The phone rang and I turned over in bed glancing at the clock. It was 1:00 am and I was on-call and I hated it. I picked up the phone before my three-year old daughter decided to do so. With a mind still half asleep, I listened to the physician from the ER telling me about a 50 year old man from interior Sindh brought with abdominal pain of four days duration, an increased heart rate, low blood pressure, kidney failure and a heart working at merely 20% of its capacity. Dreading having to explore the abdomen of this very sick man, I asked for an X-ray to look for the presence of free gas in the abdomen indicating perforation of his bowel. To my relief, there was no evidence of this on the X-ray. The patient could be admitted under medical care to the ICU for stabilization with a CT scan scheduled for the next day.

The next morning, I walked to the ICU still hoping for a medical rather than a surgical cause for the patient’s abdominal pain. There he was – a well built middle aged man writhing in pain and with several tubes running in and out of his body. The eyes of my young house officers and the ICU staff followed me as I approached the patient. I knew they expected me to place my “magical” surgeon’s hand on his abdomen and determine and then eliminate the cause of the abdominal pain. The patient seemed to want the same, begging me to get rid of his pain. “Do something,” he implored.

Dr Mujtaba, his primary physician, was of the opinion that with the patient’s clinical condition it was not possible to get a CT scan. “Our CT machine is out of order and he is too sick to be moved to another hospital for the scan,” he said. Exploring his abdomen was the only choice. We argued about the risks and benefits, spoke to the family, and finally convinced ourselves to give the patient a “chance.”

It was midday when I opened his belly. All I could see was black, dead intestine staring back at me. “Almost all of his bowel is dead, I am closing him,” I declared. “Why don’t you just take it out?” the anesthesia resident suggested the impossible, peeping over the drapes. Suddenly the patient’s heart rhythm went berserk. The consultant anesthetist said, “Let’s try some medications to see if we can correct the arrhythmia. It will be a good learning experience for the residents.” The rhythm slowly returned to normal and I was able to close the abdomen and shift the patient, still alive, to the ICU.

“Please let him go in peace,” I requested Dr Mujtaba on the phone. “Let me think,” was the answer. “What do you want to think about? The pathology is incompatible with life,” I almost screamed at him. “Allah can do miracles,” said Dr Mujtaba. “What miracle? His intestines are dead, he cannot survive with dead intestine, just do not give him any more medications to keep his heart going. Let him go.” “Well, let’s discuss it,” he said, and the argument continued.

The next morning I walked into the ICU hoping that the patient’s misery was over. But there he was, screaming and grunting with a dropping BP and a rocketing heart rate. “Please let him go,” I told the ICU in charge. “I need to ask Dr. Mujtaba, the patient is under his care,” was the reply. “But you know it is futile and he is in pain,” I insisted again before leaving.

The patient was finally allowed to go the next day, dozing off, grunting and drenched in perspiration to his death. As I stood there I wondered about the utility and the futility of treatments we offer, and our reluctance to accept when we have lost the battle.

Our initiative at SIUT to establish the country’s first bioethics centre was a leap of faith. I am delighted to see that it has not only flourished, but has contributed meaningfully to the development of this neglected interdisciplinary field in the country.

My interactions with Dr. Farhat Moazam during her doctoral research in 2002 convinced me she should lead SIUT’s first bioethics center. The Centre of Biomedical Ethics and Culture (CBEC) at SIUT has since made significant progress, enhancing ethics capacity nationwide through educational events. Since establishing Pakistan’s organ transplant program, SIUT has strived to ensure ethical practices, with CBEC advancing this mission through research and education.

In line with our ethos and policies in SIUT, we offer free medical treatment and free education to those we serve. CBEC therefore offers free postgraduate education in bioethics to all those who are selected in their programs. Additionally, the Centre also conducts free of cost workshops for national institutions and helps them to establish ethics committees. Looking ahead, I hope CBEC can enhance its impact in Pakistan, especially in clinical ethics, supported by its growing alumni network. SIUT resources will always be there for CBEC to further its mission.

I have been closely involved in the evolution of CBEC-SIUT since 2004, when I was given the role of SIUT coordinator for the Centre. The initial years were a challenge in integrating CBEC activities with SIUT, a solely healthcare provider institution. However, my role as a bridge between the two proved to be very rewarding. Over the past two decades, I have seen with pleasure CBEC attaining national and international prominence.

SIUT was the first institution in Pakistan to commit resources to foster bioethics by financing CBEC, and its academic programs. The Centre has utilized these resources effectively to provide an academic platform for bioethics in Pakistan. I hope to see CBEC maintain the high standards that it has set as it moves into its third decade and beyond.

Since 1992, the International Association of Bioethics (IAB) organizes a biennial World Congress of Bioethics (WCB) in different countries. This provides a global forum for exchange of ideas and networking between those involved in education and research in bioethics and related fields.

This year, the 14th WCB was hosted by Research Center for Islamic Legislation and Ethics (CILE) at the Hammad Bin Khalifa University in Doha, Qatar. The conference theme was “Religion, Culture, and Global Bioethics.” One of the main organizers and the Chairperson of the WCB, was Dr. Mohammad Ghaly, Professor at CILE.

The 2024 conference marked a historic occasion as it was the first time the WCB was held in the Middle East, and in a Muslim Arab country. This IAB decision in 2022 sparked a debate among bioethicists globally with concerns raised about Qatar’s human rights record and its stance on certain bioethical issues including laws related to the LGBTQ community. Many however, defended the choice, arguing that the conference’s location in Qatar would foster engagement with a cultural­ ly diverse audience from Asian and African countries.

The Doha WCB was widely attended, providing a vibrant platform for knowledge exchange and collaboration. A notable characteristic of the conference was an effort to bring religion into the bioethical discourse. There were rich discussions on ethics of research on the genome and concerns associated with artifical intelligence technologies.

During the conference, CBEC faculty was actively involved in workshops, panel discussions, and oral presentations. Dr. Moazam also delivered a keynote address titled “Doing Bioethics in Pakistan,” where she used local case studies to illustrate the sociocultural nuanc­ es and ethical challenges in Pakistani clinical practice.

I love coffee, it puts me in the right mood, it helps me deal with my morning blues, and helps me get more done throughout the day. I could not get over the fact that I finally found a place that had great coffee and I could have a cup whenever I wanted.

I carried my brimming cup of black brew over to the table and sipped away quietly as everyone else slowly made their way into the room. It was the first day of the PGD course at

CBEC. At 8.00 am, we were introduced to Dr. Wahab Suri, Professor of Philosophy at University of Karachi. He was going to set the stage for the next couple of weeks. He was the opening act, the beginning of bioethics – Philosophy and Bioethics. I examined Dr Suri and watched him as he moved around the room introducing the class to philosophy. Suddenly he stopped in front of me, paused and looked straight at me. “What do you think will happen to you when you die?” Philosophical questions are an effective tool to stimulate and develop critical thought. However, I was not prepared for this question. I had never really allowed myself to think about it. It was something that I was afraid of. I wanted to say I didn’t know, but I was afraid of being judged by a room full of medics whom I had just met. Should I tell the truth, or should I make up an answer? I was silent, he read the fear on my face and the fumbling of my soul through my eyes. He carried on with his lesson. I will never forget my first day at CBEC.

We often do not have the time to delve too deep into ourselves; life’s practicalities and challenges do not allow it, so we adopt thoughts and ideas because it is easier. For the last 17 years, CBEC has been my Wonderland, Oz, and Narnia. I have been ‘Dorothy’ looking for my way home, I have been ‘Alice’ excited and amazed constantly chasing white rabbits, and I have been ‘Lucy’ realizing that I too can be brave and change things. At CBEC I found shade when it was too hot and shelter when it rained, a cup of coffee ready for me whenever I needed it.

At CBEC, you won’t just receive an education; you’ll become part of a nurturing community where you can find intellectual nourishment, support, and a sense of belonging. From exploring humanities to navigating the challenges of pandemics, CBEC offers a space where individuals can reflect, grow, and engage with difficult questions. I have my answer now to Dr Suri’s question, I am no longer afraid to think about difficult questions nor afraid to speak up. All I need is my cup of coffee.

I did my postgraduate diploma in Biomedical Ethics from CBEC in 2010. At that time, I was working as an Assistant Professor at the Department of Dermatology, Ziauddin University (ZU), Karachi. It was an amazing experience.

Being a science student all my life, my brain had been programmed to look for facts, realities and theories which meant that I always got clear answers to my queries. But the most shocking part for me as I pursued the PGD was the realization that there can be no one, clear-cut answer in any case of ethical dilemmas and moral quandaries. The purpose of class discussions was to make us “think.” It took me weeks to adjust and realize that I was the one asking odd questions in my search for the right answer in every session.

Before I learnt anything at CBEC, I had to follow the process of “unlearning.” I had to unlearn a belief that “I am always right” and that “everyone will accept my perspective.” CBEC created a feeling of unease, which is necessary to reflect upon the decisions we make whether in a clinical setting or while conducting research.

CBEC Faculty including Dr. Moazam and Dr. Aamir created this alternative world for people like me which changed us from the core. I found that your mentors can be your guides, friends and advisors all at the same time. I received guidance from faculty as I embarked upon the task to develop procedures and refine the working of the Ethical Review Committee (ERC) at ZU.

Over the past twenty years, CBEC has done a commendable job in educating healthcare-related professionals. One cannot ‘undo’ what I learnt there. While I am no longer in Pakistan, what I learnt at CBEC guides me while doing my clinical practice in Dubai, whenever I face dilemmas related to patients presenting with sexually transmitted diseases, or when I’m dealing with pharma companies. Thank you for creating this alternative world and for helping us to bring positive changes in clinical and research settings in Pakistan.

It was a hot summer day when a senior colleague from my medical school suggested that I consider enrolling for a course on Biomedical Ethics at CBEC in Karachi. With little prior knowledge of the content and nature of the course, I appeared for the interview knowing little that this small event was about to change my life forever. I had never been part of such a focused and meaningful interview with questions that targeted areas of the medical profession that had always perplexed me. The interview struck a chord in my heart. I was instantly hooked.

What transpired during my PGD year was a journey to learn, unlearn and explore. People hold onto their beliefs dearly and stubbornly, but if provided a safe and stimulating environment, it’s not uncommon for people to open their minds and expand their hearts to ideas contrary to their long-held notions.

Adult learning in general and medical education in particular have seen remarkable changes during the last three decades and it was refreshing to witness how faculty at CBEC merged traditional styles of teaching with contemporary methods of learning. Our modes of learning ranged from student-led teaching to facilitated group discussions. Using videos as teaching tools was significantly effective in stirring interesting debates around ethical issues. A broad-based curriculum was backed by a diverse faculty instrumental in delivering the course in its true spirit and meaning. It was mentally and emotionally challenging to cover topics across the spectrum swinging from philosophy and law to children and women rights. An important aspect of the course was how the historical background of biomedical ethics was connected with modern debates around organ donation and artificial support technologies. It was fascinating to define “life” and “death” from both philosophical and scientific paradigms. As a learner, I was intrigued by formal and informal feedback I was provided through length and breadth of the course. It provided an insightful perspective on my strengths and shortcomings both as a student and as a teacher.

Learning extended beyond classrooms through informal interactions with colleagues and faculty over tea and meals providing ample opportunity to clarify concepts. It also brought to the fore a much more relatable human interaction based on mutual respect and trust. Visits to the historical sights like Makli graveyard and Shah Jahan Mosque helped in “switching off” from rigours of dense coursework and building camaraderie among classmates.

Beginning of the PGD course was unsettling as it opened doors to uncertainty and unpredictability. But as the year drew to a close, initial confusions were replaced by a reassurance that in real life, it’s important to shun conviction and embrace complexities. Human lives are not simple and our interaction with medical science provides more questions than answers. As a healthcare provider, it’s paramount to stay humble and curious.

In 2023, when I decided to enroll for the PGD in Biomedical Ethics at the Centre of Biomedical Ethics and Culture, I wasn’t sure what to expect. I certainly did not realize that I would spend a significant amount of time studying and nor did I imagine the profound impact the year would have on me. Throughout the year, we confronted new challenges brought about by advances in science and technology as well as diverse and shifting societal values. I came to understand Heraclitus’s adage that “change is the only constant.”

The year breezed by quickly and before I knew it, we were appearing for the final exam. By this time, I had a clearer idea of what I wanted to do with the new knowledge that I had acquired. I decided to not only incorporate this into my daily clinical practice but also make my colleagues within my pediatric nephrology clinical unit aware of basic knowledge in bioethics so that we could become better, ethical physicians.

My PGD journey has taught me that while empirical evidence may not always provide clear-cut answers to ethical dilemmas, it can serve as the foundation for constructing well-reasoned arguments. Equally important, the PGD has developed in me the capacity to listen to a person sitting across from me, to understand her point of view and not just respond.

For me ultimately, bioethics should be a life-long commitment to personal growth that contributes to the betterment of society.

Bioethics is about value judgements that we make in life. My awakening to this fact goes back to my early service as an army physician in the mountains of Kashmir and deep inside Baluchistan, where I increasingly found myself thinking about the “why” and the “how” of distributive justice in local communities where “most in need are found with the least” especially in health.

This aroused my curiosity and led me to search for a robust understanding of issues of fairness and justice. In 2014, I discovered an online course “Introduction to Bioethics” from Georgetown University in the USA. Instead of quenching my curiosity, this course increased it further, and I started searching for formal bioethics programs in Pakistan. My search led me to the Centre of Biomedical Ethics and Culture (CBEC) located in Karachi. I followed it with full zeal and was admitted to its PGD program in 2016.

CBEC’s existence in Pakistan turned out to be a blessing. One year spent in CBEC and the level of education there truly enlightened me “On what matters,” to borrow the title of Derek Parafit’s book.

I consider 2016 an important year of my life which transformed the way I look at human interactions, rights, values, perspectives, and contexts. I learned that intellectual flexibility and humility are the greatest of virtues.

Seven years on, post-PGD, my life is different and interesting. The knowledge gained in 2016 has helped me to further my learning by teaching a few modules on bioethics to newly inducted physicians-in-service. I have conducted and co-facilitated a few workshops and guest lectures for different specialties  in  various  hospitals.  PGD has also honed my writing skills. Since 2016,1 have published articles in scientific and popular science journals on subjects focusing on the ethics of healthcare in military settings and, those pertaining to artificial intelligence.

My journey continues. I yearn for a day when I can return to CBEC as a student of the Master’s program, an opportunity I missed in 2018 due to work commitments. I would like to not only further my knowledge in the field of bioethics but to engage with more fundamental questions related to human existence in the world.

As a Kenyan human rights lawyer with an interest in research ethics, my decision to embark on the PGD in Biomedical Ethics from Centre of Biomedical Ethics and Culture in January 2020 marked a significant departure from the conventional academic trajectory. This choice catalyzed not only my academic journey but also shaped the profound intellectual and professional expedition I would experience that would lead me to scrutinize assumptions previously held dear from a legal standpoint.

From grappling with foundational concepts to dissecting intricate case studies, each module of the program prompted  me  to  critically  reassess  real-world  medical dilemmas through a novel perspective. I discovered the inherent limitations of the law in navigating decisions within medical practice. Despite initial hesitation about transitioning to virtual learning following the first on-campusmodule due to the COVID-19 pandemic, this shift did not dilute the rich discourse integral to CBEC’s bioethics pedagogy.

Throughout the intensive year-long program, I gained invaluable insights into the pragmatic aspects of ethical decision-making. While the world grappled with the COVID-19 crisis, I found myself captivated by the allure of bioethics. Whether reviewing research protocols for ethics review committees, teaching in CBEC-KEMRI Bioethics Training Initiative (CK-BTI) certificate courses, shaping policy and legislative frameworks in my human rights endeavors in Kenya, or advocating for ethical standards in everyday interactions, ethical values permeated my approach.

I came to recognize that the influence of the PGD program transcends the boundaries of mere coursework. It inspired me to spearhead initiatives aimed at fortifying research ethics and championing the rights of marginalized communities in research and healthcare settings in my country, thus expanding my engagement with bioethics beyond the confines of my legal expertise.

This transformative journey culminated in the conceptualization of my first solo manuscript, grounded in my PGD project—an achievement that will (once published) not only validate my academic journey but also underscore the pertinence of bioethics in shaping my voice and contribution to contemporary discourse. Presently enrolled in a Master’s program in Bioethics at Amref International University Nairobi, I am positioned to actively contribute to teaching, research and the advancement of bioethics in Kenya and the wider African region.

I am humbled by the depth of bioethics knowledge acquired and the network of like-minded individuals forged along the way. Armed with the ethos of the PGD program and the ethical principles espoused, I embark on future endeavors in both my professional and personal spheres.

With two surgical fellowships and an interest in medical education, I thought I was destined to become an academic surgeon. While involved in teaching ethics to my surgical residents, I felt the need to learn more about bioethics. Hence, in 2008,1 joined the PGD in Biomedical Ethics at the Center of Biomedical Ethics and Culture (CBEC), which broadened my understanding of the intricate dilemmas in healthcare practice and research. Through engaging discussions and real-world case studies, I gained a deep appreciation of the ethical values and principles that underpin every aspect of medical practice. Little did I know then that this transformative journey into the world of bioethics would eventually shape my professional trajectory.

As I explored the field of bioethics further, I became increasingly fascinated by the intersection of bioethics and medical education. I realised that ethical competence among healthcare professionals is not merely a desirable trait but a fundamental component of high-quality patient care. This realisation inspired a profound shift in my career from a surgeon to an educationist, with a focus on integrating bioethics education into healthcare curricula and training programs.

The lessons I learned through my affiliation with CBEC during and after the PGD also enhanced my understanding of the application of educational theories. The opportunity to learn alongside individuals from diverse backgrounds, including philosophy, law and sociology, enriched my learning experience. Additionally, it provided me with a holistic perspective on the interconnectedness of social, cultural and ethical factors in healthcare education.

My experience at CBEC served as a catalyst for my doctoral research on ethics in medical education and in exploring innovative pedagogies and strategies for introducing bioethics to medical students and healthcare professionals. I am grateful to CBEC for an experience that laid the foundation of my commitment to promoting bioethics in healthcare.

Anaesthetists are the energetic souls of operating theaters, rushing around, chattering and muttering, with the constant beeping of monitors and assorted equipment. They change the environment of the OT from barren fields to combat zones where the single aim is to achieve patient care and safety.

It was May 2017. I was told arrogantly by a surgeon colleague to anaesthetize a female patient without taking her consent. I knew from the core of my heart that this was wrong even though I did not possess formal education in bioethics. We are not taught ethics during medical college and there was no one at my institute whom I could turn to for information or support. I resisted and recorded the event in my notes.

This episode led me to join the PGD in Biomedical Ethics program of CBEC-SIUT, where I was to learn that the field of ethics extends beyond informed consent. During the year I spent at CBEC, my perspectives of ethical issues and dilemmas related to research and clinical practice were completely transformed.

After completing my PGD project of introducing the fundamental principles of bioethics to postgraduate trainees of Anaesthesiology, I realized I could still do even more in sensitizing my colleagues including trainees and faculty members from other medical disciplines. Since then, I have continued ethics education cycles every year. My quest continues although it’s not easy to make cracks in rigid dogmas and firm beliefs that people hold. I believe however, that my journey will bring change in the system if not today then tomorrow.

I first heard the word “Biomedical Ethics” from a friend who suggested that I should pursue a diploma in this subject from the Centre of Biomedical Ethics and Culture in SIUT. I was confused. I remembered that during high school and college, only non-Muslim students were required to take ethics as a subject whereas Islamic Studies courses were mandatory for Muslim students. However once I obtained the necessary details, I was convinced that I needed to apply and learn about ethics.

During my interview with Dr. Moazam and Dr. Aamir Jafarey, I recall mentioning the recent theft of a car from my 15-year-old son. Dr. Moazam asked me, “Isn’t it illegal to drive before 18 years?” I felt ashamed but at the same time, I thought to myself, “Acha to yeh doctoron ko sudharte hain [So they work to improve the moral conduct of physicians].”

My experience while doing the PGD was wholesome with wonderful faculty who left me wondering, “Aisay log Pakistan me hote hain? [Do people like these still exist in Pakistan?]” Throughout my education, I had only experienced  traditional  methods  of  teaching  involving didactic lectures. At CBEC, I was exposed to interactive sessions, role-plays and learning through videos. Philosophical and religious discussions made everything more interesting. I have fond memories of my time there and I still miss those days.

I was fortunate to have a colleague who had already begun efforts to introduce ethics at my university Liaquat University of Medical and Health Sciences (LUMHS) in Jamshoro. Following my graduation from the PGD, I began to work on the foundation laid there by my colleague. A couple of years later, LUMHS became the first public medical university in Pakistan to incorporate bioethics formally in medical education curriculum for medical students.

Initially the response of students and faculty was mixed with a few dismissive of the importance of ethics. For example, when we taught informed consent, some voiced that as doctors they know the best since they know about the patient’s disease. They would ask questions like, “Why should we tell patients everything and let them decide?” However, gradually these discussions gained acceptance among faculty and students alike.

My colleague and I also established an Ethics Review Committee at my university with the support of CBEC faculty. Human subject research, mandatory for major degree programs, was being conducted without ethics approval. The administration considered ERC a hurdle for students instead of realizing its importance for the protection of human participants. However, over time, the ERC became well established in the institution although running it still has its share of problems.

All is well that ends well. At present, bioethics education remains an integral part of the undergraduate curriculum at LUMHS, and the ERC continues to work well. In the future, we have plans to establish a Centre of Bioethics and Professionalism in our institution and have already received approval from our Academic Council.

The Diploma in Biomedical Ethics from Centre of Biomedical Ethics and Culture in 2014 has opened new horizons for me. In 2021, European Society of Medical Microbiology and Infectious Diseases (ESCMID) had a position in their Ethics Advisory Committee for a representative from low-middle- income country (LMIC). The CBEC faculty encouraged me to apply for it, provided reference letters and I was selected.

My involvement with ESCMID has grown over the years with a special focus on engaging with ethical issues within infectious diseases. During the annual congress of ECCMID held in Portugal in 2022, I chaired a session on “Ethical issues in Infectious Diseases (ID).” I also involved Dr. Natasha Anwar (CBEC MBE Alumnus) and Rehan Khan (ID pharmacist from Lahore) in the conference who highlighted the inequities in COVID-19 vaccine distribution and access to antibiotics from an LMIC perspective.

In the following year, ECCMID was held in Denmark and I presented a study about the low LMIC representation in ID scientific journals, highlighting barriers such as language, colonial mindset and lack of mentors for research. In the most recent Congress, CBEC had a prominent presence. I chaired a session on “Clinical practice guidelines on ID: present and future” in which I stressed upon the lack of experts from LMICs in development of guidelines, cost considerations and access to diagnostics and treatments particularly newer antibiotics. An ID colleague as well as a CBEC PGD alumnus, Dr. Amjad Mahboob gave a talk, highlighting language barriers as one of the factors for the lack of research on neglected tropical diseases.

While doing my diploma, I had not imagined that ethics could contribute in such significant ways to my field, and that the PGD would prepare me to present Pakistan at an international level.

My journey continues. From next year, the Ethics Advisory Committee plans to initiate an online course on biomedical ethics on a regular basis targeting ID doctors and microbiologists. Our hope is to help them understand that the specialty of ID poses unique ethical and social challenges.

As a rookie house officer in a hospital in Karachi, one of the consultants asked what I would do in a case being discussed during a grand round centering on allocating resources between two children. One was a child whose parents had sold everything to keep him alive for a few more months versus a child who had a greater chance of living a longer life. I remember my righteousness, the consultant playing the ‘devil’s advocate’ and the conversation ending with my feeling furious.

My formal introduction to the subject of ethics came in 2016 when I joined CBEC for the Postgraduate Diploma in Biomedical Ethics. Like many physicians, I thought most issues are clearly defined but I learned otherwise during thought provoking sessions at CBEC. Following graduation, I served on the research ethics committee of my university and also helped in establishing a clinical ethics committee. My colleagues and I introduced bioethics in the university’s curriculum and conducted sessions with undergraduate and postgraduate students.

After 12 years, I moved to the UK to widen my surgical horizons. When asked to give an introductory presentation during the grand round as a new consultant in London I chose to talk about ‘“empathy.” The attendees included paramedic  staff,  medical  students,  house  officers  and consultants from different specialties. Noticeably, not a single surgeon was present. Many attendees approached me during the tea break to continue the discussion, inquiring about the situation of bioethics in Pakistan.

The healthcare system in the UK has defined policies but there is room for improvement. During COVID-19, I was the lead of emergency surgery in London. I remember junior doctors and nurses approaching me, scared and near tears, worried about themselves and their families. They were concerned that the Matron had asked them to not wear masks as this would frighten patients and spread panic.

Following my discussion with the Matron that patient care would be affected if the medical staff felt unsafe, she changed her stance and the Infectious Disease consultants sent out an official email to the Trust making mask-wearing mandatory in clinical spaces.

I attend webinars on ethics to keep myself updated, and participate in regular multi-disciplinary team meetings to address ethical issues. And I find myself always going back to what I learnt during my year at CBEC.

In 2014 CBEC completed its first ten years. Dr. Moazam requested Dr. Adib Rizvi, Director of SIUT, to organize a formal external assessment of the Center’s programs and activities. An External Review Committee (ERC) was constituted including national and international scholars with expertise in areas relevant to bioethics education and research. (See Box on right) The reviewers undertook an onsite visit to CBEC from May 7-10 to meet faculty, students, and alumni. Their report to Dr. Rizvi highlighted the Center’s achievements and challenges, and included valuable recommendations for the future. (See article by Dr. Alastair Campbell, ERC member).

As part of the external review process, three individuals closely involved with the Center since its inception were also asked to submit their impressions to the ERC. Brief quotations from these are presented here.

Dr. Renee C. Fox, Medical Sociologist, Professor Emerita, University of Pennsylvania, USA:

The accomplishments of CBEC “in the course of a mere decade of existence is extraordinary.” She noted that the Center’s “knowledgeable perspective on culture(s) is one of [its] most distinctive (and in my view, exemplary) attributes. It is a perspective that is minimized or marginalized … by many other bioethics centers.” Commenting on CBEC’s educational programs, Dr. Fox stated that “there are relatively few [existing centers and programs] in which such deep-structuring learning takes place.”

Dr. Paul Lombardo, Legal Historian, Professor of Law, Georgia State University, USA:

He highlighted what he considered unique features of CBEC’s educational programs. One is the “fine balance [that] is  struck  between  didactic  teaching  …  [and]  with  the exploration of how ethical norms may be applied in the clinical setting.” This is something “programs in the West and elsewhere, fail to find …” The second is the “constant attention [given] to the religious and moral bases of ethical behavior…” and the role these personal values “play in [the] lives [of] health care practitioners.”

Dr. Judith P. Swazey, Independent Scholar, Adjunct Professor Boston University, USA:

She commented on the Center’s video series, “Local Moral Worlds,” as “excellent teaching vehicles” for “courses in bioethics and/or social sciences and medicine.” She also appreciated CBEC’s reaching out to “a wider public audience through ventures such as CBEC Forum and Ethics and Culture Hour.” While commending the “very small faculty” for its “drive, commitment, knowledge and skills” to accomplish what it had in one decade, she highlighted (as did other reviewers) the urgency of recruiting more faculty.

EXTERNAL REVIEW MEMBERS:

Dr. Richard Cash
Harvard School of Public Health, USA

Dr. Amar Jesani
Editor, Indian Journal of Medical Ethics, India

Dr. Mala Ramanathan
Anthropologist Researcher, Sree Chitra Tirunal Institute, India

Dr. Alastair Campbell
Director, Centre for Biomedical Ethics, National University of Singapore, Singapore

Dr. Rizwan Azami
Vice-President, College of Physicians and Surgeons Pakistan

Dr. Aasim Ahmed
Chairperson, Bioethics Group, AKU, Karachi, Pakistan

Dr. Tasleem Akhtar
Professor Emeritus, Khyber Medical University, Peshawar, Pakistan

Dr. Asma Fozia Qureshi
Chairperson, Department of Medical Education, SIUT, Karachi

Over the past two decades, CBEC’s research portfolio showcases a remarkable diversity. This reflects not only the varied interests of the faculty but also illustrates the academic liberty provided to faculty, unconstrained by international funding requirements, to engage in relevant conversations within bioethics.

Four thematic areas prominently emerge from CBEC’s work:

Ethical Issues Related to Kidney Donation: Given CBEC’s association with SIUT, organ transplantation has been a natural focus leading to several publications. Faculty research includes public perspectives on deceased kidney donation in Pakistan, a country where demand for organs far exceeds the supply. During Pakistan’s notorious years as a kidney bazaar, CBEC conducted an ethnographic study in rural Sargodha, Punjab, a kidney trade hub. Conversations with kidney vendors provided insights into the socioeconomic hardships driving organ sales.

Gender-related Issues: CBEC has explored gender debates through a sociocultural lens. One notable study examined why many female medical graduates do not enter the workforce, amid concerns over Pakistan’s poor physician-patient ratio. The study found that ingrained gender roles and the societal importance of marriage contribute to this trend. An abridged version of this study later appeared in the national lay press as well, stirring public discourse. Building on the study with medical students, faculty are now exploring perspectives of male and female surgeons about women in surgery in Pakistan,

Mapping Research Ethics Structures: CBEC undertook mapping Pakistan’s research ethics governance structures, assessing the number, structure, strengths, and weaknesses of ethical review committees. This effort aimed to highlight the research ethics landscape in Pakistan, and provide an evidence base illustrating the variation in the quality of ethical review across institutions, with hopes of informing policy for the national accreditation of ethics committees.

Ethical Issues in Clinical Medicine: Ethical issues in clinical practice such as informed consent, privacy, confidentiality, and disclosure have been explored, and how these concepts manifest within Pakistan’s cultural realities.

These thematic areas underscore CBEC’s commitment to addressing pressing bioethical issues through diverse and methodologically varied research but with a Pakistani twist.

The idea that led to the germination of the Centre of Biomedical Ethics and Culture at SIUT began as an informal discussion over coffee in the spring of 2003 in Virginia, USA. Having put my surgical career on hold for pursuing a fellowship in International Research Ethics at the Harvard School of Public Health while Dr. Moazam was writing her dissertation for her PhD in Religious Studies with a focus on cross-cultural bioethics at the University of Virginia (UVA). She mentioned in her emails to me about Dr. Adib Rizvi’s desire to have a centre for bioethics at SIUT.

As we sat there on the bench, we envisioned that the centre would offer academic courses in bioethics relevant for the country. How we would do this, was not clear to us at that time. As it happened, Dr. Rizvi was attending a transplant conference in Boston and asked Dr. Moazam to fly over to meet him there to take the discussion forward. Over lunch of daal chawal [lentil curry with rice] and other desi dishes in a food court, we discussed the establishment of Pakistan’s first bioethics centre. Not interested in details of how and what, Dr. Rizvi simply said, “shuroo karo [Just start it].”

I joined SIUT in June 2004, as a part-time faculty of the centre, continuing my work as a general surgeon at the Aga Khan University. Dr. Moazam was still in the US finishing her thesis. We communicated through daily, lengthy emails in which we set about planning what the Centre would do.

The Centre of Biomedical Ethics and Culture was inaugurated on October 8, 2004, for which Dr Moazam flew back to Karachi. She formally joined the centre full-time in early 2005. Our first academic venture was the conference, “The Evolution of Moral Thought: From Greeks to Contemporary Bioethics” held in April 2005. The interest of the public took us by surprise indicating a genuine interest in bioethics in a more formal fashion.

In order to develop an academic program, we conducted a needs assessment survey targeting medical university hierarchy. Our findings indicated a widespread interest in the subject. However, busy healthcare professionals did not appear to be keen on full-time enrollment. This was reasonable since a degree in bioethics at that time would not have secured employment or advanced careers in existing fields. Realizing this, we devised our Postgraduate Diploma (PGD) in Biomedical Ethics, initiated in 2006, as a blended one, with four on-campus modules and asynchronous distance learning between the contact sessions.

Twenty years on, as I reflect, it is amazing how a faculty of 1.5 and a staff of one, managed to do so much. In the year 2005  alone,  we  were  involved  in  41  events  including workshops in Karachi and elsewhere, international conferences, Socratic Hours, Ethics and Culture Hour, and clinical ethics rounds at SIUT.

Similarly, in 2006, when we launched the PGD program, we were involved in 40 different events, both nationally and internationally. Now in 2024, with more faculty and 3 full-time staff members, while we are much better placed as far as hands on deck are concerned, we continue to be stretched thin.

Our portfolio of work has increased severalfold over the years. Since 2017, as a WHO Collaborating Centre of Bioethics, CBEC contributing to WHO-directed projects and missions. In collaboration with Kenya Medical Research Centre (KEMRI), in 2017, we initiated the CBEC-KEMRI Bioethics Training Initiative (CK-BTI), funded by Fogarty International Centre of the National Institutes of Health USA. This program is now in its 7^th year and second funding cycle

We have managed to maintain our standards as we have expanded our canvas. However, one centre can do only so much. Our alumni are expected to carry the flame further as we continue to offer our academic programs, broadening the scope of what we do in order to meet the requirements of changing times.

A big black hole – that was what bioethics seemed like to me. You sent in a research protocol for review to an ethics review committee. You waited with bated breath. You did not know when you would get a response or what it would look like. You dared not ask questions of the secretariat or the chairperson. It was all “hush hush.” And their word was final, even if it looked like the questions asked did not seem related to the protocol you had submitted. Like a big black hole, if you dared to stick your hand into it, you might be bitten and would not even know what had bitten you.

My frustration as a medical researcher sent me down a path of trying to understand bioethics. Why was bioethics important and how could systems that were critical to the conduct  of  research  be  responsive  to  the  needs  of researchers in Kenya? After four failed admission attempts for “administrative and other reasons” I finally got into the University of Cape Town’s ‘IRENSA” NIH Fogarty-funded Diploma in Research Ethics. Completion allowed me to “sit at the table” and initiate discussions on improving systems at my institute KEMRI. But that was not adequate to quench my thirst for bioethics training. I needed more.

I started seeking a Master’s level training. Unfortunately, most programs required a one-year full residential stay in the country in which the university was based. No training programs were available in Kenya. The Centre for Biomedical Ethics and Culture was the only institute that offered Master’s level education in a blended format. This was a perfect fit for me as I had significant administrative responsibilities as the Deputy Director at my institute.

I decided to apply, unaware that until then their training had been focused entirely on Pakistan. Fortunately, I passed the stringent preliminary examinations required and was subsequently accepted as the first non-national scholar in the Master’s program. After two years of intensive learning and empirical research, I realized that there still remained a gap in capacity building in Kenya. The CBEC program with its alternate year intake and the limited number of trainee slots for international scholars was not going to be able to water the desert sufficiently to yield adequate harvest from the Kenyan soil.

An idea of a partnership between KEMRI and CBEC took root and was pruned over a couple of attempts to yield fruit as a successful NIH grant award: The CBEC KEMRI Bioethics Training Initiative (CK-BTI). This has resulted in over 700 trainees from a variety of backgrounds trained in various certificate courses designed to improve knowledge of research ethics committee members, researchers, clinicians and other healthcare-related professionals.

Two Kenyan universities are currently approved to offer Master’s in Bioethics and the CK-BTI continues to build capacity by providing pedagogy training for the faculty at the two universities. Through this, we hope that we will continue to water the ever-growing tree of bioethics in Kenya by fueling it with innovations in teaching and education.

Let me begin by offering my sincere and enthusiastic congratulations to all the CBEC faculty, staff, and students on the centre’s 20th anniversary. One of the highlights of my academic career has been the opportunity to visit CBEC in 2023 to participate as a visiting faculty member.

I received my December 2023 copy of Bioethics Links the very week in which I was invited to write a brief word on my experience as a foreign faculty member at CBEC. That issue contains a photo of the graduating class of 2023, the very students who were present during my visit. I’ve enjoyed perusing that photograph and reflecting on the many wonderful exchanges I had with faculty and students during my time there. I’m sure I learned more from those brief encounters than what I was able to impart to all those with whom I had the pleasure of interacting.

There are more wonderful experiences to comment on than what I’m able to do in the space available here, but I will note briefly some of the highlights. I was particularly impressed by the caliber of the students enrolled in the academic programs, many of whom are senior clinicians. It was exciting to be part of a bioethics program that is having immediate and enduring impacts throughout South Asia, North Africa and beyond. Drs. Moazam, Jafarey and others have created a safe and stimulating environment for rigorous intellectual exchanges amongst those from varying cultural and religious traditions.

Aside from the academic experience, the cultural experience was extraordinary. I enjoyed unparalleled hospitality during my short stay, and I particularly enjoyed the communal lunches which provided opportunities to get to know a few individuals on a more personal level. I was treated to a tour of the impressive hospital in which the Centre is housed, as well as a local museum. It was exciting to experience some of the local culture including a wonderful meal at a seaside restaurant. Some of that excitement, I must admit, might be described as ‘anxiety’ as our various drivers navigated the Karachi traffic at what seemed to me to be an exceedingly rapid pace.

The only negative aspect of my visit to CBEC was related to the time it took to journey half way around the globe to get there, and then the challenge of adjusting to the jet lag. If I were to visit again I’d plan to come a few days earlier so that all of the above-noted positive experiences would have been even more enjoyable with a well-rested body and mind. Again, my heartfelt congratulations to everyone at CBEC. I wish a continuing success in your next 20 years and beyond.