Thursday, April 12, 2018

Back to blogging - stuff is happening :)

I have been pretty quiet on the blogging frontiers during the last few months. I have been juggling various manuscripts, including a book manuscript, as well as teaching, so basically I was too tired to blog much (well, too tired to blog at all).

Anyhow, so here's an update:

Issue CoverRuth Chadwick and I managed to send a first rough draft of our textbook to Wiley to have it externally reviewed. It will need quite a bit more work, but we hope to get this done during the summer months.

I have a lengthy review article on the ethics of Conscientious Objection accommodation in the British Medical Journal. You can find it here. 

The title is: Conscientious objection in medicine: accommodation versus professionalism and the public good.

IssuesI also, jointly with Justine Dembo and Jonathan Reggler have an Open Access paper in the Canadian Journal of Psychiatry on medical aid in dying and depression. You can find it here.

The title is: 'For their own good': A Response to Popular Arguments Against Permitting Medical Aid in Dying (MAID) where Mental Illness Is the Sole Underlying Condition.

There is also a completed book chapter to report in a Palgrave MacMillan handbook on, I think, political philosophy. I did that jointly with an undergraduate student at Queen's, Benjamin Zolf.

And there are various Editorial type papers, including (in German) this one on the use of ethical deliberation in the decision-making on public health policy.

How can we ensure that the global south benefits from and contributes to the field of bioethics?

Here's a re-post of my Editorial in the current issue of Developing World Bioethics. I will update toward the end of the Editorial relevant information about the upcoming IAB World Congress in India, as some things (like the location) have changed since the Editorial was published.

There has been a legitimate debate going on for many years about the question of how we can ensure that colleagues in the global south can both benefit from journals such as this, as well as contribute constructively to it.

Cover imageThe issue of access to subscription‐based journals has been litigated ad nauseam and I do think global publishers have done by and large a decent job in terms of implementing with WHO and other agencies myriad access themes available to those countries too resource‐constrained to afford regular subscriptions.1

Some authors disagree, insisting that only Open Access journals, a supposedly superior business model, can address the access problem adequately. And they are right, Open Access journals, by definition, pose no access problems of the kind subscription‐based journals pose. Sadly, having your cake and eating it too rarely works in the real world, and so these authors, having resolved the access to academic research problem, are faced with a different problem they did not have before. Open Access journals can only survive as viable enterprises if a sufficiently high number of authors pay what are often expensive article processing charges, or APCs. These journals often offer their equivalent to the access schemes subscription‐based journals have put in place, namely differential fees or fee waivers for those who absolutely cannot afford to pay.

Short of asking academics to exploit themselves by volunteering to produce and disseminate academic journals and their content, reliably, over decades, someone will have to pay for the resource intensive production of journals and to ensure the reliable availability of their content.

I have yet to see from those complaining about access problems realistic solutions to this challenge. They mostly, and typically correctly identify the problem, but beyond grandstanding they offer no answers. They expect someone else to sort things out for them.

As I said, authors in the global south can access our content either by means of the access schemes mentioned earlier, or by simply emailing the authors of content they are interested in and by asking those authors for a complimentary electronic copy of their article. Nobody would decline such a request.

I do think that a much greater challenge is to enable scholars from the global south to participate in international conferences and workshops both to share their own knowledge, but also to learn from colleagues and to network with a view to establishing research partnerships and the like.

I suspect you will know Facebook. I posted a photo from a workshop I had organised in the summer of 2017 in the UK, on the most recent version of the Council for International Organizations of Medical Sciences (CIOMS) research ethics guidelines. Not unexpectedly a colleague, located in an upmarket London‐based university, harangued me for the lack of diversity, perhaps most significantly, the evident lack of attendees from the global south. That colleague was right: only two of the 25 or so workshop delegates came from the Caribbean, while everyone else came from countries of the global north. Of course, I had virtually no funding to organise said workshop, and everyone who travelled there paid their own way. Nobody's flight was covered by me. I did have inquiries from various colleagues in the global south who would have loved to attend, but quickly gave up on the idea due to lack of funds for their travel expenses. The colleague who criticized me quite publicly, naturally, had no funds to offer either. It is always easier to criticize than to contribute meaningfully to change. The same, as I tried to show, holds true for academics who refuse to acknowledge the cost involved in producing academic journals.

Some constructive attempts have been made to have a more globally representative group of conference goers presenting at and attending international bioethics events. A successful example of this is the Global Forum on Bioethics and Research. The GFBR has been around for a longish time. It's funded mostly by the UK's Wellcome Trust, the Gates Foundation, the US NIH Fogarty International Center and the UK's Medical Research Council. I had a quick look at the GFBR's website, with a view to finding out who governs it, and who decides on the composition of speakers and attendees of its meetings, given that its funders reside essentially in the USA and the UK. It seems to me as if the majority of those people are either staff members of these funding organisations, or are past/current grant recipients.2 There appear to be very few truly independent scholars from the global south among those in charge of organising these global events.
I don't think that this is the result of any kind of malicious intent. It's likely a function of ‘who do we know who could serve on that steering committee who is from Africa, Asia etc’, and who does one know? Well, the answer is likely to be: ‘someone we have funded before’.
However, that alone does not address the question of whether or not the meetings are failures when it comes to the question of participants from the global south. Here are the criteria the GBFR uses to determine who among the applicants will be invited3 :

  • Country of origin: GFBR would like to ensure a representative distribution of delegates from different regions;
  • Background /current area of expertise: GFBR is aimed at anyone involved or interested in health research ethics, including researchers, policy‐makers and community representatives. GFBR seeks representation from many different disciplines;
  • Membership of an IRB/REC: Membership of an Institutional Review Board / Research Ethics Committee is not a prerequisite for attending GFBR, but may be taken into consideration;
  • Experience of ethics: GFBR encourage s a mixture of ‘old’ and ‘new’ faces at each forum so that participants can productively discuss issues of concern to them and gain from the perspectives of others. Applicants need not be experts in ethics;
  • Reasons for attending the meeting: GFBR seeks participants who will be able to actively contribute to the meeting and who expect to impact on research ethics and/or pursue a career in research ethics in their own country.
While there is the inevitable number of people who presumably just have to be at every such meeting (let's call them ‘old’ faces), the GFBR has succeeded in terms of attracting a fairly wide range of delegates from the global south to its meetings over the last few years. It's a small (and expensive) meeting, designed to host about 80 delegates, but it's probably a meeting as good as they come on the global bioethics scene. I truly wish there were more such events on the global bioethics events’ calendar. I do encourage you to give thought to how this sort of event can be replicated, for other areas of bioethics, ie. not the typically well‐funded area of research ethics but, say, for reproductive health, global health, and so on and so forth.

Let me end this editorial by encouraging you to attend the next World Congress of the International Association of Bioethics. It will be held in Bangalore from 4–7 December 2018 under the theme Health for all in an unequal world: obligations of global bioethics and is locally hosted by SAMA, the resource group for women's health, the Forum for Medical Ethics Society, and, of course, the IAB.4 With a bit of luck (and planning) there might be a plenary dedicated to figuring out how to enable more delegates from the global south to attend such events. Why don't you propose to organise such a plenary to the India‐based hosts of the event? They might consider it quite seriously.


Bioethics - Expanding Scope

Exciting changes are coming to Bioethics. Our publisher has, essentially, removed the page limitations on our budget. That provides us, of course, with growth opportunities. We have decided, informally, to begin reviewing papers that are primarily empirical in nature and/or that are primarily legal analyses. In the past we rejected such manuscripts, typically, as desk-rejects (ie the decision was made by us Editors without further review). We will now be able to accommodate such manuscripts, provided they have significant implications for bioethics. To facilitate the competent review of such submissions we have secured in-principle agreement from two colleagues in our field, who are in the process of being appointed as Associate Editors to the journal's Editorial Board. Once that paperwork between them and the publisher is sorted out, we will formally announce who is joining the team at the journal. At that point in time our informal current arrangement will become our formal new policy. 

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