The Ethics of Artificial Intelligence & Robotics - Bioethics Caribe Newsletter

EDITOR’S NOTE

G. Sirju Charran Editor

I urge you to read these articles and more importantly to click on the link provided to share your views with all members so that not only do we begin a conversation with the authors and among ourselves, but we would all gain further insights on these issues.

Only one article was received on the deadline date for submission which was on August 15, 2022 and the decision to hold this article for the next issue was disrupted by an e mail received on August 20 from Derrick Aarons who submitted a substantial article with two appendices. With some urging from the President as well as another message being sent out to members on September 20 requesting submissions for Member’ s Accomplishments ( since only one was received by that date), the date for submission was opened up and three more articles were received the last one being on September 03. I hope you forgive the delay in publication.

Four of the five articles in this issue address ethical considerations of advanced technologies which have the possibility to change humanity in unimaginable ways. The fifth article was submitted by Cheryl and addresses the role of bioethics in Climate

Change, a timely article, given the environmental disaster that is being experienced worldwide at this time. Athene explores the ethics of AI and Robotics. Derrick proposes a regulatory framework for AI Health research in the Caribbean which is further supported by two appendices . Appendix A is a letter penned to the Ministers of Health with a recommendation for adopting research regulations to protect research participants and Appendix B is the draft position paper on Human Subjects Research in the Caribbean. Chavez discusses the role of AI in Pharmacy and the Pharmaceutical Industry and Shereen makes a case for the responsible stewardship of advanced technologies. I hope you give these articles the attention they deserve as forerunners to the annual forum in November on the Ethics of AI and Robotics.

Shereen Dawkins Cox JP, MA, Bpharm, Dip Pharm

PRESIDENT’S MESSAGE

It is that time of year when our Executive engages members and a wider audience at our annual forum. This year we will focus on the very important topic: “Ethics of Artificial Intelligence and Robotics”. Artificial intelligence, machine learning, data science, robotics are all buzz words for now and the future. In fact, the future is now. We have no choice but to embrace technology and the digital era. Historically, ethicists are inclined to discuss the negative implications of research and innovation and rightly so. Someone has to be the voice of reason to temper the passions. However, we ought to also be balanced. Dialogue should highlight and encourage innovation while safeguarding the wider societal interests. The aim of this upcoming forum is to have that kind of engagement highlighting the prospects in the best possible light, noting the risks, suggesting how we can avoid the negative implications. The phrase “Ethics by design” is one to take note of by both ethicists and innovators. The Sienna project, an EU funded venture, describes ethics by design as:

“ an approach to design that aims at the systematic inclusion of ethical values, principles, requirements and procedures into design and development processes.”

With this in mind, the Executive of BSEC is targeting relevant stakeholders in the Caribbean to join the conversation on AI and Robotics. A conversation we hope will continue beyond the forum where we can develop policy positions on how we may promote creativity and ethical innovation within our region in the area of AI and robotics. There is a plethora of applications and career possibilities within this field. In addition to two feature speakers, we will also have a student presentation on a robotics project from one of our regional technology universities. We invite the members to join us on November

13, 2022 at our annual forum (register online) and to extend the invitation to others to join our society so we can continue to make a meaningful contribution to the development of our individual countries and region.

We hope this theme based newsletter will stimulate interest. The featured articles are written by our members and covers healthcare and other related fields.

Shereen Dawkins Cox President

Athene Aberdeen BA, MA, Theology 2003, 2011, Master Degree in Global Bioethics 2021

MEMBERS’ ARTICLES

The Ethics of Artificial Intelligence and Robotics Athene Aberdeen

Whether we continue to resist the technological imperative or deal with what Pope Francis calls “the technocratic paradigm”, Artificial Intelligence or AI is here to stay and continues to impact what our future holds in healthcare. (1) This area is now one of heightened research and development, driven no doubt by the quick implementation of health apps during the COVID 19 pandemic. There is also heightened attention towards having common ethical guidelines for AI use. (2) However, it is well known that ethical analyses can barely keep pace with AI developments, and there is a lack of common goals among developers themselves. (3) This short reflection therefore concentrates on the basics of moral/ethical considerations that affect the dignity of human persons, the objects of AI. Some observations on AI use in healthcare for small developing countries compared to developed ones will also appear. This topic is timely since the impact of AI in healthcare is one of global import.

What exactly is AI and how do we distinguish its various forms? According to the Bioethics

Briefing Note by the Nuffield Council (2018) there is no universally agreed definition of AI. They define the term broadly to include computing technologies that resemble processes associated with human intelligence, such as reasoning, learning and adaptation, sensory understanding, and interaction. What is of interest is that most applications of AI are narrow, in that they are only able to carry out specific tasks or solve pre defined problems. In other words, human persons like engineers and doctors specify what the machine must do in order to get a particular response. Artificial Intelligence thus draws on principles and tools, including from mathematics, logic, and biology to make sense of varied and unstructured kinds of data. The most successful type of AI in recent years says Nuffield, is Machine learning or ML, and it is the underlying approach of many of the applications currently in use. (4) The fact that ML does not follow pre programmed instructions, but can allow systems to discover patterns and derive its own rules when presented with data and new experiences demand greater attention to be placed on the nature of the human interaction. The use of ML in healthcare thus warrants attention to the ethical considerations that would arise. While the rapid development of technological capabilities points the way toward new discoveries and large scale analyses, numerous critical ethical issues have been identified, spanning privacy, data protection, transparency and explainability, responsibility, and bias. One reference of bias is presented below for it has wider implications than its original context of the USA. (5)

In 2019 as reported by Obermeyer et al, a commercial prediction algorithm affecting millions of patients was shown to exhibit significant racial bias, dramatically underestimating the health needs of Black patients. Personnel were trained using health care cost as the proxy for the need

The Ethics of Artificial

for more comprehensive care, and the algorithm had been designed specifically to exclude race as a feature, in an attempt to avoid bias. However, cost was clearly not a race neutral measure of health care need. Studies have repeatedly illuminated racial disparities in the provision of primary care services in the USA: Black patients incur less in medical costs per year compared to white patients with the same number of chronic conditions. They are also less likely to be identified as high risk for complex care in the future. The question is what should have been the best proxy to use to train the algorithm, and would it have led to a “better” algorithm and fair patient outcomes. We need to remember that the engineers and programmers of ML and all AI tools gather the data from within the community. Every community has its cultural and value laden practices that define human beings and human interaction, including healthcare. Without safeguards from within to address long standing social, cultural, and institutional biases, to inform the development and implementation of machine learning in healthcare applications (ML HCAs), the above scenarios will occur. As Char et al (2020) cautioned, the concept of value ladeness of technology is well established in applied ethics and in Science and Technology studies; discrimination in the context of ML HCAs can result from biased training data as well as contextual factors of attitudes and political convictions of stakeholders. There are as well contexts of the social and economic disparities think of the elderly, the structure of the healthcare system and the means of its financing, or the overall level of technological development of a country. (6) The last point is also pertinent to our Caribbean context.

The role of stakeholders including bioethicists would therefore encompass most of the following practices and procedures: establishing who oversees the inspection of all ML HCAs, since every health device must undergo specific trials; who makes the decision about the length of time for the device trial, and what criteria would be applied to the performance standard? Also, who is responsible for the decisions made by AI systems? Will increasing use of AI lead to a loss of human contact in care? For example, what can be the effects on people's sense of dignity and social isolation in care situations? For it is well known that AI in many instances restores the function of the person without any consideration over the deeper causes of ‘dysfunction’ a person with mental health issues is a case in point. Such a scenario should serve to remind us that human beings are both material and spiritual. On the other hand what can be the effects on the roles and skill requirements of healthcare professionals? The idea of developing empathy with patients come to mind, will that skill eventually become less important? What happens if AI systems are hacked? Above all, to whom would legal and moral responsibility be assigned? The last question is very timely. The growing and more widespread use of AI has led some ethicists, policymakers and the general public to question whether artificial entities such as robots warrant rights or other forms of moral consideration. We are also reminded that the newest generation of medical robots not only function as agile extensions of the human eyes and hand, but they have become skilful and smart partners to their human counterparts. (7) The ethical considerations of robots in medicine cannot be dealt with here but there is considerable coverage in the literature review on the subject by Harris and Anthis (2021).

As a result of the Covid 19 management strategy, a partnership with the government of India and the UNDP was entered into in 2021 to introduce robotics and telemedicine systems to Trinidad and Tobago. (8) The project named HALT “Bringing High and Low Technology to Covid 19 in TT” began in September. The aim was to develop space for digital technology like telemedicine medical consultations through automated solutions that will allow patients to do routine medical consultations over the internet, or to be registered and screened at a health centre or hospital while they wait to be vaccinated. This this use of AI has been established elsewhere for it does provide increased access to medical care for persons who live in rural areas, and, for those afraid to go to the hospital or who are physically challenged. The reduction of burdens on the healthcare system which affects nurses, doctors, and auxiliary staff is also well established. It is too early to say in 2022, how far this project has developed and how well the medical sector which one suspects is suffering from burnout as a result of Covid duty has been able to access such training. However, such a project monitored as it by PAHO and the WHO and implemented by the Ministry of Health and with technical support from the University of Trinidad and Tobago (UTT), can be seen as a necessary first step for the eventual remote patient monitoring i.e., accessing remote clinical service or RPM that developing countries are moving toward.

Artificial Intelligence is transforming the telehealth landscape. Ethically, however, all stakeholders must be prepared and trained to be able to have trust in such services. Unlike the metropoles with vast populations, unlimited access to health financing and research, a preoccupation with cost benefit services and a population more attuned to the fundamental shifts in how they are being cared for, we in Trinidad and Tobago and the wider Caribbean have to be gradually transitioned into a meaningful healthcare landscape: one in which there is an even broader ethical question to be raised, and raised very early What changes does AI bring to our understanding of human nature? When we seek to make decisions about what sort of treatment is suitable, for ourselves or for others, we are weighing up a number of things, like equity and power and cultural sensibilities. In the final analysis we are seeking with the help of AI to make healthcare more human not less so, as we extend our professional capability in these islands of the Caribbean.

The Ethics of Artificial

The Ethics of Artificial

REFERENCES:

1. Pope Francis. (2015). Laudato si’: On Care for Our Common Home. Encyclical Letter, paragraphs 101 14. Catholic Truth Society.

2. Wojtulewicz, Christopher. (2022). AI Ethics in Healthcare. Pastoral Review Vol 18, Issue 3, July Sept. 2022. From page 2: In recent years, the cogs have been turning on the production of AI ethics guidelines. In 2019, the European Union’s High Level Expert Group on AI produced ‘Ethics Guidelines for Trustworthy Artificial Intelligence’. In the same year, the Alan Turing Institute, in partnership with the UK Government, produced the document Understanding artificial intelligence ethics and safety: A guide for the responsible design and implementation of AI systems in the public sector (by David Leslie). In 2020, the Pontifical Academy for Life sponsored the ‘Rome Call for AI Ethics’ which has garnered high powered signatories and supporters. UNESCO produced a ‘Recommendation on the Ethics of Artificial Intelligence’, which was adopted on 23 November 2021.

3. Mittelstadt, B. (2019). Principles alone cannot guarantee ethical AI. Nat Mach Intell 1, 501 507 https://doi.org/10.1038/s42256 019 0114 4

4. Nuffield Council on Bioethics. (2018). Artificial Intelligence AI in healthcare and research. Briefing Note, May 2018.

5. McLennan, S., Lee, Meredith M., Fiske, Amelia., and Leo Anthony Celi (2020). AI Ethics Is Not a Panacea, The American Journal of Bioethics, 20 (11): 20 22, DOI: 10.1080/15265161.2020.1819470

6. Char, D.S., Abramoff, M.D., and C. Feudtner. (2020). Identifying ethical considerations for machine learning healthcare applications. The American Journal of Bioethics 20 (11):7 17. doi: 10.1080/15265161.2020.1819469

7. Harris, J., Anthis, Jacy Reese. (2022). The Moral Consideration of Artificial Entities: A Literature Review. Science and Engineering Ethics (2021) 27 53.

8. Chaitram, Ria. (2021). US 1m for robotics, telemedicine system for Trinidad and Tobago’s Covid 19 fight. T&T Newsday, Thursday, October 21, 2021, Online, at newsday.co.tt See also Media release from the United Nations Trinidad Office October 21, 2021. [Accessed on: 13/07/2022].

Dr. Derrick Aarons MB.BS.(UWI); M.Sc. (Bioethics); PhD (McGill)

Consultant Bioethicist and Family Physician

Member of the Executive Council of RedBioetica UNESCO

MEMBERS’ ARTICLES

Needed For The Caribbean: A Regulatory Framework For A-I Health Research

Dr. Derrick Aarons

Introduction:

The convergence of Artificial Intelligence (A I ), big data methods, and microsystems engineering makes AI based algorithms for computational neuroscience one of the fastest growing fields of neuro medical research (IBC, 2021). A I algorithms in clinical neuroscience research may be used in several ways, e.g., to detect early signs of Alzheimer’s disease and mental illness (IBC, 2021). However, ethical issues such as incidental findings with privacy concerns, transparency and bias, and algorithm discrimination may arise in the process (Social and Human Sciences Commission, 2021).

Further, continuous risk monitoring may be needed when A I medical devices are being researched or being used in research endeavours, and so responsive regulatory mechanisms must be in place (Ho, 2021). Therefore, to protect the participants in such research processes, robust

and appropriate regulations for research involving artificial intelligence should be implemented across all Caribbean countries, which would be in keeping with the aims of the research protections proposal that were made in 2015 within the Caribbean Community and Commons Market (CARICOM) (Aarons, 2019).

Regulating Research:

In 2015, the Caribbean Public Health Agency (CARPHA), the regional public health institution in the Caribbean with the responsibility for providing strategic direction in analyzing, defining, and responding to the public health priorities of the 24 member states across the Caribbean, presented the Ministers of Health of the Caribbean Community (The COHSOD) with a ‘green paper’ proposal to regulate the conduct of research with human participants to provide ‘best practices’; ensure consistency and harmonization throughout the Caribbean; and through legislation protect the inhabitants of countries in the region from ‘ethics dumping’ and harmful exploitative research activities (Aarons, 2019).

The COHSOD was requested to establish a regional regulatory framework for research involving human participants by approving model legislation for CARICOM countries to regulate research along with regulations for sanctions for non compliance (See Appendix A Letter to Ministers of Health). The specific recommendations were:

“CARPHA’s Research Ethics Secretariat recommendations to CARICOM Ministers of Health is presented in the draft position paper in Appendix B

1. The establishment of a Regulatory Framework for the conduct of research with human participants based on research ethics principles and standards and including the following requirements:

i. all researchers must apply for approval from an appropriately designated research ethics

ii. an appropriately constituted research ethics committee with the required legal authority shall review all research proposals that involve human participants;

iii. all approved research should be monitored for the well being of research participants by the research ethics committee.

2. The preparation of a model legislation for CARICOM countries to regulate research with human participants. The legislation should contain the provision of appropriate sanctions for non compliance.

3. That CARICOM Ministers of Health approve the Proposals for implementation of a regulatory framework in principle, and agree to their adoption as Policy, pending the implementation of the process for enactment of legislation.” (Appendix B ).

CARPHA’s proposal was put to the vote and approved unanimously by the COHSOD, with the approved green paper being sent to the CARICOM headquarters in Guyana for the legislative drafters to draft the legislation (See Appendix B Draft Position Paper on Human Subjects Research in the Caribbean). To date, nothing further has been heard on the matter.

Artificial Intelligence in health research:

With the current accelerated use of A I in the collecting and processing of health data for research, including discovering associations in the health data of populations and assessing impacts of algorithms for interventions in health ethical review of such protocols will require research ethics committee (REC/IRB) members to be cognizant of the particular ethical challenges that arise with the use of AI in health research, and will therefore need update training. The legislation and regulations being drafted at the CARICOM Headquarters will also need updating to address these new challenges.

In 2016, the Caribbean Public Health Agency developed a network of RECs/IRBs across the Caribbean (called CANREC) and provided research ethics training for the twenty one member committees of the CANREC (Aarons, 2019). The contents of these training workshops included: i) The ethical principles in research with human participants; ii) Evaluation of value and scientific validity; iii) Fair selection of research participants; iv) Informed Consent, Confidentiality, and Conflicts of Interests; v) Research methodologies; vi) Assessing risks and benefits; vii) Vulnerable populations; viii) Oversight and Monitoring of ongoing research; ix) International Guidelines for Biomedical Research; and x) International Collaborative Research.

Such REC/IRB training has facilitated the conducting of the ethical review of health research protocols across the Caribbean at a high standard (Aarons, 2017). Further, the research ethics review processes in the various countries of the Caribbean have been harmonized to some degree through the work of CARPHA and the CANREC. However, except for Guyana and the Bahamas, national legislation for research with human participants is yet to be enacted in these countries. Consequently, it is opportune to update the model draft legislation for the countries of CARICOM presumably being currently prepared at the CARICOM headquarters to address many of the new ethical issues posed by the use of artificial intelligence in health research.

Needed for the Caribbean

Needed for the Caribbean

Conclusions:

Most RECs/IRBs across the Caribbean may not have the A I experience or the expertise needed to conduct an appropriate risk assessment of proposed health research that involves artificial intelligence. RECs/IRBs will therefore need the necessary skills to perform adequate risk/benefit assessments, evaluate the model of consent proposed by researchers, and assess any complex algorithms to be used in the health research. Consequently, research regulations should require REC/IRB members to undergo annual (or biannual, depending on available local resources) update training to keep abreast of new developments in the field of artificial intelligence and their ethical implications.

At these update training sessions, REC/IRB members should be required to discuss particular challenges to implementing A I in Caribbean research, including inadequate access to reliable and affordable internet, unreliable power infrastructure across many of the lower and middle income communities of the Caribbean, the lack of human resources, too little education and insufficient skills among local populations, inadequate local investments, and the risk of job losses that A I and automation may produce. These deliberations will provide REC/IRB members with better insights when they seek to provide solutions to the ethical challenges they will meet in reviewing the research protocols submitted to them.

The regulations being drafted should also address the specific challenges posed to consent, privacy and security, and the power imbalances between A I data collectors and research participants to engender public trust in the research endeavours. In addition, the regulations should stipulate the need for public engagement in all such research projects by requiring the involvement from the conceptual stages of not only community representatives but also representatives from vulnerable or marginalized groups where the research may involve them, to inform the design of the research, assist in identifying and mitigating unforeseen risks, assessing possible local and community benefits, and facilitating transparency.

With the expansion of the scope of these draft regulations in seeking to protect not only individuals and their interests but also to balance the risks and benefits to society, a more robust, if not comprehensive research ethics framework would have been facilitated for the countries of the Caribbean to address the new realities and challenges posed by the use of artificial intelligence in health related research.

Needed for the Caribbean

cont

d REFERENCES:

1. International Bioethics Committee (IBC). Report of the International Bioethics Committee of UNESCO (IBC) on the Ethical Issues of Neurotechnology. Paris; December 2021: SHS/BIO/IBC 28/2021/3 Rev.

2. Social and Human Sciences Commission (SHS) of UNESCO. Recommendation on the Ethics of Artificial Intelligence. Report of the SHS, 41st UNESCO General Conference, 2021: pp. 14 39.

3. Ho, Wai Loon C. Bridging the Research Therapy Divide in the Regulatory Governance of Artificial Intelligence as Medical Devices. In Laurie, G et al (Eds). The Cambridge Handbook of Health Research Regulation; Cambridge University Press. 2021; pp. 277 286. DOI: http://dx.doi.org/10.1017/9781108620024.035

4. Aarons D. The historical development of research ethics in the English speaking Caribbean. CANREC Bull.2019; 1(1): 3 7.

5. CARPHA (The Caribbean Public Health Agency). (2015). Draft Position Paper on Human Subjects Research in the Caribbean. A submission to the CARICOM Ministers of Health (COHSOD), PAHO Headquarters, Washington DC.

6. Aarons D.E. Research in epidemic and emergency situations: A model for collaboration and expediting ethics review in two Caribbean countries. Developing World Bioethics Journal Jul.2017; 00:1 10. https://doi.org/10.1111/dewb.12157

A:

Letter to Ministers of Health to accompany Template for Research Regulation

B:

Draft Position Paper on Human Subjects Research in the Caribbean

APPENDIX A

Letter To Ministers Of Health – To Accompany Template For Research Regulation: Dr. Derrick Aarons

Dear Minister:

RE: REGULATION TO PROTECT RESEARCH PARTICIPANTS IN YOUR COUNTRY

CARPHA hereby invites you to commence the enactment of Regulations to protect research participants in your country.

The legal regulation of research as well as research ethics are important because the human subjects of research may be harmed. Further, not all risks can be predicted in advance, hence laws should be written to ensure compensation from research harms.

The history of modern research is replete with scandals and abuses of research participants. Whilst the world knows about the research abuses that occurred in the Nazi experiments during World War II where the intended outcome of very many experiments was the death of the victims (e.g. plutonium injected into hospitalized patients to study bio distribution of radioactive material in the human body; cereal with tracer doses of radioactive isotopes fed to boys in a school for the mentally handicapped), there have been less well known experiments all over the globe in which subjects were harmed.

Some include live cancer cells injected into elderly patients, carcinoma in situ in the cervix being allowed to run its course for observation without any treatment intervention, and mentally retarded institutionalized children being injected with hepatitis virus to study immunity. More recently in one of our Caribbean countries, there was a research proposal which sought to use human faeces to produce gas, as a sustainable initiative. However, only vulnerable persons from a certain area of the society would have been targeted for their faeces!

Due to the trusting nature of many of the Caribbean’s research naïve inhabitants, research protection for these persons should be enshrined in the law of the country. The Caribbean basin now hosts a large number of offshore medical schools, colleges, and local institutions that require research be done by enrolled students and tutors. Further, Caribbean countries have very limited resources and their inhabitants are vulnerable to exploitation by overseas sponsors of research and researchers who are very aware of minimally functioning ethics review committees and policies, and the varying literacy levels among inhabitants in many of our countries. Some Caribbean countries have Research Ethics Committees to evaluate research proposals and protect potential participants from harm, but such committees do not have the backing of specific law addressing research in the country.

Nearly all developed countries have such laws to protect their inhabitants in research. CARPHA hopes that our Caribbean member states will similarly move to protect all inhabitants through appropriate legislation similar to that suggested by the attached Template for Research Regulation.

Sincerely, Derrick Aarons MD, PhD, Ethicist

The Caribbean Public Health Agency (CARPHA)

APPENDIX B

Draft Position Paper On Human Subjects Research In The Caribbean

Dr. Derrick Aarons

Preamble:

This paper draws attention to the need by CARICOM Ministers of Health to regulate the conduct of research with human participants to provide best practices, ensure consistency and harmonization, and protect the countries in the region from harmful exploitative research activities through legislation as a matter of urgency.

STATEMENT OF THE ISSUES:

The international standards to be met:

Research: Research is a step into the unknown, but it is essential to gain new knowledge that benefits individuals and society Because research seeks to understand something not yet known or revealed, it often entails risks to research participants and to others. History offers unfortunate examples where research participants have been needlessly, and sometimes profoundly harmed by research, sometimes even dying as a result.

Consequently, research with human participants should be carried out only by, or strictly supervised by, suitably qualified and experienced investigators and in accordance with a proper research protocol that has been scientifically and ethically appraised by one or more suitably constituted review bodies, independent of the investigators. As required by the Declaration of Helsinki, the Council for International Organizations of Medical Sciences (CIOMS), and other International Health Research Regulatory bodies, all proposals to conduct research involving human participants must be submitted for a priori review of their scientific merit and ethical acceptability to an ethical review committee. The investigator must obtain their approval or clearance before undertaking the research.

Sanctions: Ethical review committees (research ethics committees) generally have no authority to impose sanctions on researchers who violate ethical standards in the conduct of research involving humans. These committees should be required to monitor the implementation of an approved protocol as well as its progression, and to report to governmental authorities or project sponsors any serious or continuing non compliance with ethical standards in the protocol that were approved by the research ethics committee. Failure to submit a protocol to the committee or to adhere to the approved protocol should be considered a clear and serious violation of ethical standards, and subject to an appropriate sanction.

The ethical review of research: Contemporary research often involves collaborative partnerships among researchers from multiple countries or sites. Researchers and sponsors from outside the Caribbean region should submit their research protocols for ethical and scientific review in their own country as well as in the Caribbean country in which research is proposed, and the ethical standards applied should be no less stringent than they would be for research carried out in developed countries. The health authorities of the researched country, as well as any national or local

research ethics committee, should ensure that the proposed research is responsive to the health needs and priorities of the researched country and meets the requisite ethical standards.

Vulnerability to exploitation: Before undertaking research in a population or community with limited resources, the sponsor and the investigator must make every effort to ensure that:

the research is responsive to the health needs and the priorities of the population or community in which it is to be carried out; and

any intervention or product developed, or knowledge generated, will be made reasonably available for the benefit of that population or community.

This is a CIOMS guideline that is concerned with countries or communities in which resources are limited and the extent to which they are, or may be, vulnerable to exploitation by sponsors and investigators from the relatively wealthy countries and communities.

It is not sufficient simply to determine that a disease is prevalent in the population and that new or further research is needed; the ethical requirement of "responsiveness" can be fulfilled only if successful interventions or other kinds of health benefit are made available to the population. This is applicable especially to research conducted in countries where governments lack the resources to make such products or benefits widely available. Even when a product to be tested in a particular country is much cheaper than the standard treatment in some other countries, the government or individuals in that country may still be unable to afford it. If the knowledge gained from research in a less developed country is used primarily for the benefit of populations that can afford the tested product (i.e. developed countries), the research may rightly be characterized as exploitative and, therefore, unethical. Various types of harm to research participants are also always possible.

If an investigational drug has been shown to be beneficial, the sponsor should continue to provide it to the subjects after the conclusion of the study, pending its approval by a drug regulatory authority.

If there is good reason to believe that a product developed or knowledge generated by research is unlikely to be reasonably available to, or applied to the benefit of the population of a proposed host country or community after the conclusion of the research, it is unethical to conduct the research in that country or community.

Right of injured subjects to treatment and compensation: Investigators should ensure that research subjects who suffer injury as a result of their participation in research are entitled to free medical treatment for such injury and to such financial or other assistance as would compensate them equitably for any resultant impairment, disability or handicap. Further, that in the case of death as a result of their participation, their dependents are entitled to compensation. Research participants must not be asked to waive the right to compensation.

Strengthening capacity for ethical and scientific review of biomedical research: In externally sponsored collaborative research, sponsors and investigators have an ethical obligation to ensure that biomedical research projects for which they are responsible in less developed countries contribute effectively to national or local capacity to design and conduct biomedical research, and

to provide scientific and ethical review and monitoring of such research. Capacity building may include, but is not limited to, the following activities: establishing and strengthening independent and competent ethical review processes/ committees strengthening research capacity developing technologies appropriate to health care and biomedical research training of research and health care staff educating the community from which research subjects will be drawn

External sponsors and investigators have an ethical obligation to contribute to a host country's sustainable capacity for independent scientific and ethical review and biomedical research. Before undertaking research in a host country with little or no such capacity, external sponsors and investigators should include in the research protocol a plan that specifies the contribution they will make. The amount of capacity building reasonably expected should be proportional to the magnitude of the research project.

What is happening in some Caribbean countries:

Many Caribbean countries lack the capacity to assess or ensure the scientific quality or ethical acceptability of biomedical research proposed or carried out in their jurisdictions. Some CARICOM countries have established research ethics committees (RECs), some have committees in name only, while some do not have any type of ethics committee. For those who have RECs, whilst a few members of these committees may have received some training in research and research ethics, the majority of members are in need of specific training in the international ethical standards to be met for research in developing countries. A recent survey by the Caribbean Public Health Agency (CARPHA) of research ethics committees currently working in the Caribbean revealed that they varied widely in their ability to properly evaluate research proposals, that their members were all volunteers who sometimes could not meet to carry out the work of the committee effectively, that some have resource shortages, and that all would welcome training for their members.

In many developed countries, research with human participants is governed by regulation or legislation that specify the terms and conditions to be met in carrying out research within their various jurisdictions. For example, in the USA (from whence the majority of sponsors and researchers come for research in our Caribbean countries), the HHS Regulations, 45 CFR part 46, govern all aspects of research with human participants. The International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) brought together the regulatory authorities of Europe, Japan, and the United States to produce the Guidelines for Good Clinical Practice that was adopted by several countries, including Canada, for clinical trials research.

The UK Clinical Trials Regulations 2004 stipulate that the regulations are intended to protect the rights, safety and well being of research participants, and to simplify and harmonize regulatory processes. The European Union Clinical Trials Directive and the Oviedo Convention have been ratified by several European countries, and reflect ethical principles regarding research with human participants upon which a broad consensus across Europe has been reached. These and other legal instruments are referred to and referenced where appropriate, and it is required that researchers and research ethics committees comply with all the relevant laws in those countries.

In the Caribbean, only Guyana has any regulation that addresses medical research involving human participants. However, that regulation now needs updating to address matters such as the fair selection of research participants, specific safeguards for confidentiality, the right of research injured participants to appropriate treatment and compensation, and enforcement and penalties.

Some Caribbean countries are presently being approached for conducting drug studies and similar research because they are viewed as not having the very stringent ethical requirements for research that exists in the more developed countries, and where the costs of conducting research is far less. Where local expertise does not exist to properly evaluate these research proposals to the international ethical standards, and law does not exist to specifically protect the participants in research, then local participants may be exploited and harmed. Ethically, harms may not only be physical, but also psychological/emotional, social, financial/ economic, and legal.

A regional Research Ethics Committee now exists at CARPHA, and is fully constituted with experts to give support in all matters of research and research ethics. If invited to do so, CARPHA can also provide training in this area.

PROPOSALS FOR ADDRESSING THESE CONCERNS:

CARPHA’s Research Ethics Secretariat hereby recommends the following to CARICOM Ministers of Health:

1. The establishment of a Regulatory Framework for the conduct of research with human participants based on the principles and standards outlined above and including the following requirements:

i) All researchers must apply for approval from an appropriately designated national or regional research ethics committee before embarking on research

ii) An appropriately constituted research ethics committee with the required legal authority shall review all research proposals that involve human participants

iii) All approved research should be monitored for the well being of research participants by the research ethics committee

2. The preparation of a model legislation for CARICOM countries to regulate research with human participants. The legislation should contain the provision of appropriate sanctions for non compliance.

3. That CARICOM Ministers of Health approve the Proposals for implementation of a regulatory framework in principle, and agree to their adoption as Policy.

4.This Policy will have immediate effect, pending the implementation of the process for enactment of legislation.

Submitted by:

Derrick Aarons MD, PhD

Ethicist The Caribbean Public Health Agency (CARPHA)

Chavez Foster Pharmacist

Artificial Intelligence in Pharmacy and the Pharmaceutical Industry

Chavez Foster

A Few months ago, I was invited to Stanford University’s 2022 graduation from the Faculty of Computer Science and Engineering. I was in awe at the number of Ph.D. theses in Artificial Intelligence (AI) and the realisation that these works were poised to unlock a lot of information which could enable greater conveniences in numerous specialties and disciplines of life. This was a great reminder of how much the world is evolving, and that the demands of mankind are burgeoning as we try to do more work in a shorter time. It should therefore come as no surprise, that artificial intelligence is being explored at depths, to help us create solutions and grow businesses. Dr. V.R. Palanivelu and Sona Vasanthi (2020) noted in a study that AI is seeing the most growth in the business sector, as companies can reach bigger audiences with great efficiency in services. AI’s popularity and utilization are growing and making a great impact in numerous fields. Harvard Business Review contributors Thomas Daveport and Rajeev Ronanki (2018) also highlighted that cognitive technologies are increasingly being used to solve business problems; indeed, many executives believe that AI will substantially transform their companies within three years.

Artificial Intelligence refers to the stimulus of machines to dispense human/human like intelligence. Machines are being programmed to think independently and produce human like responses. Professor John McCarthy (2004) while at Stanford University defined Artificial Intelligence as the science and engineering of making intelligent machines, especially intelligent computer programs. It is related to the similar task of using computers to understand human intelligence, but AI does not have to confine itself to biologically observable methods. Tech research and consultancy company Gartner Inc (2022) underlines the fact that AI applies to advanced analysis and logic based techniques, including machine learning, to interpret events, support and automate decisions, and take actions. AI can be grouped as strong AI (machine learning and deep learning applications) and weak AI (Siri, Alexa, and facial recognition).

Traditionally the thought of computer programs exhibiting human intelligence has led to numerous conversations about “opening pandora box”; ethical considerations; and job security. However, Artificial Intelligence has helped us to solve numerous problems over years and created numerous solutions. AI is becoming increasingly popular and IBM Cloud Education (2020) lists a few of the common AI systems examples as Speech Recognition, Customer Service, Computer Vision, Recommendation Engines, automated stock trading, and fraud detection. These are systems we utilize daily to make life easier and less complicated from Siri to Alexa and facial recognition to more complex applications as seen in the tesla cars. AI boasts and promises growth and success in numerous disciplines and fields. Healthcare is one such field, specifically pharmacy and the pharmaceutical industry.

Artificial Intelligence in Pharmacy

The Pharmaceutical Industry has experienced tremendous growth in recent decades as a result of AI. AI is now being utilized in drug discovery and development, as well as the analysis of clinical trial data. Pfizer stated that thanks to process and technology optimizations, including a new machine learning tool known as Smart Data Query (SDQ): the COVID 19 vaccine clinical trial data was ready to be reviewed a mere 22 hours after meeting the primary efficacy case counts. Drug companies are progressively partnering with tech companies to meet increasing demands for cures and treatment options with minimal side effects. Sanofi and Atomwise recently crafted a billion dollar partnership that will see the utilization of the AI platform Atomnet, to uncover and study up to five drugs. Softigel by Procaps has been creatively improving the technologies used to create softgels and other dosage forms, to aid the mode of administration and improve adherence. Several of the top pharmaceutical companies are partnering with AI organizations to develop systems to add value to their marketing, research, and productivity.

AlphaFold is an AI program that can predict protein structures; this program recently opened the doors to endless possibilities in drug discovery. There is also nano robotic AI which is being utilized to improve drug delivery and minimise adverse events.

The pharmacist’s role continues to evolve with a widened scope of practice. Pharmacists are increasingly pressed with administrative responsibilities, phone calls, and documentation among other tasks. In 2017, the International Pharmaceutical Federation (FIP) shared data from a survey of seventy four responding countries and territories, representing 5,614 million people (76 % of the world’s population), which revealed that out of a total of 4,067,718 licensed or registered pharmacists, only 2,824984 are actively practicing. This may indicate a need for more pharmacists, but it is also an opportunity for pharmacies to consider the utilization of more AI applications in the dispensaries. The varying tasks in the dispensary sometimes result in a shortened time with patients. AI has the potential to impact the way the dispensary operates positively. Pharmacies can benefit from applications to improve patient compliance, support patient interventions and adherence, along with analyzing data to support guidelines and healthcare policies, amongst other things.

Fitbits and tracking devices are very popular and can capture health data for patients that can impact their respective therapeutic management. Pharmacies can utilize these devices in their community health programs. Automated Delivery Systems (ADS) are used to dispense and supply patients’ medication. Director of Pharmacy Practice Laboratories at Wingate University

Dr Nicholas Ferencz (2014) noted that ADS are an opportune way for patients to obtain drugs, but only if a pharmacist and other caregivers can intervene, when needed, before administration of the drugs received through such systems. There is also Kirby, which can count large quantities of tablets and capsules. The software in the dispensaries is becoming more eloquent to capture drug interactions and prescription related problems while flagging discrepancies.

Inventory, Telemedicine, emails, and automated response are areas poised to benefit meaningfully with AI applications in the dispensary. Researchers at Harvard John A Paulson School of Engineering and Applied Sciences (SEAS) shared their findings on the use of AI systems to identify those who may be better suited to promote healthy behaviors in social groups and reduce associated risks.

The ethical concerns for artificial intelligence are numerous. AI is revolutionary and the need for ethical guidelines and committees to address the issues around Data Protection, Patient Privacy, Biases & Prejudices in creating AI Algorithms, Environmental Impact, Politics, the possibility of AI replacing Humans, and transparency in AI software, is growing exponentially. The conversation of opening pandora's box became more popular recently after a former Google engineer, Blake Lemonie (2022) voiced concerns about LaMDA, a google application in the works that potentially possess sentient abilities, in addition to human intelligence. How much is enough? At what point do we stop these AI explorations? Will sentient machines with machine learning abilities replace humans? Who will be responsible for possible errors in AI software? These are just a few questions that need consideration as the conversation surrounding AI evolves. Mankind is constantly searching for ways to make life easier and more efficient; but how much is enough? Jeff Goulbum in the Famous Jurassic Park Movie (1993) said, “Your scientists were so preoccupied with whether or not they could that they didn’t stop to think if they should.” Some pundits believe that the hype around AI will fade with time, as some of the predictions are overly ambitious. The developments continue to evolve, and as such, it is an opportune time for ethical groups and pharmacy groups to become a part of the conversation in their respective regions to maximize the utilization of AI for benefits; and reduce the postulated risks.

Artificial Intelligence has played and continues to play a pivotal role in disease prevention, diagnosis, and treatment in the healthcare sector. There are several issues to be addressed about Artificial Intelligence, but there are also with numerous prospects to be explored for a brighter tomorrow. There are several research currently being pursued with the hopes of making greater impacts and advances. Government officials, healthcare policymakers, ethicists, and AI technocrats should ensure that ethical concerns are addressed and that these intelligent technologies will propagate more good with minimal harm. Under Secretary General for Political and Peacebuilding Affairs Rosemary DiCarlo (2022) told the United Nations Secretary Council that “We have a critical opportunity to build consensus on how digital technologies can be used for the good of people and the planet while addressing their risks; But collective action by Member States remains essential towards this goal”. Pharmacists and Pharmacies should align themselves to seize and create newer opportunities via training and workshops in AI. Whilst the initial cost to implement some of these AI applications may seem exorbitant, with the correct strategy and system, the returns are likely to worthwhile

Artificial Intelligence in Pharmacy cont’d

Artificial Intelligence in Pharmacy

References

1. Blake Lemonie 2022, Google Engineer on his sentient AI claims interview with Bloomberg Technology. Retrieved August 1, 2022, from https://www.youtube.com/watch? v=kgCUn4fQTsc

2. Caricom 2022, More consensus needed over digital technology for ‘people and the planet’ Retrieved August 07, 2022, from: https://today.caricom.org/2022/05/24/more consensus needed over digital technology for people and the planet/

3. Gartner Inc 2022, Gartner Glossary: Artificial Intelligence (AI). Retrieved September 16, 2022, from https://www.gartner.com/en/information technology/glossary/artificial intelligence

4. IBM Cloud Education 2020, Artificial Intelligence (AI), retrieved August 02, 2022, from: https://www.ibm.com/cloud/learn/what is artificial intelligence

5. John McCarthy 2004, What is Artificial Intelligence? Retrieved August 02, 2022, from: http://jmc.stanford.edu/articles/whatisai/whatisai.pdf

6. Leah Burrows 2021, AI can help reduce the risk of HIV in high risk communities Retrieved August 07, 2022, from: https://news.harvard.edu/gazette/story/2021/02/using ai to reduce the risk of hiv/

5. Nicholas Ferencz 2014, Safety of Automated Dispensing System. Retrieved August 07, 2022, from:

6. https://www.uspharmacist.com/article/safety of automated dispensing systems

7. Pfizer, how a Novel ‘Incubation Sandbox’ Helped Speed Up Data Analysis in Pfizer’s COVID 19 Vaccine Trial. Retrieved August 07, 2022, from: https://www.pfizer.com/news/ articles/ how_a_novel_incubation_sandbox_helped_speed_up_data_analysis_in_pfizer_s_covid_19 _vaccine_trial

8. Rosemary DiCarlo 2022, Remarks by Under Secretary General Rosemary DiCarlo to the Security Council on Technology and Conflict. Retrieved August 01, 2022 from: https:// dppa.un.org/en/remarks under secretary general rosemary dicarlo to security council technology and conflict

9. Thomas Davenport and Rajeev Rononki 2018, AI and Machine Learning: Artificial Intelligence for the Real World. Retrieved August 07, 2022, from: https://hbr.org/2018/01/ artificial intelligence for the real world

10. VR Palanivelu and B Vasanthi (2020), Role of artificial intelligence in business transformation retrieved August 06, 2022, from: https://www.researchgate.net/profile/Palani Velu/ publication/345304894_ROLE_OF_ARTIFICIAL_INTELLIGENCE_IN_BUSINESS_TRANSFO RMATION/links/5fa24741a6fdccfd7b9b7be0/ROLE OF ARTIFICIAL INTELLIGENCE IN BUSINESS TRANSFORMATION.pdf

Shereen Cox

President, Bioethics Society of the English Speaking Caribbean

Doctoral Research Fellow, Centre for Medical Ethics, University of Oslo

Scientific Progress and Ethics: the Responsible Stewardship of Technological Advancement

By: Shereen Cox

"Scientific progress makes moral progress a necessity; for if man's power is increased, the checks that restrain him from abusing it must be strengthened" (Madame de Stael)

Technological advancement over the past century has made what was once considered fiction a reality. While many gave no more than a passing thought to the drama of fighting deviants in science fiction movies released by Marvel and DC movie industries, others were fascinated by the possibilities. Imagine being invincible and evading death (immortality) like Wolverine or to get to live through centuries and never age like Captain America (longevity). Significant investments by a group of individuals who are purporting a philosophy known as transhumanism are realizing some of these fantasies that were was once considered only an excellent script for the movies. We are now on the cusp of a new paradigm of living an era where human lives are intertwined with technology. An era where technology is so advanced that algorithms guide clinical diagnosis and treatments, and cure disabilities. Technological advancement is geared towards human enhancement cognitively, physically, and socially. The spectrum includes gene therapy, regenerative medicine, advanced bionic technology (cyborgs), and applications of artificial intelligence in research and health. These enable advancement in managing disease and have provided possibilities for longevity and enhanced levels of intelligence, key features of the so called transhumanist movement.

Transhumanism is a philosophical belief that advancements in science and technology will transform humans beyond our current capabilities. This is becoming a growing and highly controversial global sociopolitical movement (Porter, 2017). Despite the controversial dimension of transhumanism, we must acknowledge that mankind is progressing scientifically, and the plethora of possibilities and repercussions will be the subject of endless debates by scientists, moral philosophers, anthropologists, social scientists, politicians, and ordinary citizens. One scholar early in the discourse on the impact of technology on human life is David Collingridge. He disputed what is now notably known as the Collingridge Dilemma. He posits that with the advancement in technology, society is faced with both an information problem and a power problem. Firstly, it is difficult to predict the consequences of technology during the developmental stage (information deficit), and secondly, it is hard to control the technology once it has become part of society (Genus & Stirling, 2018; Wikipedia, n.d.). Adam Thierer describes this dilemma as the pacing problem in that it is challenging to manage technological advancements when the technology is outpacing the regulation of the technology (Thierer, 2018). An approach to this dilemma is responsible research and innovation, where innovation is allowed but with measures to ensure accountability a form of preemptive control (Genus & Stirling, 2018)

Other scholars have argued for accountability as a suitable response to the Collingridge dilemma, however, accountability may be reactive, e.g. punitive measures for scientific misconduct without addressing the issue of prevention, a key point when discussing the precautionary principle. The precautionary principle is predicated on avoiding harm when faced with uncertainty.

Scientific Progress and Ethics

Sven Ove Hansson notes, "It is mandatory to limit, regulate, or prevent potentially dangerous technologies even before the scientific proof is established". He outlines four components for responsible stewardship in regulating technology. These are:

1) the threat component, expressed in the phrase "potentially dangerous technologies";

2) the uncertainty component, expressed in the phrase "even before scientific proof is established";

3) the action component, expressed in the phrase "to limit, regulate, or prevent"; and

4) the prescription component, expressed in the phrase "is mandatory"(Hansson, 2009).

The WHO promotes six principles for ethical and scientific progress in technologies such as AI. These are also applicable to advanced bionic technology (man/machine integration), regenerative medicine, and genetic manipulation. The principles are 1) protecting human autonomy, 2) promoting human well being and safety and the public interest, 3) ensuring transparency, explainability, and intelligibility, 4) fostering responsibility and accountability, 5) ensuring inclusiveness and equity, and 6) promoting AI that is responsive and sustainable (WHO, 2021c). The guiding principles are comprehensive and provides a framework for discourse on balancing science with technological advances. Technological advancements in human genome research, AI and regenerative medicine are creating possibilities beyond our imagination but hopefully not beyond our control.

References

1. Genus, A., & Stirling, A. (2018). Collingridge and the dilemma of control: Towards responsible and accountable innovation. Research Policy, 47(1), 61 69. https://doi.org/10.1016/ J.RESPOL.2017.09.012

2. Hansson, S. O. (2009). Risk and Safety in Technology. Philosophy of Technology and Engineering Sciences, 1069 1102. https://doi.org/10.1016/B978 0 444 51667 1.50043 4

3. Jensen, S. R. (2020). SIENNA D3.4: Ethical Analysis of Human Enhancement Technologies https://doi.org/10.5281/ZENODO.4068071

4. Porter, A. (2017). Bioethics and Transhumanism. The Journal of Medicine and Philosophy:A Forum for Bioethics and Philosophy, 42(3), 237 260. https://doi.org/10.1093/jmp/jhx001

5. Reinares Lara, E., Olarte Pascual, C., & Pelegrín Borondo, J. (2018). Do you want to be a cyborg? The moderating effect of ethics on neural implant acceptance. Computers in Human Behavior, 85, 43 53. https://doi.org/10.1016/J.CHB.2018.03.032

6. Thierer, A. (2018). The Pacing Problem, the Collingridge Dilemma & Technological Deter minism. In The technology Liberation Front https://techliberation.com/2018/08/16/the pacing problem the collingridge dilemma technological determinism/

7. WHO. (2021c). WHO issues first global report on Artificial Intelligence (AI) in health and six guiding principles for its design and use. In World Health Organisation. https://www.who.int/ news/item/28 06 2021 who issues first global report on ai in health and six guiding principles for its design and use

8. Wikipedia. (n.d.). Collingridge dilemma Wikipedia. Retrieved March 18, 2022, from https:// en.wikipedia.org/wiki/Collingridge_dilemma

Dr. Cheryl Cox Macpherson PI, CREEii Professor and Head, Bioethics Division St. George’s University

What Can Bioethicists Do About Climate Change?

Dr. Cheryl Cox Macpherson

Industrial policies that drive global emissions higher and higher cause climate change. In that sense, climate change is an unwanted side effect of policy involving globalization, economic development, and industry. Climate change makes our home on planet earth less healthy for our families and for the rest of earth’s growing global population. In addition to the fossil fuel and agricultural industries that are responsible for the lion’s share of global emissions, the healthcare industry is estimated to contribute significantly to global emissions. Healthcare, with its commitment to promoting and maintaining health, undermines health through its emissions. As a wealthy, valued, and influential industry, one can argue that healthcare has both capacity and responsibility to adopt environmentally sustainable policies and practices. Health systems in the United Kingdom, United States, and elsewhere demonstrate that it is possible to deliver current standards of care while making large improvements in environmentally sustainability.

From clinical to research and public health ethics, bioethicists help communicate complex ideas about autonomy, truth telling, patient centered care, and resource allocation, to name a few. They do this for diverse stakeholders in varied locations and contexts. The ability to do this effectively can be applied to climate change, the causes and consequences of emissions, and associated ethical concerns about resources and injustices. Bioethics literature on topics like justice, the built environment, genomics, and One Health is increasingly touching on climate change. Bioethicist authors of such work are thus subtly helping to drive environmental sustainability and reduce global emissions production. Reducing emissions today delays damages to ecosystems and the resources these provide for health and healthcare, and brings present and future benefits. Although advocacy and activism are not the main function of bioethics, and bioethicists have other professional commitments to fulfil, many bioethicists perceive advocacy and activism as inherent to their routine work.

Bioethicists in clinical settings, academia, research, and public health aim to increase public understanding of health issues at stake, improve patient outcomes, and influence policymaking. With emissions wreaking havoc through extreme floods in Puerto Rico, Florida, Alaska, Pakistan, Bangladesh, and beyond (in September 2022 alone), too few bioethicists acknowledge any connection between emissions or environments and their professional aims or work. Examining global emissions or industrial policy in the context of routine bioethics activities can expand and deepen understanding of the trade offs being made by decision makers. It might better inform decision makers and consumers, with global benefit. Such work is a form of advocacy within the realms in which bioethicists function and are influential.

Health is worsened by emissions through extreme weather, sea level rise, global warming, and other manifestations of climate change which weaken the stability of institutions and democracies and escalate unprovoked violence around the world. Bioethics position within healthcare is reason enough to engage.

What can bioethicists do cont

It might start (as Bruce Jennings and others have called for) by re defining individual autonomy as embedded within populations, ecosystems, and the socioeconomic and physical environments that bear on health, access to care, and the type and standard of care available. Individual autonomy exists only within relationships to others and environments. Bioethicists can help improve understanding among diverse stakeholders, from the public to policymakers, students, and others, about the significance of these relationships.

Persistent advocacy and activism by early bioethicists drove the shift from paternalistic and Hippocratic standards of medicine to current standards that value autonomy and informed consent. This same energy can be applied to environmental sustainability within healthcare and healthcare education. Bioethicists (and other professionals) can encourage related discussion within their institutions, among their students, and with their colleagues. The interdisciplinary nature of bioethics lends itself to multidisciplinary collaborations that are needed to make a meaningful difference in global emissions. Bioethicists should learn about and highlight for others the benefits of and for healthcare organizations that implement more environmentally sustainable policy and practices, for example, with respect to supply chains.

Bioethics is embedded in healthcare, and healthcare is responsible for a large percentage of global emissions. Bioethicists can inform and influence at least some health systems and organizations about the benefits of adopting environmentally sustainable policies and practices. They should take industrial emissions production seriously. As consumers, they should reduce their own contributions to the problem (eat local, choose local products and those with less packaging, fly less often, use less energy, produce less landfill waste, etc.). As professionals, they should reflect on ethical concerns about the well documented harms of emissions, and the relationships, harms, and benefits of actions that produce industrial levels of emissions. That the main industrial emissions producers benefit commercially from doing so is one such concern. Bioethicists are positioned to facilitate related dialog in their workplace through webinars, journal clubs, or on coffee breaks. They should integrate the causes and consequences of emissions into their routine work whether in clinical practice, education, research, or policy. Each effort helps build momentum toward environmental sustainability which is needed for a healthy and well future for ourselves, our grandchildren, and people around the world.

d

Acknowledgment: This article draws from a paper by Cheryl Macpherson in a forthcoming special issue of Perspectives in Biology and Medicine addressing bioethics responses to the ‘deleterious effects of failed health and social policy’ and from her 2022 editorial in Global Bioethics

MEMBERS’ ACCOMPLISHMENTS

Dr. Derrick Aarons

2022: Ethics Consultant, The Caribbean Public Health Agency (CARPHA) Co coordinator and Co Editor of the International Bioethics Committee (IBC) Prelimi nary Draft Report on “The Principle of Solidarity and Cooperation”

Tutor Masters in Bioethics, St. George’s University, Grenada, Universidad Autonoma de Queretaro, Mexico, and Clarkson University, USA Caribbean Research Ethics Education Initiative

Member The IBC Bureau of UNESCO

Member The Executive for the Caribbean Association of Medical Councils (CAMC)

PEER REVIEWED JOURNAL PUBLICATIONS:

Aarons Derrick. Deliberations on Principles of the Universal Declaration on Bioethics & Human Rights: Summary of The Principle of Protecting Future Generations. IBC Newsletter, UNESCO 2022; Vol.3: p.13 14.

Aarons Derrick. Ethical considerations during a Pandemic. BioethicsCaribe. Feb. 2022: 9 14.

KEYNOTE ADDRESSES:

1. July ’22:“The multi-faceted issue of abortion” and “Legal Prohibition: Public good or legislating morality?” The Annual Ethics Conference, the Association of General Practitioners of Jamaica

2. Jan. ’22: “The ethical use of social media among medical professionals” Medical Council of Jamaica Ethics Webinar 2022

3. Dec. ’21: “Final draft Report on the Principle of Protecting Future Generations” International Meeting of the International Bioethics Committee (IBC) of UNESCO

REGIONAL PRESENTATIONS:

1. Apr.’22: “Vital Communications in Medicine: Informed Consent & communication with Relatives” Surgeons Association of Central Jamaica

2. Oct.’21: “Ethical Considerations During a Pandemic” Conference, Antigua & Barbuda Medical Council

INTERVIEWS:

The Ethics of Organoids Interviewed by the University of Norway for the new European project, HYBRIDA, on the regulatory framework for organoid research and gene editing and cloning technologies around the world Jun’21

Accomplishments Cont

Prof. Cheryl MacPherson

RESEARCH SUPPORT (2 active)

ACTIVE R25 TW009731 01 Administrative Supplement 09/01/22 08/30/23

CC Macpherson PD/PI

ACTIVE R25 TW009731 01 (Renewal) 02/01/20 12/31/24

R25 TW009731 01 06/01/14 12/31/18

CC Macpherson PD/PI

NIH Fogarty International Center. Caribbean Research Ethics Education Initiative

PUBLICATIONS

1. Can bioethics do for our planet what it’s done for autonomy? Perspectives in Biology and Medicine. Invited. submitted June 2022.

2. Macpherson C. Global bioethics: it’s past and future. Global Bioethics. January 2022. 31;33 (1):45 9.

3. Jennings NP, Chambaere K, Macpherson CC et al. Medical end of life decision making in a small resource poor Caribbean country: a mortality follow back study of home deaths. Ann Palliat Med 2021. Online First. https://dx.doi.org/10.21037/apm 21 1793

PRESENTATIONS

1. Macpherson, CC. How bioethics can help mitigate climate emissions. Invited speaker. Ethical Perspectives on Health Impacts of Climate Change: NordForsk Conference. Umea, Sweden and virtual. 22 23 September 2022. https://www.nordforsk.org/events/2022/ethical perspectives health impacts climate change

2. Jennings N, Chambaere K, Macpherson CC, Cox K, Deliens L, Cohen J. Medical end of life decision making in a small resource poor Caribbean country: a mortality follow back study of home deaths. Health systems research 7th global symposium (III HSG Pre Conference in the Americas). Jan 18, 2022.

3. Macpherson, CC. Promoting research ethics around the globe (panelist). Bioethics Program of Clarkson University and Icahn School of Medicine at Mount Sinai: 20th Anniversary Speaker Series. January 14, 2022.

4. Macpherson, CC. Panelist: Ethics, Climate Change, and Future of Work (in webinar series ‘Ethics and the Future of Work’). The University of Colorado’s Center for Bioethics and Humanities and Center for Health, Work & Environment at Colorado School of Public Health. Nov 22, 2021.

5. Macpherson, CC, Cummins P, Romero Zepeta, H. Bilingual education for research ethics. SGU Research Day, October 24, 2021

6. Noel N, Macpherson, CC. Climate Change and Bioethical Challenges for Low and High Resource Countries. SGU Research Day, October 24, 2021

Accomplishments

Shereen Cox, Doctoral Research Fellow

MEETINGS

Empirical Bioethics Summer School, Amsterdam UMC & VU university

PUBLICATIONS

Cont

 Shereen Cox, Jan Helge Solbakk, Rosemarie D. L. C. Bernabe. (2022) Research ethics commit tees and post approval activities: a qualitative study on the perspectives of European research ethics committee representatives. Current Medical Research and Opinion 0:0, pages 1 11.

2. Cox, Shereen, Seetharaman,Hariharan. (2022) Off label use of pharmaceutical drugs during the COVID 19 pandemic: Reflections from the English Speaking Caribbean Redbioetica UNESCO. 2022 https://redbioetica.com.ar/wp content/uploads/2022/07/RELATO SOBRE CARIBE INGLES Cox Seetharaman.pdf

3. Cox S, Solbakk J, Bernabe Rosemarie, The role of research ethics committees after the approval of clinical trial protocols in the EU and the USA: a descriptive content analysis of international and regional normative documents. Current Medical Research and Opinion https://doi.org/10.1080/03007995.2021.1905621 (2021) 37(6) 1061 1069

PRESENTATIONS

1. Professional Ethics in Pharmacy Practice, Guyana Pharmacy Association, February 2022

2. Data Protection Act and Pharmacist: From Confusion to Compliance T Geddes Grant Virtual Webinar, Jamaica, July 2022

3. A Duty to care: Ethics and Pharmacy Practice, Cayman Pharmacists Association, July 2022

Sherry Ephraim Le Compte, Vice President, BSEC

APPOINTMENT

Recently appointed member of CARPHA REC

PRESENTATION

Presentation on local REC to the Minister and PS of Health Wellness and Elderly Affairs in Saint Lucia.

Athene Hilary Aberdeen, Facilitator (Retired).

AWARDS

Masters Degree in Global Bioethics Dec. 2021from University of Anahuac, Mexico. A Collaboration of Anahuac, UPRA in Rome and /UNESCO Chair in Bioethics.

Accomplishments Cont

Prof. Donald Simeon

PUBLICATIONS

1.Bolleddula J, Simeon D, Anderson S, Shields L, Mullings J, Ossorio P, Bethelmey A, Kasafi Perkins A (2022) No person left behind: Mapping the health policy landscape for genomics research in the Caribbean. The Lancet Regional Health Americas Volume 15, 100367. https:// doi.org/10.1016/j.lana.2022.100367

2.Ramdass MJ, Gonzales J, Maharaj D, Simeon D, Barrow S. Breast Carcinoma Receptor Expression in a Caribbean Population. Surg J (N Y). 2022 Sep 19;8(3):e262 e265. doi: 10.1055/s 0042 1756632. PMID: 36131945; PMCID: PMC9484866.

APPOINTMENT

Member of the Global Steering Group (GSG) of the WHO Evidence informed Policy Network (EVIPNet)

Balford A. Lewis, Associate Professor

PUBLICATIONS

Co editor of the Reader: Lewis, Balford, and Luke Plutowski. (Eds.) 2021. The Political Culture of Democracy in Jamaica and in the Americas, 2021: Taking the Pulse of Democracy. Vanderbilt University, Nashville, TN USA https://www.vanderbilt.edu/lapop/jamaica/AB2021JAM Country Report English Final 220411.pdf

Kandamaran Krishnamurthy, Pediatric ICU Consultant

ACCOMPLISHMENTS

FRCPCH UK MEETINGS

International transplant conference 2021,India gave talk on world Brain death project https://www.researchgate.net/profile/Kandamaran_Krishnamurthy

Leon Budrie, Clinical ethics Fellow, Baylor College of Medicine, Houston

PUBLICATIONS

Budrie L, Narinesingh A. Locked out: An ethical analysis of Trinidad and Tobago's COVID 19 border closure. Ethics Med Public Health. 2022 Feb;20:100749. doi: 10.1016/ j.jemep.2021.100749. Epub 2021 Dec 7. PMID: 34901364; PMCID: PMC8648578.

Recently started a 2 year postdoctoral fellowship in clinical ethics at Baylor College of Medicine.

Accomplishments Cont

Mr. Latelle Barton

Accepted into Harvard Medical School Center for Bioethics Fellowship Program for September class 2022 2023.

Dr. Barbara Landon, Professor Emeritus

Saving Brains Grenada have founded the CCCN. A list of publications and other activities can be found at our brand new website: https://cccnd.org/publications/peer reviewed journals/

ANNOUNCEMENTS

Caribbean Research Ethics Education initiative

CREEi-Hastings Center (CHC) Bioethics Scholar Program

Members who are graduates of CREEi (1 or 2 year program) and hold a master’s degree or higher are encouraged to apply for the new CREEi Hastings Center (CHC) Bioethics Scholar Program. This is an opportunity for professional development and involves mentored writing over about 9 months. Funded by NIH, the program aims to improve critical thinking and writing skills and thereby enhance contributions to research ethics scholarship, education, and policy development in the region; and to provide opportunities for leadership in advancing ethical issues relevant to your country and region.

All relevant information is provided in the attached document. NIH funding stipulates that only CREEi graduates are eligible.

Submit a complete application by email to the CREEii Program Coordinator at kcoomansingh@sgu.edu by the deadline of November 15, 2022.

CREEi Hastings Center (CHC) Bioethics Scholar Program

For more information on CREEi, visit the website https://creeii.org/

For additional information on the Bioethics Society of the English Speaking Caribbean (BSEC) please visit our website http://bioethicscaribe.com BioethicsCaribe.BSEC@gmail.com