Bibliotheca Alexandrina Conference Center TWAS – ARO Roundtable on Responsible Science 28-29 November 2017 Ethical issues facing research integrity in the Arab region Prof. Rafia Ghubash 2017
ETHICAL THINKING – A shift from seeing oneself as the moral universe (egocentrism) to following social rules (e.g. one should stick to the speed limit) to holding reasoned principles (e.g. one should adjust one ’s car speed for the benefit of other road users even in the absence of a speed limit). Figure 1. Indicators of progression in ethical reasoning.
Main ethics issues The main areas that are addressed during the Ethics Appraisal procedure and in the Ethics Self-Assessment guidance document include: 1. Human embryos and foetuses 2. Human beings 3. Human cells or tissues 4. Personal data H2020-ITN-2016 5. Animals Coordinators Day 6. Non-EU countries 7. Environment, health & safety 8. Dual use 9. Exclusive focus on civil applications 10. Potential misuse of research results Ethics & 11. Other ethics issues This presentation shall neither be binding nor construed as constituting commitment by the European Commission Research Integrity Self-Assessment Guidance Timea BALOGH Key Document Research Executive Agency 1-Ethics issues Checklist: Unit REA-A1 2- How do I deal with the issues?
First Epidemiological study in UAE 1988 -1992
1 st Study: Prevalence Rates of Mental Disorders in Females in Dubai Summary of Diagnostic Breakdown of Cases According to ICD-9 Coding Categories Depressive Disorders 13.7% Anxiety Disorders 7.0% Psychotic Disorders 1.9% Total Mental Disorders Rates 22.7% Prevalence Rates Comparison of Mental Disorders in Females in Different Populations Northern European Countries 7.5 to 12.2 Mediterranean 19.4 to 22.6 United Arab Emirates 22.7 Africa 27.0
Attitude- behaviour Difference in Socio-Cultural Change Scores in Relation to Psychiatric Morbidity Group Non-cases Cases N % N % A 30 62.5 18 37.5 B 66 78.6 18 21.4 C 74 83.1 15 16.9 D 53 79.1 14 20.9 2 = 8.0, df = 3, p = 0.047 Minus values: bahaviour score is more than attitude score Plus values: attitude score is more than bahaviour score Group a: attitude index-behaviour index >0.1 Group b: attitude index-behaviour index 0 to <0.1 Group c: attitude index-behaviour index <0 to – 0.1 Group d: attitude index-behaviour index <-0.1
2 nd Study: Post Partum Psychiatric Morbidity: The Dubai Study (Rafia Ghubash, and M. T. Abou-Saleh et al) Psychiatric Morbidity- Prevalence of caseness • (SRQ>6) 24.5% • (1 st Week ) using (EPDS) 17.8% • (8 th week) using (PSE) 15.8% • (30 th week) using (PSE) 4.2%
3 rd Study:
3 rd Study: Community-Based Psychiatric Survey in the UAE: Al-Ain Study – 1998 Overall rate 7% Women 22% Men 24% Depressive Disorder Male Female Overall 2.5% 9.5% 6.0% (Prof. M. T. Abou-Saleh, Dr. Rafia Ghuvash and Dr. Tewfik Daradkeh)
4 th Study: Measuring the Health of the Nation United Arab Emirates Health & Lifestyle Survey 2000 (UAEHALS2000) Objectives • Describe health status of UAE nationals • Assess life style including diet, physical activity and smoking • Study health care utilization • Compare findings with other regional & international surveys Acknowledgement 1.UAE University – financial support 2.Ministry of planning, central dept. of statistics – sample, data collection in Abu-Dhabi 3.Ministry of health & Ministry of Interior – data collection in Al-Ain and Abu-Dhabi
Many More …
International publications per year (1996-1999) 14 12 10 8 6 4 2 0 Saudi UAE Tunis Egypt Kuwait Morroco Lebanon Jordan 17
Ethics in Psychiatry
“ETHICS” – What the Word Means Ethos ( ) is the root of ethica ( ), both terms are important for understanding the meaning of right and wrong. The Greek word ethos refers to the basic orientations or disposition of a person toward life, the word was used to refer to what a person carries within himself • Interior attitude • Disposition • Relationship to him/herself and to the world around him/her • Ethos, in the sense of a person’s very inner being, is the root or font of all particular acts. Contemporary medical ethics emphasize concern with external acts Medical ethics in our day, however, is so preoccupied with particular actions that the older, original meaning is ignored.
General and Global Principles Respect for human life and recognition of the inherent worth and dignity of individuals and their right to confidentiality. Respect for persons recognizes all people as autonomous agents and requires that their choices (consent or refusal) be observed. Doing good (beneficence) and doing no harm (non- malfeasance) are two complementary ethical principles that impose affirmative duties on researchers to maximize any benefits for subjects and minimize risks to them. Justice requires that all humans be treated equally.
Basic Concepts in Psychiatric Ethics • Every patient must be offered: – Best therapy available – Protection from harm – Proper care.. respecting patient’s autonomy – Informed consent ..The patient must trust the physician to disclose intimate concerns • Confidentiality: – Situations, which override confidentiality – Threats to confidentiality – Legal protection of confidentiality
Relationship of Law and Ethics Central to all medical ethics is the conflict between the autonomy of the patient (e.g. concerning consent) and the duty of care of the doctor (e.g. in negligence, consent to treatment) – Principle of autonomy i.e. patient has the right to control his/her own body. – The law may also define absence of consent (in spite of patient saying ‘yes’ ) on basis of legal invalidation of ‘apparent consent’. – What does consent mean? – There is no valid (ethical) consent without all elements satisfied. – How do you define each element?
Code of Ethics • Consider first the well-being of the patient. • Honor your profession and its traditions. • Recognize your limitations and the special skills of others in the prevention and treatment of disease. • Protect the patient's secrets. • Teach and be taught. • Remember that integrity and professional ability should be your only advertisement. • Be responsible in setting a value on your services. The Canadian Medical Association Code of Ethics Annotated for Psychiatrists. Prepared by Clive Mellor, MD
Hawaii Declaration To obtain the patient's consent before he is presented to a class or meeting. All reasonable measures should be taken to ensure that the anonymity and reputation of the patient is preserved.
Psychiatrist’s Rights • To refuse to accept a patient • To discontinue, or arrange alternative treatment The refusal to accept a patient, or the discontinuation of care, should be adequately explained to a patient beforehand, and the alternatives which are available to the patient discussed.
“ Societies that discriminate by gender pay a high price in their ability to develop ” The World Bank ( Engendering Development, 2002 )
International and regional initiatives for the empowerment of women scientists Gender advisory board The IPAZIA UNESCO program UNIFEM Arab States Regional Office (UNIFEM ASRO ) L’Oreal for Women in Science UNESCO chairs “Women, science and Technology” Third World Organization for Women in Science (TWOWS ) ESCWA Centre for women International Network of Women Engineers and scientists (INWES )
“ The interaction of Arab Women with Science and Technology” - The Abu Dhabi Declaration “ Data bases for Arab women specialized in S&T should be created and a periodical bibliography giving their curriculum vitae and achievements should be prepared. The information gathered should be circulated between Arab countries and international organizations through information networks such as the Internet . ”
September 2003 A regional meeting was held in Cairo in which it was decided that an Arab Network for Women in Science and Technology (ANWST) would be established . 2003-2004 Two preparatory meetings were then held at the Arabian Gulf University Representatives from academic institutions, NGOs and private sector were invited to participate in these meetings
Launching the ANWST network : February 6-7, 2005 The Arab Network for Women in Science and Technology was launched in Arabian Gulf University in the Kingdom of Bahrain under the patronage of H.H. Shaikha Sabeeka Bint Ibrahim Al-Khalifa , Wife of His Majesty the King of Bahrain and Chairwoman of the Supreme Council of Women
ANWST: Goal To build an integrated scientific community capable of meeting the challenges of sustainable development in the Arab Region through empowering women and strengthening their effective participation and contribution in science, technology and innovation .
ANWST: Objectives Crafting strategies , Build bridges Enhance awareness Capacity building of Arab women Training opportunities Serve as a catalyst
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