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Presentation in the UNESCO's regional conference on women's health and research (Cairo University, Dec. 8, 2011)

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  • 1.Assistant Professor of BioethicsFaulty of medicine, King Fahad Medical CityRiyadh, Saudi ArabiaEmail: ghaiathme@gmail.comPhone: 00966566511653

2. Basic definitions What are the sources of ethical concerns inhealthcare for and research on/for women? Conceptual challenges related to care forwomen Ethical challenges to healthcare for women Examples of the ethical issues that ariseduring provision of care to women Ethical challenges to research on/for women Recommendations for future steps 3. What do we mean byEthicsConceptualPracticalTo what do we refer in Morality: the beliefs and deciding what isHow are we going to so standards of good and bad, right/wrong?what we decided as rightright and wrong,in healthcare, research?Philosophy? Utlitarian, Ethics is defined as thedeontology, feminisme, virtue, systematic study of morality. rights-based, principle-based? How are we going tomanage situations whenBioethics: is normative ethicsethical guidance isapplied to decision-making and violated? Religion? Islam? Whichpublic policy in the domains ofinterpretations? Christianity? biology, health care and Which church? research. 4. What makes healthcare/research to women ethically sensitive?Status Ethical implicationsDiminished physical diminished decision-making capacitypowerProne to coercion, abuse, exploitationLess 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 careDiminished politicalLaws/regulations/guidelines that protect womanempowermentare either absent, irrelevant, or not affective Lack of gender-sensitive healthcare (research agenda) Diminished representativeness in research oversight mechanismsAs a child-bearer Restricted personal rights (vs. rights of the fetus &/or the father?) 5. Conceptual Challenges Lack of guidance (moral status of fetus,surrogacy, new RH technologies) Contradicting guidance (national vs. intl) Different interpretations of notions inguidance (intl declarations) De-alignment of legal and ethical guidance Dominance of community values overreligious guidance (female circumcision) Abuse of variation in religious interpretations catholic church and pro-life groups irrational jurisprudence rulings (Fawtas) 6. Practical challenges in care provision Lack of gender-sensitive healthcare Waiting areas Privacy Confidentiality (e.g. husband access to the wifes medical information) Gender insensitive policies (e.g. consent) Male-led management Gender insensitive (discriminative) practices(e.g. C-sections) 7. Examples of gender imbalanced care Mens interference (marital authorization) in the womens RHdecisions (contraception, abortion, protected sex); Diminished freedom of consent (in non-RH issues) Womans right to know (her spouses STD status, treatmentalternatives, 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 womans confidentiality by male family members Women get tested in ANC visits, while men are discovered onlyon voluntary basis (except for visa purposes?) Womens dependence on men to get access to care Undue denial of safe abortion, even when religiously allowed 8. Challenges related to researchResearchResearch Research topicsmethodologies oversightClinically-focused Inclusion/exclusion Womens issuestopicsbiases(risks) are not wellLack of gender- Facility-basedacknowledgedrelated studies onstudies (access) Ethical guidelinesdeterminants of Consent are developed dont get pregnant mostly by whitehealthduring trial menLack of studies on Inadequate Gender-vulnerable groups Imbalanced RECamong women (age, Compensationmembershipssexual-orientation,disability) 9. How our network can help inresolving conceptual andpractical challenges to womenshealth & research? 10. Approach to ethical challenges in healthcare Individual level Raise awareness about patients right, in general, and womensright in particular Positive involvement of men in advocacy for women Assist in minimizing the womens illiteracy and financialdependence Organizational/Institutional level Provide gender-sensitive care (waiting areas, examinationrooms ,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) regardingwomen health Advocate for womens health issues among politicians andpolicy makers 11. Approach to ethical challenges inresearch Train researchers in research ethics, especially vulnerability Improve gender balance in REC structures Educate ethics committees members on womens healthresearch, gender analysis, and participatory actionmethodologies, and to ensure gender issues and analysis arepart of funding criteria Train more female researchers on research methods andethics Encourage/Adopt community-based methodologies Review the current guidelines to makes them more gender-sensitive Funding agencies should encourage research with membersreflecting the diversity of the population; North-South exchange of experience and head for sustainabledevelopment, guided by the MDGs related to maternal health 12. Questions and DiscussionPlease feel free to contact me:Ghaiath M. A. HusseinEmail: ghaiathme@gmail.comPhone: 00966566511653Website:https://sites.google.com/site/medicalethicscourse