Abstract
In June 2016, the University of Edinburgh hosted the 13th World Congress (IAB2016) of the International Association of Bioethics (IAB). It is critical both to reflect on the event past and to consider how we might keep future events relevant and to adequately bridge the periods in-between. In other words, how do we generate and maintain legacy and help to keep communities consistently engaged over time? This brief article undertakes these functions by reflecting on some of the lessons learned from IAB2016 in the hope that it will prove useful to future IAB Congress organizers (and indeed other international conference organizers).
Introduction
In June 2016, the University of Edinburgh, and more specifically the Mason Institute, 1 had the challenge and pleasure of hosting the 13th World Congress (IAB2016) 2 of the International Association of Bioethics (IAB), 3 a first for a UK institution since 2000. The quality of preceding Congresses and the rightly anticipated conviviality of Scottish culture meant that the pressure to deliver a memorable Congress to the over 700 delegates from 44 countries was palpable. Now, several weeks distant from the Congress, and with our Ceilidh-related injuries healed, it is critical both to reflect on the event past and to consider how we might keep future events relevant and to adequately bridge the periods in-between. In other words, how do we generate and maintain legacy and help to keep communities consistently engaged over time? This brief article undertakes these functions by reflecting on some of the lessons learned from IAB2016 in the hope that it will prove useful to future IAB Congress organizers (and indeed other international conference organizers).
Factors associated with choice and success, and their relevance to IAB2016
It has been found that individual attendance at an international conference (self-evidently, a critical factor in the conference’s ultimate success) is influenced by a number of practical and academic factors, namely
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The fees associated with attendance; The destination (quality of accommodation, ease of transport, safety of and health conditions in the region, heritage and potential for sightseeing); The ‘brand’ of the hosting institution; The specialists represented on the conference committee and by the keynote speakers; The possibilities of securing useful peer feedback on research; The chance to exchange ideas with others from the same and from other disciplines; and The possibilities for networking
The general significance of these factors will inevitably vary from individual to individual, with potential delegates emphasizing different reasons for attendance.
The setting of fees for IAB2016 was outwith the Organizing Committee’s (OC) sphere of influence, being dictated by the size of the Congress and the expectation that host institutions collect IAB membership on behalf of the IAB Board. Nothing more will be said on that other than to note that the OC has recommended to the IAB that the matter of fees be considered moving forward, together with the benefits of IAB membership, which must be better communicated to potential participants.
On destination, the OC was well aware that Edinburgh is a safe and easily accessible city with many modern amenities and that its internationally recognized cultural characteristics would make it attractive to many potential participants. Contrariwise, Edinburgh’s cost of living would prove a challenge for some participants. Similarly, the OC assumed that the historical significance of the University of Edinburgh, one of the ancient universities of Scotland and a highly ranked research institution internationally, would be a draw to participants.
Thanks to the range of expertise of the OC members, we believe that the keynote speakers were well chosen; they represented a diversity of experience and disciplinary expertise from around the world, and so brought both gravitas and multiple cultural, historical, and academic perspectives to the problems emphasized by the IAB2016’s themes. 5 The title for IAB2016 was ‘Individuals, Public Interests and Public Goods: What is the Contribution of Bioethics?’, and the overarching themes around which the substantive contributions were organized and to which they were expected to contribute were ‘global bioethics’, ‘individuals, public interests and public goods’ and ‘public health, ethics and law’.
The final three choice-influencing factors – useful peer feedback, exchanging ideas with common and multiple disciplines and networking – are all evaluated against the academic and social programme that is developed for the conference, and the OC was at pains to ensure that the programme was full and robust, as well as representative of some of the most pressing health- and bioethics-related issues of the day (and of tomorrow).
Content, communication and culture and their realization at IAB2016
Bearing in mind all of the aforementioned attendance-influencing factors, it has been argued in the literature that adequate (and creative) communication is essential for a successful international conference. In other words, while the content obviously matters to a significant degree, that content (and the overarching themes) must be comprehensible and well communicated, and they must be accompanied by intercultural social events that offer opportunities for informal contacts to be forged, all of which can have a profound impact on participant experience and satisfaction. 6
IAB2016 was intentionally informed by a bridge-related meme that drew on the iconic Forth Rail Bridge.
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This meme offered helpful metaphors or concepts around which the content of the Congress and its multiple programmes were shaped. These metaphors, which should be simultaneously understood as ambitions, are Complexity Spanning gaps and building connections Collaboration Continuity
These concepts helped both to convey and ground the overarching themes of the Congress, noted earlier and described in more detail below, and they offered a foundation through which to explore the possibilities of cultural convergence and divergence in deep and positive ways.
Obviously, a challenge associated with fashioning a (necessarily) large academic programme around multiple themes is the unenviable task of accommodating a high number of sessions over a limited period of time; a balance must be sought between volume of presentations and quality of research. In other words, the OC must carefully consider the need for inclusivity, which reflects the breadth and ambition of the IAB and which responds to the large number of abstracts submitted, while also ensuring that the criteria of quality, significance and rigour are met by all presenters. The lesson learned from IAB2016 is that the tension between these competing ambitions is unavoidable, and no solution will satisfy all interested parties. Ultimately, the OC chose quality, significance and rigour over volume of presentations. 8 Efforts were also taken to support delegates robustly and to encourage them to see each Congress as a platform for further and deeper interactions that they themselves must craft. 9
Complexity
Just as bridges (and particularly the Forth Rail Bridge) are comprised of interwoven and complex structures, the challenges of the modern world – globally, regionally and locally – and the multiple actors and disciplines that are implicated require us to engage at deep and sustained levels in the complexity of the problems that we face in health and social care, welfare and human health research. A core challenge to achieving this objective lies in putting together a programme that promotes and facilitates meaningful and productive interactions that endure beyond any given Congress and which spawn new initiatives of their own. The complexities associated with constructing such a programme revolve around the need to include an increasingly diverse range of topics and disciplinary contributions that nonetheless relate to overarching themes. As noted earlier, the themes of IAB2016 were global bioethics, individuals, public interests and public goods and public health, ethics and law.
The idea of global bioethics was to explore how bioethics can and should move beyond traditional bioethics, switching its focus from the individual to the broader context and consequences for both the individuals and others. It emphasized the importance of the health of communities and groups, and practices that support or hinder this. Topics that were presented under this theme include traditional issues as they cross borders to become transnational (i.e. medical or reproductive ‘tourism’); social and environmental contexts that compound health threats and health injustice (i.e. exacerbation of health threats in conflict zones or as a consequence of climate change, pandemics, etc.); the interaction of global inequalities and health (i.e. the comparative lack of funding for research into diseases of the developing world) and the structures of global health governance and regulation (i.e. international law, codes and institutions).
The theme individuals, public interests and public goods was aimed at uncovering insights about the nature of ‘public interests’, ‘public values’ and ‘public goods’ as these impact on health and the experience of ill health. It asked delegates to focus on the actors, values and outcomes for individuals and collectives and to examine the interactions between person-centric and community-centric initiatives in human health. Topics that arose include rights and responsibilities; the management of tensions between interests; the ethical, legal and social challenges of generating and managing public goods; the nature, scope and limits of ethical values and principles in promoting or hindering the realization of some interests at the expense of others; the ethical, legal and social implications of policies designed to promote collective goals in human health and the role of values and principles in delivering health objectives.
The theme public health, ethics and law focused on the practical and normative aspects of implementing good public health in local, national, regional and international contexts, and it had a particular focus on public policy, law and other forms of social intervention. The central premise meant to be explored was that ‘classical’ bioethics has, in recent years, been through a ‘public health ethics’ turn and that all bioethical problems are, in an important sense, social and public problems. Such a reframing changes (or ought to change) in important ways how we think about such problems, with implications for both the theory and practice of bioethics.
While some themes were more represented in the programme than others – a natural consequence of the work that delegates who met the selection criteria are doing – all themes received substantive attention within all three programmes of activities to which we turn now.
Bridging gaps and building connections
At base, bridges are designed to span gaps or to connect disconnected and/or remote things. In the context of the IAB generally, multiple connections are sought between different disciplines, cultures, communities and individuals. For IAB2016 more specifically, we developed three complimentary programmes (i.e. three individual but linked programmes of research and activities, each of which reflected the Congress themes identified earlier). Thus, in addition to a standard academic programme represented by traditional conference symposia, oral presentations and posters on work that the delegates are pursuing, we designed a dedicated Arts + Ethics (A&E) Programme and a comprehensive Early Career Researcher (ECR) Programme, both of which are typically absent from, or under-represented at, such events, and, in either case, are not integrated into the fabric of the academic content.
The A&E Programme
While previous IAB Congresses have had an arts element, and while a loose arts and bioethics network was previously founded within the rubric of the IAB, IAB2016 engaged more extensively with the arts than ever before and integrated that engagement across Congress themes. Importantly, the A&E Programme contained both artistic and academic works that drew on, or reflected, two very different approaches to interdisciplinary work that includes the arts. 10 One approach views the arts as an adjunct to explain or supplement academic work (i.e. it uses the arts instrumentally, arguably placing it in a subservient position to the academic work). The other approach adopts a more critical perspective to creativity; the arts is much more protagonist, in cooperation with other disciplines, and emphasizes more strongly its own norms and sensibilities in exploring the subject topic. The tension between these two approaches was the source of significant and useful debate throughout IAB2016.
The A&E Programme was widely engaged with, even by delegates with little or no experience with such collaborations, and the largely informal feedback received from delegates was very positive. This supports our view that there is a great potential for an arts element to enrich future Congresses despite the fact that retaining an interdisciplinary arts component entails special organizational demands and such is in keeping with the plenary keynote address of Paul Macneill, who emphasized the potential of the arts to facilitate bioethics and academic reflections and dissemination more generally, but who encouraged such collaborations to challenge and provoke. Of course, some of that feedback betrayed a lack of understanding of the possibilities that such cross-disciplinary engagements offer and of the artistic and academic rigour that they exemplify, so the full potential of the arts has yet to be fully realized or appreciated. 11
The ECR Programme
While large international conferences offer junior colleagues the chance to listen to more senior colleagues, the opportunities for ECRs to discuss their own research can be limited (and intimidating). It is important to balance career-specific support and opportunities for ECRs, while ensuring that their attendance and participation alongside more-established bioethics community peers are genuinely inclusive and valued. For this reason, IAB2016 adopted a five-pronged approach to the ECR Programme, which, we would argue, ought to be taken up in future Congresses.
First, in recognition of the limited funds available to ECRs, we offered numerous bursaries, supporting 40 colleagues from 23 countries, many of them are ECRs from low- to middle-income countries. Second, we offered three ‘master classes’; one on funding, careers and influencing policy; one on publishing and one on presenting. Third, we made it a prerequisite for all symposia to include at least one ECR member. Fourth, we offered novel presentation formats within the academic programme such as ‘Got Originality?’ and ‘20 × 20’ sessions, which were open to all participants, but for which the majority of presenters were Early Career Researchers. Finally, we offered a plenary keynote on the topic of Research Careers, where Alastair V. Campbell, Anant Bhan and Sarah Chan offered helpful advice to researchers at all stages of their careers, with a particular focus on junior colleagues starting out in bioethics.
Formal and informal feedback strongly suggested that this ECR dimension is welcomed, and the OC intends to continue to interact with this community through the hashtag #International Association of Bioethics Early Career Researcher (IABECR) to reach out to other ECR gatherings and to build a supportive bridge to IAB2018. 12
All told, a distinctive contribution of IAB2016 was the explicit and unique connection of the academic programme to both the arts and the early career communities.
Also relevant to this metaphor is the finding from previous conference research that individuals can be dissuaded from attending or can be distracted when attending international conferences by ‘cultural confusion’. 13 Essentially, individuals out of their normal cultural context can be confounded and their well-being temporarily undermined. While the integration of an A&E and an ECR Programme may have had the potential to incite that confusion, the risks were viewed as more than offset by the benefits of their inclusion. Further, it has been argued that, in the context of international conferences, well-designed and executed social events can alleviate this confusion, 14 and we viewed our social events as chances to serve as strong and important intercultural opportunities for delegates and as a chance for delegates to feel welcome and to experience some Scottish culture. Given that it has been demonstrated that informal dinners are more valued than formal receptions or dinners, 15 IAB2016 included an informal ceilidh with drinks and traditional Scottish finger foods rather than a formal sit-down dinner. This gala was felt to facilitate the delegates in making connections with multiple individuals in a light-hearted context. This event was also supplemented by an evening performance of HeLa by Adura Onashile, a profound monologue inspired by the true life story of Henrietta Lacks and the life of the HeLa cell line derived from her tissue. This performance drew the social into the substantive themes of the Congress. 16
Collaboration
The construction of bridges is reliant upon numerous individuals with diverse skills, working together towards a common goal. From a substantive perspective, the high-level question for IAB2016 was ‘What is the contribution of bioethics?’ Therefore, delegates were encouraged not only to reflect upon the contribution of bioethics generally but also to explore the value of bioethics to their own disciplines, and vice versa, to consider how individual activities and contributions can be expanded to include others to achieve a reshaping and improvement in this ever-expanding field and to provide more robust answers to increasingly challenging questions.
From an organizational perspective, Congresses are entirely reliant upon positive collaboration to successfully manage the logistics of a large, rigorous, multicultural event. Thus, the OC was tasked with the following duties: Serving as and sourcing additional peer reviewers for the vast number of abstracts (who must fairly evaluate many abstracts in a timely manner); Identifying funders (who must also appreciate the significance of bringing together delegates, generously enabling this to take place via sponsorship); Encouraging volunteers (who must agree to work tirelessly behind the scenes to ensure the smooth running of the event); Inviting and working with keynote speakers (who must provide inspiring and thought-provoking presentations); Asking (and sometimes cajoling) individuals to be session chairs (who must generously facilitate sessions); Working with the many presenters (who contribute to moving pre-existing discussions forward by sharing their research); and Trying to meet and encourage as many delegates as possible (who commit the time and resources to attend and participate in the Congress itself).
Without the individual effort and positive collaboration of all of these individuals, international conferences simply cannot take place, and the IAB2016 OC has been humbled by the conviviality and dedication of all of those who contributed towards IAB2016.
Continuity
Bridges must be built to last. They must endure new stresses and demands over time. The primary aim of this editorial report (as laid out in the introduction) is to better enable future OCs to carry on the important discussions that have taken place at IAB2016, bridging the gap between the previous Congress (in Mexico City) and the next Congress (in Delhi) in December 2018. To this end, two legacy activities in particular are deserving of attention.
First, we are constructing a dedicated online ECR platform, which not only pulls together the various ECR-focussed presentations and discussions that took place at IAB2016 but also will be used to facilitate the continuation of these conversations. We seek to bring together and share advice, challenges and experiences from ECRs as well as more senior colleagues in approaching ECR-related issues. Second, we have founded an international Arts and Ethics Research Group (AERG) supported in the first instance by the University of Edinburgh’s Institute for Advanced Studies in the Humanities. 17 The AERG seeks to encourage new insights and public debate around ethical, legal and social aspects of the practice and governance of medical research and healthcare through the partnering of different academic disciplines with the creative arts. 18 The aim is to work collaboratively around four broad themes – (1) the transformative potential of the arts, (2) medical practice (i.e. the doctor–patient relationship and the patient experience), (3) communication of science and healthcare (i.e. how arts and the humanities can facilitate robust knowledge-exchange and dialogue) and (4) innovation and global justice (i.e. values, interests and power dynamics in designing and delivering global healthcare) – and in doing so to generate both academic and artistic outcomes.
These two ongoing activities are strong legacies of IAB2016 and will hopefully achieve continuity through (formal) participation in future Congresses.
Ongoing challenges and final thoughts
Formal feedback on IAB2016 has been positive, but concerns about price are prevalent and we share those concerns. There is evidence of strong support for more permanent commitment to an ECR stream, so long as this remains integrated into the main programme to avoid any sense of marginalization of junior colleagues. The challenge of securing bursaries will continue to be a central issue for future organizers; no matter how low the Congress and Membership fees are set, colleagues from around the world must still cover travel and accommodation costs. If the IAB genuinely wishes to make its Congresses truly global events, more support and imagination will be required to bring together colleagues who might never have had the opportunity to attend an IAB Congress. For our part, we are unceasingly grateful to our major sponsors: the Wellcome Trust, the University of Edinburgh, the Nuffield Council on Bioethics, the University of Pennsylvania Department of Medical Ethics & Health Policy and the Harvard Medical School Center for Bioethics. Without their support, and Institute for Advanced Studies in the Humanities (IASH’s) support of the AERG, IAB2016 would simply not have been possible. We – the authors specifically and the OC more generally – are additionally grateful to the Board of the IAB for giving us the opportunity to allow Edinburgh and its networks of colleagues to contribute to making a small difference in the ongoing struggles for a fairer, more just, more egalitarian and more equal world committed to improvements in human health, well-being and flourishing.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.