As the ethicist for the Caribbean Public Health Agency (CARPHA) and founding president of the Bioethics Society of the English-Speaking Caribbean (BSEC), Dr. Derrick Aarons is on a mission to educate. His conscientious work has helped build a culture of bioethics in the Caribbean, and he is committed to sharing his region’s bioethical perspectives with the rest of the world.
Dr. Aarons has been called the Caribbean’s first trained bioethicist, and like many in research ethics he happened upon his vocation by chance. As a young physician, he worked with the Medical Association of Jamaica’s first ethics committee, and when neither the committee’s chair nor vice chair could attend the first Caribbean Conference on Healthcare Law and Ethics, the invitation landed in Dr. Aarons’ hands.
“I was so fascinated,” says Dr. Aarons. “By the end of the first day I said ‘This is what I want to do for the rest of my life!’” He shared his excitement with one of the event’s speakers, Professor Margaret Somerville, AM, FRSC, of McGill University at the time (Professor Somerville is now professor of Bioethics at the University of Notre Dame Australia in Sydney), and was glad he did; Professor Somerville invited him to enroll in McGill’s newly formed master's program in bioethics. Dr. Aarons completed his master's degree and continued on to earn a PhD in Experimental Medicine and Bioethics before returning to his home in the Caribbean.
“When I went back, people said, ‘Bio-what?’” he laughs. “I had to educate people on the concept.” Today, Dr. Aarons says that nearly all of the countries in the Caribbean are now aware of and sensitive to the ethical components that underpin health care, research and public health issues around the world. Many government agencies and institutions in the region now have policies and guidelines in place to address these issues. “We’re building capacity throughout the Caribbean in healthcare ethics and research ethics,” he says.
Cultural differences between North America and its Caribbean neighbors are important to consider when evaluating bioethical issues, Dr. Aarons cautions. “The culture of the north [referring to United States and Canada] is built on the concept of autonomy, self-determination, and the rights of individuals,” he says. In contrast, Caribbean countries are “being fair to those who are vulnerable and protecting them not so much on the individual level but collectively as communities. We all respect the concepts of bioethics, but the emphasis may be different depending on the culture. The collective is very powerful in countries [of the Caribbean],” says Dr. Aarons.
“It depends on the culture you’re going to do the research in—there’s a delicate mix within each country [and] sector of society,” he says. “If [the research] is being done in, say, Guyana, then the concept of the community leader giving the ‘okay’ to go into Amerindian villages to conduct research is paramount. If it is being done in the Bahamas, [that culture] closely mirrors the North American concept of individual informed consent.
“When conducting research in a culture that values the collective, you need to go into the community and explain to the leader what you plan to do,” Dr. Aarons explains. Once verbal consent is obtained from the leader, researchers can then approach individuals in the community about the study, following standard informed consent discussion requirements. If potential participants are illiterate, Dr. Aarons advises researchers to follow established international guidelines. “You’ve got to break down your explanation to the potential participant’s level of understanding,” he says. “Ask them questions for feedback to ensure that they have understood. Give them time to think about it and to consult with their relatives or with whomever they wish.”
Dr. Aarons’ work with CARPHA has helped make research more consistent and accessible in the region. He worked to establish a regional research ethics committee serving all 24 member states, and in March of this 2017, his team established the Caribbean Network of Research Ethics Committees (CANREC). CANREC works to harmonize ethical reviews among member states and provides the infrastructure and support for collaboration among network members. Dr. Aarons also founded the Bioethics Society of the English-Speaking Caribbean, which seeks to increase knowledge and understanding of bioethics across the region and in collaboration with international partners.
“I feel that I ought to make a difference in the world,” says Dr. Aarons, “whether in terms of healthcare and my training as a doctor, or knowledge based on what I’ve learned through my [bioethics] training. My wish is to give. When I depart this life, I ought to have made a difference.” He laughs. “That’s my motivation for existence, really.”
Stephanie Pyle, MFA, is the Manager of Community and Communications at Advarra. She manages the organization’s external communications on IRB, IBC and other research compliance topics, developing instructional content and guidance material, blogs and other articles. She also organizes Advarra’s regular educational webinar series. She is an alumna of PRIM&R’s Blog Squad.