siut centre of biomedical ethics and culture june, 2018 new.pdf · bioethics: hifting aradigms in...

Bioethics Links

Volume 14 Issue 1 June 2018

Centre of Biomedical Ethics and Culture

On April 11, 2018, the Aga KhanUniversity (AKU) Bioethics Group (BG)organized a symposium to commemorate its20th anniversary. For the occasion BGmembers and AKU faculty were joined bymany from the city who had been associatedwith the BG in the past but have moved on toother healthcare institutions where theycontinue to pursue bioethics related activities.The audience in the symposium reflected theunique role played by the BG in the growth anddissemination of bioethics in AKU and beyond,something that was perhaps not envisioned byits founders two decades ago.

The BG was formed in 1997, spearheadedby Dr. Farhat Moazam who was thenAssociate Dean, Postgraduate MedicalEducation Bioethics had been taughtto medical students since 1986 through theefforts of Dr. Jack Bryant, Chair Departmentof Community Health Sciences. ccording toDr. Moazam, the BG was formed to bring the

and practice of bioethics into theclinical settings involv clinicians andresidents. She gives credit to Dr. JamesBartlett, a psychiatrist and Dean of Faculty ofHealth Sciences, for generating her interest inbioethics. She recalls him handing her aHastings Center Report and later sponsoringher for a 5 day workshop at the KennedyInstitute of Ethics in Washington DC.

After her working paper on the proposedBG was discussed and approved in the Dean'sForum, department chairs were invited tonominate one member from their respectivedepartments in order to form the group. Thefirst BG meeting was held on June 13, 1997,attended by 8 members: 4 physicians (anephro log i s t , a neonato log i s t , ananesthesiologist, and a pediatric surgeon), 2nursing professionals, a clinical psychologistand a social scientist. Besides discussingTerms of Reference and th working paper,members were enthusiastic

,

, in AKU.

,A

educationby ing

eContinued on page 6

*Riffat Moazam Zaman, Professor, Department of Psychiatry, Aga Khan University, Karachi

Pakistan

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Dr. Riffat M. Zaman’s lead article looks back to the time when the Bioethics Group (BG) of theAga Khan University was conceived and traces its subsequent, unanticipated role as afountainhead for bioethics in Pakistan. CBEC alumni from Patel Hospital and ZiauddinUniversity describe the development of bioethics in their institutions, and a physician from theFederally Administered Tribal Areas writes about “discovering” bioethics. Also included is aphoto collage celebrating CBEC’s move to a new home in January 2018. Editor

On April 25, 2018, SIUT organised an event to commemorate

CBEC’s designation as a WHO Collaborating Centre for Bioethics

Pictured above from left to right: Dr. Adib Rizvi,

Dr. Farhat Moazam and Dr. Aamir Jafarey receiving the

WHO flag from WHO delegates, Dr. Andreas Reis and

Dr. Mohammad Assai Ardakani

Centre of Biomedical Ethics and Culture, SIUT, Pakistan

AKU Bioethics Group: Fountainhead for Bioethics in PakistanRiffat Moazam Zaman*

Do healthcare institutions act as moralagents? Can they acqu i re mora lcharacteristics through capacity building?Do individual clinicians get influenced byvalue-based organizational activities? Theseare difficult to answer philosophicalquestions. But this phenomenon has beenput to test in one of the healthcareinstitutions in Karachi.

Patel Hospital is a 250 bedded, not forprofit, community-based hospital whichinitially focused on the provision of generalsurgical and gynecology and obstetricsservices. But gradually, it evolved into atertiary care hospital providing multi-disciplinary care at affordable cost along withpostgraduate teaching and training.

Along with its growth n clinical andacademic fronts, Patel hospital has shownsignificant growth on the ethical front as well.It all started in 2004, when the clinical headof the institution, Dr. Tufail Bawa, asked me,the new inductee of the institution, todevelop a hospital ethics committee(HEC).Having been introduced to the ethicaldiscourse in patient care through ethicsconsultation and ethics grand rounds duringmy surgical training at the Aga KhanUniversity Hospital (AKUH), I had some clueas to the solution but was completelyignorant of the process.

O the lead faculty at C, Dr. Aamir

Jafarey, came to my rescue and helped theinstitution in developing procedures andprotocols for a HEC. That was the beginningof a never-ending relationship between

initiatingdevelopment as a moral agent.

Today we have:A Hospital Ethics Committee functioning

since 2004 as a clinical ethics committee as

well as an institutional review board

A medical error reporting and analysiscommittee as an offshoot of ethical discoursewithin the HEC on organizational ethics andmedical error

Ethical review of institutional policies as andwhen brought to the notice of the HEC by thestakeholders

Research ethics workshops for capacitybuilding in collaboration with CBEC

Three CBEC alumni associated with theinstitution, namely, Ms. Shabana Tabassum,Dr. Abeer Saleem and , are contributingto the ethical discourse via coordination andchairing of various institutional bodies dealingwith ethics and postgraduate ethics teachingprogram. Dr Saleem, in fact, continues to runthe postgraduate ethics teaching program evenafter moving to another institution.

thics an important element indecision-making at all levels within

, making it a moral agent for change.

o

the entre ofBiomedical Ethics and Culture

CBECand Patel hospital, the latter’s

-

forresearch-

-

-

-

myself

a.

E has becomePatel

Hospital

ne of

Together We EvolveNida Wahid Bashir*

*Nida Wahid Bashir, Head General Surgery, Patel Hospital, KarachiPGD Alumnus (2010), of

International students during CBEC’s Public Health and Research

Ethics Module, from April 23 to May 3, 2018, in Karachi. Seen

from left to right: Mr. Gideon Cornel Msee (Kenya), Dr. John

Weru (Kenya), Ms. Winfred Nazziwa (Uganda), Ms. Enas Khattab

(Qatar), Ms. Yvonne Opanga (Kenya) and Mr. James Nguya

Wanja (Kenya).

Bioethics LinksVolume 14, Issue 1 (June 2018)Pakistan

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I remember the day my friend andcolleague asked me to meet the secretary ofour hospital's ethical review committee(ERC) at KDLB Campus withinsix months of joining the institute. I wasnominated by the (late) chairman to be thenext secretary and started my journeytowards bioethics and the 'baggage' thatcomes with it.

My transition from being a ofthe hospital's ERC to doing a postgraduatediploma in bioethics and then becoming thechairperson of the committee has been quitean experience. We were three candidatesfrom this institute who did theirPostgraduate Diploma(PGD) in 2016 from the Centre ofBiomedical Ethics and Culture andwe already had three other

PGD graduates working at ZiauddinUniversity Hospital before us.

The ERC was well established in ouruniversity since 2008 but bioethicsactivities had been taking place in itsKeamari Campus as early as 200 . Still,very few people knew about this committeeor the bioethics activities. What our seniorshad started in promoting and teachingbioethics, the three of us took a stepforward. Amongst us we taught andintroduced bioethics to the postgraduates inour respective campuses onecolleague being a basic sciences teachertook up 3rd year undergraduate students.But that is not the only arena where westarted nudging people in this direction. Theuniversity supported us and with the help ofthe department of education, bioethics hasbeen inculcated in the undergraduatecurriculum,

Suddenly, we had quite a few 'non-

believers' take notice of the importance ofwhat we have been doing. It s a sad and avery common situation that the resistancehas always come from people in the positionof seniority, the 'old school' who did not missa single chance of making digs about 'somepeople need to learn about ethics, othersdon't'. We saw a reluctant change in thisgroup, particularly when they attended someof our sessions and realized that there was no'preaching' in bioethics, we simply spokeabout dilemmas that we all often face in ourpractice. This attitude has markedlychanged, not just in the classrooms but alsoin the faculty lounge, in the surgeon's room,in the administration and in many of theassociated committees of the hospital aswell as the University.

As a clinician, having a positive impacton the stakeholders of healthcare has meanthuge progress at a very important level. But,and I think my colleagues who have played apivotal role in promoting bioethics will agree,what we find most satisfying is seeing thechange in our undergraduates andpostgraduates. They will be the torch bearersand will hopefully take bioethics much furtherthan any of us have done so far.

that

in Keamari,

secretary

in Biomedical Ethics

(CBEC)colleagues who

were

7

while

something that bioethicspioneers in Pakistan have been advocatingand working toward.

i

Bioethics: hifting aradigms in Ziauddin University HospitalS PAruna Dawani, Qudsia Hassan, Fasiha Sohail*

*Aruna Dawani, Qudsia Hassan, Fasiha Sohail, PGD alumni (2016), Ziauddin University Hospital, Karachi

An MBE seminar during CBEC’s Research Ethics Module. Seen

from left to right: Dr. Moazam, Dr. Natasha Anwar, Dr. Francis

Muregi, Ms. Sualeha Shekhani and Ms. Sharmeen Khan


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The foundation must be sound: Dr. Moazam in action

Dr. Bushra, Ms. Sualeha &Ms. Anika in transit from

the old to the new

Shehzad, Loretta & Michelleorganize the new staff area The final touch: Dr. Aamir

polishes it up

Faculty, staff, students & alumni with WHO representatives in the “new” CBEC

CBEC gets a New Home, 7th Floor, SIUT Transplant Tower, January 2018


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From the Old to the New

From a congested seating area to a spacious one

From improvised working spaces in corridors to roomy, bright offices

From an old poky room for teaching students to a modern bright one


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in

in

a

irhistorical

biocannot be denied.

is being

ShaikhZayed Hospital, Lahore and Shifa College ofMedicine, Islamabad,

educating themselves; consequently, allmeetings included discussion of publishedpapers on clinical/research ethics.

The monthly 90-minute meetings of theBG provided a safe space to discussdilemmas faced in clinical care. By early1998, the group began undertaking activitiesmeant to include the larger AKU community.An Ethics Grand Round, the first such eventto be conducted in Pakistan, was held in theSchool of Nursing on March 27, 1998. Titled“Death with Dignity,” the format included apresentation by a resident about a 58 yearold, terminally ill, ventilator-dependent manadmitted in the ICU, whose son wanted totake his father home against medical advice.The session generated an enthusiastic andlively discussion by the well-attendedaudience, and Ethics Grand Rounds is apopular BG event that continues to date.

Also in 1998, the BG published a one-page, black and white newsletter, prepared inDr Moazam's office since few offices hadcomputers. This was replaced by a coloredand glossy 5 page version the following yearwith funds from the Dean whose help,encouragement, and accessibility wereintegral to the continuation of the BG. Thefirst formal “ethics consult” in the history ofAKU Hospital, and perhaps of the country,was sought from the BG by a surgeon about aventilator dependent 18-year old male withDown's syndrome. This landmark case wassubsequently published in

in 2003, in an article titled “Atthe Interface of Cultures.” In 2001, whilepursuing recognit ion by the JointCommission on International Accreditationthe hospital Medical Director turned to the BGfor help setting up the required HospitalEthics Committee (HEC). Several membersof the HEC, including its first Chair, were BGmembers.

In addition to ethics consults, the HECalso organized biennial symposiums thathelped take bioethics beyond AKU to others

interested in this field. A noteworthy event ofthe second HEC Clinical Ethics Symposium in2003 was the decision to create a city widebioethics group to include healthcareprofessionals from both private and publicsector institutions in Karachi. This idea waspursued by Dr. Nida Wahid Bashir, an AKUalumnus and a general surgeon at PatelHospital, and the Karachi Bioethics Group(KBG) was born in 2004 with members from11 hospitals in Karachi. Fourteen years later,KBG continues to meet every two months with

different hospital playing host to the groupeach year.

The BG (with now twice the number ofmembers than at its inception) continues inAKU and focuses on revisions, expansionsand methodologies best suited to teachingbioethics in the undergraduate and postgraduate curriculum. However BG'sposition as the fountainhead of ethics inPakistan Its founding chair,Dr. Moazam, left AKU in 2000 to pursue a PhDfrom the Department of Religious Studies inthe University of Virginia. She returned toPakistan to set up the Center of BiomedicalEthics and Culture (CBEC) in SIUT which wasinaugurated in October 2004. She was joinedin CBEC by Dr. Aamir Jafarey who hadreturned after completing a fellowship inresearch ethics from Harvard University andalso happened to be among the earliest BGmembers. Several former and current BGmembers continue to interact closely withCBEC including as teaching faculty in itsprograms.

CBEC is the only institute in Pakistanwhich provides formal postgraduate educationin bioethics and awards graduate level degreesin the discipline. Through the Center's alumni,bioethics introduced to students,trainees, clinicians and researchers ininstitutions across the country such asZiauddin University Hospital, Karachi,

to

The Journal ofClinical Ethics

“AKU Bioethics Group: Fountainhead for Bioethics in Pakistan” from page 1

Continued on page 8


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O my God!I got it 9 years later. Can you believe ?You plant a tree and you forget it. You

forget it for 9 years and suddenly you realizethat it is important to water it. How can youjustify this act of ignorance? Maybe youcannot.

When I received a letter from the healthdirectorate of the Federally AdministeredTribal Areas (FATA) to participate in a twoday workshop for health professionalsarranged by the National BioethicsCommittee of Pakistan my mind wasnot clear about how helpful it would be. Butafter attending the workshop, I told Dr.Moazam that I intend to write for the firsttime, and that is on bioethics.

I graduated in 2009 as a doctor. At thattime I had no idea about this vital subjectwhich is known as bioethics. Although wehear about the ethics which is fundamental inlife, we know but little about professionalethics. Today, while thinking as a doctor,bioethics is so fundamental for a healthprofessional, just as water for a tree.Healthcare profession in the absence ofbioethics and moral obligations is just like atree without water which loses all its charm.In the current era of scientific advancement,the field of healthcare is no exception. Withmuch advancement in the field of medicineand research the role of bioethics hasincreased manifold. In developed nations,bioethics is keeping pace by formulating newlaws and obligations, but where do we stand?

We are far behind in building a standardfoundation which is ethically and morallyacceptable for our community and healthprofessionals to stand on. So what can bedone? Who will do it? How can it be done?And from where should we start?

Not going into much detail, being a new

student to the subject and lacking the requiredexpertise, I will highlight the core place wherebioethics has been ignored. That core place isthe medical curriculum at graduate level wherebioethics is not taught as a basic subject (atleast, as far as I know from the curriculum ofmy province). Currently we are producingdoctors with very little knowledge regardingbioethics. Although the NBC is currentlyholding workshops for health professionals,this is a very small number getting trained. Inmy view, the best way is to develop a nationalconsensus and approach the Pakistan Medicaland Dental Council to include bioethics in thecurriculum of the graduation course in themedical colleges/universities throughout thecountry. The emphasis on the subject ofbioethics should not be less than on any othersubject in the curriculum of medical graduates.

There remains a lot to be done. But I amthankful to the NBC for providing me theopportunity to learn about the basics ofbioethics regarding medical practice andresearch. I will be much pleased to continue todevelop my understanding of bioethics in thefuture.

that

(NBC) ,

*Dr. Himayat ullah, Fellow, The Field Epidemiology & Laboratory Training Program (FELTP), Pakistan

Following a CBEC Forum on Astronomy, “Among the Stars,” with

Mr. Abubaker Shekhani on April 27, 2018, participants

queue up to view the night sky through a telescope

set up on the CBEC terrace.

Bioethics Where e tand: Do W S ?Himayat Ullah *


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Workshop participants discuss the role of media in enhancing public

knowledge about organ donation

As part of,

public aboutorgan donation

h ,e

large

R

On thesecond day,

r of

the SIUT National Conferenceon Organ Donation and TransplantationCBEC hosted a workshop on the importance ofmedia in advancing knowledge

. Moderated by Mr. GhaziSala uddin, an esteemed journalist and Dr.Farhat Moazam, th workshop attracted a

number of participants from bothelectronic and print media.

On the first day, the diverse groupdeliberated upon the different avenues thatcan be utilized within media to enhance publicawareness. ecommendations includedconversations about the topic on morningshows, using celebrities to increaseawareness and utilizing popular forms ofmedia such as films and TV dramas.

rapporteurs Dr. Rubina Naqvi andDr. Aamir Jafarey presented theserecommendations to the large audience theconference.

Workshop on Role of Media

n Public Education

April 2 21, 2018

i

0 -

Centre of Biomedical Ethics and CultureSindh Institute of Urology and Transplantation

7th Floor, Transplant Tower, Yaqoob Khan Road

Near Civil Hospital, Karachi 74200, Pakistan.

Phone:(92 21) 9921 6957

Email: [email protected] www.siut.org/bioethics

With the recent spate of dangerousepidemics, like SARS, H1N1, Ebola andZika, the World Health Organisation (WHO)has been working on different fronts toaddress the various challenges that theworld faces. In addition to making guidelineson the ethics of provision of healthcare andconducting research in epidemics, the worldbody has also recently focused on the ethicalaspects of controlling vectors responsiblefor the transmission of many of theseinfections. Dr. Aamir Jafarey was involved intwo of these consultations aimed at devisinga set of guidelines for the ethical limits ofcontrolling vectors, in February 2017 andrecently, in May 2018 in Vienna.

“AKU Bioethics Group...” from page 6

n

nwith the BG

.Funded by a grant,

began last year, replicating

CBEC’s educational programs

ame a few. CBEC faculty and its alumni aremembers of the National Bioethics Committeeof Pakistan, and the Center was recentlyawarded the status of WHO CollaboratingCenter for Bioethics. The ripples that bega

twenty years ago are nowspreading beyond the borders of Pakistan

NIH the CBEC-KEMRITraining Initiative to developformal bioethics training in Kenya

.

WHO Initiative on Ethics and

Vector-Borne Diseases

Dr. Aamir Jafarey (second from right) along with WHO meeting

participants in front of the Josephinum at the Medical University,

Vienna where the May 2018 meeting was hosted



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