Conceptual and practical challenges to the ethics of women's health care and medical research ghaiath-dec8.2011
Assistant Professor of BioethicsFaulty of medicine, King Fahad Medical CityRiyadh, Saudi ArabiaEmail: email@example.comPhone: 00966566511653
• Basic definitions• What are the sources of ethical concerns in healthcare for and research on/for women?• Conceptual challenges related to care for women• Ethical challenges to healthcare for women• Examples of the ethical issues that arise during provision of care to women• Ethical challenges to research on/for women• Recommendations for future steps
What do we mean by Ethics Conceptual Practical To what do we refer in Morality: the beliefs and deciding what is How are we going to so standards of good and bad, right/wrong? what we decided as right right and wrong, in healthcare, research? Philosophy? Utlitarian, Ethics is defined as the deontology, feminisme, virtue, systematic study of morality. rights-based, principle-based? How are we going to manage situations whenBioethics: is normative ethics ethical guidance isapplied to decision-making and violated? Religion? Islam? Whichpublic policy in the domains of interpretations? Christianity? biology, health care and Which church? research.
What makes healthcare/research to women ethically sensitive?Status Ethical implications•Diminished physical diminished decision-making capacitypower Prone to coercion, abuse, exploitation•Less educational levels Absent or inefficient contribution to care/research (bear more burden, e.g. contraceptives)•Less involvement in Less representation in ethics committees (policy,ethics research, clinical)•Economic dependence Diminished access to care•Diminished political Laws/regulations/guidelines that protect womanempowerment are either absent, irrelevant, or not affective Lack of gender-sensitive healthcare (research agenda) Diminished representativeness in research oversight mechanisms•As a child-bearer Restricted personal rights (vs. rights of the fetus &/or the father?)
Conceptual Challenges• Lack of guidance (moral status of fetus, surrogacy, new RH technologies)• Contradicting guidance (national vs. int’l)• Different interpretations of notions in guidance (int’l declarations)• De-alignment of legal and ethical guidance• Dominance of community values over religious guidance (female circumcision)• Abuse of variation in religious interpretations ▫ catholic church and pro-life groups ▫ irrational jurisprudence rulings (Fawtas)
Practical challenges in care provision• Lack of gender-sensitive healthcare ▫ Waiting areas ▫ Privacy ▫ Confidentiality (e.g. husband access to the wife’s medical information)• Gender insensitive policies (e.g. consent)• Male-led management• Gender insensitive (discriminative) practices (e.g. C-sections)
Examples of gender imbalanced care• Men’s interference (marital authorization) in the women’s RH decisions (contraception, abortion, protected sex);• Diminished freedom of consent (in non-RH issues)• Woman’s right to know (her spouse’s STD status, treatment alternatives, etc.)• STDs protection (and contraception) is more woman-dependant (pills, IUCDs, hormonal therapy, etc.)• Women with HIV/AIDS: right to treatment, stigmatization, confidentiality, counseling strategies on pregnancy continuation/ termination, future child bearing, and use of contraception• Breach of woman’s confidentiality by male family members• Women get tested in ANC visits, while men are discovered only on voluntary basis (except for visa purposes?)• Women’s dependence on men to get access to care• Undue denial of safe abortion, even when religiously allowed
Challenges related to research Research Research Research topics methodologies oversight•Clinically-focused • Inclusion/exclusion • Women’s issuestopics biases (risks) are not well•Lack of gender- • Facility-based acknowledgedrelated studies on studies (access) • Ethical guidelinesdeterminants of • Consent are developed • ‘don’t get pregnant mostly by ‘whitehealth during trial’ men’•Lack of studies on • Inadequate • Gender-vulnerable groups Imbalanced RECamong women (age, Compensation membershipssexual-orientation,disability)
How our network can help inresolving conceptual andpractical challenges to women’shealth & research?
Approach to ethical challenges in healthcare• Individual level ▫ Raise awareness about patients right, in general, and women’s right in particular ▫ Positive involvement of men in advocacy for women ▫ Assist in minimizing the women’s illiteracy and financial dependence• Organizational/Institutional level ▫ Provide gender-sensitive care (waiting areas, examination rooms ,etc.) ▫ Train providers on ethics (FAB) ▫ Balanced gender management• Policy-making level ▫ Develop gender-sensitive policies ▫ Encourage women involvement in policy-setting ▫ Continuous communication with Ulama (scholars) regarding women health ▫ Advocate for women’s health issues among politicians and policy makers
Approach to ethical challenges inresearch• Train researchers in research ethics, especially vulnerability• Improve gender balance in REC structures• Educate ethics committees members on women’s health research, gender analysis, and participatory action methodologies, and to ensure gender issues and analysis are part of funding criteria• Train more female researchers on research methods and ethics• Encourage/Adopt community-based methodologies• Review the current guidelines to makes them more gender- sensitive• Funding agencies should encourage research with members reflecting the diversity of the population;• North-South exchange of experience and head for sustainable development, guided by the MDGs related to maternal health
Questions and DiscussionPlease feel free to contact me:Ghaiath M. A. HusseinEmail: firstname.lastname@example.orgPhone: 00966566511653Website:https://sites.google.com/site/medicalethicscourse