PAHO Forum on Bioethics, Public 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

Dr. Derrick Aarons MD, PhD 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

Dr. Derrick Aarons MD, PhD Bioethics in Jamaica: 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.

Dr. Derrick Aarons MD, PhD Bioethics in Jamaica: 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.

Dr. Derrick Aarons MD, PhD Bioethics in Jamaica: 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.

Dr. Derrick Aarons MD, PhD Bioethics in 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.

Dr. Derrick Aarons MD, PhD Bioethics in Jamaica: 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.

Bioethics in Jamaica: Ethical Issues in the treatment of HIV-positive Mother to prevent Mother-to-Child transmission – A training workshop, Ministry of Health, Jamaica (1999).

Bioethics in Jamaica: 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)

Bioethics in Jamaica: 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.

Bioethics in Jamaica: 1 st Caribbean Ethics Conference – Jamaica Campus of the University of the West Indies, April 29-30, Theme: Research Ethics: A Global Concern – Opportunities and Challenges for Developing Countries.

Dr. Derrick Aarons MD, PhD Bioethics in Jamaica: 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.

Dr. Derrick Aarons MD, PhD 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

Dr. Derrick Aarons MD, PhD The work in Bioethics continues with… Discussions of topical issues in Bioethics in the Jamaican media The formation of the Bioethics Society of the English- speaking Caribbean (BSEC)

Dr. Derrick Aarons MD, PhD The work in Bioethics continues with… 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.

Dr. Derrick Aarons MD, PhD The work in Bioethics continues with…. 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.

Challenging issues… 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.

Challenging issues… 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.

Challenging issues… 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.