Will there be an improvement of ecosystems in the world post-pandemic?

Purpose/Background. Inconsiderate human activities have led to ecological imbalances, and pollution and degradation of our natural environment. However, for humans to continue to exist on Earth in the future and for sustainable development to occur, we must preserve our ecosystems. Methodology/Approach. This paper examines some ethical considerations that are important to human interaction with the environment, by identifying conditions that existed before the Covid-19 pandemic. Results/Findings. The world is currently challenged by global inequality and global climate change, both of which adversely affect our living environment and very sensitive ecological systems. The physical confinement and social distancing measures imposed by governments worldwide during the Covid-19 pandemic produced a reduction in human interactions and activities which had a positive impact on the ecological environments around the world. Discussion/Conclusions/Contributions. As governments release their citizens from the tight restrictions, and people return to their customary activities, we can expect a return to pollution of our environments. This will occur unless, during the period of 'lockdown', humans had become more aware of the harmful effects some of their activities were having on the ecosystem and had been motivated to minimize these activities.

Propósito/Contexto. Las actividades humanas desconsideradas han llevado a desequilibrios ecológicos y a la contaminación y degradación de nuestro entorno natural, sin embargo, para que los seres humanos sigan existiendo en la Tierra en el futuro y para que se produzca un desarrollo sostenible, debemos preservar nuestros ecosistemas. Metodología/Enfoque. Este documento examina algunas consideraciones éticas que son importantes para la interacción humana con el medio ambiente, al identificar las condiciones que existían antes de la pandemia de COVID-19. Resultados/Hallazgos. Actualmente, el mundo enfrenta el desafío de la desigualdad global y el cambio climático global, los cuales afectan negativamente nuestro entorno de vida y sistemas ecológicos muy sensibles. Las medidas de confinamiento físico y distanciamiento social impuestas por los gobiernos de todo el mundo durante la pandemia de COVID-19 produjeron una reducción en las interacciones y actividades humanas que tuvieron un impacto positivo en los entornos ecológicos de todo el mundo. Discusión/Conclusiones/Contribuciones. A medida que los gobiernos liberan a sus ciudadanos de las estrictas restricciones y las personas regresan a sus actividades habituales, podemos esperar un regreso a la contaminación de nuestro medioambiente. Esto ocurrirá a menos que, durante el periodo de "bloqueo", los humanos se hayan vuelto más conscientes de los efectos nocivos que algunas de sus actividades tenían en el ecosistema y se hayan motivado a minimizar estas actividades.

Finalidade/Contexto. Atividades humanas imprudentes levaram a desequilíbrios ecológicos, poluição e degradação do nosso ambiente natural. No entanto, para que os humanos continuem a existir na Terra no futuro e para que o desenvolvimento sustentável ocorra, devemos preservar nossos ecossistemas. Metodologia/Abordagem. Este artigo examina algumas considerações éticas que são importantes para a interação humana com o meio ambiente, identificando as condições que existiam antes da pandemia de Covid-19. Resultados/Descobertas. O mundo é atualmente desafiado pela desigualdade global e pelas mudanças climáticas globais, que afetam negativamente nosso ambiente de vida e sistemas ecológicos muito sensíveis. As medidas de confinamiento físico e distanciamento social impostas pelos governos em todo o mundo durante a pandemia de Covid-19 produziram uma redução nas interações e atividades humanas que tiveram um impacto positivo nos ambientes ecológicos em todo o mundo. Discussão/Conclusões/Contribuições. À medida que os governos liberam seus cidadãos das rígidas restrições e as pessoas retornam às suas atividades habituais, podemos esperar um retorno à poluição de nossos ambientes. Isso ocorrerá a menos que, durante o período de 'lockdown', os humanos tenham se tornado mais conscientes dos efeitos nocivos que algumas de suas atividades estavam causando no ecossistema e tenham sido motivados a minimizar essas atividades.

Addressing the challenge for expedient ethical review of research in disasters and disease outbreaks.

Guideline 20 of the updated International Ethics Guidelines for Health-related Research Involving Humans (2016) by the Council for International Organizations of Medical Sciences (CIOMS) provides guidance on research in disasters and disease outbreaks against the background of the need to generate knowledge quickly, overcome practical impediments to implementing such research, and the need to maintain public trust. The guideline recommends that research ethics committees could pre-screen study protocols to expedite ethical reviews in a situation of crisis, that pre-arrangements be made regarding data sharing and biomedical sample sharing, and that sponsors and research ethics committees seek to minimize risk to researchers conducting research during a disaster. This paper critiques these recommendations against the background of the findings of a survey of public health officials and chairs of research ethics committees in the Caribbean during 2016, which sought to determine the best template for the expeditious ethical review of research proposals in emergency and epidemic situations in the Caribbean, and whose findings can serve as a model for other low- and middle-income countries.

Research in epidemic and emergency situations: A model for collaboration and expediting ethics review in two Caribbean countries.

Various forms of research are essential in emergency, disaster and disease outbreak situations, but challenges exist including the long length of time it takes to get research proposals approved. Consequently, it would be very advantageous to have an acceptable model for efficient coordination and communication between and among research ethics committees/IRBs and ministries of health, and templates for expediting (done with speed and efficiency) ethical review of research proposals in emergency and epidemic situations to be used across the Caribbean and in other low and middle income countries. This project involved a literature search and the interviewing of ministry of health officials, public health practitioners, and research ethics committee/IRB members in Jamaica and St. Lucia, to obtain suggestions for the best model for efficient coordination and communication between research ethics committees (RECs), and developed a template for expediting review of research protocols in epidemic and emergency conditions.

Exploring the risk/benefit balance in biomedical research: some considerations / Explorando el balance riesgos/beneficios en la investigación biomédica: algunas consideraciones / Explorando o balanceamento entre riscos e benefícios em pesquisa biomédica: algumas considerações

Abstract Risk and benefit assessment is one of the fundamental requirements in the ethical review of research involving human participants. As a result, researchers should evaluate and seek to minimize all foreseeable risks involved in their proposed research and members of research ethics committees should evaluate and balance the risks and potential benefits involved in each research proposal as a part of their ethical obligations regarding research protocols. However, current literature provides little detailed guidance on the specifics of how this balancing process should occur. Consequently, this article provides some details of the process to balance risks and benefits in biomedical research and reminds members of research ethics committees of their responsibility to protect those who are vulnerable from exploitation in research projects.

Resumen La evaluación de riesgos y beneficios es uno de los requisitos fundamentales en la revisión ética de la investigación con participantes humanos. Como resultado, los investigadores deben evaluar e intentar minimizar todos los riesgos previsibles involucrados en la investigación propuesta, y los miembros de los comités de ética en investigación deben evaluar y hacer un balance de los riesgos y beneficios potenciales implicados en cada propuesta de investigación como parte de sus obligaciones éticas respecto de los protocolos de investigación. Sin embargo, la literatura actual proporciona escasas guías sobre los detalles específicos de cómo debe ocurrir este proceso de equilibrio. En consecuencia, este artículo ofrece algunos detalles del proceso para equilibrar los riesgos y beneficios en la investigación biomédica y les recuerda a los miembros de los comités de ética de investigación su responsabilidad de proteger a aquellos que son vulnerables a la explotación en proyectos de investigación.

Resumo A avaliação de riscos e benefícios é um dos requisitos fundamentais na revisão ética da pesquisa envolvendo participantes humanos. Consequentemente, os pesquisadores devem avaliar e procurar minimizar todos os riscos previsíveis envolvidos nas pesquisas propostas e os membros dos comitês de ética em pesquisa devem avaliar e balancear os possíveis riscos e benefícios envolvidos em cada proposta de pesquisa como parte de suas obrigações éticas em relação aos protocolos de pesquisa. No entanto, a literatura atual fornece poucas orientações detalhadas sobre como especificamente esse processo de balanceamento deve ocorrer. Consequentemente, este artigo fornece alguns detalhes do processo de balanceamento de riscos e benefícios na pesquisa biomédica e lembra aos membros dos comitês de ética de pesquisa de sua responsabilidade de proteger os vulneráveis da exploração em projetos de pesquisa.

Terms of reference: Caribbean Network of Research Ethics Committees (CANREC)

The Caribbean Network of Research Ethics Committees (CANREC) is established by the cooperation of Research Ethics Committees across the Caribbean Public Health Agency (CARPHA) Member States. The purpose of the Network is: i) To provide a sustainable infrastructure for research ethics committees within CARPHA member states to promote, exchange, and cooperate intra-regionally and internationally in matters of research and research ethics. ii) To provide harmonization of multidisciplinary ethical reviews between network members to improve the protection of human participants in all aspects of medical and health-related research involving human beings, human material and data. iii) To augment sharing of information and intellectual resources, policies, and review strategies among network members.

Overcoming barriers to pain relief in the Caribbean.

This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated in light of clinical and scientific evidence, iii) opioid procurement policies be adjusted to facilitate increased medical use, iv) medical charts and records be modified to routinely elicit and document patients levels of pain, and v) educational campaigns be developed to inform the public that moderate and severe pain can be safely relieved at the end of life and other stages of life. The professional, respectful, and beneficent response to patients in pain is to provide rapid and aggressive pain relief or to urgently consult a pain or palliative specialist. When a health system hinders such efforts the ethical response is to identify, facilitate and advocate for overcoming barriers to improvement.

Ethics, medicine and society: imperatives for the future

Historically, medicine has been a caring profession and social factors have directly and indirectly affected clinical practice, yet the social roots of disease and suffering in patients and the ethics of patient care have often been left out of medical teaching and discussions at medical conferences. As health and social problems are inseparable, ethically, medicine and medical teaching need to respond to social suffering, and should help to solve the economic problems in health care. Further, since all intervention in the lives of human beings carries ethical content through the nature of care, ethical competence involving ethical analysis, critical thinking, and problem-solving should be developed in medical students and doctors simultaneously with clinical judgement and expertise.(AU)

Medicine and its alternatives: health care priorities in the Caribbean

In the Caribbean as as in many other areas costly biomedical resources and personnel are limited, and more and more people are turning to alternative medicine and folk practitioners for health care. To meet the goal of providing health care for all, research on nonbiomedical therapies is needed, along with legal recognition of folk practitioners to establish standards of practice.(Au)

The impact of advanced technology of critical care: dilemmas in the making

Advanced technology has enhanced our ability to diagnose and treat critically ill patients thereby assisting in prolonging life for many. However, its high cost has been prohibitive, and it may impose more burdens than benefits on some patients. Although technological advances has accelerated social change, many have also fuelled legal and ethical concerns. Consequently, the rationale for the use of advanced technology in the care of criticaly ill patients should be clear and ethically justified.(AU)

Ethnics, medicine, and society in the Caribbean

While the Medical Faculty of the University of the West Indies has produced many outstanding scholars and practitioners over the past 50 years, social processes in many Caribbean countries have resulted in much suffering. Despite this, the social roots of disease and suffering often have been left out of our medical teaching and ethical discussions. The moral basis of medical care is oriented not only by the individual suffering of patients, but also by the collective experiences of humankind. Hence, failure to engage the social aspects of suffering undermines the moral and pragmatic aspects of medical practice. In the Caribbean, if you are poor, you are likely to have a poor health status. So ethically, medicine and medical teaching need to respond to social suffering, as health and social problems are inseparable. Moreover, the last 3 decades have all seen the call for respect for persons and justice as important values in medical practice in many societies. These values have given medicine its contemporary identify, stressing the paramountcy of the welfare of the patient, the need for informed consent, the requirement to make decent health care equitably available to all, and the importance of empathy and kindness as hallmarks of humane medical care. Historically, the practice of medicine has rested on two pillars: medical knowledge and expertise, and irreproachable medical conduct. Unfortunately, in the Caribbean society a huge discrepancy exists in the time and attention paid to these essential pillars. Nearly all of a doctor's occupations have ethical implications due to the nature of care involving persons: therefore medical teaching and conferences that focus only on the scientific and technical aspects of medicine, without addressing the ethics of care for patients or the developing and improving of the ethical competence of students and practitioners, are incomplete.(AU)

Research ethics

This article reviews the ethical requirements for research. The ethics of human experimentation are informed by the basic principles of beneficence, justice and respect for persons. The principle of beneficence requires that a research protocol present a favourable risk/benefit ratio to subjects. Justice demands that the burden and benefits of research be equitably distributed. Respect for persons entails an obligation both to obtain informed consent from research subjects and to protect those who are unable to consent from the risks of research. The fundamental tenet of research ethics is a priori review by a panel of peers. This article argues for the establishment of Research Ethics Committees across the Caribbean to ensure that clinical research conforms to the highest scientific and ethical standards (AU)