THE ASIA PACIFIC BIOETHICS PROGRAM OF THE UNESCO CHAIR IN BIOETHICSCAN RESEARCH IN DEVELOPING COUNTRIES BE BOTH ETHICAL AND BENEFICIAL TO LOGAL COMMUNITY ?

Abstract

Abstract
ln 2005 at the 33rd Session of General Conference at UNESCO, it adapted the Universal
declaration on Bioethics and Human Rights. Declaration article 1.1 outlines the principals that
respond to ethical issue related to medicine, life sciences and associated technologies as applied
to human beings. Thus the international standards for Bioethics are grounded in a language of
rights -to safe guard human dignity and human rights. UNESCO made ethics of Science and
technology one of its 5 priority areas. lt is charged with promoting the education of ethical issues
of Science and Technology. The UNESCO Program in this area aims to strengthen lhe ethical
link between scientific advancement that is taking place and the Cultural, Legal, Philosophical
and religious context in which it occurs.The disparity of health amongst the world's communities
is largely determined by the wealth of the countries. Developed countries have access to clean
waters, vaccines and new medical technologies whereas developing countries do not.
Researches in these countries are also funded by the wealthy countries and we will need to
protect these countries from exploitation by those with the means in the name of clinical
research.Hence, we have to discuss the necessary conditions for models allowing lnstitutional
Review Boards to grani exceptions in low income countries to circumvent the need for "World
Best Practices" in their research requirements. There are commentators arguing that "World's
Best Practiees sheuld always be used in ali countries, but financial burden in the developing
couniries prevents this. A total ban cn any research other than the world's best practice would
prevent exploitation, but this may block important research that can improve health care in these
countries. So is it possibie to address the potentiai for exploitation while allowing research that
has the potential to benefit the host communities.We argue that lnstitutional Review Boards
should be allowed to grant exceptions for research on grounds that the research satisfies the
Scientific Necessity, Relevance for the host communities, sufficient host community benefits and
Subject and Host Community nonrnaleficence.The argument has focused on the controversial
HIV vertical transmission, and the trials used. World Best Practice is currently the long course
treatment using AZT (zidovudine), but this is expensive involving early prenatal visits, frequent
visits and lV infusions during labour, which is not feasible nor affordable in these countries.
However studies in South Africa has identified that apprcximalely 75% of HIV vertical
transmissions occurs ciuring or after delivery. Hence, trials comparing short ccurse AZT
treatment against placebo were done on ihe grounds that it is better than no treatment at all. The
trials suggested that short course ti'eatment is possibly better than placebo. Yet the variability in
the transmission rate may suggest that the short-course treatment was not woi-th pur"suing.The
knowledge thal.75% of HIV vertical transmission occurs during delivery has led investigators to
the iandmark trials using nevirapine as a single dose given during labour offerring a feasible and
affordable treatment for reducing the rate of vertical transmission.To justify the relevance of these
issues, the Elizabeth Glaser Paediatrics AIDS Foundation has devoted $100 miilion to prevent
HIV vertical transmission. Assuming a cost of $250 per mother-child treatment using the long
course AZT would translate to 65,000 fewer HIV infected child. Yet devoting the same money to
a single-dose nevirapine, at $4 per mother-child can translate to 270,000 fever HIV infected child,
lffrttE Supplemen Majalah Kedokteran Andalas. Vol. 37. No.Supl.1, [/aret 2014
potentially saving an additional 200,000 lives. The UNESCO Chair in Bioethics was established
to coordinate and stimulate an international network of lnstitutes for Medical Ethics Training. ln
this role there is a need to develop an up to date syllabus for Medical ethics education which will
satisfy requirements of the Medical fraternity. These followed Two lnternational Studies in 2001
that UNESCO undertook in researching the importance and quality of education in ethics in
Medical Colleges and faculties all over the world. The results confirmed that there is an emerging
need for introduction of teaching of Medical ethics as a consequence of several social and
scientific processes that have taken place. These included the relationship between health care
providers and their patients, the choice of medical interventions for the individual patient, the
choice of Public health interventions, the evaluation of effects of health care interventions, the
collaboration between teams engaged in health care activities and the choice of goals and
methods of medical reseai'ch.Hence, research using less than the world's best practice can be
ethical and has the potential to provide sufficient benefit for the host communities and IRB should
be given the authority to approve such activities on a case by case basis.
Affiliasi Penulis : Director Centre for Asia Pacific Bioethics Studies, Korespondensi : Theong H. Low, email :
thlow@bigpond. net.au,