However, these committees have not yet been

established.


Ethical Issues in the treatment of HIV-positive Mother

to prevent Mother-to-Child transmission – A training

workshop, Ministry of Health, Jamaica (1999).


The West Indian Medical Journal WIMJ has

published a series on Bioethics, including:

- Issues in Bioethics: Teaching Research Ethics

(2003)

- Issues in Bioethics: Ethics in Health Policy

and Guidelines in Health Care (2006)


Numerous Radio interviews on various stations

across Jamaica on bioethical issues, e.g. The

ethics of face transplants, The ethics of surgery for

adult conjoined Twins joined at the head, human

cloning, in-utero diagnosis of diseases, euthanasia

& physician-assisted suicide, ethical dilemma in

harvesting semen from a deceased man for

impregnation, etc.


1st Caribbean Ethics Conference – Jamaica Campus

of the University of the West Indies, April 29-30, 2005.

Theme: Research Ethics: A Global Concern –

Opportunities and Challenges for Developing

Countries.



2006: HIV vaccine research began in Jamaica.

Much difficulty in obtaining healthy participants to

enroll, due to the stigmatization and fear in Jamaica

of anything to do with the word HIV.


The work in Bioethics continues with…

The review of research protocols by the Research

Ethics Committee at the UWI, Mona, and at the

Ministry of Health, Jamaica

Presentations of Bioethics topics at seminars and

conferences



Discussions of topical issues in Bioethics in the

Jamaican media

The formation of the Bioethics Society of the English-

speaking Caribbean (BSEC)



BSEC’s Mission is to to increase knowledge and

understanding through deliberations about bioethical

issues that are relevant to the English-speaking

Caribbean.

The Society currently has 66 members from across

the Caribbean.



. BSEC has established a Bioethics Discussion

Network, and will be facilitating the updating of its

members in areas relevant to Bioethics, the setting up

of research ethics and health care ethics committees

to serve territories within the Caribbean, and

advocating the formulation of ethical policies in health

and biology, biotechnology, health care, and research.

Challenging issues in Public Health

Challenging issues…

The need for respect of privacy and confidentiality in

public health care settings in Jamaica against the

background of very limited space with numerous

patients being present within earshot of doctor-patient

discussions.

Health care providers being overburdened in coping

with the number of patients, their attitude, their

impatience, general aggressiveness with some being

quick to verbally abuse.


The need for a policy for clinical practice, that would

stipulate that public sector doctors do not order HIV

antibody testing of patients without pre-test

counselling and the seeking of permission to test.

If one respects autonomy, how much should

unwilling commercial sex workers be coerced to

undergo HIV antibody testing for public health

planning purposes.


Against the background of autonomy, should pregnant

ladies be subjected to mandatory HIV antibody

screening to help protect the future welfare of their

newborn. Accompanying this, should there be

compulsory partner notification.

In Jamaica, contact tracing for HIV infection forms a

part of the traditional public health approach to prevent

communicable diseases, and reporting of all HIV

infection to the Ministry of Health is required by law.


Public health professionals who keep abreast of

recent scientific discoveries may find it difficult to

influence policy-makers in government who are more

preoccupied with community perceptions and

political considerations.

PAHO Forum on Bioethics, Public Health, and Health Policy PERSPECTIVES AND EXPERIENCES FROM JAMAICA...

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