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LETTERS: Adnan A Hyder, Delon Human, Francis Crawley, Carel IJsselmuiden, Peter A Singer, and Solomon R Benatar Revised Declaration of Helsinki BMJ 2001; 323: 283 [Full text]

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Ethical competence of poor countries

Luis Justo   (9 August 2001)

Ethical competence of poor countries 9 August 2001
Luis Justo, Assistant Professor of Bioethics Universidad Nacional del Comahue - Argentina Send response to journal: Re: Ethical competence of poor countries	We feel grateful to Johns Hopkins University, University of Toronto, Harvard University and many others that are worried by the ethical competence of poor countries. As we, in underdeveloping1 countries, are also worried we are trying to put theory into practice. In the Neuquén Province of Argentina we are starting a program to have an Ethics Committee in every Hospital. They are intended to be the starting point in ethical education for health workers, and to bring to patients and communities an instrument to have active participation in health as a community resource. Far from just reciting Codes or mantras, we go to the people in the Cordillera de los Andes and the Patagonian barren plains trying to encourage the feeling that they are worthy of a correct treatment, and instill into health workers that people deserve a proper and respectful health care. Bioethics is the right frame for this effort. But (and there is always a but), the Ethics Committees Program means that some modest funds are needed (for printed materials, teachers, travel, etc). Of course in a underdeveloping country money is always needed for basic health requirements, so we don’t get any. As we think that Ethics Committees are not enough we are also engaged in teaching bioethics to medicine students, but there are no national nor (that I know) international funding for this task. So we go on without funds, books, journals, etc. (University resources have been slashed by 13% this month). But at the same time there are international pharmaceutical companies that want to make some multicentered international double-blind placebo-controlled studies in our province. So we assemble a group of people technically sound but untrained in research ethics in the Subsecretaria de Salud to work on the theme, and try to do our best. This year I had the privilege of being awarded a scholarship to make a course in the Harvard School of Public Health on International Research Ethics. The course was excellent and Richard Cash an inspired organizer. I had to travel without any University or Government support, since there is no money for courses. When I came back I found the old reality: there are no books, no journals, no funding, no paper for PC printers. So our developed world colleagues must know that we are trying to develop programs, to teach, to control research ethics, and that we are quite aware of the steps that would be needed to do so. But one of the difficulties is that we don’t find international funding programs working towards this goal2 . I don’t remember any worldwide consultation process asking us what do we think about tools for bioethics development in poor countries. I agree to a point with Hyder: “It depends on what these people trained in ethics do, where they do it, how they sustain their efforts, and how they integrate their contributions within the overall health development of nations”3 . (As long as there is any health development). I concur in that “ethics is not just for ethicists”. Ethics is for people and we, as physicians, should make good use of it. I also agree with Singer4 in that: “A key factor for success is that the funds should primarily be used for direct support of ethics centers in developing countries” . (But ethics centers should be founded, staffed and funded). I furthermore think that, as long as injustice and greed prevail as a global social system, ethics and human rights could and should be a nonviolent fighting weapon in poor countries. We know it, and we are trying to work on it as much as we can, but we are (and will be) chronically underfunded and understaffed. Why should corrupted governments want to invest in ethics? I suggest interested scholars to read the significant debate between Singer et al.5 and Benatar et al.6 in BioMed Central. I believe that Fogarty’s is a good proposal, but, to the end of getting ethics as a clinical and health system practice in areas as Argentine’s Patagonia, it seems remote. Perhaps some day there will be a comparable plan for ethics teaching and development in hospitals and universities in poor countries. I believe its effects would be quite considerable, if (and that’s a big if) there is a previous wide consultation process among underdeveloping countries’ universities and institutions. Luis Justo MD Bioethics Assistant Professor Universidad Nacional del Comahue, Argentina luisjusto@web-mail.com.ar 1 Since social and economic progress is being hindered by multiple factors and many nations are getting poorer and with rampant unemployment, perhaps an existent new category should be recognized: the underdeveloping countries. It may not be politically correct, but it is consistent with reality. With the exception of the 2 With the exception of the Fogarty proposal on research ethics. 3 Hyder A. Ethics is not just for ethicists. BMJ 2001;323:283. 4 Singer P, Benatar S. Authors' reply. BMJ 2001;323:283. 5 Singer P, Pellegrino E, Siegler M. Clinical ethics revisited. BMC Medical Ethics (2001) :1 2. 6 Benatar S et al. Clinical ethics revisited: Responses. BMC Medical Ethics (2001) :2 2.