This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated in light of clinical and scientific evidence, iii) opioid procurement policies be adjusted to facilitate increased medical use, iv) medical charts and records be modified to routinely elicit and document patients levels of pain, and v) educational campaigns be developed to inform the public that moderate and severe pain can be safely relieved at the end of life and other stages of life. The professional, respectful, and beneficent response to patients in pain is to provide rapid and aggressive pain relief or to urgently consult a pain or palliative specialist. When a health system hinders such efforts the ethical response is to identify, facilitate and advocate for overcoming barriers to improvement.

Various forms of research are essential in emergency, disaster and disease outbreak situations, but challenges exist including the long length of time it takes to get research proposals approved.Consequently, it would be very advantageous to have an acceptable model for efficient coordination and communication between and among research ethics committees/IRBs and ministries of health, and templates for expediting (done with speed and efficiency) ethical review of research proposals in emergency and epidemic situations to be used across the Caribbean and in other low and middle income countries.This project involved a literature search and the interviewing of ministry of health officials, public health practitioners, and research ethics committee/IRB members in Jamaica and St. Lucia, to obtain suggestions for the best model for efficient coordination and communication between research ethics committees (RECs), and developed a template for expediting review of research protocols in epidemic and emergency conditions. K E Y W O R D Sresearch in emergency, ethics review, research ethics, research protocols, research ethics committee / IRB, ministry of health | INTRODUCTION: RESEARCH IN EMERGENCY SITUATIONSDisasters, emergency situations, and epidemic infections are occurring almost annually, and when they occur, the public expects there will be an emergency response with the quick activation of public service agencies and rapid solutions to the disaster or epidemic infection.However, for the responses to be appropriate, measured, and effective, they need to be informed by the requisite evidence that often can only be obtained by relevant research during the actual emergency or epidemic. 1 Research, by its very nature, seeks to gain new information for the benefit of society. 2 In conducting research, the methodologies used will vary widely, but whatever design is used, research that seeks to benefit human beings should give priority to people's health problems and seek to reduce inequities. 3,4 Research in emergency situations will therefore require adequate preparation and anticipatory planning, with the requisite education and training.In every emergency or epidemic situation, 'time is of the essence', and valuable time may be lost particularly when the coordinating body 1 Global Forum on Bioethics in Research (GFBR). (2015). Global Forum on Bioethics in Research (GFBR) meeting on 'Emerging epidemic infections and experimental medical treatments'. Annecy,France: GFBR. Nov. 3-4. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |AARONS within a country has to undergo preparations in order to function. We saw examples of this during the 2014 -2016 Ebola virus epidemic in parts of Africa, and the chikungunya virus infection that caused much morbidity in all countries of the Caribbean. We are now witnessing a wave of zika infection with its severe adverse n...

In the Caribbean as in many other areas costly biomedical resources and personnel are limited, and more and more people are turning to alternative medicine and folk practitioners for health care. To meet the goal of providing health care for all, research on nonbiomedical therapies is needed, along with legal recognition of folk practitioners to establish standards of practice.

Risk and benefit assessment is one of the fundamental requirements in the ethical review of research involving human participants. As a result, researchers should evaluate and seek to minimize all foreseeable risks involved in their proposed research and members of research ethics committees should evaluate and balance the risks and potential benefits involved in each research proposal as a part of their ethical obligations regarding research protocols. However, current literature provides little detailed guidance on the specifics of how this balancing process should occur. Consequently, this article provides some details of the process to balance risks and benefits in biomedical research and reminds members of research ethics committees of their responsibility to protect those who are vulnerable from exploitation in research projects. Keywords: Research subjects-Protocols-Ethics. Human experimentation. Ethics Committees, research. Research design. Health vulnerability. ResumoExplorando o balanceamento entre riscos e benefícios em pesquisa biomédica: algumas considerações A avaliação de riscos e benefícios é um dos requisitos fundamentais na revisão ética da pesquisa envolvendo participantes humanos. Consequentemente, os pesquisadores devem avaliar e procurar minimizar todos os riscos previsíveis envolvidos nas pesquisas propostas e os membros dos comitês de ética em pesquisa devem avaliar e balancear os possíveis riscos e benefícios envolvidos em cada proposta de pesquisa como parte de suas obrigações éticas em relação aos protocolos de pesquisa. No entanto, a literatura atual fornece poucas orientações detalhadas sobre como especificamente esse processo de balanceamento deve ocorrer. Consequentemente, este artigo fornece alguns detalhes do processo de balanceamento de riscos e benefícios na pesquisa biomédica e lembra aos membros dos comitês de ética de pesquisa de sua responsabilidade de proteger os vulneráveis da exploração em projetos de pesquisa. Palavras-chave: Sujeitos da pesquisa-Protocolos-Ética. Experimentação humana. Comitê de ética em pesquisa. Projetos de pesquisa. Vulnerabilidade em saúde. ResumenExplorando el balance riesgos/beneficios en la investigación biomédica: algunas consideraciones La evaluación de riesgos y beneficios es uno de los requisitos fundamentales en la revisión ética de la investigación con participantes humanos. Como resultado, los investigadores deben evaluar e intentar minimizar todos los riesgos previsibles involucrados en la investigación propuesta, y los miembros de los comités de ética en investigación deben evaluar y hacer un balance de los riesgos y beneficios potenciales implicados en cada propuesta de investigación como parte de sus obligaciones éticas respecto de los protocolos de investigación. Sin embargo, la literatura actual proporciona escasas guías sobre los detalles específicos de cómo debe ocurrir este proceso de equilibrio. En consecuencia, este artículo ofrece algunos detalles del proceso para equilibrar los riesgos y beneficios en la investigación...

Guideline 20 of the updated International Ethics Guidelines for Health‐related Research Involving Humans (2016) by the Council for International Organizations of Medical Sciences (CIOMS) provides guidance on research in disasters and disease outbreaks against the background of the need to generate knowledge quickly, overcome practical impediments to implementing such research, and the need to maintain public trust. The guideline recommends that research ethics committees could pre‐screen study protocols to expedite ethical reviews in a situation of crisis, that pre‐arrangements be made regarding data sharing and biomedical sample sharing, and that sponsors and research ethics committees seek to minimize risk to researchers conducting research during a disaster. This paper critiques these recommendations against the background of the findings of a survey of public health officials and chairs of research ethics committees in the Caribbean during 2016, which sought to determine the best template for the expeditious ethical review of research proposals in emergency and epidemic situations in the Caribbean, and whose findings can serve as a model for other low‐ and middle‐income countries.