I believe that some of the most rewarding experiences and the greatest events that occur in life often rest on serendipity, some-thing you have not planned for as one does 5 year and a 10-year plans. I think CBEC, the way it came about in SIUT, is an example of this, a leap of faith on the part of Dr. Adib Rizvi and myself. Our biggest national challenge in the last 20 years has been to develop diverse educational activities, from formal degree awarding bioethics the Center to workshops in provinces for researchers and other health care related professionals. monumental task undertak-en by a small but dedicated faculty.

Farhat Moazam, Professor and Chairperson

Twenty years ago, our first conference, “Foundations of Moral Thought: From the Greeks to the Contemporary Bioethics,” was a litmus test for us, for the Centre, of what was ahead of us. We had a tremendous response to that… Twenty years later, we still look ahead. There is no highway. We have to build our own way forward even now. Every step has to be thought through, and every step has to be is what we have learned.

Aamir Jafarey, Professor

When I first enrolled in the PGD, I had no idea that years later, I would eventually become a faculty member at the center. These two decades CBEC have been nothing of a rollercoaster. The has grown and so have I. reworked traditional methods for a field that is by shades of grey and that’s the kind of innova-tion I hope we can continue into the future.

Bushra Shirazi, Professor

I came to CBEC following its 10-year exter-nal review, which recommended bringing in someone with a social sciences background. CBEC has shaped my professional journey. Last year, while helping put together the special anniversary edition of our newsletter and planning the 20-year conference, I felt the warmth of the Centre’s rich.  I sifted through old photographs, collected memories faculty and alumni. That realize that I am a small part of something bigger.

Sualeha Shekhani, Assistant Professor

While I had been drawn to abstract ideas in philosophy since my first year in university, it was only at CBEC that I saw how philosophy breathes differently when rooted in lived contexts, engaging with real people, and social structures. This conference was a culmination of applying  bioethics:  thinking,  creating,  organizing,  and making it meaningful for people from across disciplines. What CBEC has given me is not just training in bioethics, but a way of seeing life holistically.

Farid bin Masood, Senior Lecturer

I have been part of CBEC since its beginning, and it has become a place for my intellectual growth. As a clinician interested in bioethics, I have always searched for spaces where my intellect could be nourished, and I kept coming back here, whether I was a faculty or not. I believe we need more

places like this where clinicians can engage in reflection. Being one of the organizers and a presenter as well, was full  of  learning  like  any  other  experience  at  CBEC.

Nida Wahid Bashir, Part-Time Faculty

CBEC’s goals include building and enhancing national bioethics capacity in clinical and research ethics within institutions and healthcare professionals of the four provinces in Pakistan. The Centre has been able to do so in Sindh, Punjab and Khyber Pakhtunkhwa, through invited workshops and enrollment of their professionals in its bioethics programs.  However, CBEC’s reach into Balochistan, the country’s most disadvantaged province, had been minimal due to a paucity of medical fraternity contacts despite faculty efforts.

This changed in 2023 when Dr. Rukhsana Majeed, Head of the Department of Community Medicine, Quetta Institute of Medical Sciences (QIMS), participated in a CBEC workshop to review the WHO Tool for Benchmarking Ethics Oversight of Health-Related Research. The following year, at Dr. Majeed’s invitation, CBEC faculty ran a very well-attended two-day bioethics workshop in QIMS. Participants included enthusiastic professionals from other institutions in Quetta, requesting that CBEC undertake the same for them.

Building on the momentum from the QIMS workshop, CBEC faculty conducted a second workshop at the Sheikh Mohamed Bin Zayed Al Nahyan Institute of Cardiology, Quetta (SMBZAN ICQ). Brig. Dr. Omer Iftikhar Kahloon, the institute’s Commandant, extended the invitation and demonstrated his strong support through active participation throughout the event. Dr. Hania Hashmi, Research Officer at the institute, played a key role in organizing the workshop. CBEC faculty, Dr. Farhat Moazam, Dr. Aamir Jafarey, and Mr. Farid bin Masood, were involved in teaching.

Day one focused on Clinical Ethics, beginning with a comparative exploration of traditional medical ethics versus contemporary bioethics. This was followed by sessions on informed consent, privacy, and confidentiality. Two specially developed CBEC videos effectively helped participants contextualize the nuances of consent and privacy in clinical encounters relevant to local Pakistani settings. Day two centered on Research Ethics, starting with an activity to differentiate between clinical practice and research, highlighting the distinct ethical implications. A session on the basics of research ethics introduced common ethical challenges and the importance of ethical oversight mechanisms. This led to an introduction to the WHO Benchmarking Tool for Ethics Oversight. The day concluded with a dynamic research case discussion, where participants divided into two groups deliberated on ethical issues, as members of a simulated ethics review committee.

The workshop brought together a diverse group of participants, with balanced representation across specialties and hierarchy, including clinical, nursing, diagnostic, and administrative departments. Participants actively engaged in all discussions, sharing experiences and perspectives unique to their professional contexts. Brig. Dr. Kahloon sat through all the sessions of the workshop, displaying the institute’s commitment.

Besides the two workshops, CBEC has had a student from Balochistan who completed the Clinical Ethics Certificate Course and another who is currently enrolled in the PGD program.

CBEC-SIUT has had a long relationship with Khyber Medical University (KMU), a public sector institution in Khyber Pakhtunkhwa (KPK). It began in 2009 when KMU Professor Tasleem Akhtar approached CBEC with her conviction of the important role of integrating ethics in biomedical research, public health and professional clinical practices, and expressed the university’s commitment to expand bioethics education in the province. Since then, CBEC faculty have undertaken many workshops in KMU and its affiliated institutions in helping them to achieve their goals. Recent workshops have focused on research ethics to enhance the knowledge and sound functioning of ethical review committees (ERC) and their members in KPK.

The most recent CBEC workshop, “Methods and Ethics of Health Research,” took place in May 21-23, 2025 at the invitation of Dr. Khalid Rehman, Director of the Institute of Public Health and Social Sciences (IPH&SS), KMU. Held at KMU’s newly established campus in Mansehra, the workshop aimed to introduce participants to foundational concepts in health research ethics, public health challenges, and the ethical regulatory frameworks in Pakistan.

CBEC faculty, including Dr. Aamir Jafarey, Ms. Sualeha Shekhani, and Mr. Farid bin Masood, along with associate faculty and MBE alumnus Dr. Natasha Anwar, facilitated the sessions. Participants came from diverse fields, including public health, epidemiology, family medicine, basic sciences, and dentistry, reflecting a wide interest across disciplines.

During the workshop, CBEC faculty encouraged participants to apply for its formal certificate courses in Research and Public Health Ethics, as well as Clinical Ethics. KMU organizers also committed to adopting the WHO benchmarking tool to evaluate and strengthen the Ethics Review Committees across its constituent institutions.

During the closing session, KMU’s Vice Chancellor, Dr. Zia-ul-Haq, expressed a strong interest in initiating formal bioethics education programs at the university and invited CBEC to support this endeavor. This marks not just the continuation of a long-standing relationship but also holds promise for shaping an ethically grounded healthcare landscape in the KPK province.

There was a time when the presence and role of women were not mentioned in history. The part played by women in nurturing civilization and promoting language and literature was barely recognized. The patriarchal system not only ignored women but also considered them as nonexistent, essentially manifesting that women are devoid of any intellectual capabilities and wisdom. It was in the 1960s that women writers started to challenge such patriarchal practices by highlighting feminist consciousness in their literary writings.

Feminism’s rise in literature finds its profound connection with women’s social and political awareness. The global women’s rights movement played a key role in shaping it, and gradually it made its way into literature as well. Feminist consciousness refers to the awareness and understanding of women’s issues, their despotic oppression, and their courageous struggle for equality in a male-dominated society. In Urdu literature, feminist thoughts began in the early 20th century when women raised their concerns through writings.

Early magazines for women played an important role in developing this consciousness. Through writings in “Tehzeeb-i-Niswan,” “Khawateen,” and “Ismat,” women started to establish their own unique identities. These publications provided women a platform to express their thoughts freely and challenge societal norms that restricted their potential and confined their thoughts. Through these magazines, women writers not only documented their experiences but also presented alternative narratives that contradicted patriarchal assumptions.

In his article, “How Can Society Be Reformed?” Maulana Hali argued that women’s education is essential for eradicating repressive customs from our culture. His contemporary, Zahida Khatoon Sharwaniya, wrote the masnavi [narrative poem] “Aaina-i-Haram” in the style of Iqbal’s Shikwa [The Complaint] and published it in 1915 through the Dar-ul-Ishaat Punjab of Maulvi Mumtaz Ali. In this sixty-couplet masnavi, the men of the subcontinent are lamented for keeping women ignorant and inflicting great injustice and atrocities upon them and their offspring.

Zay Khay Sheen (Zahida Khatoon Sharwaniya) emerges as the first important figure within this tradition of feminist writing in Urdu literature. She was born in Behkampur, Aligarh, in 1894 and died in 1922. She was also the first female poet who could not be ignored due to her own unique thought and style of expression. At first, she tried to conceal her identity and kept changing her poetic name. Her famous mussaddas [six-line stanza], “Aaina-i-Haram,” was published along with her ten poems voicing women’s concerns. Her second collection, “Firdous-i-Takhaiul,” was published after her death in 1940 and proved her literary prowess. Her poetic voice posed a challenge to the patriarchal repression and narrated the experiences of women in a society that oppresses women. Her work stands as a testament to the fact that women’s intellectual capabilities are not inferior in any aspect, but rather have been systematically undervalued by men in society.

By the mid-1930s, the Progressive Movement brought a new era of women’s writings. Writers who were influenced by this movement, and later by modernism, remained in solidarity against misogynistic customs of society, included notable figures like Rashid Jahan, Ismat Chughtai, Qurratulain Hyder, Hajra Masroor, Khadija Mastoor, Ada Jafarey, Mumtaz Shireen, and Khalida Hussain. They leveraged their literary capabilities to expose and critique patriarchal structures that oppress women.

The feminist movement all over the world gained momentum in 1975, after the first UN conference on women held in Mexico. In our part of the world, the term ‘feminist’ gained acknowledgment in the same year. Many important women of Pakistan adopted a unique and singular approach to express themselves in the late 20th century. Among them were Kishwar Naheed, Fahmida Riaz, and Zahida Hina, who developed a connection between Urdu literature and the global feminist movement. This period marked a turning point in feminist consciousness in Urdu literature, as many women writers began to explicitly align their work with feminist principles and ideologies.

It is encouraging that a large number of women from the new generation are establishing their position in the fields of writing and education, and they are aware that as human beings, they are neither inferior nor superior. Their male contemporaries have largely moved beyond a negative attitude and are considering them as their equals. This was a long and difficult journey made possible by these important female writers whose works contributed significantly to this journey. However, women writers continue to assert their presence in literary spaces challenging patriarchal narratives due to the deeply entrenched discrimination and urban-rural awareness gaps in our society.

How does one describe Hayy ibn Yaqzan — literally, Living, Son of Awake? This Arabic work of fiction, whose renderings, paraphrases, shadows, and footprints are found in Hebrew, Latin, English, German, French, Spanish, and elsewhere, is in the generic sense a piece of fiction no doubt. But what kind of fiction? It has been described as a “novel,” “fable,” “edifying tale,” “allegory,” “parable,” and often “philosophical romance.” Then, following the Latin Hayy tradition, it is also called a pioneering work in “autodidacticism,”— a word that combines two Greek words autós (“self”) and didactikos (“teaching”), thus meaning “teaching oneself without the guidance/mediation of an external teacher.”

Nor is the substantive question straightforward: Is the Hayy a work of rational philosophy? Or is it a Sufi discourse in which philosophy functions merely as a ladder to reach mystical heights? In other words, is the author seeking ‘ilm, discursive knowledge, or is he rather a wayfarer traversing his path towards the station of ma‘rifa, what may be described as gnosis? Then, a related question: Is his fundamental inspiration Greek philosophy, in particular Aristotle and Plato, in whose thoughts he is often drenched? Or does this inspiration ultimately happen to be the indigenous Islamic intellectual and spiritual ethos, given his running citations and frequent implicit references to the Quranic text, among other Islamic scriptural sources? Indeed, these complicating issues make the work ironically a richer historical and literary phenomenon, opening up many new vistas that bring before us dazzling sights.

The Hayy was written some 900 years ago in the early 12th century in Andalus, Muslim Spain. Its author, the philosopher and theologian Ab Bakr Ibn Tufayl (Latinised, Abubacer Aben Tofail) was a vizier of the Almohad (al-Muwahhidn) ruler Ab Ya’qub Yusuf, whom he also served as a physician. This polymath author of the Hayy, who died in 1185, was a great supporter of his younger contemporary, Ibn Rushd, the redoubtable philosopher held to be the greatest Aristotelian in the whole history of philosophy. It was Ibn Tufayl who had urged Ibn Rushd to work on Aristotle and to purify this Greek giant from the obscurities of his commentators. Given Ibn Rushd’s decisive impact on European philosophy, only this act is enough to give Ibn Tufayl a high place in world culture Hayy ibn Yaqzan is the name of the protagonist in Ibn Tufayl’s tale. This human was born in an uninhabited island in the Indian Ocean, so goes the story, without human begetters. But his birth is explained not in transcendental-symbolic terms, but in naturalistic-physical terms, in terms that may legitimately be described as “scientific.” This was the case of spontaneous generation that comes to pass through the mixing of natural elements and confluence of natural forces — the underlying element being the mud of the shore. Hayy is then suckled and reared by a gazelle. So a feral human being grows up.

The main thrust of the tale is autodidacticism — learning without an external teacher but through one’s own rational powers. Through the exercise of reason alone, then, Hayy discovers the real facts of the world, finding out the workings of the cosmos and arriving at philosophical truths; and indeed by the sole means of his inborn intelligence he acquires biological knowledge, ethical knowledge and, ultimately, knowledge of God, the “Necessarily Existent Being.” We may well characterize Hayy’s mode of inquiry as embodying a “scientific method” by means of which he carries out all his discoveries of the physical world’s operations and of virtuous social conduct. Since he grew up in the wild among animals, and his moral sense remained pristine without any family or communal biases, he also develops an ecological sensitivity, caring about all creatures around him and not arrogating himself higher than any other being in the natural environment. Hayy here stands as a leader of our contemporary environmental concerns.

The use of reason here takes many forms of manifestations— sometimes Hayy makes logical deductions from self-evident premises in an Aristotelian vein; sometimes he makes “inductive” generalisations; here we see him contemplating in the style of Plato and the Sufis; there we find him making systematic observations. When his mother gazelle dies, he dissects her body and proceeds precisely like a biologist to discover the centrality of the heart for life. Hayy’s ascent on the steps of cognizance manifests a paradigm case of self-tutelage, autodidacticism that is, a process that leads him finally to “the Cause of all things,” “the Maker,” and then he declares more in the Sufi mode than the rationalistic:

He is being, perfection and wholeness. He is goodness, beauty, power, and knowledge. He is He [huwa huwa]. “All things perish except His face.” (Quran, 28:88).

Note the Sufi cry, “He is He!” The story moves on: when Hayy is a fully mature man, he experiences his first human encounter. A man called Asal visits his island. Who is this stranger? He came from another island, but one that sustained a human population. After some initial struggle to make Asal overcome his phobia of the unknown fellow man, a struggle during which Hayy even uses brute force to subdue the evading stranger, the two become friends. Asal then teaches Hayy his human language, and they are now able to converse.

They compare notes about their cosmological ideas, their ethical principles, their notion of upright life, and, of course, about God. Lo! Hayy finds that they are identical; what Asal had learnt through the guidance and instruction from an external teacher, from some kind of an apostle, was no different from the body of knowledge that Hayy had gained by himself through exerting his own innate faculties of reason. And here Ibn Tufayl makes that resounding declaration that constitutes a core doctrine of Islamic philosophy — that reason and revelation lead to identical truths. The two have cognitive equivalence. What religion teaches by means of parables and stories, and what philosophy yields through the exercise of reason — these two are substantively the same. Indeed, Muslim philosophers recognize a higher status for prophets on account of their direct, instant knowledge of the truth, given that they are “gifted ones.”

Hayy ibn Yaqzan’s historical impact on world intellectual culture was massive; in fact, mind-boggling. We hear its chimes all over Europe — in pure philosophy, in science proper, and in educational doctrines, not to speak of literature and that liberating genre of fiction. In 1671, Edward Pococke the Younger translated the Hayy into Latin from an Aleppo manuscript copied in 1303 that is now held in the famous Bodleian collection at Oxford University. Pococke called it Philosophus Autodidactus. And then, it feels like a continuous spring shower.

Just three years after the Latin translation, we saw the first English translation by George Keith, and another in 1686 by George Ashwell. Then we meet Simon Ockley, who renders the Hayy into English directly from the Arabic, The Improvement of Human Reason: Exhibited in the Life of Hai Ebn Yokdhan, published in 1708. Now the famous philosopher Spinoza, a pioneering foundational figure of the Enlightenment, finds the Hayy standing in such harmony with the spirit of the times, that he convinces his friend Johannes Bouwmeester to translate it into Dutch. More translations were to come and scholars say that the Hayy had become a “bestseller” during the Scientific Revolution.

The tide of the historical vicissitudes of the Hayy rises. In 1719, it charms Daniel Defoe and the world saw Robinson Crusoe modelled after it, set likewise on an island, although our Arabic tale may not have been the only source for Defoe. Rudyard Kipling’s The Jungle Book is yet another ramification from the same literary seed. One recalls that Robinson Crusoe is considered to be the first novel in English, just as its source Hayy has the acclaim that it is the world’s first philosophical novel with an “enormous impact” on the Enlightenment. And so the spirit of Hayy lives in our modern sensibilities.

Turning to the domain of intellectual history, the chimes of the Hayy are to be heard all over. The founder of empiricism in modern-day philosophy, John Locke, happened to be a student of Pococke, the Latin translator of the Hayy, and knew his teacher’s translation since he refers to it. But what is more, historians say that the English philosopher’s classic tabula rasa (“blank slate”) theory — the theory that the human mind at birth is a blank slate — is inspired by the Hayy; this observation is highly plausible. Historians have also traced the Arabic tale’s diffusion in, and in many cases, direct impact on, the thought of Robert Boyle, Voltaire, and even Karl Marx. This includes Emile, or On Education of Rousseau.

But far away in time from all of this is a medieval Hebrew translation of the Hayy carried out in Muslim Spain. The scholar Rudolph Altrocchi in 1938 provided a groundbreaking body of historical evidence: he demonstrates that Dante read this translation. Yes, indeed, there are many crucial parallels between the Hayy and the Divine Comedy, such as one ecstatic and “gorgeous vision” of Hayy — a vision whose sharp reflections are to be found in Dante’s description of Paradise.

A very large number of scholars have made Ibn Tufayl and his Hayy their subject of research; L. Goodman is one of them, whose translation of the text I have reproduced. Here, one recalls an article published in The Guardian many years ago, written by M. Wainswright. It was called, ‘Desert Island Scripts: Footprints of a 12th-century Muslim Robinson Crusoe.’ Wainswright tells us that the drizzle continues until now.

A longer version of this essay by Syed Noman-ul-Haq previously appeared in Dawn on Sunday, May 22, 2016.

I have been associated with CBEC as visiting faculty for the better part of a decade and have taught cohorts in the Master’s and Post-graduate diploma programs. My focus has been introducing students to approaches to religious ethics, the history of the academic study of religion in the Western academy, and theorizing how the dimensions of our lives we might label “religious” or “religion” are entangled with the rest of our lives.

I was honored to be invited to the 20th anniversary of CBEC in January 2025 as one of the presenters at the event. My presentation drew on the history of medical applications of mesmeric trances in India in the 19th century and the hopes pinned on spiritual telegraphy in the US in the same century for elucidating an important distinction between two different ways of thinking about bioethical problems. What I want to share with us in this brief essay are the contours of that distinction and the implications it has for how we might think about bioethics as a “problem-solving” discipline or area of inquiry.

On the one hand, it is possible to conceive bioethics as a discipline that conceptualizes and resolves problems of a “tame,” finite, specifiable, and resolvable nature. The term “tame problems” was coined by Rittel and Webber in 1973 to designate problems where “the mission is clear.”¹ These are problems that can be clearly formulated, about which you can suggest finitely specifiable pathways of resolution, and you are sure when the problem’s been “solved.” Webber and Rittel provide the example of a game of chess as a tame problem. You can specify the rules of the game, you can unambiguously identify when a game has been won or lost, and, in some sense, each chess game is isolatable from other chess games or non-chess games. As they put it: “Chess has a finite set of rules, accounting for all situations that can occur.”²

If bioethics were to be conceived as a response to a set of tame problems, then it stands to reason that the essential task of bioethics is providing a set of frameworks and approaches that can offer pathways, rules, and guidelines, via which the bioethical equivalents of a game of chess, or mathematical problems, are conceptualized and resolved. My contention is that approaches such as Fitz Jahr’s – one of the early “founders” and architects of bioethics – engage in this sort of theorization when they offer Kant-inspired “bioethical imperatives” as frameworks for resolving bioethical problems.

In his commentary on Jahr’s bioethical imperative, Hans-Martin Sass notes: “The Bioethical Imperative is a necessary result of moral reasoning based on empirical physiology and psychology of humans, plants, and animals; as such it needs to educate and steward personal and collective cultural and moral attitudes and calls for new respect and responsibilities toward all forms of life.”³

Similarly, Beauchamp and Childress use the phrase “the common morality” to refer to “the set of universal norms shared by all persons committed to morality…It is not merely a morality, in contrast to other moralities. The common morality is applicable to all persons in all places, and we rightly judge all human conduct by its standards.”⁴ What I want to point out is that such principles are appropriate to bioethics, if bioethics is conceived as a way to address tame problems.

On the other hand, if bioethical problems are not clearly specifiable in the way that a game of football, cricket, or chess might be specified, and they are more akin to what Rittel and Webber call “wicked problems,” then, perhaps the way to go about them is not to come up with an exhaustive approach or a set of frameworks. Rittel and Webber attribute ten characteristics to wicked problems in order to distinguish them from tame ones. Unlike tame problems, wicked problems resist finite formulation and there are no clearly specifiable criteria through which one can conclude that a problem has been “resolved.” Wicked problems are “radical,” in  that,  they  require  us  to  figure  out  how  one  might live-well-with-a-problem rather than eradicate or resolve it and imagine a world without it. They may be thought of as “existential problems” that one has to negotiate and figure out as a matter of course, rather than address at a particular point in time.

While Webber and Rittel draw on social policy-related problems to make their case, their framework can be employed to make sense of problems that one has to “cope with,” “resist,” “palliate” rather than overcome, eliminate, and cure. If we are to think of bioethics as a discipline that theorizes and conceptualizes wicked problems, then its claims should sound less like clearly articulated principles, pathways, and guidelines, and more like Richard Rorty’s claims about philosophy.

Rorty notes that the quest for arriving at a programmatic “method” or a set of “principles” that will clarify the nature of the problems that vex us is wishful thinking: “It is useless to hope that objects will constrain us to believe the truth about them, if only they are approached with an unclouded mental eye, or a rigorous method, or a perspicuous language.”⁵  For Rorty, the only recourse available to us in the face of “wicked problems” – think climate change, justice, distribution of material  resources,  living  with  a  chronic disease – is “conversation”: “Our conversation with our fellow-humans [is] our only source of guidance. To attempt to evade this contingency is to hope to become a properly-programmed machine.”⁶

In the face of intractable problems, Rorty suggests that we count and rely on “our loyalty to other human beings clinging together against the dark, not our hope of getting things right… Our glory is in our participation in fallible and transitory human projects, not in our obedience to permanent non-human constraints.”⁷

To my mind, Rorty’s claims against the search for procedural fixes to intractable problems offer two important insights. First, the search for procedure and method as our “savior” can be a symptom of our desire to evade the responsibility of constructing a fallible course of action and to, instead, posit an undeniable “principle,” a “non-human” constraint as the source of our actions. Our search for such principles may belie  our  desire  to  evade  the  messiness  of  human construction in the hopes  of becoming a “properly -programmed machine.”

Secondly, and perhaps more importantly, conceiving our ethical task as the construction of principles, procedures, and rules, is a way of preventing our thinking from becoming capacious, expansive, and political. It carries the risk of directing our intellectual labor to the construction of “scripts” and “cogs” that work within bureaucratic and professional settings, which we have to take as “givens,” as non-negotiable parameters within which our principles, rules, and procedures have to find their place.

I can do no better than cite Rihito Kimura’s hopes about bioethics as more than a set of procedures for resolving tame problems. He noted in 1986: “Bioethics is a totally new form of discipline which goes beyond the notion of interdisciplinary studies: it is suprainterdisciplinary; it is deprofessionalizing medicine; it is a civil action movement.”⁸ To my mind, too, the degree to which bioethics is a discipline that addresses wicked problems, it ought to be akin to Rorty’s claims and Kimura’s rallying cry.

References:
¹ Horst W. J. Rittel and Melvin M. Webber, “Dilemmas in a General Theory of Planning,” Policy Sciences 4, no. 2 (1973): 160.
² Ibid., 164
³ Hans-Martin Sass, “Fritz Jahr’s 1927 Concept of Bioethics,” Kennedy Institute of Ethics Journal 17, no. 4 (2007): 283. Emphasis added.
⁴ Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (New York : Oxford University Press, 2013), 3.
⁵ Richard Rorty, “Pragmatism, Relativism, and Irrationalism,” Proceedings and Addresses of the American Philosophical Association 53, no. 6 (1980): 726.
⁶ Ibid.
⁷ Ibid., 727.
⁸ Quoted in Sass, “Fritz Jahr’s 1927 Concept of Bioethics,” 291.

Scholarly literature on gender in Pakistan has traditionally ignored the everyday experience of women, especially the domestic experiences of women within the household.[i] In order to explore this gap, we may have to turn to women’s voices that are present in non-formal archives such as diaries, biographies, memoirs, and even fiction—sources where we find women speaking in non-public spaces (Rouse 1996).[ii]

Following the above discussion, I elaborate on these insights by focusing on the 1960 film Saheli (Female Friend), to open up the question of domestic life and sexuality in Pakistan by turning to an underused archive: cinema. This analysis enables me to open up an argument about women’s representation in popular media in Pakistan, in order to create a different archive of women’s cultural and sexual politics and histories.

The passing of the Family Law Ordinance in 1961 was seen as major victory for women’s rights in Pakistan as it provided some legal curbs against polygyny, expanded the right for women to initiate divorce proceedings and also dealt favorably with inheritance rights for women. This move by General Ayub’s military government may not have been reflected in its cultural politics. The same year the Ordinance was passed, the film Saheli (1960) received five President of Pakistan medals for different categories. The film’s central theme was the friendship between two women and depicts one of them letting her friend marry her own husband as a second wife.

Let me offer a brief plot of the film and then share a reading that questions its more obvious interpretive reception (polygamy). The film was directed by S.M. Yusaf, a veteran of the Bombay film industry who had migrated to Pakistan and tells the story of two female friends, Jamila (Shamim Ara) and Razia (Nayyar Sultana), who grow up together in Rawalpindi with Jamila’s mother and her elder brother.

When Razia is called away to her relatives in Hyderabad, the two friends constantly miss each other and write letters to stay in touch. But these are intercepted by Jamila’s brother who has a soft spot for Razia, yet also has a mistress whom he keeps promising to marry. The friends, hence, are unable to communicate.

Pining for her friend, Jamila fakes an illness and wants the doctor to tell her mother that she should be sent to Razia to recuperate. The doctor, played by Darpan, falls in love with Jamila. She reciprocates his feeling and their marriage date is fixed. On the day of the wedding, the doctor dies in a car accident and Jamila, traumatized, enters a shock-like condition. The family takes her to Karachi to a specialist, renowned for healing psychological problems When Jamila opens her eyes in the Karachi hospital she sees Darpan again, who is now playing the character of the elder brother of the deceased doctor (but looks identical) and is married to Razia.

Jamila, of course, does not know this and she is eager to get married to the doctor. Razia persuades her husband to marry her friend as that is the only way she would recover from her condition.  Jamila gets married without knowing that Darpan is already married to Razia.

Jamila’s brother in the meantime takes the intercepted letters to Darpan and convinces him that his first wife, Razia was actually in love with him (Jamila’s brother).  The letters were of course addressed to Jamila but only through the term of endearment, habib (my love), and were signed by Razia. The doctor is convinced of his first wife’s unfaithfulness and is willing to give her up.

In the meantime, the doctor’s loyal servant tells Jamila that the person she was supposed to marry was dead and that Razia had sacrificed her marriage for Jamila’s happiness. Jamila calls Razia on the phone and hears her shriek. Jamila’s brother, who lusted after Razia, had forcefully entered her house and was threatening to rape her. Jamila arrives at the house with a gun, confronts her brother and shoots him through a broken window-pane.

The movie is actually a flashback that Jamila narrates in front of the judge hearing the murder trial. At the end, Jamila’s brother’s long-suffering mistress comes forward and says that he  was actually killed by her bullet.  She killed him, she says in her testimony, because she could not see him ruin another life. The last shot shows the two friends embracing each other and then riding back to their mutual home in a large convertible, the husband nowhere to be seen.

In her book Between Women: Friendship, Desire, and Marriage in Victorian England (2007), Sharon Marcus reads Victorian fiction to discuss female relationships in England of that era. She shows the intensity of these relationships in terms of mother-daughter dynamics, in female friendships, in the mutual investment of women in images of femininity and the range of different ways women associated with each other.

These homo-social relationships were deeply imbibed by ideas of altruism, generosity and mutual indebtedness. The book concedes that the power of men, patriarchy and the institution of heterosexual marriage defined lives for these women, but also asserts that we need to understand the strong affective and complex bonds that women had between each other that these forces could not undermine.

Although the film can be read as a melodrama, following Marcus, we can acknowledge that the two women protagonists of this film were part of a male dominated society where they could be seen to perpetuate the institution of heterosexual marriage and even polygamy. But the viewers also witness that the bond between Jamila and Razia is far stronger than what they have with their respective male companions. At the very beginning of the film, the script allows them to address each other as habib and mahboob, both terms of endearment used for lovers in the Urdu language. In fact, when they write to each other they do not address each other by name, but rather with  terms that are normally reserved for relationships between men and women (there is clearly an eroticized message being conveyed, which the censors or the general public did not object to).

Since the strongest bond of affection in the film is among these two women, the separation created by Razia’s departure to Hyderabad results in a creative dilemma that the script needs to resolve. This is akin to the tropes of firaq (separation) and vasl (meeting), so common in Urdu literary writings. In this case, irrespective of the conventional tropes, the reunion of these women could only happen with the removal of one male love interest. Hence, Jamila’s fiancé had to be killed in order for the friends to be together again, without conforming to the demands of two husbands. We may condemn the institution of polygamy, but in this film we may want to see it as cultural metaphor (a bowing to convention or a cinematic sleight of hand) that allows the two who truly desired each other to come together within the patriarchal tradition of taking the second wife. As mentioned above, despite the twists and turns, the relationship between the two women is the one that triumphs and the last scene focuses on them, while the husband is off camera.

The film does develop a triangle of desire between the two females and their mutual husband, but the male character remains superfluous and is used like a prop. In Saheli, the affection between the two women remains paramount and the narrative arc creates an ending that shows them being together. This in itself was a radical decision by the director. He pushes this narrative by subtly bringing attention to how women work, live, care for, provide support to, and also desire other women.

My revisiting (and re-reading) Saheli  may be a small step in opening up a discussion on forms of cultural aesthetics in Pakistan and their representation of what may remain unsaid and silenced in national histories, the history of desire, of sexuality, of domestic violence, of gendered subordination.

[i] Hence the famous title of a book—nods to Lenin’s tract notwithstanding—written by two Pakistani feminists, Khawar Mumtaz and Farida Shaheed, Women of Pakistan: Two Steps Forward, One Step Back? (1987).

[ii] Autobiographies and fiction have been used effectively in the Indian context, especially in historical writings on gender by participants in the subaltern studies project. In the Pakistani context, there is some work by feminist scholars who have engaged with female voices from low-income backgrounds on their experiences during processes of urban conflict or forced migration. See Chaudhry (2004) and Khattak (2001), among others.

On April 11, 2018, the Aga Khan University (AKU) Bioethics Group (BG) organized a symposium to commemorate its 20th anniversary. For the occasion BG members and AKU faculty were joined by many from the city who had been associated with the BG in the past but have moved on to other healthcare institutions where they continue to pursue bioethics related activities. The audience in the symposium reflected the unique role played by the BG in the growth and dissemination of bioethics in AKU and beyond, something that was perhaps not envisioned by its founders two decades ago.

The BG was formed in 1997, spearheaded by Dr. Farhat Moazam who was then Associate Dean, Postgraduate Medical Education. Bioethics had been taught to AKU medical students since 1986 through the efforts of Dr. Jack Bryant, Chair of Department of Community Health Sciences. However, according to Dr. Moazam, the BG was formed to bring the teaching and practice of bioethics into the clinical settings and to involve clinicians and residents. She gives credit to Dr. James Bartlett, a psychiatrist and then AKU Dean of Faculty of Health Sciences, for generating her interest in bioethics. She recalls him handing her a Hastings Center Report and later sponsoring her for a 5 day workshop at the Kennedy Institute of Ethics in Washington DC.

After her working paper on the proposed BG was discussed and approved in the Dean’s Forum, department chairs were invited to nominate one member from their respective departments in order to form the group. The first BG meeting was held on June 13, 1997, attended by 8 members: 4 physicians (a nephrologist, a neonatologist, an anesthesiologist, and a pediatric surgeon), 2 nursing professionals, a clinical psychologist and a social scientist. Besides discussing Terms of Reference and the working paper, members were enthusiastic in educating themselves; consequently, all meetings included discussion of published papers on clinical/research ethics.

The monthly 90-minute meetings of the BG provided a safe space to discuss dilemmas faced in clinical care. By early 1998, the group began undertaking activities meant to include the larger AKU community. An Ethics Grand Round, the first such event to be conducted in Pakistan, was held in the School of Nursing on March 27, 1998. Titled “Death with Dignity,” the format included a presentation by a resident about a 58 year old, terminally ill, ventilator-dependent man admitted in the ICU, whose son wanted to take his father home against medical advice. The session generated an enthusiastic and lively discussion by the well-attended audience, and Ethics Grand Rounds is a popular BG event that continues to date.

Also in 1998, the BG published a one-page, black and white newsletter, prepared in Dr Moazam’s office since few offices had computers. This was replaced by a colored and glossy 5 page version the following year with funds from the Dean whose help, encouragement, and accessibility were integral to the continuation of the BG. The first formal “ethics consult” in the history of AKU Hospital, and perhaps of the country, was sought from the BG by a surgeon about a ventilator dependent 18-year old male with Down’s syndrome. This landmark case was subsequently published in The Journal of Clinical Ethics in 2003, in an article titled “At the Interface of Cultures.” In 2001, while pursuing recognition by the Joint Commission on International Accreditation the hospital Medical Director turned to the BG for help setting up the required Hospital Ethics Committee (HEC). Several members of the HEC, including its first Chair, were BG members.

In addition to ethics consults, the HEC also organized biennial symposiums that helped take bioethics beyond AKU to others interested in this field. A noteworthy event of the second HEC Clinical Ethics Symposium in 2003 was the decision to create a city wide bioethics group to include healthcare professionals from both private and public sector institutions in Karachi. This idea was pursued by Dr. Nida Wahid Bashir, an AKU alumnus and a general surgeon at Patel Hospital, and the Karachi Bioethics Group (KBG) was born in 2004 with members from 11 hospitals in Karachi. Fourteen years later, KBG continues to meet every two months with different hospitals playing host to the group each year.

The BG (with now twice the number of members than at its inception) continues in AKU and focuses on revisions, expansions and methodologies best suited to teaching bioethics in the undergraduate and post graduate curriculum. However BG’s position as the fountainhead of medical ethics in Pakistan two decades ago remains in place. Its founding chair, Dr. Moazam, left AKU in 2000 to pursue a PhD from the Department of Religious Studies in the University of Virginia. She returned to Pakistan to set up the Center of Biomedical Ethics and Culture (CBEC) in SIUT which was inaugurated in October 2004. She was joined in CBEC by Dr. Aamir Jafarey who had returned after completing a fellowship in research ethics from Harvard University and also happened to be among the earliest BG members. Several former and current BG members continue to interact closely with CBEC including as teaching faculty in its programs.

Currently CBEC is the only institute in Pakistan which provides formal postgraduate education in bioethics and awards graduate level degrees in the discipline. Through the Center’s alumni, bioethics has been introduced to students, trainees, clinicians and researchers in institutions across the country such as Ziauddin University Hospital, Karachi, Shifa College of Medicine, Islamabad and Shaikh Zayed Hospital, Lahore, to name a few. CBEC faculty and its alumni are members of the National Bioethics Committee of Pakistan, and the Center was recently awarded the status of WHO Collaborating Center for Bioethics. The ripples that began twenty years ago are now spreading beyond the borders of Pakistan through a NIH funded program, the CBEC-KEMRI Training Initiative, mandated to develop formal bioethics training programs in Kenya for East African countries.

“Double shot, extra hot, please” I said as I ordered my coffee at a Starbucks in Charlottesville, in the vicinity of the University of Virginia. The extra caffeine was required to prime my brain for the discussion that I was about to have with Dr Moazam, who was at that time based in this quaint little university town, completing her PhD with a focus on bioethics from the Department of Religious Studies, University of Virginia.

This was 14 years ago. I had borrowed by brothers’ old van, and driven down from Boston, where I was pursuing my year-long Fellowship in International Research Ethics and the Harvard School of Public Health as a Fogarty Fellow, to meet Dr Moazam. Our one point agenda was a discussion on the yet very nebulous concept of a bioethics centre in Pakistan, an idea floated a couple of years earlier by Dr Adib Rizvi, Director of SIUT where Dr Moazam had been doing her research for her PhD.

I can’t claim that we had at that time envisioned CBEC as it had turned out today, in its early teens now. But bioethics in Pakistan predates CBEC by at least 20 years. The first formal space for bioethics was created in 1984 in the Aga Khan University (AKU) in Karachi, where Biomedical ethics was gradually introduced in the curriculum of medical students in AKU by Dr Jack Bryant, an American public health physician and the then Chairman of the Department of Community Health Sciences. This was later also extended into the courses of the School of Nursing at AKU. Bioethics thus earned its small space in the classroom in at least one medical institution in the country.

In addition to these educational initiatives, an informal Bioethics Group (BG) was initiated at AKU in 1997 by Dr Moazam, comprising of clinicians and nurses who had an interest in bioethics. The BG, now in its 20^th year, still meets fortnightly over lunch to discuss ethical issues and has emerged as a premier self-education and discussion forum for bioethics.

The late 1990s also saw an enhanced demand for workshops on research ethics, and training for IRB members all over Pakistan, more so from Karachi. The initial awareness and interest in bioethics was limited to research ethics, driven by pragmatic reasons for training people to populate IRBs and open possibilities for external findings for their research, publication and accreditation.  This was not unique for Pakistan, and much of the developing world academia was scrambling to enhance capacity in this area. Many individuals, including this author, availed opportunities through programs focusing on research ethics (with some having a broader focus on bioethics as well) funded by the Fogarty International Centre of the National Institutes of Health of the US government at institutions in Canada, US, and Australia. What is noteworthy is that whereas these were all academics who took time off from their clinical work to pursue bioethics, it was purely based on their own initiative and not as a result of a focused institutional strategy to enhance bioethics capacity, with institutional support limited to granting an extended leave of absence for them. Another interesting aspect in this initial phase of formal bioethics capacity enhancement is that whereas these foreign opportunities were open to all, it was only members of the medical community that availed of them. The people who shaped bioethics in Pakistan were therefore primarily from the medical sciences, and with little no involvement of philosophers, social scientists, religious scholars or lawyers.

In Pakistan, bioethics was born at a medical university, and remained there for about 15 years, fueled primarily by individual efforts. It was only in the early 2000s that it finally became a serious academic discourse with the advent of indigenous, degree awarding bioethics programs, and a wider circle of participants.

The first academic degree program that was offered in bioethics in the country was CBECs Postgraduate Diploma in Biomedical Ethics (PGD) which commenced in 2006 and a Masters in Bioethics (MBE) which commenced in 2010. Whereas both these programs are continuing to date, a Masters in Bioethics program started by AKU in 2009 with NIH funding, ceased after the funding dried up in 2012, and the university did not step in to sustain it.

All these programs have been open to medical as well as non-medical applicants; however have attracted mostly medical scientists, clinicians and researchers with very few social scientists, educationists, journalists expressing an interest in this new emerging discipline in the county. Philosophers and religious scholars, generally seen to be in the leadership of bioethics initiatives in the West, have practically had to be coaxed to contribute to the discipline, as faculty in academic sessions on philosophy and religion, which are integral to any bioethics coursework. Whereas several medical institutions have now taken the initiative of starting bioethics departments, and offer courses at different levels, to the best of the authors’ knowledge, no philosophy department in the country offers courses in bioethics as yet.

From classrooms to boardrooms, being “done” sitting on swivel chairs, bioethics in Pakistan has defined for itself an indoor trajectory and never really taken on the mantle of activism or even advocacy in any sustained and meaningful manner. The one major legislation on a bioethical matter, organ trade which impacted the poorest of the poor, was initiated and spearheaded by an advocacy campaign by SIUT, with the medical fraternity and media contributing. The role of the bioethics community in general was at best, peripheral.

The bioethics discourse in the country has up till now also generally steered clear of “non-medical” ethical issues, like for instance the exploitative displacement of poor communities for multimillion rupee development initiatives aimed for the rich, or bonded labor, honor killings and so on. One reason for this is perhaps the preponderance of medical fraternity in bioethics in Pakistan, and plenty of “hot” issues within the medical domain to discuss.

This rather narrow focus on clinical and research of bioethics is bound to change as non-medical people pursue it as an academic discipline. Already, through CBEC, advances have been made into school systems, with structured workshops being offered to high school teachers, and sporadic sessions being organized for students.

One major challenge for bioethics to emerge as a choice destination for emerging academics is that there is practically no return on investment possibilities at the moment in the country for anyone investing time and effort in a degree in bioethics. There is also still hardly any meaningful “official” recognition for bioethics, with the Pakistan Medical and Dental Council, the College of Physicians and Surgeons of Pakistan and the Higher Education Commission yet to make any space for bioethics in their respective domains. Even with the introduction of academic degree level educational programs in Pakistan, bioethics remains very much a personal quest, with no real career prospects.