SIUT Centre of Biomedical Ethics and Culture Pakistan December, 2014.pdf · Volume 10 Issue 2 December 2014 Centre of Biomedical Ethics and Culture Drones are probably the most advanced,

Bioethics Links

Volume 10 Issue 2 December 2014

Centre of Biomedical Ethics and Culture

Drones are probably the most advanced,and misunderstood, examples of hightechnology systems in the field of robotics,mechatronics and aeronautics. Also known as“Unmanned Aerial Vehicles” (UAV's) - theycome in a range of sizes, shapes and functionscontrolled either remotely from the ground orautonomously. They are generally used tocarry out tasks where manned flight isconsidered to be risky or dangerous. Dronesmostly find use in military missions, but therehas been a massive increase in their use incivilian applications such as electronic newsgathering, agriculture, forestry, search andrescue, and meteorology. The technology hasevolved over the years to create machines thatperform their 'missions' with a high degree ofstealth and precision.

The earliest drone prototypes were derivedfrom scaled or 'model' aircraft used byhobbyist aviators. A typical drone is made oflight composite materials such as fiberglass,Kevlar, and carbon fiber - to reduce weight andprovide ease of low-cost manufacturingwithout requiring expensive tooling and dies.The lightweight composite constructionprovides a high power-to-weight ratio allowingdrones to fly longer and higher thanconventional aircraft. They are equipped with

state of the art infra-red cameras, GlobalPositioning Systems (GPS), laser or GPSguided missiles and other sophisticatedcommand and control systems.

Drones are controlled through a groundcontrol station which could be as small as alaptop in a briefcase or large, truck-mounted,shelters housing several operators at multiplelocations. Drones come in a wide variety ofsizes and weights ranging from a fewkilograms to several tons. They can belaunched by hand or from short runways. AUAV system has two parts, the drone itself andthe control system. The drone is controlledfrom the ground by trained combat pilots oroperators each performing

How Do They Work?

Continued on page 4

Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 1

D : A A M T ?rones erial ssasins or isunderstood echnologyRaja Sabri Khan*

*MS in Aeronautics and Astronautics, CEO, Integrated Dynamics, Karachi

We publish this issue with a heavy heart. On December 16, Taliban militants attacked a school in Peshawar brutally

killing more than 130 children along with of their teachers. People of Pakistan have suffered similar attacks

for years but this calculated, planned massacre of innocent children plumbs depths of evil for which no words can be

found. Printing this edition is our way of education and

dissemination of knowledge in Pakistan; not to do so is to give in to the militants' barbaric agenda.

many

reiterating our commitment toBioethics Links

Editor

Pakistan

cbecSIUT

“Dharnacopter:” A drone equipped with a camera hovers

over people staging a political protest in Islamabad, Pakistan

(http://mashable.com/2014/09/29/drone-beat-hollywood-national-park-fine/)


The phone rang andat the clock. It was am and I

on-call and I I picked upbefore my three-year old decided todo so. With half asleep, I tothe from the ER telling me about a 50year old from interior Sindh brought withabdominal pain of days duration,increased heart rate, low blood pressure,kidney failure and a heart working at20% of its . Dreading to explorethe abdomen of this very sick man, I asked foran X-ray to look for the presence of free gas inthe abdomen perforation hisbowel. my relief, ofthis on the X-ray. The patient beadmitted under medical care ICU forstabilization with a CT scan thenext day.

The next morning, I walked ICUhoping for a medicalcause for the abdominal pain. Therehe was - a well built middle aged man writhingin pain and

The eyes of my young houseofficers and ICU staff followed me as Iapproached the patient. they expectedme to place my “magical” hand onhis abdomen andthe the pain. The patientseemed to want the same begging me to getrid of pain. “Do .

Dr Mujtaba, his primary physician, was ofthe opinion that with the clinicalcondition it was not possible to get a CT scan.“Our CT machine is out of order and he is toosick to another hospital for thescan,” . Exploring was theonly . We argued about the risks andbenefits, spoke to the family, andconvinced ourselves to a“chance ”

It was midday his belly. All I

could see was black, dead intestine. “Almost all of his bowel is dead, I

am closing him ” I declared. “Why don't youjust take it out?” the anesthesia resident

peeping. heart rhythm

went berserk. The consultant anesthetistsaid, “Let's try to see if wecan t will be a goodlearning for the residents.” Therhythm to normal and I wasable to close the abdomen and shift

, to the ICU.“Please let him go in peace I requested

Dr Mujtaba on the phone. “Let me think,” wasthe answer. “What do you want

The pathology is incompatible withlife,” I screamed at him. “Allah can domiracles,” said Dr Mujtaba. “What miracle

intestines are dead, he cannot survivewith dead intestine, just do not give him anymore medications to his heart going.Let him go.” “Well, let's discuss it,” he said,

the argument continued.The next morning I walked into the ICU

that misery was over.there he was screaming and grunting

with a dropping BP and a heart rate.“Please let him go ” I the ICU in charge.I need to ask the patient is

under his care,” was the reply. “But you knowit is futile and he is in pain ” I insisted againbefore leaving.

The was allowed to go thenext day, dozing off grunting and inperspiration to . As Iwondered about the utility and the futility oftreatments we , and

when battle.

I turned over in bedglancing was

hated it. the phonedaughter

a mind still listenedphysician

manan

merelycapacity having

indicating ofTo there was no evidence

couldto the

scheduled for

to the stillrather than a surgical

patient's

with several tubes running in andout of his body.

I knewsurgeon's

determine and eliminateabdominal

his something,” he implored

patient's

to be movedhe said his abdomen

choicefinally

give the patient

when I opened

staringback at me

over thedrapes Suddenly the patient's

some medicationscorrect the arrhythmia. I

experienceslowly returned

thepatient still alive,

to thinkabout?

almost?

His

keep

and

hoping the patient'sBut

rocketingtold

Dr. Mujtaba,

patient finallydrenched

his death I stood there

offer our reluctance toaccept we have lost the

1:00

four

the

thencause of

,

.

,

suggested the impossible,

,”

,

,“

,

,

Please let him go!

Nida Wahid Bashir*

* , KarachiPGD Alumnus Consultant General Surgeon, Patel Hospital,

Pakistan

cbecSIUTBioethics Links

Volume 10, Issue 2 (December 2014)

A series of writings in which CBECalumni share their professional and

personal experiences with our readers.

CBEC review: Impressions and insightsAamir Jafarey*

The Centre of Biomedical Ethics andCulture turned ten in October 2014. Wecelebrated our first decade the way we knowbest - by creating more work for ourselves! Asreported in the previous edition of the

( access i b l e a t :http://www.siut.org/bioethics/Newsletter%20June,%202014.pdf), CBEC facultydecided that the Centre needed to be reviewedby an international group of peers so that wecould get an unbiased opinion regarding ouraccomplishments, our shortcomings and ourfuture trajectory. The fact that such a reviewof a bioethics centre had never been reportedin English language literature did not deter us;we are quite used to inventing our ownwheels. Our reviewers were also brave toaccept the challenge of the unknown and takeup the onerous task of doing something theyhad never done before. Their commitmentlasted much longer than the four days theyspent on campus; it consumed several weeksthereafter during which the eight willingacademics visited CBEC, toiled hard to makesense of what they observed, and to put it allin a report that was submitted to the SIUTDirector in June 2014. Their findingsresonated with those of three externalevaluators who had submitted their analysesbased on their experience with CBEC and itsactivities and a faculty report that had beensent to them.

Our reviewers found the academicprograms to be rigorous, interactive andchallenging. Commenting on the course workthey said, “The quality and topic range of themodules are world class.” Regarding theimpact of the programs, they opined thatCBEC's “bioethical influence has extendedbeyond its office walls to other medical andalso non-medical institutional settings ...”

The review team found several distinctive

features of CBEC which set it apart from otherbioethics centres around the world. In theopinion of one reviewer, among CBEC's mostdistinguishing characteristic(s) was the“inclusion of the term and concept of 'Culture’

in its name” and the attention given to religionas a source of ethics. Another commentedthat, “CBEC's conception of ‘culture’...attempts to link ‘particularism’ and‘universalism’ through its recognition of the‘commonalities’ along with the dissimilaritiesthat persons who belong to different societiesand cultures bring to a moral life ... This kind ofmulti-faceted and knowledgeable perspectiveon culture(s) is one of CBEC's most distinctiveattribute. It is a perspective that is minimizedor marginalized, if not largely ignored by manyother bioethics centres.”

Reviewers noted that an important featureof the teaching is “how well groundedinstruction is in the clinical realities thatstudents face in their professional lives. A finebalance is struck between didactic teachingand exposure to conceptual bases of bioethics... many programs in the West and elsewhere,fail to find this balance.”

The review team also appreciated theformal inclusion of literature,

B i o e t h i c s L i n k s ,


*Associate Professor, Centre of Biomedical Ethics and Culture, SIUT, Karachi.

Pakistan



Whiskered guests: Last month, CBEC was host to a family ofkittens that took temporary residence with their mother

on one of the Centre’s window sills.

Continued on page 7

a discrete function. When surveillance is theobjective, live video streams from onboardcameras are sent to satellites from where theyare received by ground forces to form attackstrategies and locate vulnerable areas. Dronescan fly at extremely high altitudes to avoiddetection. Along with all these features,comes a heavy price tag. A military dronesystem, such as the Predator, along with theground control system costs around $50million.

Drones were initially developed to carryout surveillance and intelligence operations.Since drones had removed the “humanelement” - they found further uses in otherfields which involved risking human lives suchas search and rescue, monitoring radioactivecontamination, weather and meteorologicalresearch, flood and irrigation control, assetmonitoring (oilfields, gas pipelines). Today,an army which has a fleet of drones isconsidered to have the upper hand.

Drone applications

Drones are used in situations wheremanned flight is considered too risky ordifficult. They provide troops with a 24-hour"eye in the sky", seven days a week. Eachaircraft can stay aloft for up to 17 hours at atime, loitering over an area and sending backreal-time imagery of activities on the ground.

Drone legislation and the use of drones inboth civilian and military regulated airspace isa subject of constant discussion around theworld. A 'Wild West' scenario prevailscurrently where any person or governmentwith access to the technology uses it in amanner they seem to find suitable for theobjectives. This unregulated use of dronetechnology is seen as having far-reachingconsequences into the ethics and privacyinvas ion issues that uncont ro l l eddissemination of other dual-use technologieshas caused in the past.

PresidentBarack Obama has confirmed the US is usingunmanned aircraft to regularly targetsuspected militants in tribal areas of Pakistan.He has defended the drone attacks, sayingthey made precision strikes and were kept on a"tight leash". The use of such unmannedaircraft in the area began under PresidentGeorge W. Bush, but more than doubledunder the Obama administration.

The drones used by the United States AirForce and Royal Air Force range from smallintelligence, surveillance and reconnaissancecraft - some light enough to be launched byhand - to medium-sized armed drones andeven larger 'spy' drones.

Drones are seen by many in the military asdelivering precision strikes without the needfor more intrusive action. However,they are not without controversy. Hundreds ofpeople have been killed by the strikes inPakistan - civilians as well as militants,causing outrage. One of the deadliest attackswas in March 2011 when 40 were killed, manybelieved to be civilians at a tribal meeting.

Drone control bases may be local to thecombat zone or thousands of miles away -many of the drone missions in Afghanistan arecontrolled from Creech air force base inNevada, USA - although take-off and landingare always handled locally.

The politics of drones

Although the US does not speak publiclyabout operations involving drones,

has

military

CIA leadership has recently said thatdrones are “the only game in town.” The CIAhas been using drones in Pakistan and othercountries to assassinate “terrorist leaders.”While this program was initiated by the BushAdministration, it has increased under Obamaand there have been 41 known drone strikes inPakistan since Obam ecame President.Analysis by an American think tank TheBrookings Institution on drone attacks inPakistan has shown that for every militantleader killed, 10 civilians also

a b


Pakistan



“Drones: Aerial Assasins or Misunderstood Technology?” 1from page

Continued on page 5

have died.The UN's Special Rapporteur on

extrajudicial, summary or arbitraryexecutions, Philip Alston, has said that theuse of drones is not combat as much as'targeted killing'. He has repeatedly tried toget the US to explain how they justify the useof drones to target and kill individuals underinternational law. The US has so far refused todo so. In a report to the UN he has said the USgovernment (and by implication the UKgovernment) “should specify the bases fordecisions to kill rather than capture particularindividuals … and should make public thenumber of civilians killed as a result of droneattacks, and the measures in place to preventsuch casualties”.

A further question is the extent to whichoperators become trigger happy with remotecontrolled armaments, situated as they are incomplete safety, distant from the conflictzone. Keith Shurtleff, an army chaplain andethics instructor at Fort Jackson, SouthCarolina worries “that as war becomes saferand easier, as soldiers are removed from thehorrors of war and see the enemy not ashumans but as blips on a screen, there is veryreal danger of losing the deterrent that suchhorrors provide.”

Military drone manufacturers are lookingfor civilian uses for remote sensing drones toexpand their markets and this includes the useof drones for domestic surveillance. Droneswill no doubt make possible the dramaticexpansion of the surveillance state raising

the limits of governmentintrusion and policing of society. With theconvergence of other technologies it may evenmake possible machine recognition of faces,behaviors, and the monitoring of individualconversations. The sky, so to speak, is thelimit, and new quandaries related to privacywill arise.

,new concerns about

The futureAs with many technologies, a lot depends

on the ends they are used for. Drones arebeing used for many beneficial purposes.New applications are coming into picture asthe work efficiency and tolerance capacity ofdrones have surpassed all expectations.

Civilian applications such as 'dronejournalism' - small quad copter dronesequipped with cameras known as “dharnacopters” - are a regular feature on PakistaniTV channels. Other uses such asagriculture, ocean mapping, search andrescue, and medical supply deliveries arebeing tested and evaluated around the world.

Drones are here to stay. The technologyhas evolved and progressed over the lastdecade and spin-off applications are filteringinto many other fields such as distanceeducation, telecommunications, commercialfilm-making, biomedical engineering etc. It isup to humans to use technology forconstructive rather than destructive ends.The technology and machines are trulyhuman ingenuity at its best and mostcreative - encompassing the best ofaerospace, mechanical, electronics andsoftware engineering.

There just might be a day, not far fromnow, when children will be told that aircraftwere once flown by human pilots.


Pakistan



“Drones: Aerial Assasins or Misunderstood Technology?” 4from page

Building Drones for Pakistan: Raja Sabri Khan leads a CBEC

ion aboutForum discuss how technology can be used for

both destructive and constructive human ends.

Drs. Farhat Moazam and AamirJafarey were invited by Dr. AsgharChanna, the Vice Chancellor of ShaheedMohtarma Benazir Bhutto MedicalUniversity (SMBBMU), Larkana, Sindh, toconduct a bioethics workshop on October23-24, 2014. Larkana is more than 450kilometres away from Karachi near thehistoric ruins of Mohenjo Daro, an Induscivilization dating back to 5000 BC.

The workshop was conducted atChandka Medical College and began with awell-attended opening plenary session.Participants were introduced to bioethics,highlighting traditional codes and theevolution of modern bioethics. Thesession was followed by the workshop forabout thirty senior faculty membersincluding professors and heads ofdepartments.

The first day of the workshop focusedon research ethics while the second daywas devoted to clinical ethics. CBECvideos and case scenarios were used togenerate discussion on different issues.At the conclusion of the workshop, theVice Chancellor requested CBEC toconduct another workshop in the next fewmonths for younger faculty of SMBBMU.


Pakistan



Workshop at Shaheed MohtarmaBenazir Bhutto Medical University,

Larkana, October 23-24, 2014

Workshop for Balochistan BioethicsCommittee Members, Quetta,

November 13-15, 2014

The National Bioethics Committee ofPakistan (NBC) organized a two day,Research and Clinical Ethics Workshop inQuetta, from November 14-15, 2014. Thiswas part of training Balochistan's newlyappointed Provincial Bioethics Committee(PBC). The workshop followed a scheduledmeeting of the NBC and the inauguralmeeting of the PBC of Balochistan. PBCmembers and other health care providers ofthe province attended the workshop.

Together with Dr. Farhat Moazam whochairs the NBC's Healthcare EthicsCommittee, Dr. Aasim Ahmad, Chair of theResearch Ethics Committee and Dr. AamirJafarey also a NBC member, Mr. ShaukatJawaid, medical journalist and pastmember of the NBC, facilitated workshopsessions.

On the first day the focus was onclinical ethics while the second day'ssessions were related to research ethics.While appreciating the usefulness of theworkshop, participants voiced a need forfurther workshops for the PBCs beingappointed in different provinces.Accordingly, an ethics workshop will beheld in Azad Kashmir in March 2015together with the next NBC meeting.

poetry and humanities in formal educationalsessions. They were particularly pleased withthe way CBEC faculty keep in touch with thealumni and facilitate them in their variousbioethics related activities. The efforts made tokeep the network of alumni engaged in bioethics,years after their graduation was also noted.

While acknowledging the Centre'sachievements at national and internationallevels, the reviewers however felt that the smallcore faculty could eventually “burn out” if facultyand support staff were not increased, stronglyrecommending an increase in their numbers.While impressed by the research output fromCBEC over the last decade reviewersrecommended that we devise a research agendaand appoint faculty specifically trained inresearch to be able to use our potential to theoptimal. Dr. Adib Rizvi, SIUT's Director, knowshow to consolidate his successes. Based on thereview recommendations, he has asked CBEC toembark upon an immediate expansion of itsprograms.

Needless to say, CBEC faculty was delightedwith the report! We also found the review processto be a learning experience providing us newinsights into ourselves, while also helping us tochart our future directions.


Pakistan



CBEC faculty, Dr. Farhat Moazam andDr. Bushra Shirazi, participated in the 5thNBC, held in Bangalore, India. In herkeynote talk, Dr. Moazam spoke about"The Dualism of Biomedicine: A CartesianHeritage." Critiquing modern medicine,she exp l a i ned tha t Desca r t es ’

philosophical theory of the 16 century,separated body and mind into distinctrealms and freed science from thedominance of religion. However, this alsoled to a dehumanized medicine in whichpatients are not perceived holistically butas biological machines, that need to be“fixed.” She also spoke about the ways inwhich healthcare professionals in Pakistanand the region have reduced medicalethics to a mantra of four philosophicalprincipals while disregarding local valuesand social realities that are intrinsic tohuman relationships.

Dr. Shirazi ran a workshop “WatchingBioethics” for a group of physicians,community health workers and others.She shared CBEC's experience in makingshort, teaching videos on a modest budgetwith professional colleagues and alumnivolunteering as actors and scriptwriters.CBEC's latest production “Walking aTightrope” was also shown. Dr. Shirazialso participated in a panel discussionabout unethical practices in interactionsbetween biomedical professionals and thepharmaceutical industry.

A surprise in store for Dr. Moazam wasa “Felicitation Ceremony” organized byNBC to honor her for “her life's work in thepromotion of bioethics education” and“her efforts to support ethical organtransplantation programs.”

th

“CBEC review: Impressions and insights” 3from page

5th National Bioethics Conference(NBC), Bangalore, IndiaDecember, 11-13, 2014

5th National Bioethics Conference, Bangalore: Dr. Moazam receivesa scroll from Dr. G.D. Ravindran, Professor of Medicine

and Ethics, (St. John’s Medical College, Bangalore), at a‘Felicitation’ ceremony to commemorate her life’s work.

Centre of Biomedical Ethics and CultureSindh Institute of Urology and Transplantation

5th Floor, Dewan Farooq Medical Complex,Karachi 74200, Pakistan

Phone:(92 21) 3272 6338 Fax:(92 21) 3520 6738Email: [email protected] www.siut.org/bioethics

In December, PGD( lass of 2014) completed their year-longdiploma bec m ofthe CBEC family. The following extracts are

from their feedback in whichthey shared their perceptions about the

PGD program on theirprofessional and p lives.

“It has been a year of challenging longheld notions. A journey of self discovery andfinding answers to disturbing questions. Theprogram has made me more tolerant ofdivergent views.”

“The most important thing I came toknow after my PGD is in order to change mycountry for better I need to understand myp e o p l e . P a r t i c u l a r l y , I n e e d t osympathetically understand their love fortheir religion, only then can I do somethingpositive for my country.”

“Previously, the ultimate goal ofinformed consent to me was to get it signedfrom the participants, however I have learnedthat it is a process rather than merely a pieceof paper.”

“Now I see my patients from an entirelydifferent angle. I respect them more. I listento them more attentively and I try to askthem what they want.”

“It has made my life more difficult forexample when dealing with my patients andmaking decisions regarding their health care,especially illiterate persons & persons withpoor socioeconomic status ... I have to thinknot to infringe or violate their rights.”

“I feel there is responsibility on myshoulders to teach others about thediscipline as I was fortunate enough to bepart of this course. I feel I can bring changeby sensitizing and making them recognizethe ethical issues around.”

current studentsC

course and a e new members

selected written

impact of theersonal

Bioethics LinksVolume 10, Issue 2 (December 2014)Pakistan

cbecSIUT

CBEC completes its 6th PGD cyclein December 2014

Dr.th

M T

T

ors Thesession was organized by Dr. MariamHassan, alumnus, PGD (Class of 2010).

Aamir Jafarey participated in the

13 Annual Shaukat Khanum Memorial

Cancer Hospital and Research Centre

Symposium on November 23, 2014 via

Skype. The CBEC video "A atter of rust"

was used to highlight ethical issues in

clinical research. he participants of the

panel included IRB members, researchers

and senior hospital administrat .

13th

November

Annual Shaukat KhanumMemorial Cancer Hospital andResearch Centre SymposiumLahore, 23, 2014

The outgoing PGD Class of2014 at a dinner hosted Dr. Moazam, their final

examinations module, December 1-6, 2014.Standing : Nazli Hossain, Asma Nasim,

Habiba Sharaf Ali, Faisal Rashid Khan, Salman Ahmed Tipuand S. H. Kolambage Seated : Altaf Ahmed Talpur,

Faiz Ahmed Raza, Quratulain Omaeer and Ali Raza

New members of the CBEC family:farewell by following

in the last academic(from left to right)

; (from left to right)Faiza Bashir,

Documents

SIUT Centre of Biomedical Ethics and Culture Pakistan December, 2014.pdf · Volume 10 Issue 2 December 2014 Centre of Biomedical Ethics and Culture Drones are probably the most advanced,