A Global Ethical and Human Rights Perspective On Old Age: Eradicating Stigma, Exclusion and Inequality

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Bioethics Caribe
Newsletter of the Bioethics Society of the English-Speaking Caribbean
Issue No 5 Number 1
December 2011
_____________________________________________________________________________________
NEWSLETTER, DECEMBER 2011
Secretariat: Bioethics Department, St George‟s University (SGU) Grenada
www.bioethicscaribe.org
CONTENTS
Editor’s Corner
President’s Report
BSEC Patron’s message
Ethics Stigma and Equality: Featured Articles & Abstracts
Articles
 A global ethical and human rights perspective on old age: eradicating stigma, exclusion and
inequality
 Fundamental ethics and higher education
 Conscientious refusal: bridging the gap between absolutism and incompatibly
Abstracts
 Ethics, Equality & Stigma – Some Issues of Relevance to the English-Speaking Caribbean
 The Changing Face of Stigma: Social Taboos and Ethics
 Disclosure of STD infection to sex partners in Louisiana
 Ethics and Inequalities Associated with Caribbean Impacts of Climate Change
 The Ethical Challenge Posed by Stigma to Public Health Promotion Campaigns and the Health-
Care Professional Patient Interaction
 Human Rights: A Framework for Confronting Stigma in the Caribbean
 Ethics, Equality and Stigma: a Canadian Perspective
 Ethical dilemmas of critically and terminally ill HIV/AIDS patients in the ICU
Regional News
Publications, Presentations and Accomplishments in 2011 by BSEC members

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EDITOR’S CORNER
Shereen Dawkins Cox, Vice-President (2010-2012), BSEC
Bpharm (Hons), (Utech, Jamaica), MA, Healthcare Ethics and Law, (Uni. Of Manchester, UK)
Dear Valued Readers,
BSEC in collaboration with Ross University School of Medicine, Dominica; has just concluded one of its
most successful forums thanks to the tremendous efforts of the Local organizing committee spearheaded
by Dr Paul Ricketts and BSEC member, Ms. Rosana Emanuel. The caliber of presenters and presentations
were par excellence. For the first time, the forum was transmitted via a live webcast. This was because of
the collaborative work of Ross University and LIME Dominica. Acknowledgment must be given to the
Ross University family who not only funded the Forum but were exceptional hosts.
Under the theme, “Ethics, Equality and Stigma”, our minds were indeed stimulated about the many
bioethical issues surrounding Stigma and Equality. One of the highlighted presentations was on “aging”
where we were reminded that we are an aging population and as such should not discriminate against the
aged among us. This topic was aptly delivered by Dr Astrid Stuckelberger and is shared, among others, in
this issue of Bioethics Caribe.
The French proverb, “the more things change, the more they remain the same”, appositely describes some
of the concerns surrounding stigma and equality especially as it relates to social issues. It would seem that
no matter how much effort is put into removing stigmatization through lobbying measures, other forms of
discrimination are identified. Psychologists and sociologists have addressed the pain of stigma, the need
for human rights activism and the inequities of affirmative action ad nauseam. Are there philosophical
arguments to proffer regarding stigma, discrimination and equality? Perhaps the utilitarian purview may be
that equality is a fallacy and what matters is: “the greatest good for the greatest number”. What is the role
of social responsibility in stigma? Do human rights laws offer “true” equality? These questions should be
discussed further by ethicists and I therefore submit a challenge that we should start thinking, start writing
and start publishing more on the issues of Ethics, Equality and Stigma.

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PRESIDENT’S REPORT 2011
Cheryl Macpherson, PhD., BSEC President, 2010-2012
Professor and Chair, Bioethics Department, St George’s University School of Medicine, Grenada
6th Annual Business Meeting 10/Nov/2011
BSEC has enormous potential to influence medicine, research, and other significant realms of daily life in the
Caribbean, and beyond. It is an honor to serve as BSEC‟s 2nd President, and to have the opportunity to build
upon the vision of our Past President Derrick Aarons. Derrick‟s professional qualities and character that made
it possible to establish and sustain BSEC. Under his leadership we‟ve more than doubled in membership and
had some notable accomplishments including:
 The promotion of research and dialog through Annual Forums (the quality of which is consistently
superb) and Annual Newsletters (the 2011 edition of Bioethics Caribe is being edited by Vice
President Shereen Dawkins Cox)
 Contributions to the establishment of Jamaica‟s National Bioethics Committee and appointments as its
members
 Ongoing efforts to establish a National Bioethics Committee in Trinidad and Tobago
 The drafting of a Caribbean Template for establishing Research Ethics Committees, and its circulation
to all Chief Medical Officers in the English-speaking Caribbean
 Receipt of a Wellcome Trust grant to support the 2010 Forum
 The appointment of prestigious bioethicists as BSEC‟s Honorary Members
o Carl Elliott, Center for Bioethics at University of Minnesota
o Ken Goodman, Director of the Bioethics Unit at the Univ of Miami
o Fernando Lolas-Stepke, Director of PAHO‟s Bioethics Unit
o Ruth Macklin, Albert Einstein College of Medicine and Past-President of the International
Association of Bioethics (IAB)
o Andres Peralto-Cornielle, Professor of Bioethics in the Dominican Republic and member of
UNESCO‟s International Bioethics Committee
o Daniel Piedra Herrera, Exec Secy of the Cuban National Bioethics Committee
BSEC has a responsibility to engage in dialogue and collaboration with varied stakeholders. Increasing the
number of bioethics publications of its members in peer reviewed journals will help to fulfill that responsibility
and enhance BSEC‟s reputation. Building on the foundation laid by Past President Derrick Aarons, my goal as
President is to further develop BSECs visibility and credibility. Encouraging and nurturing bioethics
authorship among our members is a significant step in this direction and the 2011 workshop on publishing
bioethics (led by Dr Udo Shuklenk, Co-Editor of Bioethics and Developing World Bioethics) supports that
goal.
Bioethics publications may center on empirical data as well as theory, narrative, and/or context.
Interdisciplinary projects and publications enhance bioethics by extending its relevance into the sciences,

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social sciences, economics, politics, and policymaking. Caribbean perspectives on bioethics may have
relevance within and beyond the region. What might BSEC members write about?
Since its inception in the 1960‟s bioethics has tended to focus on autonomy more than on other principles.
Autonomy and respect for persons are understood differently in wealthy democratic nations than in nations
where economic and political context thwart abilities to exercise individual autonomy. Several recent
publications note that bioethics overemphasizes North American values like autonomy, and that doing so
marginalizes attention to socioeconomic and cultural contexts that impact health and health disparities.
Overemphasis on North American values is a form of bias that permits bioethics to sidestep moral problems in
low and middle income nations. Even prestigious international bioethics programs perpetuate this bias in their
curricula, research, and publications. However, in its report this year the U.S. Presidential Commission for the
Study of Bioethical Issues highlighted the principles of public beneficence, responsible stewardship,
democratic deliberation, and justice. The report commented that burdens and benefits should be shared across
society; that democratically obtained decisions require ongoing evaluation of risks, burdens, and benefits; and
that social responsibility warrants greater attention. These comments may help to divert attention from
autonomy to community and societal issues like utility, justice, and the responsibilities of health systems and
nations.
BSEC can help bioethics to look beyond its North American orientation and better understand the priorities of
low and middle income nations. It can help to document how priorities and values change with time and
circumstance. BSEC‟s choice of theme for its 2011 Forum „Ethics, Stigma, and Equality‟ was a timely step in
furthering this agenda. BSEC and its members, however, can also begin to explore and document Caribbean
conditions, values, and priorities that bear on health and healthcare. The Caribbean context raises unusual
concerns about paternalism, privacy and confidentiality, informed consent, conflicts of interest, and research
priorities.
BSEC members ought to undertake interdisciplinary investigations into such issues, and how Caribbean values
and societal circumstances affect regional interpretation and implementation of bioethical principles and
standards. How are nations to protect patient rights or privacy without the necessary resources, or when the
sharing of personal information about illness and/or hardship within families and communities is a cultural
norm? BSEC members are ideally placed to ask, and begin to answer, such questions in light of the realities of
Caribbean culture and socioeconomic conditions.
Such work would be of great interest to mainstream bioethics journals, and particularly to Developing World
Bioethics (DWB). Derrick and I both serve on its editorial board, and we jointly published a paper therein
about undertreated pain in the region. Authoring at a publishable standard takes time and energy. If not quite
up to that standard, BSEC members attempts to write reflective or empirical reports might be published in our
newsletter Bioethics Caribe to inform and motivate others, and to provide experience writing and editing.
To make BSEC more visible, credible, and influential I have worked closely with our Executive to and to fund
and develop a more vibrant website, and to establish a Secretariat that will indefinitely be based in and funded

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by the Bioethics Dept at SGU. BSEC‟s new website is a work in progress subject to guidance from its
Executive and membership.
At the urging of our Executive, I have the pleasure of launching our new website now during our 2011 ABM:
http://www.bioethicscaribe.org/. BSEC‟s new website will be easier to navigate; updated regularly; better
inform our members and others about BSEC‟s purpose and accomplishments; help to increase membership;
and facilitate payment of dues online.
 The home page carries our mission, constitution, and background
 Resources including BSEC newsletters and its Research Ethics Template are accessible
 The current Executive is listed and contact information for the Secretariat is provided
 The membership application, types of membership, and annual dues for each type of membership are
provided
This is an exciting time for BSEC which is poised to generate and participate in dialogue about Caribbean
priorities and values, and to inform and enhance the entire discipline of bioethics. As President I am grateful
for the opportunity to support our mission by motivating dialog and authorship.
A few pictures from the BSEC 2011 Forum in Dominica
BSEC Forum Group
BSEC Forum Speakers and Organizers
Audience at BSEC Forum 2011
Paul Ricketts, Grace Charran and
Hamish Mohammed
Derrick Aarons and Eileen Boxill
at the workshop
Derrick Aarons and Paul Ricketts
Shereen Cox and Donald Simeon

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BSEC PATRON’S MESSAGE
Sir George Alleyne, Patron, Chancellor, University of the West Indies
Colleagues,
I must congratulate you on the work you are doing and the effort you are making to maintain interest in
bioethics and once again I regret not being able to join you. Regrettably, retirement has not meant that I
am less busy and able to devote myself to the many worthy issues that give me intellectual pleasure and
more importantly are useful.
The title you have chosen for your conference this year is especially attractive: “Ethics, equality and
stigma”. These will, I am sure provoke considerable discussion. I am sure the “equality “in your title will
stimulate discussing on the more fundamental problem of equity,
Had I been able to attend, I would have referred to the health issue that is having considerable echo
locally, regionally as well as globally. The burgeoning problem of the non-communicable diseases, partly
as a result of Caribbean initiative, has been the focus of a recent United Nations High Level Meeting
which produced a Political Declaration on “The Prevention and Control of Non-communicable Diseases”.
This Declaration has relevance to the theory and practice of bioethics and is likely to attract considerably
more attention in the future. I urge the members of the Society to read the Declaration. The world‟s Heads
of State and Government committed themselves inter alia to “Encourage the development of
multisectoral public policies that create equitable health-promoting environments that empower
individuals, families and communities to make healthy choices and lead healthy choices”. The problem of
stigma is also important for these diseases. The relevance of this to bioethics in general and your theme in
particular is immediately obvious as there is little doubt that the prevention and control of these diseases
are matters of distributive justice. Indeed, much of the interest of young people in this area is because of
the concern for social justice and the reduction of poverty. It would have been good to hear discussion on
the views of bioethicists on the approach for the Caribbean. I have been intrigued recently by arguments
reflecting consequentialism which assess policies by their consequences and the proceduralists who
believe that “fair processes will yield fair decisions”. However, I am sure as in many other areas the
contextual aspect is of critical importance.
I wish you a productive meeting and hope that the participants will leave with even more enthusiasm to
continue to explore the relevance of bioethics to the problems they face on a regular basis.

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A Global Ethical and Human Rights Perspective
On Old Age: Eradicating Stigma, Exclusion and Inequality
Astrid Stuckelberger, PhD
University of Geneva Public Health School, Switzerland, Chair, NGO Committee on Aging, United
Nations Geneva (IAGG-SSG)1, President, Geneva International Network on Aging, Secretary-General -
Association of Gerontology and Geriatrics for the European Region
The paradox of the ‘Invisible Older’
All around the world, people are living longer and in better health than ever before. Yet, the phenomenal
increase in population aging and in a multi-generation society has unveiled a whole range of inequalities
and unprecedented exclusions on the grounds of old age. This situation also revealed the vacuum in legal
and ethical measures to protect old age and the human rights of older persons globally, and underlined the
need for urgent to respond to age discrimination and stigma.
There are many situations where older persons suffer from „ageism‟, stigmatisation and multiple
discriminations which lead them to be increasingly excluded or victims of inequalities. This is especially
obvious for those affected by life events such as widowhood or by physically or mentally disabling
conditions which make them vulnerable to abuse of all kinds. To cite a few examples:
- Older employees are statistically more frequently unemployed, are not being offered continuous
training at work, suffer from the stigma that they are „old fashioned‟, not up to date with
technology‟ and with the false prejudice that competencies decrease with „being older‟
- Older poor are neglected in the statistics and policies on poverty at the global level (e.g. UN and
World Bank reports but also national statistics), they suffer from the absence of safety nets and
social security policies. Older widows, the majority of the 80 year old and more, have been found
to be more often victims of financial or inheritance abuse or loss of land by ignorance of law and
lack of protection (especially in conflict situations or war-torn countries).
- Older patients often receive unequal treatment and care compared to younger patients and do not
obtain the best standard of care available for different reasons, which rise ethical questions such as
medical rationalization, chronic care management, under- or mis-treatment with effects of
polymedication pharmaco-dynamics, security and constraint measures, informed consent with
patients affected by dementia and Alzheimer disease, end-of-life and pain management, etc
In general, older persons are also more often excluded from „normal‟ social activities, such as long life
education partly because policies and the social system is unprepared and has not yet adapted to population
ageing but also because older persons are ICT-excluded and need age-friendly technology to avoid a
“digital homeless” old age society.
Another explanation to this situation is that the ancestral image of old age and aging as an irreversible
decline in functions and social roles is still prevailing while medical progress has demonstrated that
pathological ageing is not the norm today. Therefore the stigma of old age as a destiny of deterioration has
1 IAGG: International Association of Gerontology and Geriatrics – SSG: Swiss Society of Gerontology

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also led to create “the invisible old” excluded from research and policy causing a frequent mindset among
decision-makers such as “why invest in the old, there is no cash return!”, or “older persons are going to die
anyway...”! This engrained stigma can only be reversed with a scientific reality-check and by addressing
age discrimination with a solid human rights and ethical framework. Only with such measures will we be
able to ensure a society for all ages and offer the highest possible standard of life for all ages!
The problem of social exclusion and inequality based on age has not been given much attention and
researchers are only starting to analyze the causal chain and processes involved in old age stigma,
exclusion and inequality while they have underlined the complexity of the issue. One way to address the
topic is by understanding definition, concepts and processes.
The root of stigma, exclusion and inequality
Ageism and the development of scientific knowledge on aging
To better define stigma and discrimination in old age, Dr Robert Butler in 1969, pinned down the term
“Ageism” and drew the attention of the scientific community to the negative attitudes towards old age:
“Ageism is a process of systematic stereotyping of and discrimination against people because they are
old, just as racism and sexism accomplish this for skin colour and gender. Old people are categorized as
senile, rigid in thought and manner, old-fashioned in morality and skills...Ageism allows the younger
generation to see older people in different from themselves, thus they subtly cease to identify with their
elders as human beings” (Butler, 1975, p. 35).
Defining “ageism” also led more researchers to consider the positive aspects of old age and not only the
traditional pessimistic view of traditional geriatric medicine portraying an irreversible decline and passive
degeneration process. In the 80s, the developmental psychologists, spearheaded by Margret and Paul
Baltes in Berlin, started studying and conceptualizing “Successful Aging” (1990), the optimisation of old
age as a long life development process. In the 90s, John Rowe and Robert Khan (1998) further conducted a
wide meta-analysis of existing cross sectional longitudinal studies and demonstrated that the current
scientific data available is countering old myths and stigma held against old age. For example, they
stressed that 1) the majority of old people are in good health and are autonomous until the last year-months
of their life, 2) old age is not determined by our genes (only 25%), the impact of genetic factors decrease
while acquired cumulative life course factors play a stronger role, 3) older persons contribute to the
economy and to the family in substantive ways, 4) at any age, you can learn, improve and reshape your
life! At the turn of this Century, following those positive developments, Ronald Katz and Robert Goldman
(2003) launched with a group of medical doctors the „anti-aging medicine‟ movement in response to what
they denunciated as the neglect of the geriatric establishment to offer the best and highest technology to
prevent and treat pathological aging and they criticize the traditional medical view on treating the disease
processes by “waiting until something was broken, and usually inextricably broken, before it could
attempted to fix it” (Stuckelberger, 2008).
As can be seen, the evolution of the concept of aging follows scientific progress. What is normal aging and
pathological aging during last century has in many ways changed, setting new norms but also new stigma,
exclusion and inequalities as seen in medicine. It also shows very bluntly that our negative perception of
old age as pathological must be revised in the light of new science and possibilities to monitor chronic
diseases, to slow down or reverse pathological functions or diseases. For example, bone and muscle loss
can be recovered with simple exercises (even in Alzheimer patients), frailty and depression can in many

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cases be restored with metabolic bioregulation, neuronal cells can be reactivated and increased, body parts
can be replaced and sensory functionality can be restored improving mobility and quality of life. While
those situations pose new ethical issues (Stuckelberger, 2011a), older persons should have the right to
benefit fully from science if accessible. However, by ignorance or discrimination, many professionals and
policy-makers might deny to older persons the same right to access the highest standard of care, security or
social activities as younger people. The question is how to ensure that older persons have access to the
same rights as other groups of the population up to the end of their life?
Age discrimination as the root of exclusion and inequality: the EU example
While stigma and exclusion are words more frequently used in social and psychological science to qualify
unfair and unjust treatment, inequality and discrimination are used when addressing the aspects of social
justice and legislation. The fact that age discrimination has not been seriously addressed until the last
decade is symptomatic of the fact that aging of the population went unseen for many decades. Europe is
the „oldest continent‟ in the world with a high and growing percentage of older persons. Therefore, since
the turn of the Century, the EU has taken this issue more seriously and has considered age discrimination
as the root of stigma, exclusion and inequalities. According to the European Commission (2000),
„Discrimination’ is the application of different treatment in a negative and unfavourable way, on the basis
of race or origin, ethnicity, religion or convictions, handicap, age or sexual orientation”. Since 2000, age
discrimination is contrary to EU law, as stipulated by the Council Directive2, which establishes a general
framework for equal treatment in employment and occupation. To monitor progress, the “Eurobarometer”
was put in place, a „discrimination indicator‟ surveying perceptions and attitudes on discriminations in the
EU. The 3rd Eurobarometer survey (2009), conducted with a sample of 26,756 people interviewed in 30
countries, confirmed the former surveys which revealed that age discrimination was the most experienced
discrimination reported (among all other types listed in the definition) and that the rate was increasing at
each surveys. Other surveys in the EU such as the European Social Survey are even more alarming
(Stuckelberger et al., in press for 2012, Abrams et al., 2011).
Global Policy and older persons: The need for age-specific human rights and ethics
At the global level, despite increasing evidence of the specific needs of older persons, the analysis of
policy and data shows the absence of a specific framework for older persons regarding two key aspects to
protect the dignity and autonomy of older persons:
a) lack of age-specific binding international human rights instruments
b) lack of bioethics guidelines concerning old age.
Policy analysis of international instruments and structures show that older persons are still very rarely
mentioned in the United Nations system and its agenda. There are no age-specific UN agencies or
international bodies, no age-specific international programme and no fixed budget allocated to old age,
except 2 positions with a secretariat and no budget (Stuckelberger, 2011b). Therefore it is only an
understatement to say that older persons are excluded from the United Nations daily work and budget! The
international system needs to embed and mainstream aging and a „multi-older-generational‟ perspective in
all international agencies and programmes (e.g. migrants, refugees, displaced persons, women, emergency
operations, food programme, technology, etc).
2 http://ec.europa.eu/justice_home/fsj/rights/discrimination/printer/fsj_rights_discrim_en.htm

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The scientific community and the NGO committee on aging at the United Nations in Geneva3, have taken
actions in the past years which yield important consequences (Stuckelberger and Vikat, 2008). Results
have emerged: in 2010, CEDAW4 adopted a general recommendation on older women, in 2011: the
Human Rights Council requested 2 reports (social security and extreme poverty in old age), adopted the
creation of an open-ended working group on the rights of older women, and asked that the rapporteur of
health reviews the situation of older person, a report that concludes “Age is not good for your rights”.
In the area of research ethics framework, the situation is not better: despite international consensus on
ethical guidelines or standards, none of the basic international documents mention the specific conditions
of old age (e.g. CIOMS biomedical ethical guideline, UNESCO bioethics documents).
Conclusion
The imperative of developing instruments and policies on human rights and ethics for older persons should
be a priority to ensure social cohesion and a peace based on inclusion and equal rights for all ages. The
grandeur of a civilization is often viewed in the way it treats its elderly. With ever more people living
longer, the protection and promotion of older persons' rights and security is a matter not only of public
policy but of basic human rights and dignity of a civilization. A long life society requires long life human
rights which will maximize the quality of life of each and everyone to the very end of their lives.
References
1. Abrams, D., Russell, P.S, Vauclair, M., & Swift, H. (2011). Ageism in Europe and the UK: Findings from
the European Social Survey. London: Age UK. (125pp). http://www.ageuk.org.uk/documents/en-
gb/id10704%20ageism%20across%20europe%20report%20interactive.pdf?dtrk=true
2. Baltes Paul B. and Baltes Margaret M. (1990), Successful Aging: Perspectives from the Behavioral
Sciences, Cambridge, UK: Cambridge University Press.
3. Butler N.R. (1969). Ageism: Another form of bigotry, The Gerontologist, 9, 243–6.
4. Butler N.R. (1975), Why Survive? Being Old in America. New York: Harper & Row.
5. EU researchers tackle age discrimination in clinical trials (2009). PREDICT Charter
http://ec.europa.eu/research/headlines/news/article_10_02_19_en.html
6. European Commission (2000). Council Directive 2000/78/EC of 27 November 2000 establishing a general
framework for equal treatment in employment and occupation, Official Journal L 303 , 02/12/2000 P. 0016 –
0022. See http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32000L0078:en:HTML
7. European Union (2009). Discrimination in the EU in 2009. Special Eurobarometer 317. European
Commission: Bruxelles. http://ec.europa.eu/public_opinion/archives/ebs/ebs_317_en.pdf
8. Klatz R. and Goldman R. (2003), The new anti-ageing revolution. Basic Health Publications.
9. Rowe J.W. and Kahn R. L. (1998), Successful Aging. New York: Random House.
10. Stuckelberger A. and Vikat A. (Eds) (2008a). A Society for all Ages: Challenges and Opportunities. United
Nations Economic Commission for Europe (UNECE). United Nations: Geneva and New York.
http://www.unece.org/pau/pub/mipaa.htm
11. Stuckelberger A., Abrams D. and Chastonay P. (in press, 2012). Age discrimination as a source of exclusion
in Europe : State of the art and need for a human rights plan for older persons. In N. Keating (Eds) Exclusion
- Inclusion in later life. The Policy Press: United Kingdom.
3 See documents and statements of the NGO Committee on Ageing at the United Nations in Geneva
https://sites.google.com/site/unngocommiteeonaginggeneva/ and the Geneva International Network on Ageing
(GINA) http://sites.google.com/site/ginagenevaintlnetworkonaging/
4 CEDAW: The United Nations Committee on the Elimination of Discrimination against Women, an expert body
established in 1982, is composed of 23 experts on women's issues from around the world.
http://www.un.org/womenwatch/daw/cedaw/committee.htm

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12. Stuckelberger A. (2008b). Anti-Ageing Medicine : Myths and Chances. ETH Verlag, Zurich, Switzerland.
See book http://www.vdf.ethz.ch/vdf.asp?showArtDetail=3195 and report http://www.ta-
swiss.ch/e/them_biot_anti.html
13. Stuckelberger A. (2011a). Is human ageing setting the stage for prejudices or transhuman medicine?
Bioethica Forum, Swiss Journal of Biomedical Ethics, Volume 2, pp. 57-59.
14. Stuckelberger, A. (2011b). Human rights of older persons at the United Nations: How are we advancing?,
UN AAFI-FAFICS Bulletin 1, January 2011. United Nations Geneva.
Fundamental Ethics and Higher Education
Francis O. Severin, Ph.D.
Head, UWI Open Campus Dominica
Introduction
It is quite possible to argue that a university‟s role in any society is to set positive models, ideal types or
standards for the society in which it is located. It does this via its traditional roles of teaching, research and
community service. Further, it is possible to achieve such outcomes in practically any discipline or faculty,
whether in the social sciences, humanities, pure and applied sciences, engineering, medicine, law, and so
on. In developing societies like Dominica, this “standard-setting” role can be particularly crucial as they
grapple with social, economic and political problems that are often beyond the capacity of individual
governments to successfully address. If one argues that the societies described above are still in some
formative stages of unfolding or evolution, then the role of the academy is a unique one, that is, a
decidedly society-shaping or inventing one.
What is the responsibility of the academy vis-à-vis ethics?
Arguably, the regional University of the West Indies (then the University College of the West Indies) - like
those in Africa (e.g., Khartoum University College; University College of Ibadan; University College of
Ghana; Makerere University College) – was formed in the 1940s in order “shepherd” the British West
Indian colonies through the eras of colonialism, post-colonialism and Independence (see Cobley in Howe,
2000). Professor Alan Cobley (2000) of the University of the West Indies asserts that the history of higher
education in the Caribbean, as indeed in other parts of the world, may be located in the role of the sage in
traditional societies. The sage was the community‟s thinker, philosopher, intellectual or scholar whom
people sounded out or sought advice from due to his or her exclusive and expert knowledge and erudition
on fundamental matters in the community.
According to Cobley, the sage might be an adviser, a counselor, an arbitrator, a spiritualist, a psychic, a
healer, a rainmaker. Very often, specially chosen candidates were apprenticed to the sage who taught
his/her novices by several methods, including oral instruction and, very importantly, through example. The
curriculum‟s gamut was indeed extensive. Hence:
Indigenous higher education produced and transmitted new knowledge necessary for
understanding the world, the nature of man, society, God and various divinities, the promotion

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of agriculture and health, literature and philosophy. (Ajayi, Goma & Johnson, 1996, cited in
Cobley, 2000, p. 1)
Contemporary society is far more complex. This is not to suggest however that the mission is quite
different today. To be sure, the academy, while it must continuously revise its mission, must not lose sight
of what ought to be its enduring raison d'être – to set the societal scaffolding or framework. One common
variable in all of this is the matter of ethics. No society is too poor or too wealthy to take on board the
subject of ethics in guiding its developments in every aspect of the society. The subject of ethics inheres in
the culture of every society and it is the present paper‟s burden that universities ought to lead the way in
that regard. Stated differently, universities must locate themselves as “endemic” ethical entrepreneurs in
their respective societies.
In recommending the foregoing role for the academy, the present author grasps the concept ethics in the
sense that Harry J. Gensler (1998) describes or illustrates it, especially what he refers to as normative
ethics. Hence:
Normative ethics studies principles about how we ought to live. It asks questions like: What are
the basic principles of right and wrong? What things are ultimately worthwhile in life? What
would a just society be like? What makes someone a good person? What are the basic human
rights? Is abortion right or wrong? (p. 4)
The appellation “Fundamental Ethics” has been suggested not as a departure from the above definition.
Rather, it is a matter of emphasis - “normative ethics” ought to guide a university‟s teaching, research and
community service/outreach, centrally and throughout. This is on one level. On the other perhaps equally
or even more important level, those people who graduate from universities must, through their respective
professions, live out the moral philosophies or ethics of their professions so that ultimately, their societies
in turn, are guided by the sorts of questions which Gensler (1998) poses above. Gensler states this aptly:
… moral philosophy [ethics] can deepen our reflection on the ultimate questions of life. This is
of value in itself, regardless of its practical benefits. If you haven‟t wrestled with some of life‟s
deeper questions, then you aren‟t a well-educated person. (p. 5)
Other reasons for allowing fundamental normative ethics to guide the academy and its students are for the
very important boon that it offers them a perspective for thinking and acting. Indeed, one‟s perspective is
greatly enhanced making faculty, students and graduates more reflective and their actions better thought
out. Their thinking about specific moral issues and all matters that they must address in their daily lives are
provided with a more profound and solid fillip and foundation (Gensler, 1998).
Fundamental normative ethics allows its beneficiaries to sort through, sieve and delineate the myriad
values they have accumulated (as it were) over several years. This allows them to develop their own
beliefs, in the optimum way. Importantly, fundamental normative ethics or moral philosophy teaches
important intellectual skills thereby honing graduates‟ general thinking processes (Gensler, 1998). Faculty,
students and graduates – all part of the human resources of society – become critical thinkers, problem
solvers and creative participants in our society. Says Gensler (1998):

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We learn to think critically about fundamental questions – to understand and evaluate
conflicting points of view – to express ideas clearly – and to reason in a careful way. These
skills are valuable in real life … (p. 6)
“Fundamental ethics” is also used here to broadly define the general principles that ought to guide various
professionals in their determination of ethical courses of action in various contexts. Such principles or
guidelines epitomize the highest standards of professional conduct and behaviour. It is argued that no
attempt is made to split hairs between such principles and the normative ethics or more relevantly the
applied normative ethics which Gensler (1998) speaks to.
Against the backdrop of the above, the burden of the argument here is that these Fundamental Ethics
should not be left to chance. They have to be taught! The academy cannot assume that they will be adopted
by students along the way, especially in areas where they are not traditionally a secure part of the
curriculum and the “profession” by extension. Hence “fundamental ethics” covers both normative and
applied ethics. It is quite possible to posit that fundamental ethics should not be restricted to the
“traditional professions”, such as medicine and law. If one therefore reflects on all what has been
articulated above, it is not difficult to arrive at the conclusion that a better society is possible when its
people, especially its professionals, have the “ethical wherewithal” to guide their actions on a daily basis.
Is there a blurred line between the law and ethics?
While the applied aspects of ethics vary between professions, occupations and roles, they should underlie
the professional conduct and responsibilities of all, but especially university-trained human resources. E.
R. Walrond (2005) makes the point, quite persuasively, that:
The law is distinct from ethics. Law is used to emphasize and enforce those areas of ethical
conduct that are agreed upon and defined. The law, however, can only act as a framework for
settling differences in those areas of professional conduct where there is no consensus and in
areas that are disputed but have not been resolved. There is therefore an interface between
ethical conduct and the law that must be constantly borne in mind, even in emergency
situations. (p. 3)
This is a significant point in the context of the present conversation. What is legal may not necessarily be
ethical and what is ethical may not necessarily be legal. The area of sexuality and sexual behaviour tends
to illustrate this quite well and is often drawn upon so to do. As Walrond (2005) argues for reasons
unrelated to the foregoing illustration, society may at times attempt to “circumvent moral and ethical issues
and opt for what is often termed the pragmatic approach” (p. 4). Hence, he continues, “it is vital … that
right and wrong practice within health care be kept under constant review, not only within the traditional
health-care professions but through the wider lens of social, legal and religious concerns” (pp. 4-5).
Arguably, this recommendation is as pertinent to health care as it is to law or legal practice, engineering,
the social sciences, and various other disciplines. It is not an unreasonable expectation for a society to
always require its university graduates to be accountable where fundamental ethics are concerned. Beyond
this, the graduates themselves must constantly ponder where they are in terms of these fundamental ethics

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and they must make recommendations for legislation in order to make them (fundamental ethics)
“endemic” in their society.
Do ethics enhance or hinder the robustness of the disciplines?
The American Sociological Association (ASA) has a comprehensive Code of Ethics which lays down the
standards for its member sociologists‟ professional responsibilities and code of conduct. Its preamble is
prescriptive:
This Code of Ethics articulates a common set of values upon which sociologists build their
professional and scientific work. The Code is intended to provide both the general principles
and the rules to cover professional situations encountered by sociologists. It has as its primary
goal the welfare and protection of the individuals and groups with whom sociologists work. It
is the individual responsibility of each sociologist to aspire to the highest standards of conduct
in research, teaching, practice, and service.
One expects to find within the ASA‟s Code of Ethics, much attention paid to both normative and applied
ethics. This Code is cited here since it appears to be thorough and covers a very wide gamut, including,
professional competence; integrity; professional and scientific responsibility; respect for people‟s rights,
dignity and diversity; social responsibility (General Principles); professional and scientific standards;
competence; representation and misuse of expertise; delegation and supervision; non-discrimination; non-
exploitation; harassment; employment decisions; conflict of interest; public communication;
confidentiality (Ethical Standards); and so on.
Even a quick scan of the ASA‟s Code of Ethics will reveal almost immediately that they serve to enhance
and strengthen the profession and indeed make especially research more robust. Arguing for the legal
profession, Banks (2009) asserts that, “If we cannot draw upon an ethical framework, we have to rely upon
emotion, instinct, and personal values, and these cannot supply an adequate answer to moral dilemmas” (p.
4). She then explored a wide range of areas which justify the study of ethics. The following provides a
mere sample:
 Decisions involving discretion, force, and due process that require people to make open-minded
moral judgments;
 Questioning and analyzing assumptions that are normally not questioned, for example in areas of
activity like business and politics as well as the criminal justice system (crime and justice, the role
of law enforcement, the place of punishment, the limits of punishment, the authority of the state,
the proper functions of prisons, etc);
 The matter of right and wrong (wrong is wrong and right is right, to invoke local parlance) and the
right way to conduct oneself;
 The ability to define unethical behaviour and a firm understanding that it includes not only “bad”
and “evil” acts but also inaction that allows “bad” and “evil” acts to proceed and thrive.
The foregoing provides compelling reasons for the place of Fundamental Ethics as a core element in the
academy. There ought to be no anxiety whatsoever that Fundamental Ethics will hinder the robustness of
the disciplines. If anything the disciplines are completely strengthened by Fundamental Ethics.

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What are the ethical responsibilities of professionals to people (the community) as opposed to
institutions?
The answer to the above question is well expressed in the ASA Code of Ethics and is no doubt expressed
in the Hippocratic Oath as well as the code of ethics of myriad professions. Professionals ought to be
aware of their professional and scientific duty to the communities and societies in which they reside. This
is an important point simply because the aim within the academy must be to create graduates who are
leaders, who are discerning and who are prepared to clearly and unambiguously express their views based
on the research, objective facts and their learning as opposed to assuming a sycophantic posture. Graduates
who do not use their knowledge to add value to debates, to make plausible recommendations and generally
to ameliorate the hardships in their communities are to all intents and purposes a great financial burden to
their societies. People and community must come before institutional loyalty or “fealty”.
Conclusion
I have been interested in Paulo Freire‟s Pedagogy of the Oppressed especially his critique of the banking
concept of education. That the pedagogical paradigm should increasingly be shifting from the teacher to
the learner, is the central argument in that thesis. Denouncing this pedagogical method he labels as the
banking concept of education, Friere (1975) contends that:
Narration (with the teacher as narrator) leads the student to memorize mechanically the
narrated content. Worse still, it turns them into „containers‟, into receptacles to be filled by the
teacher. The more completely he [sic] fills the receptacles, the better a teacher he [sic] is. The
more meekly the receptacles permit themselves to be filled, the better students they are. (pp.
138-139)
In similar fashion, Friere asserts that education therefore:
…becomes an act of depositing, in which the students are depositories and the teacher is the
depositor. Instead of communicating, the teacher issues communiqués and „makes deposits‟
which the students patiently receive, memorize, and repeat. This is the „banking‟ concept of
education, in which the scope of action allowed to the students extends only as far as receiving,
filing, and storing the deposits. (p. 139)
The present author wishes to conclude this paper by suggesting that Fundamental Ethics in the academy
can be greatly facilitated if the pedagogy is shifted to one that encourages critical and analytical thought
and provides encouragement – and offers the liberty to - the students to think freely in an unfettered
environment. As graduates, they will hopefully go forth and multiply that intellectual “free-spiritedness”.
As time unfolds, the society will begin to take for granted that university graduates are not simply taught to
discern between right and wrong, but these graduates will in fact do what is right and eschew what is
wrong.
References
1. Banks, Cyndi (2009). Criminal justice ethics: Theory and practice (2nd ed.). Los Angeles: Sage.

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2. Cobley, A. (2000). The historical development of higher education in the Anglophone Caribbean. In G.
Howe (Ed.), Higher education in the Caribbean: Past, present and future directions (pp. 1-23). The UWI
Press: Barbados.
3. Freire, P. (1975). Pedagogy of the oppressed. In M. Golby, J. Greenwald & R. West (Eds.), Curriculum
design (pp. 138-149). London: The Open University.
4. Gensler, H. J. (1998). Ethics: A contemporary introduction. London: Routledge.
5. Neuman, W. L. (2003). Social research methods: Qualitative and quantitative approaches (5th ed.).
Boston: Allyn and Bacon.
6. Walrond, E. R. (2005). Ethical practice in everyday health care. Kingston, Jamaica: University of the West
Indies Press.
Conscientious Refusal: Bridging the Gap Between Absolutism and
Incompatibly
Robert N. Mucciola, MD, MA (Bioethics), FACOG,
Chairman, Department of OB/GYN, Ross University School of Medicine
Creekside Medical Center is located in a midsize southern city. The department of Obstetrics and
Gynecology and the Accreditation Counsel for Graduate Medical Education (ACGME) Ob-Gyn residency
are responsible for the majority of obstetrical care in the community. Recent additions to the residency
faculty include a group of perinatologists offering prenatal specialized diagnostic testing. As a result,
some patients are electing to terminate pregnancies with genetic defects or congenital anomalies. The
logistics and process of the termination procedures are carried out in the Labor and Delivery suite. Many
L&D nurses, a few residents and one general OB-Gyn attending have asked to be exempt from this process
because of moral objections.
Some medical services have long generated deep moral controversy within the
medical profession as well as in the broader community. Such controversies have led to conscientious
refusals by some health care professionals to provide or participate in certain services to their patients.
Abortion is an obvious and prominent example, but others include assisted reproductive services for
unmarried couples, terminal sedation for dying patients, physician-assisted suicide in states where it is now
legal, embryonic stem cell research, and the use of emergency contraception.
Nurses, physicians and pharmacists have claimed a moral right of conscience to refuse certain services.
The involvement in question are refusals to perform a procedure or participate in a practice that is legal
and professionally accepted but that the individual professional believes to be deeply immoral. The
accommodation of theses actions may result in limited access to care and undue burden on colleagues.
Mark Wicclair argues that these claims must be grounded in the importance of individuals‟ moral integrity.
Deeply held and important moral judgments of conscience constitute the central basis of such integrity.
They define who the individual is and what she stands for. Maintaining her moral integrity then requires
that she not violate her moral commitments and gives others reason to respect her for doing so. Because

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the maintenance of moral integrity is an important value, central to one‟s status as a moral person, Wicclair
claims that those commitments must not necessarily be true or justified. (1)
There are those who contend that refusing to provide a legal service within the scope of a clinician‟s
professional competence is contrary to the practitioner‟s professional obligations. Julian Savulescu most
succinctly states the incompatibility thesis. “If people are not prepared to offer legally permitted efficient
and beneficial care to a patient because it conflicts with their values, they should not be doctors.” (2) His
argument is countered by the fact that health care professionals are themselves moral agents as well as
health care providers. Failing to accommodate their conscience-based refusals can compromise their moral
integrity.
At the opposite extreme, the organization, Pharmacist for Life International, subscribes to conscience
absolutism. They support the contention that health care professionals should be exempted from
performing any action that is contrary to their conscience. Their model conscience clause is quite
unconditional. “The rights of conscience of any person being a duly licensed pharmacist, who shall object
on personal, ethical, moral or religious grounds to the performance of any act in the normal course of
professional performance or dispensing, shall be respected.”
Objectors to conscience absolutism emphasize the special obligations realized by professionals.
Responsibilities ranging from an obligation of health promotion to respecting patient autonomy are often
cited. Conscience-based refusal in health care always affects someone else‟s health or access to care
because the refusal interrupts the delivery of health services. Therefore, conscientious objection in health
care always has a social dimension and cannot be framed solely as an issue of individual rights or beliefs.
(6)
Faced with the chasm between the incompatibility thesis and conscience absolutism, let us consider a
reasonable compromise. Framing such a compromise must accommodate health professionals‟ claims of
conscience without unduly compromising other interests or values. It must prevent feelings of guilt, and
respect the intrinsic value of moral integrity. A compromise must promote and tolerate diversity in health
care, realizing that some practices will remain controversial.
In 2010 the American College of Obstetricians and Gynecologist (ACOG) reaffirmed a previous
Committee on Ethics Opinion. The ACOG framework for analysis was an attempt to maximize respect for
health care professionals‟ consciences without compromising the health and well-being of the women they
serve. Conscience refusals should be limited if they constitute an imposition of religious or moral beliefs
on patients, negatively affect a patient‟s health, are based on scientific misinformation, or create or
reinforce racial, social or socioeconomic inequalities. (4)
ACOG continues by providing a listing of conscience-based refusal limitations. Any conscience-based
refusal that conflicts with a patient‟s well being should be accommodated only if the primary duty to the
patient can be fulfilled. Health care providers must impart accurate and unbiased information so that
patient can make an informed decision about her health. When conscience implores deviation from
standard practices, physicians must provide patients with prior notification of their personal moral
commitments. Physicians and others have a duty to refer patients in a timely manner if they do not feel
they can in conscience provide the standard reproductive services.
While claiming consideration for a practitioner‟s moral integrity, the ACOG Opinion sets another
interesting criterion for evaluating authentic conscientious refusal. They stress the scientific integrity of the
facts supporting the objector‟s claim. They employ the core commitment to evidence-based scientific

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information and its foundation to the practice of medicine. Indeed they state that when refusals reflect a
misunderstanding of science, limits to the conscience-based refusal should be defined by the strength or
weakness of the science on which the refusal is based. But in promoting the protection of moral integrity,
must the beliefs of the objector always be based on evidence-based medicine? Protecting a person‟s
concept of a good or meaningful life does not require randomization. Avoiding feelings of guilt, remorse,
and shame as well as loss of self-respect is not assured with being double-blinded. With minimal
exception, respect for moral integrity generally excludes evaluating a health professional‟s reasons for
refusing to perform or assist in performing a service.
I support the proposal that whenever feasible, health care professionals‟ conscientious refusals should be
reasonably accommodated, and that the two extreme positions are rejected. Bridging the gap between
conscience absolutism and the incompatibility thesis must simply employ the girders of reasonable
accommodation. Reasonable accommodation must preclude impeding patients‟ timely access to health
care services. It must also avoid placing undue burdens on colleagues, co-workers, supervisors,
adminstrators and organizations.
Creekside Medical Center convened a two-day educational conference to discuss the basis of the
expressed concerns, while not discounting the administrative challenges and patient access to care. Invited
discussants included a national prolife perinatologist, legal system representatives, the ethics department
chairman at a local university, and nursing department representatives. As a result of this interactive
conference, nurses were permitted to complete a document stating their participation limitations. This
allowed the nursing supervisor to appropriately schedule and staff elective terminations. Ob-Gyn residents
were not required to participate in terminations, but were all schooled in the management of possible
complications. All of the attending generalists agreed to intervene if complications developed during a
termination procedure during their scheduled responsibility for the L&D suite.
References:
1. Mark Wicclair, “Pharmacies, Pharmacists, and Conscientious Objection. Kennedy Institute of Ethics Journal
(2006)16 (3): 225250.
2. Julian Savulescu, “Conscientious Objection in Medicine,” British Medical Journal, 332:294-297.
3. Dan W. Brock, “Conscientious Refusal by Physicians and Pharmacists: Who is Obligated to Do What, and
Why?” Theor Med Bioeth (2008) 29:187–200.
4. The Limits of Conscious Refusal in Reproductive Medicine. ACOG CommitteeOpinion No. 385. American
College of Obstetricians and Gynecologists. Obstet Gynecol 2007;110:1203-8.
5. Maternal Decision Making, Ethics, and the Law. ACOG Committee Opinion No. 321. American College of
Obstetricians and Gynecologists. Obstet Gynecol 2005;106:1127-37.
6. Nancy Berlinger, “Conscience Clauses, Health Care Providers, and Parents,” in From Birth to Death and
Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and
Campaigns, ed. Mary Crowley (Garrison, NY: The Hastings Center, 2008), 35-40.

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ABSTRACTS
Ethics, Equality & Stigma – Some Issues of Relevance to the English-Speaking
Caribbean
Derrick Aarons JP, MB.BS.(UWI), M.Sc.(Bioethics)(McGill), PhD
Health systems throughout the world offer mixed results for their populations – both in terms of health
outcomes and access to the conditions that enable individuals to achieve good health. Many health
systems throughout the globe, e.g. the American health system, paradoxically produce both therapeutic
gains as well as major discrepancies in access to high quality care. Medical advances have improved
patients‟ lives dramatically, yet stark inequalities regarding access, quality, financial burdens, and resource
priorities actually undermine the impact of technological and scientific progress. Universally, the cost of
health care is also on the rise. Although health care providers, health-policy experts, ethicists, and
government officials have attempted to address many of these issues, few proposals for reform have
succeeded in many countries.
It is against this background that this paper will look at some issues surrounding ethics, equality, and
stigma of relevance to peoples of the English-speaking Caribbean, and make tangible recommendations for
improvement or implementation.
The Changing Face of Stigma: Social Taboos and Ethics
Shereen Dawkins Cox Bpharm, (Utech) MA (Healthcare Law and Ethics) (Uni. Of Manchester)
Stigma is described by sociologist Ervin Goffman as an attribute, behavior, or reputation which is socially
discrediting in a particular way: it causes an individual to be mentally classified by others in an
undesirable, rejected stereotype rather than in an accepted, normal one. Stigma is as a result of two groups;
those who are the stigmatizers and those who are stigmatized. However, the changing dynamics of life has
also impacted on stigma and many persons or things once stigmatised are now socially acceptable.
However. there are times those who oppose these changes (the once stigmatisers) have experienced the
brunt of reverse discrimination.Human Rights laws have been written and enacted to give equal rights to
all but do they always offer solutions or do they create more problems? Can we ever truly obtain equality
in a society that is so divided about what is socially acceptable? Could the utilitarian notion of doing "the
greatest amount of good for the greatest number" be applied to agree on what is socially acceptable? Do
individuals who chose to participate in activities considered social taboos have a responsibility to society
to limit these activities to their private lives or does society owe these individuals the right to exercise their
autonomy? The pain of stigma is far reaching and cannot be ignored but one would need to examine all
parameters and decide on whether stigma is always bad or is there a place for it.

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Disclosure of HIV infection to sex partners in Louisiana
Hamish Mohammed, PhD, MPH, Department of Biomedical Engineering and Health Sciences, University
of Trinidad and Tobago
Objective: 'To determine the correlates of HIV disclosure to sex partners in persons living with HIV/AIDS
in small town and rural Louisiana.'
Methods: A convenience sample of 273 HIV-infected persons residing throughout nonurban Louisiana
were administered a questionnaire by in-person interviews. Data on demographic and clinical
characteristics were collected, as was information on disclosure to sexual partners at the time of initial
HIV-positive diagnosis and at the time of the interview (an average of 5.76 years later). Bivariate and
multivariate associations with both disclosure outcomes were determined using generalized estimating
equations logistic regression.
Results: The prevalence of disclosure to past and current sex partners was 57% and 81% respectively.
Those who reinitiated sex with their partner since testing positive for HIV and those who received partner
notification were more likely to disclose to past partners. Non-African Americans and those with only one
partner were more likely to disclose to present sex partners.
Conclusion: Disclosure was not universal in this nonurban setting, and interventions to increase the level
of disclosure are essential
Ref: Mohammed H, Kissinger P. Disclosure of HIV serostatus to sex partners in rural Louisiana. AIDS Care. 2006;
18 Suppl 1: S62-9.
Ethics and Inequalities Associated with Caribbean Impacts of Climate Change
Authors
Cheryl Cox Macpherson, PhD, Bioethics Department, St George‟s University School of Medicine
Muge Akpinar-Elci, MD, MPH, Department of Public Health and Preventive Medicine,
St George‟s University School of Medicine
The global health impacts of climate change affect all nations and populations with
disproportionate impacts upon poor and rural communities, children, marginalized groups, and in
low and middle income nations. Caribbean states are particularly vulnerable to climate change
because their large coastal areas are directly exposed to rising sea levels and their middle income
status makes them heavily reliant on foreign aid. The Caribbean comprises about half of the 39
members of the Association of Small Island States (AOSIS), and small island states comprise
about 5% of global population.

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Interdisciplinary collaboration aimed at protecting health against climate change is impeded by
the view held by many that “climate change won‟t affect me personally”. This view may be
countered by discussions about the lived experience of climate change and how it threatens things
we value. A bioethics and public health collaboration involves focus groups of Caribbean
academicians from varied disciplines in discussions about how climate change affects them and
Caribbean life. They described socioeconomic and environmental changes in the Caribbean that
they attribute to climate change including extreme weather, unusual rain and drought, drying
rivers, beach erosion, declining fish catches, and others. Their discussion exposed impacts on
individuals, businesses, agriculture, and disaster preparedness. Our data helps to reframe climate
change as a personal reality rather than a vague future concern, and to identify some of the
disparate socioeconomic impacts.
References
1. Alliance of Small Island States (AOSIS). Accessed July 6, 2011. http://aosis.info/members-and-observers/
2. Spence A., Poortinga W., Butler C., Pidgeon N.F. Perceptions of climate change and willingness to save energy
related to flood experience. Nature Climate Change. March 2011. Accessed July 6, 2011.
http://www.nature.com/nclimate/journal/vaop/ncurrent/full/nclimate1059.html
The Ethical Challenge Posed by Stigma to Public Health Promotion Campaigns and the
Health-Care Professional Patient Interaction
Professor Udo Schuklenk, Ontario Research Chair in Bioethics, Queen's University, Canada; Joint Editor-
in-Chief of Bioethics and Developing World Bioethics
This brief presentation will discuss some of the ethical challenges posed by stigmatized behavior in the
context of health promotion activities as well as in the health-care professional patient interaction. Given
that many socially stigmatized behaviors occur in our sexual relations I will look specifically at teenage
pregnancy and gay male patients as well as possibly obesity (time permitting). The overarching ethical
questions are to do with the professional obligations of health-care professionals who have moral or other
objections to a particular stigmatized behavior, as well as with the obligations of those tasked with
undertaking health promotion campaigns aimed at improving public health.

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Human Rights: A Framework for Confronting Stigma in The Caribbean
Merle Mendonca, Co-ordinator, Guyana Human Rights Association
Persistence of the stigma associated with HIV/AIDS in the Caribbean continues to rob a significant range
of people of the support and care environment they need in order to live their lives as normally as the
burden of an incurable disease will permit. Stigma has proven impervious to legal, educational and
medical initiatives to confront and eradicate it.
The purpose of this presentation is to assess the potential of a human rights approach to confronting the
obstacles that sustain stigma. The paper suggests that human rights provide a more effective foundation for
promoting the ethical duty to care, because it is rooted simply in the fact that people are people.
Human rights are not modified or enhanced as an entitlement by a person‟s beliefs, possessions, status,
location or personal history. They do not require conversion from one life-style to another, nor is the
ultimate destiny of people as individuals or as a universe relevant to the individual esteem each person can
claim by virtue of being human. Human rights assert that there is something about the fact of each of us
that makes every one of us count.
Ethics, Equality and Stigma: a Canadian Perspective
Professor Emeritus Thomas J. Murray, Former Dean of Medicine, Dalhousie University
Ethics, equality and stigma are important issues for medical education and for the health care system. In
Canada there has been an effort to provide a health care system that was based on principles of equality.
The 5 guiding principles are for a system that is universal, comprehensive, accessible, portable, and
publicly administered to all Canadians. It has been a struggle to maintain equality and resist privatization
and two-tiered medicine as the pressures of funding increase.
In the past it has been taken for granted that health care professionals would be ethical in their care of
patients, but education in ethics had been minimal. Now ethicists are involved in the design of
undergraduate curricula and the Royal College of Physicians and Surgeons of Canada has made education
in medical ethics a mandatory aspect of all postgraduate training programs. I will outline the CanMed
principles used in Canadian medical education.

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Ethical dilemmas of critically and terminally ill HIV/AIDS patients in the ICU
Seetharaman Hariharan,Professor, Anaesthesia & Critical Care Medicine, The University of the West
Indies, St. Augustine, Trinidad & Tobago
Notwithstanding the efforts of the Governmental and Non-Governmental organizations to eliminate the
stigma associated with HIV/AIDS, the harsh reality is that people living with HIV/AIDS (PLWH) have to
still struggle with the societal challenges. Due to fear of being stigmatized, there are a considerable number
of PLWH who do not disclose their illness even to their spouses. When such patients get admitted to the
intensive care units (ICU) with critical illnesses, healthcare personnel in the ICU face many challenges,
especially while interacting with the close relatives.
Patient autonomy perspective as well as the legal requirement of maintaining confidentiality mandates
healthcare personnel not to divulge patient-details to others. However, when the patient becomes critically
ill, unconscious and put on life support machines, the relatives most often wish to know the health status of
the patient including the reason for such deterioration in patient‟s health condition. The issues of breach of
confidentiality versus the „greater good‟ of getting the spouse and the family counseled (and if necessary
treated) for HIV is one of the major dilemmas faced by the ICU personnel. Occupational hazards such as
needle-stick injuries in ICU personnel from a patient whose HIV status is hitherto unknown pose another
dilemma, whether one is justified in testing the patient for HIV without a personal consent. ICU personnel
also face multiple types of ethical issues and dilemmas when children with HIV/AIDS are admitted to
ICU. HIV/AIDS is still a notifiable disease in some Caribbean countries!
Ethical and legal knowledge is paramount for an ICU practitioner while dealing with such issues and there
is a clear need for incorporating clinical ethics and jurisprudence into the medical curriculum even at the
undergraduate level.

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REGIONAL NEWS
PUBLICATIONS AND PRESENTATIONS
The following are publications and presentations made this past year by members of the BSEC Executive.
Cheryl Macpherson
CC Macpherson. Caribbean research ethics. RG2 Newsletter of the Association of Commonwealth
Universities. October 2011. 2: 6-7.
CC Macpherson, M Akpinar-Elci. Bioethics and Public Health collaborate to reveal impacts of climate
change on Caribbean life. SGU Research Day, Grenada. Sept 2011.
N Chiochankitmun, CC Macpherson, OC Elci, M Akpinar-Elci. Palliative Care resources in the
Caribbean. SGU Research Day, Grenada. Sept 2011.
Hamish Mohammed
Gift TL, Kissinger P, Mohammed H, Leichliter JS, Hogben M, Golden MR. The cost of expedited partner
therapy compared to the cost of standard partner referral for the treatment of chlamydia or gonorrhea.
Sexually Transmitted Diseases. 2011; 38 (11): 1067-107.
Mohammed H, Smith J. First record of Anopheles albimanus from St. Kitts. West Indian Med J. 2011; 60
(5): 562-563.
Derrick Aarons
D. Aarons. Ethical issues and dilemmas in pharmacy practice. The Pharmacy Council of Jamaica, 2011,
Jamaica.
D. Aarons. The ever-expanding nature of Medical Ethics. The Jamaica Association of Otolaryngologists,
2011. Jamaica
D. Aarons. The conceptual framework to making ethical decisions. The North-East Branch of the Medical
Association of Jamaica, 2011. Jamaica
D. Aarons. Empirical Ethics – A CME & framework for making ethical decisions. The Ophthalmological
Society of Jamaica, 2011. Jamaica
D. Aarons. Empirical Ethics. The North-East Branch of the Medical Association of Jamaica, 2011.

25
Bioethics Caribe
Issue No. 5 No.1
December 2011 www.bioethicscaribe.org
Shereen Dawkins Cox
S. Dawkins Cox. Research on human subjects and universal access to health – The Jamaican perspective
- The Meeting of Bioethics Consulting Bodies in the Region of the Americas, Mexico City, Mexico. Oct
2011.
Merle Mendonca
M. Mendonca . Verbal Submission to the Special Select Committee on Criminal Responsibility of HIV
Infected Individuals (Resolution No. 129 of 2010), following on Written Submission of June 22, 2011,
Chrystol Albert (G+), Jacqueline Delph/Hyacinth Sandiford (NAC) and Merle Mendonca (GHRA), July
13, 2011, Guyana
CONGRATULATIONS
The Executive of BSEC would like to congratulate the following members for their various
accomplishments:
1) President Cheryl Macpherson was appointed as Resource Expert for Bioethics beyond Borders
(BBB), Center for Healthcare Ethics, Duquesne University.
2) Immediate Past President, Derrick Aarons was appointed to the Executive Council of
Redbioetica, UNESCO and is a founding member of the Steering Committee for the Sub-Regional
Bioethics Network of the Spanish, English, French and Dutch Caribbean.
3) BSEC member, Sir Errol Walrond on his knighthood!
4) BSEC member, Hariharan Seetharaman was appointed Full Professor of Anaesthesia and
Critical Care Medicine in the Faculty of Medical Science,The University of the West Indies, St.
Augustine, Trinidad and Tobago.
5) BSEC member, Dave Chadee was appointed professor in 2010 at the University of the West
Indies, Trinidad and was one of five persons who won the prestigious UWI Vice Chancellor‟s
Awards for Excellence in the same year.