Saturday, November 21, 2015

Future Infectious Catastrophic Disease Outbreaks: Ethics of Emergency Access to Unregistered Medical Interventions and Clinical Trial Designs


The mass media excitement about Ebola has receded. The 2014-2015 West African outbreak has been brought under control not thanks to the deployment of successful treatment regimes, because there are none that are known to work. I participated recently in an international meeting of experts debating the ethical and methodological issues pertaining to trial designs for emerging infectious diseases like Ebola. It was both astounding and also immensely frustrating that to a large extent the controversies that exercised the minds of the delegates of this meeting exercised the minds of many an AIDS activist and clinical trials’ expert prior to the advent of highly active antiretroviral therapy, a good quarter of a century ago.[1] [2]Are placebo controls an ethically defensible methodological tool when patients face a terminal illness? Different alternative trial designs involving placebo controls, adaptive trial designs, and multi-stage approaches involving active controls were discussed during the meeting. The heated nature of some of these debates reminded me strongly of the passion that was on display during the early HIV trials. It turns out, despite decades of informed debate about these issues, a number of significant normative questions have not been settled.

A cluster of difficult ethical questions that engendered justifiably a lot of debate has to do with the use of placebo controls in trials involving patients facing a very high mortality risk (some in excess of 90%) and a fast-acting infection resulting in the death of these patient within 2-8 days after admission to a treatment centre. This scenario mirrors the sobering reality faced by a subset of Ebola Virus Disease patients. This issue was already highly contentious during the early HIV trials, and then patients and clinical investigators were faced with a virus that was nowhere near as fast-acting as the Ebola virus. The ethical conflict that arises here is this: We know that those randomized into the placebo arm face the same greater-than-90%-risk of death within a few days as those who receive the standard of care treatment. In some trial design the placebo control arm could be identical to the gold standard of (unsuccessful) clinical care provided in a particular clinical setting. Given that those who are randomized into the arm featuring the unregistered medical intervention might do better, or might do worse, or might do roughly as badly as those in the placebo control arm, the ethical question remains whether a trial design featuring a placebo control is ethically justifiable, given the almost certainty of imminent death faced by those randomized into the placebo arm. During the meeting I alluded to earlier a fairly contentious debate arose also over the question of whether trials producing less reliable results than placebo controlled trials might be acceptable under such circumstances.

What exacerbates the ethical challenges for those who undertake such trials is that their trial participants are arguably not true volunteers. Their – dying - trial participants are not given the opportunity to choose between participating in the placebo controlled randomized trial versus accessing the unregistered medical intervention on their own volition outside the trial process. It is perfectly conceivable that some patients might choose to participate in such trials in order to facilitate the development of a successful intervention capable of helping future patients like them. Or they might accept that there exists true clinical equipoise between the trial arms and they might be volunteering to be randomized under such circumstances. In the absence of alternative access routes to the unregistered medical intervention, we can never be certain that the patients agreeing to be randomized are not simply responding to what constitutes a coercive offer.

Clinical investigators colluding in this process, and arguably benefiting from it, are not absolved of their ethical responsibilities because they did not create the regulatory frameworks that gave rise to the problem. It is true that they did not create the regulatory framework under which they operate, but they undoubtedly benefit from its existence. We could respond to this kind of argument by pointing to the societal need for sound trial designs and the detrimental impact of permitting patients to access unregistered medical interventions outside the clinical trials’ system. The likely impact of permitting patients access, as a senior biostatistician attending the workshop rightly pointed out to me, would be a significant slowing-down in the trial recruitment process. Some trials might never be able to recruit sufficient patients, because most patients might be voting with their feet and opt to take their chances with the unregistered medical intervention. Surely that is not quite what is in the best interest of any society battling an emerging infectious disease such as Ebola. Does this justify coercing dying people into particular trial designs? I do not think so, but this is a contentious issue where reasonable, well-informed people can justifiably differ. A WHO panel looking at this question argued that while it would be ethically defensible to offer emergency access to unregistered medical interventions to Ebola patients, this should be subject to that emergency access not slowing down trial recruitment.[3] The panelists (not featuring a single expert or disease survivor from the affected countries) took a policy line here that mirrors US regulations. Other countries, including Canada and South Africa do not make this a threshold condition for emergency access. As it is with these sorts of panels, the advice it rendered on this controversial topic is not actually reasoned for, so policy makers and regulators as well as patient rights advocates aiming to balance the competing interests of access versus trial recruitment in a fair manner will be left wondering about the ethical reasons for this policy stance taken by the WHO panel, assuming there are any.

There are other ethical issues that arise in this context: Some experimental agents existed at the time only in insufficient quantities, for instance ZMapp, an unregistered medical intervention composed of monoclonal antibodies, was only available in very limited quantities. In light of this situation, is it acceptable to prioritize patients in comparable clinical circumstances who are willing to be randomized in a placebo controlled trial over patients clamoring for direct emergency access, given that the available quantities of this unregistered medical intervention would have been used up in the placebo controlled trial?

And here is another difficult question: While the AIDS activists of days gone by were highly educated about their disease and about the available unregistered medical interventions considered for expanded access programs, this is not quite the case with regard to the average West African Ebola patient. These patients were unlikely able to provide valid first person informed consent, because they were unable to demonstrate a reasonable person understanding of what was known about the unregistered medical intervention, about their options and so on and so forth. This is the case both because of educational limitations as well as disease progression. Are short-cuts to informed consent ethically justifiable under such circumstances? Given that time is of the essence and proxy consent might not be feasible due to family members being deceased or in a far-away village, are our informed consent requirements reasonable under such emergency circumstances?

The WHO panel suggests that evidence from nun-human primate experiments might be sufficient to justify offering a particular unregistered medical intervention for emergency access. Is that an ethically justifiable stance, given the high mortality rate and fast-acting nature of the infection?

Let me leave you with a final difficult question to ponder: Imagine you were running a medical NGO providing access to unregistered medical interventions to patients you care for in your emergency medical centre. By some fluke your unregistered medical intervention permits some of your patients to survive, but that survival comes at a high price, debilitating after-effects of the Ebola virus as well as of the unregistered medical intervention. Given concerns about your patients’ capacity to provide valid informed consent, should you accept responsibility for the patients’ future care and upkeep, given the lack of state infrastructure to assist these patients? If you accept responsibility for their care, say, by taking out an insurance package from some provider for them, you will expend a fair amount of donor monies on these patients (potentially for decades) that you cannot use to assist patients also facing life-threatening illnesses in other parts of the world. In other words, you face another ethical challenge, a resource allocation challenge. How should that medical NGO go about addressing this challenge?

Monday, November 16, 2015

Trudeau Curtails Harper's Anti-Choice Activist End-of-Life Panel Activities

This is brilliant. Former PM Stephen Harper appointed in the dying weeks of his government a smallish panel of anti-choice activists to advise his government on how to implement the Supreme Court of Canada's ruling on assisted dying. The CBC reports today that PM Trudeau's government has moved to curtail this panel's scope of activities. It doesn't want advice from the panel on possible legislation any longer, the federal government simply asks the panel members to summarise the results of its consultation. I'm pretty sure the results of this panel's activities will be filed away right after that. Game over for these anti-choice activists. Here is some more background information on two of them. Note that both of them were expert witnesses on behalf of the Harper government fighting the case against assisted dying in our courts. Their expertise sank without a trace when the Supreme Court decided unanimously that depriving us of access to assisted dying violates our Charter rights. Mind boggling the amount of tax monies that were wasted on their activities.

Finally out - my new bioethics textbook

After a year's worth of intensive sourcing of new content and a year's worth of intensive deliberations with Helga Kuhse and Peter Singer, the new edition of Bioethics - An Anthology is finally out. In case you care about bioethics, check it out. Amazon currently has the Kindle version on sale, but I understand that the print copy is arriving in warehouses as I write this.

Friday, October 30, 2015

Do we need a delay on the implementation of assisted dying in Canada?

There's movement on the assisted dying frontiers. Yesterday representatives of religious organisations held a press conference declaring that they are opposed to assisted dying and that we ought to strive to improve palliative care. As far as I can see they are not insisting any longer - democracy be damned - that assisted dying must not come to Canada, no matter what. The reason for this, presumably, has also to do with the fact that their own followers are in favor of the decriminalization of assisted dying. Other than that, they stated the obvious, it's a good idea to improve the state of palliative care in the country. It's not an either-or type situation, of course. We can have assisted dying and improved palliative care!

We also had a federal election that turfed out Stephen Harper and his merry band of evangelical government ministers. After the Supreme Court judgement declaring the bits of our criminal code that criminalize assisted dying unconstitutional - government was given 12 months to change relevant legislation - Mr Harper did nothing to implement the ruling. Eventually, in the dying days of his government, and seeing the writing on the wall for a return to power, he quickly installed fellow anti-choice activists as a federal panel to advise his government on the implementation of the Supreme Court ruling. His political calculus with regard to this panel might well be paying off. Its chairperson was yesterday on the CBC's Power and Politics and announced that he thinks his panel is still appointed to report to government, alas, the government that appointed him doesn't actually exist any longer by the time it plans to release its recommendations. Because it's also so very partisan in terms of its membership, it's unclear why anyone would want to take its views as anything other than the utterances of people who supported the Harper government's efforts during the Supreme Court hearings. They worked tirelessly to prevent Canadians from exercising their constitutional rights. Well, that's true for two of the three panelists.

Comes Justin Trudeau, our Prime Minister elect. He will ask the Supreme Court to give him another 6 months to implement the ruling. Initially I thought that that was not unreasonable, but then I wondered. The delay is supposedly needed for his government to decide on how to regulate the matter. The question is whether that is actually needed. The Supreme Court declared parts of the criminal code invalid. Health care is a provincial matter. The provinces and territories have established a task force aimed at advising them on how to implement the Supreme Court judgment. Quebec's legislation is already in place. Once the other provinces have put their legislation and regulations in place, there does not seem any need for federal regulations.

So, why wait?

Wednesday, October 28, 2015

Quixotian attack on Bioethics journals leads to retraction

I have blogged a few weeks ago on this website about a Quixotian attempt by a team of authors aimed at blaming leading mainstream subscription based bioethics journals for their alleged imperialist nature and what not else. A version of this blog entry has since been published here. I pointed out that the analysis of said article rested essentially on a questionable letter by the same team of authors that manipulated categories of the Human Development Index in order to generate a particular result plus false empirical claims about the availability of these journals through access schemes administered by the World Health Organisation.

I am pleased to report that the journal that published said article as a peer reviewed output has since retracted said content. There is no shame in retracting content found significantly wanting.

Discussion of 'Treatment resistant depression and assisted dying'

Readers of this blog might recall that Suzanne van de Vathorst and I published a paper in the Journal of medical ethics arguing for the desirability to make assisted dying available to competent treatment resistant depressed people. There has been a bunch of responses, namely this and this and this and this and this to which we responded here. Since then Frank Miller also offered a thoughtful commentary here to which we responded here.

Today a website dedicated to mental health issues has published a lengthy summary of the debate in the hope of triggering a discussion about our analysis and those of our critics.

Check it out when you have a minute, well worth reading.

Sunday, October 25, 2015

Mustn't we talk in universities about whether trans women are women?

I have been watching for some time with ever-growing horror a movement of - let's be honest, mostly progressive - folks, aka my friends, that strives to limit what we can and cannot debate in university settings. It happens on various levels and is quite insidious. There's the thing about trigger warnings where we are supposed to warn our students each time they might encounter something in class that might deeply upset, disturb or even distress them. Well, I teach bioethics, there's a fair chance that that could happen in every class that I teach. My students are also all of mature age, so should I really aim my classes at not upsetting their emotional well-being or should I aim to challenge and potentially even upset them? It's a rhetorical question. I begin my classes by issuing a general trigger warning for the rest of the course, including every class without exception. Box ticked. Sorted. Would I change my content based on whether a student might be deeply disturbed by the topic, or a case scenario, or a video clip? Not a chance. What's the point of taking a bioethics class and not being challenged frequently to reconsider how you look at the issues we are considering in class. There is no way to run a class on, say, the ethics of animal experimentation, abortion, euthanasia, even cochlear implants, without upsetting someone.

I'm not a junior faculty member in a tenure track position, 'student led' teaching evaluations will neither make nor break me. I doubt junior colleagues would be able to afford doing the same.

Part of this ongoing campaign to keep universities conflict free, and to avoid 'offending' students are no-platform events. No-platform events are events where particular speakers are no platformed, meaning they are prevented from speaking on campuses. This is either achieved by student organisations declaring particular speakers persona non grata, or by university administrations preventing invited speakers from speaking due to 'security' concerns. This has been going on for some time, mostly in the UK, not so much in North America. Initially the objective was to keep neo-Nazi organisations off college campuses. No platform to the BNP or the KKK, that sort of thing. More recently though the victims were secularist speakers aiming to address Muslim fundamentalism on college campuses (including enforced seating arrangements for men and women attendees, enforced head covers, and other such medieval niceties) and there were invariably 'concerns' expressed and offense taken about their 'racism'. 'Racism' here is the preferred misnomer for critiques of a man made ideology.

The latest round of no-platform campaigning has hit feminist author Germaine Greer. She doesn't think that trans women are women. I do think one can have a legitimate debate about human-made categories such as 'man' and 'woman'. However, I also think it's pathetic that student activists think they ought to prevent such debates from occurring by declaring that people who were born 'male' could now define 'woman' in such a way that it includes some of them and that this should be binding on the rest of society. I understand the desire of trans women that society should see them in the same way as other women, as much as I understand that some feminists as well as other people will find that idea offensive. It's a great debate to have - we should teach classes on this subject.

Alas, trigger warnings will be considered necessary in many universities, student activists queer and otherwise will need to be placated and what not else. None of this is acceptable. If we cannot interrogate (there's that dreaded term) these sorts of concepts and categories in universities, where else should or could we do so? How would we even be able to determine whether our culturally evolved categories about ourselves are fit for purpose? And for what purpose?

What's troubling about this defense of free speech on college campuses is that there is a price to be paid for such open debate, and it is mostly to be paid by trans people, that is people who are subjected already to unacceptable forms of societal discrimination and disapprobation. They will find their claims analysed and critiqued, courtesy of the internets, in ways that will be vicious at the best of times. That is deeply troubling seeing that suicide rates among trans people are as sky-high as they are. And yet, while pleading for civility, I am convinced that a public airing of these issues is what is in the best interest of trans people themselves. It helped liberate gays and lesbians, we had to subject ourselves to debates about normality, and naturalness, whether we suffer from a mental illness, perversion, and what not else. Being able to debunk these falsehoods one by one worked for gays and lesbians. I'm afraid trans people and their allies will have to face these issues head-on, make their case with the best arguments and evidence available and win the argument in the public domain as well as in the academy.

No platforming speakers we disagree with is counter productive. The idea that these issues will go away by suppressing debate about them is naive at best.






Friday, August 28, 2015

Health Care - Not an Issue for Major Political Parties in Canada's Federal Election Campaigns

It's a somewhat surreal election campaign that is currently in full swing in Canada. It stays clear of issues of vital importance to Canada and Canadians. There we have a rapidly ageing population and really we need a national seniors strategy that accounts for that. One can nearly feel sorry for the Canadian Medical Association here. The association tried hard during the last few months to make this issue an issue in the current election campaign. It was rightly supported by sympathetic journalists such as the Globe and Mail's Andre Picard. Yet, for all those efforts, the issue gained no traction with any of the major parties. Our federal leaders' heads remain firmly planted deep in sand, with no effort made to look ahead and address major, dramatic challenges to our health care system. Instead we were treated to a good two weeks' worth of Mike Duffy and the usual corrupt shenanigans that are a hallmark of Prime Minister Harper's political operation.

I spoke yesterday to a journalist interviewing me on the state of federal and provincial planning with regard to the implementation of our Supreme Court's decision  on assisted dying. He asked why the political parties, in my estimation, haven't taken up this issue in their respective campaigns? He was puzzled that an issue that enjoys broad support among Canadians is ignored by the major political parties. What was I to say other than 'I don't get it either'. A new poll, released today, confirms what I told the journalist yesterday, it is not only the case that the vast majority of Canadians want to see the decriminalization of assisted dying, it is also the case that the vast majority of conservative party voters supports the decriminalization. 77% of Canadians generally support decriminalization and a whopping 67% of conservative party voters and 84% of NDP voters. This does beg the question why none of the mainstream parties have leveled with their supporters and the general voting public on how they would implement the Supreme Court judgment. I do still wonder why Prime Minister Harper appointed an advisory panel stacked with discredited anti-choice activists, given that the majority of his party's supporters is in favor of decriminalization. Why on earth would he stack his panel with folks known to be opposed to decriminalization? I sometimes wonder about the credit that is given to Mr Harper who is hailed as a master political tactician. His whole election campaign seems a shambles to me.

Tuesday, August 25, 2015

Surveys and surveys - The Canadian Medical Association should know better

The Canadian Medical Association currently debates the issue of assisted dying. That's a reassuring thing as everything points in the direction of doctors becoming the gatekeepers once assisted dying is regulated and will be made available to eligible Canadians who request it.

Strangely, the Association seems to put a lot of store in an on-line poll it inflicted on its members, where only 29% of those who responded said that they were willing to provide assisted dying to eligible patients while 63% objected. I'm surprised the Association's staff would have even mentioned this survey. It's troubled by obvious ( and quite deadly, pardon the pun) methodological problems that renders it useless.

The Associations Vice President Professional Affairs, Dr Jeff Blackmer produced a 34 slide presentation titled (no doubt to the horror of most living medical ethicists) 'End-of-Life Care in Canada: A Principles Based Approach to Assisted Dying'. There will be only few people left in bioethics who have not come to realize that the much celebrated principles approach to medical ethics guarantees arbitrary recommendations and outcomes. The principles approach is neither action guiding nor action justifying, it's useless as a tool of ethical or policy analysis and justification. Blackmer decided to add random other principles to the Georgetown Mantra, including vacuous nice sounding stuff like the 'dignity of life' (yes, really, he did!). We spent a fair amount of time in our Royal Society of Canada Report on the subject matter dissecting this particular issue.

After delivering to his audience this hotchpotch of principles, there's an unconnected slide with recommendations, followed by 8 or 9 slides reporting the results of the CMA's on-line poll. Blackmer reports that of about 80 000 doctors in Canada about 1400 clicked their way thru the on-line poll. At a minimum the negligible turnout suggests that most doctors in Canada didn't care to complete a survey that they probably realized ultimately tells us nothing about Canadian doctors' views on assisted dying. The reason for this is methodological. These kinds of surveys may or may not be representative, we just cannot know, because the survey participants may or may not be representative. If anything we should be suspicious of these results, because no professional survey organisations ensured that the sample was actually representative. Those who feel strongly about the subject matter - physicians opposed to it - will fire up their supporters to reject assisted dying and proclaim no collaboration.

Other surveys, including one reported in our above mentioned report, suggest significantly higher levels of support. It is all the more disheartening that a seasoned journalist like the Globe and Mail's Andre Picard takes the 29% figure at face value in his twitter reporting of the Blackmer presentation. (See the image above.) Doing that permits the anti-choice activists to feel good about their campaign strategy, their encouraging their like-minded doctor supporters to click thru the survey would pay off if people fell for this nonsense. I left a slightly more polite comment to this account under Blackmer's public slide presentation, but it was quickly deleted. Go figure.

The CMA recognizes that we will be getting assisted dying in some form or shape (determined by the criteria set out in the Supreme Court of Canada judgment on this subject) and that a small number of its members will be called upon to provide assisted dying services to their patients. The Association is rightly concerned about ensuring patient access while protecting its objecting members' conscience choices. There is a precedent for this. Abortion. Objecting doctors will be obliged to transfer their patients to a colleague they know will oblige them, without unreasonable delay. The CMA is apparently supportive of this compromise.

The train toward assisted dying in Canada has departed but hasn't reached its destination yet.

Wednesday, August 19, 2015

Joint Open Letter to Prime Minister and President of Bangladesh: re the killings of secularist bloggers by Islamist fanatics

We, concerned members of the blogging and activist community of Bangladesh and internationally, along with representatives of human rights organisations and other civil society organisations and supporters, wish to protest in the strongest possible terms the institutional attack on Bangladeshi citizens who profess humanist, atheist or secularist views.
In the last two years, five bloggers (variously identifying as humanist, rationalist, atheist, and variously writing about science, humanist values, against Islamist extremism, or in favour of human rights and justice) have been murdered, hacked to death by assailants acting for fundamentalist militant groups (according to their own claims of responsibility). These victims are: Ahmed Rajib Haider, the science author Avijit Roy, Washiqur Rahman Babu, Ananta Bijoy Das, and Niladri Chatterjee (pen name Niloy Neel). Four of these murders have occurred since February this year. In other cases, individuals like Jafar Munshi and Anjali Devi have been killed for alleged or perceived acts of ‘defamation of religion’, such as refusing to enforce hijab on students. And since 2013, supporters of the Shahbag movement and the war crimes justice process (the accused being Islamist leaders) have also been brutally murdered by similar Islamist entities. The victims include: Ashraful Alam, Arif Raihan Deep, Nurul Islam Faruki, Jagat Jyoti Talukder, Jakaria Babu.
The murderers and their ideological supporters are of course to be condemned and must be brought to justice.
In addition, instead of helping to confront this outrageous injustice, political and state institutions have begun blaming the victims themselves and making matters worse.
Following the murder of Niladri Chatterjee on 7 August, the Inspector General of Police engaged in victim-blaming, called for self-censorship, and threatened bloggers — the very people who are being murdered — with legal action under the current quasi-blasphemy law. Meanwhile, despite some counter-terrorism operations, the police have comprehensively failed to disrupt the networks that are ordering or carrying out these cowardly attacks. Even with two of the killers caught at the scene (after the murder of Washiqur Rahman) and claims of responsibility made openly on social media and via news outlets, still the attacks go on, and the extremists behind the killings remain at large. Instead of calling for vigilance and evidence against the murderers from the general public, police have instead encouraged the public to report alleged atheistic writings.
Faced with fresh death threats against numerous named Shahbag activists and others branded “enemies of Islam” in the week after the most recent murder, a police spokesperson told those threatened merely to “lodge police complaints” if they thought they were being followed! This is a grossly inadequate, highly negligent response to what is evidently a most serious and potentially fatal threat.
A number of Islamist groups, including Awami Olama League which is closely associated with your own Awami League party, have made new demands of death penalties for all atheist bloggers and activists, echoing the rhetoric of Islamist extremists in other parties. Obviously, this demand represents a gross violation of the rights of the non-religious to freedom of thought, and against freedom of expression generally and must be firmly and explicitly rejected.
Furthermore, your Cabinet Committee for Law and Order, headed by Minister of Industries Amir Hossain Amu, on their 9 August 2015 meeting decided “to declare Atheist authors as criminals”, thereby making them subject to prosecution, and intelligence agencies have been asked to monitor blogs to find those atheist writers. Even under the current law, such a mass arrest of people who profess non-religious views in their online communications would represent a grave violation of the international human rights obligations to which Bangladesh is committed. The Home Minister in a separate speech was seen repeating the same warning message.
These institutions and officials of the state through their current stances — demonising free expression, while appeasing murderous extremists — are destroying Bangladesh’s claim to be a democratic state that upholds the human rights of all citizens. To criminalize the expression of “anything that may hurt anyone’s religious sentiments or beliefs” (as the Inspector General of Police puts it) means in practice that fundamentalists and extremists can say and do anything they want, while anyone who stands for democracy, free expression, rationalism, justice, and human rights would be reduced to silence.
This is a recipe for a theocratic state in thrall to the most extremist members of society. People must be able to discuss and debate religion and politics, beliefs and practices. If they cannot, then injustice, fear and violence will reign.
To fail to confront and refute these oppressive and illiberal tendencies now, will mark the beginning of the end of Bangladesh as a free and democratic country.
We implore you to:
  • ensure the safety and security of those individuals whose lives are threatened by Islamist extremists, including the witnesses and family members
  • instruct the police to find the killers, not to harass or blame the victims
  • disassociate yourself publicly from those who call for death penalties against non-religious Bangladeshis, and ensure using your executive authority that individuals within your party membership maintain the same standard of respect for freedom of conscience and expression
  • work decisively for legal reform to repeal Section 295A of the Penal Code and section 57 of the ICT Act of 2006, in order to bring the legal system of Bangladesh in line with the  spirit and values of freedom of expression and ‘of conscience’ as enshrined in the Constitution of Bangladesh, and as per obligations under the international human rights instruments to which Bangladesh is party.
[Full list of signatories follows below the Bangla version of this statement]

বাংলাদেশের প্রধানমন্ত্রী এবং রাষ্ট্রপতির নিকট সন্মিলিত খোলা চিঠি

মহামান্য রাষ্ট্রপতি আবদুল হামিদ ও মাননীয় প্রধানমন্ত্রী শেখ হাসিনা সমীপে,
আমরা, বাংলাদেশের ও আন্তর্জাতিক ব্লগিং ও এক্টিভিস্ট সম্প্রদায়ের উদ্বিগ্ন সদস্য, মানবাধিকার সংগঠনের প্রতিনিধি, সমাজকর্মী ও মুক্তচিন্তার সমর্থকবৃন্দ, বাংলাদেশের মানবতাবাদী, নাস্তিক ও ধর্মনিরপেক্ষ নাগরিকদের উপর প্রাতিষ্ঠানিক আক্রমণের তীব্র প্রতিবাদ জানাচ্ছি।
গত দুই বছরে পাঁচ জন ব্লগার, যারা বিভিন্নভাবে মানবতাবাদী, যুক্তিবাদী, নাস্তিক হিসেবে পরিচিত এবং বিজ্ঞান, মানবতাবাদ, মানবাধিকার ও ন্যায়বিচারের সপক্ষে অথবা ইসলামী চরমপন্থার বিরুদ্ধে লেখালেখিতে জড়িত ছিলেন, খুন হয়েছেন। মৌলবাদী জঙ্গি গোষ্ঠীর ঘাতকেরা (তাদের নিজেদের স্বীকৃতি অনুযায়ী) তাঁদের নৃশংসভাবে কুপিয়ে মেরেছে। নিহতরা হলেনঃ আহমেদ রাজীব হায়দার, বিজ্ঞান লেখক অভিজিত রায়, ওয়াশিকুর রহমান বাবু, অনন্ত বিজয় দাশ এবং নীলাদ্রি চ্যাটার্জি (ছদ্মনাম নিলয় নীল)। এর মাঝে  চারটি খুনের ঘটনাই ঘটেছে চলতি বছরের ফেব্রুয়ারী থেকে আগস্টের মধ্যে। এর বাইরে জাফর মুন্সি বা অঞ্জলী দেবীর মত ব্যক্তিরা খুন হয়েছেন কথিত ‘ধর্মীয় অবমাননা’র অভিযোগে- যেমন শিক্ষার্থীদের হিজাব পরিধানে বাধ্য করতে অস্বীকার করা, ইত্যাদি।  এছাড়াও ২০১৩ সাল থেকে, শাহবাগ আন্দোলন ও যুদ্ধাপরাধের বিচার প্রক্রিয়া (যার অভিযুক্তরা কথিত ইসলামী নেতৃবৃন্দ) এর সমর্থকরাও একই রকম ইসলামিক শক্তির হাতে নির্মমভাবে নিহত হয়েছেন। এদের মধ্যে আছেনঃ আশরাফুল আলম, আরিফ রায়হান দীপ, নুরুল ইসলাম ফারুকী, জগৎজ্যোতি তালুকদার, জাকারিয়া বাবু।
হত্যাকারী এবং তাদের মতাদর্শিক সমর্থকদের অবশ্যই অভিযুক্ত করে বিচারের মুখোমুখি দাঁড় করাতে হবে।
এই ভয়াবহ অপরাধ মোকাবেলা না করে  রাজনৈতিক ও রাষ্ট্রীয় প্রতিষ্ঠানগুলো উল্টো অপরাধের শিকার ব্যক্তিদেরই দোষারোপ করা শুরু করেছে, যা পরিস্থিতিকে আরো খারাপ করে তুলেছে। বংলাদেশের গণতন্ত্র  এতে আরো বিপন্ন হয়ে পড়েছে।
গত ৭ আগস্ট নিলয় হত্যাকান্ডের পর, পুলিশের মহাপরিদর্শক আক্রান্তদের দোষারোপে লিপ্ত হয়েছেন, সীমা লঙ্ঘন না করার হুঁশিয়ারিদিয়েছেন এবং ব্লগাররা,- যারা আক্রান্ত ও খুন হচ্ছেন – তাদের বিরুদ্ধে বিদ্যমান  ছদ্ম-ব্লাসফেমি আইনের আওতায় এনে আইনি ব্যবস্থাগ্রহণের হুমকি দিয়েছেন। এদিকে, কিছু সন্ত্রাস-বিরোধী অভিযান সত্ত্বেও, পুলিশ এই কাপুরুষোচিত হামলা বাস্তবায়নকারী বা আদেশদানকারী নেটওয়ার্কগুলোকে প্রতিহত করতে পুরোপুরি ব্যর্থ হয়েছে। এমনকি ওয়াশিকুর রহমানের হত্যাকান্ডের পর ঘটনাস্থল থেকে দু’জন খুনি ধৃত হলেও এবং সামাজিক মাধ্যম ও পত্রপত্রিকায় প্রকাশ্যে খুনের দায়স্বীকারের বিবৃতি প্রচারিত হলেও, হত্যাকান্ড ঘটেই চলেছে এবং খুনের পেছনের জঙ্গিরা বহাল তবিয়তে আরো হুমকি দিয়ে যাচ্ছে। জনসাধারণকে খুনিদের বিরুদ্ধে সতর্ক  থাকা ও অপরাধের প্রমাণ দাখিলের আহবান না জানিয়ে পুলিশ বরং তাদেরকে কথিত নাস্তিক্যবাদী লেখার বিরুদ্ধে অভিযোগ করতে উৎসাহ দিচ্ছে।
সাম্প্রতিক হত্যাকাণ্ডের পরে বেশ কয়েকজন পরিচিত শাহবাগ কর্মী ও ‘ইসলামের শত্রু’ তকমা লাগিয়ে দেয়া ব্যক্তিরা যখন নতুন করে হত্যা হুমকির মুখোমুখি হচ্ছিলেন, তখন পুলিশের একজন মুখপাত্র কেবল এই বলে পরামর্শ দেন যে, কেউ যদি আশংকা করে যে তাকে অনুসরণ করা হচ্ছে তবে সে যেন পুলিশের কাছে অভিযোগ দায়ের করে। এমন গুরুতর ও মারাত্মক হুমকির মুখে তা নিতান্তই অপর্যাপ্ত এবং অত্যন্ত উপেক্ষামূলক প্রতিক্রিয়া।
আপনার দল বাংলাদেশ আওয়ামী লীগের সাথে ঘনিষ্ঠভাবে জড়িত আওয়ামী ওলামা লীগ সহ অপরাপর ইসলামী সংগঠনগুলো নাস্তিক ব্লগার ও আন্দোলনকর্মীদের মৃত্যুদণ্ডের বিধানসম্বলিত আইন প্রণয়নের দাবী নতুন করে জানিয়েছে, যা অন্যান্য ইসলামী জঙ্গি দলগুলোর বক্তব্যেরই প্রতিধ্বনি। স্পষ্টতঃ এমন দাবী নিধার্মিকদের চিন্তার স্বাধীনতা ও সাধারণ মতপ্রকাশের স্বাধীনতার অধিকারের সুস্পষ্ট লংঘন বিধায় অত্যন্ত দৃঢ়তার সাথে ও স্পষ্টভাবে প্রত্যাখ্যান করা আবশ্যক।
উপরন্তু, আইন-শৃঙ্খলা সংক্রান্ত সংসদীয় কমিটির সভাপতি, আপনার মন্ত্রীসভার শিল্পমন্ত্রী আমির হোসেন আমু গত ৯ আগস্ট এক সভায় ‘নাস্তিক লেখকদের অপরাধী ঘোষণা করে তাদেরকে বিচারের মুখোমুখি করা হবে’ বলে সিদ্ধান্ত জানান। একই সভায় ব্লগগুলোর উপর নজরদারির মাধ্যমে ওইসব নাস্তিক ব্লগারদের খুঁজে বের করতে গোয়েন্দা সংস্থাগুলোকে নির্দেশ দেয়া হয়েছে । অথচ বর্তমান আইন অনুযায়ী অনলাইন যোগাযোগে নিধর্মী দৃষ্টিভঙ্গি ধারণকারী মানুষজনের এমন গণগ্রেফতার বাংলাদেশ কর্তৃক প্রতিশ্রুত আন্তর্জাতিক মানবাধিকারের বাধ্যবাধকতারও চরম লংঘন। স্বরাষ্ট্রমন্ত্রী একটি পৃথক বার্তায় একইরকম সতর্কবার্তার প্রতিধ্বনি ঘটান।
খুনি জঙ্গিদের রোষ প্রশমিত করার ভ্রান্তনীতিতে ভেসে গিয়ে, রাষ্ট্রীয় প্রতিষ্ঠান ও কর্তাব্যক্তিরা  মুক্তমত প্রকাশকে ক্ষতিকর ও হুমকি হিসেবে চিহ্নিত করছেন। এতে সকল নাগরিকের মানবাধিকার সমুন্নত রাখা সম্ভব হচ্ছে না এবং বাংলাদেশ নিজেকে গণতান্ত্রিক রাষ্ট্র হিসেবে দাবি করার অধিকার হারাচ্ছে।
‘যেকোন নাগরিকের ধর্মীয় অনুভূতি বা বিশ্বাসে আঘাত লাগার মত যেকোন কিছু’কে অপরাধ হিসেবে (পুলিশের আইজির ভাষ্যমতে) দেখার বাস্তব অর্থ হল- মৌলবাদী ও জঙ্গিরা যেকোন কিছু বলতে ও করতে পারবে। অপরদিকে গণতন্ত্র, মুক্তমত, যুক্তিবাদ, ন্যায়বিচার ও মানবাধিকারের ঝাণ্ডাধারী যে কোন ব্যক্তির কন্ঠরোধ করা হবে।
এসব কণ্ঠরোধী কর্মকাণ্ড সমাজের সবচেয়ে উগ্র জঙ্গি গোষ্ঠীর আজ্ঞাবহ একটি ধর্মভিত্তিক রাষ্ট্র বানানোর পাঁয়তারা। সকল নাগরিকেরঅবশ্যই ধর্ম ও রাজনীতি, বিশ্বাস ও লোকাচার নিয়ে আলোচনা ও বিতর্ক করার সুযোগ থাকতে  হবে। এমন সুযোগ না থাকার অর্থ হল অবিচার, আতঙ্ক আর নৃশংসতার জয় ঘোষণা করা।
এমন জবরদস্তিমূলক ও সংকীর্ণ প্রবণতা দ্রুত মোকাবেলা ও খণ্ডনের ব্যর্থতা মুক্ত ও গণতান্ত্রিক দেশ হিসেবে বাংলাদেশের ভাবমূর্তি ধ্বংসের সূচনা ঘটাবে 
তাই আপনাদের কাছে আমাদের সনির্বন্ধ অনুরোধঃ  
১। ইসলামী জঙ্গিদের কারণে যেসকল ব্যক্তির জীবন আজ হুমকির মুখে- তাদের, তাদের পরিবারের সদস্যবৃন্দের এবং সাক্ষীদের নিরাপত্তা ও সুরক্ষা নিশ্চিত করুন।
২। আক্রান্তদেরই দোষারোপ বা হয়রানির বদলে পুলিশকে নির্দেশ দিন খুনিদের খুঁজে বের করার।
৩। নাস্তিক ব্লগারদেরদের বিরুদ্ধে যারা মৃত্যু পরোয়ানা দাবী তোলে, তাদের কাছ থেকে নিজেদের পৃথক করার প্রকাশ্য ঘোষণা দিন এবং চিন্তা, বিবেক ও মত প্রকাশের স্বাধীনতার প্রশ্নে আপনার দলের সকল সদস্য যাতে সমমর্যাদাসম্পন্ন মূল্যবোধ লালন করেন, আপনার কার্যকরী নেতৃত্বের প্রয়োগে তা নিশ্চিত করুন।
৪। গণপ্রজাতন্ত্রী বাংলাদেশের সংবিধানে সন্নিবেশিত মত প্রকাশের স্বাধীনতা এবং চিন্তা ও বিবেকের স্বাধীনতার আকাঙ্ক্ষা ও মূল্যবোধের সাথে সংগতিপূর্ণ আইনি ব্যবস্থা প্রণয়নের উদ্দেশ্যে এবং আন্তর্জাতিক মানবাধিকার দলিলের বাধ্যবাধকতা অনুযায়ী বাংলাদেশ দণ্ডবিধির ২৯৫(ক) ধারা ও তথ্যপ্রযুক্তি আইন ২০০৬ এর ৫৭ ধারা প্রয়োজনীয় আইনি সংশোধনীর মাধ্যমে বাতিল করুন।

Signatories
The signatories include threatened Bangladeshi bloggers and activists, representatives of organisations focused on human rights including freedom of expression or freedom of belief, religious and secular groups, and also individual writers, journalists, artists, academics and other professionals with Bengali connection or in solidarity.
Abdul Muttalib — Retired Principal, Bangladesh
Abir Shomudro — Student, Shahid Abdur Rab Serniabat Textile Engineering College, Barisal
Abul Hasnat — Humanist; London, UK
Adam Lagerqvist — Humanisterna, Sweden
Adam Reakes — Producer and host, The Herd Mentality Podcast
Aditi Kabir — Interpreter; Independent Translator
Administrators of the Bangla Community Blog Alliance – BCBA
Afrina Akhter Jesmin — Activist; Program Secretary, Bangladesh Short Film Forum
Ahmedur Rashid Tutul — Publisher, Shuddhoshor
Ajanta Deb Roy — Gonojahoron Moncho, UK
Ajit Kumar Ray — Professor, North bengal University, West Bengal, India
Ajoy Roy — Author; Academic; Human rights campaigner; Professor of Physics, retired, Dhaka University; editor, Muktanwesa; advisor, Mukto-Mona
Alain Davis — Secularist Campaigner and Migrants Rights Activist, UK
Alex Zakreski — Member, Canadian Journalists for Free Expression – CJFE
Alice Carr — President, Progressive Atheists Inc.
Alice Klein — President, Canadian Journalists for Free Expression, CJFE
Amanor B. Apenkro — President, Humanist Association of Ghana
AmarBlog, amarblog.com
Anders Stedtlund — Software Designer
Andrew Copson — Chief Executive, British Humanist Association; President, International Humanist and Ethical Union
Andrew Hobson — Blogger, Cyber Atheist
Ani Zonneveld — Founder, President, Muslims for Progressive Values
Anne-France Ketelaer — Vice-President, International Humanist and Ethical Union
Ansar Ahmed Ullah — Secular Activist & Campaigner, UK
Anu Muhammad — Chief editor, Sarbojonkotha; Member secretary, National Committee to Protect Oil, Gas and Mineral Resources, Power and Port; Professor, Jahangirnagar University
Anupam Shaikat Shanto — Sarbojokotha Editor; General Secretary, Bangladesh Short Film Forum
April Jones — Freethinker, USA
Argentine Humanist Association, Deodoro Roca
Arifur Rahman — Blogger, arif.eu; Activist
Arik Platzek — Editor, diesseits (The Humanist Magazine) Berlin, Germany
Arman Rashid — Columnist; Member, International Crimes Strategy Forum-ICSF
Arne Mobrand — Humanist Stockholm
Arpita Bhowmik — Activist; Atheist and Humanist; Pharmaceutical Microbiologist, Japan
Ashfaque Anup — Blogger; Member, International Crimes Strategy Forum
Ashim Chakraborty — Journalist, Blogger
Ashis Saha — PhD Researcher in Johns Hopkins University
Ashley Davidson — Writer, Flagstaff, Arizona, USA
Ashoke Mukhopadhyay — General Secretary, Centre for Studies in Science and Society, Kolkata, India
Ashraful Alam — member of Progressive Atheists Inc, Melbourne, Australia
Ashraful Kabir — Research Coordinator
Asif Islam Khan — Activist; Academic, University of California, Berkeley
Asma Sultana — Visual Artist, Writer
Atheist Alliance International
Atheist Republic — atheistrepublic.com
Austin Dacey — Philosopher; Human rights activist
Ayella Collins — Humanist Empowerment of Livelihoods in Uganda
Baidik Bhattacharya — Academic, Delhi University
Barun P Mondol — IT professional
Benjamin Ismaïl — Head of Asia-Pacific Desk, Reporters Without Borders
Bo Borg — Humanisterna Sweden
Bob Churchill — Director of Communications, International Humanist and Ethical Union
Brendan de Caires — Programs & Communications Coordinator, PEN Canada
Brian D. Engler — Author and Humanist, Virginia
Carolina Josefsson — Local chairman, Swedish Humanist Association
Centre d’Action Laïque
Chitralekha Saha — Consulate of France in Calcutta
Christophe Deloire — Secretary-General, Reporters Without Borders
Crispy Sea — Blogger; Author
Cristina Iacob — Romanian Humanist Association
David Curry — Prophetcast
David Rand — President, Libres penseurs athées – Atheist Freethinkers, Canada
Deana M Naraparaju — Blogger; Online Activist
Debdas Anamoul — Blogger
Dilshana Parul — Activist, Save the Children
Dinky Daruvala — Associate professor , Karlstad University, Sweden
Dipen Bhattacharya — Physicist, Riverside College District, California, USA
Donna Van Toen — Author; East Hamilton Spiritual Church
Douglas Bernard Wallis — Atheist, Humanist – Isle of Man, Great Britain
Dr Jim Walsh — CEO, Conway Hall Ethical Society
Dr Mahmudul Sumon — Associate Professor, Jahangirnagar University, Savar Dhaka Bangladesh
Dr Meredith Doig — President, Rationalist Society of Australia
Ekush Tapader — News Editor, Sylhettoday24.com
Emily Newman — Communications Coordinator, American Ethical Union
Eric Eriksson — Humanist, Sweden
Erwin Kress — Humanistischer Verband Deutschlands, HVD
Erwin Kress — Vice-president, Humanist Association of Germany
Esa Ylikoski — General Secretary, Union of Freethinkers of Finland
Esha Karim — Swedish Institute Scholar
Fahmidul Haq — Writer; Blogger; Academic, Factulty at Dhaka University
Farid Ahmed — Author and Editor of Mukto-mona
Farzana Kabir Khan — Blogger; Activist
Felipe Galicia — Biologist
Ferdaush Ahmed — Activist; Founder, Organisation for War Heroines, London
Fran Kurth — Executive Director, Capital District Humanist Society, New York, USA
Fredrik Idevall, — President Humanisterna Orebro, Sweden
Garga Chatterjee — Columnist and Cognitive Scientist
George Broadhead — Pink Triangle Trust
Gitiara Nasreen — University of Dhaka
Göran Björk — Humanisterna, Sweden
Gordon MacRae — Chief Executive, Humanist Society Scotland
Greg Epstein — Humanist Chaplain, Harvard University
Gulalai Ismail — Chairperson, Aware Girls, Pakistan
Gustaf Andersson — Humanist, Sweden
Hana Shams Ahmed — Columnist, Activist
Hans Kleine — Local chairman, Swedish Humanist Association
Hasan Mahmud — Advisory Board Member,  World Muslim Congress; General Secretary, Muslims Facing Tomorrow, Canada
Hemant Mehta — Editor, Friendly Atheist
Heriberto ‘’Pito’’ Rosario — Riverdale-Yonkers Society for Ethical Culture
Hidde Gaastra — Atheist/Secular Activist, Master in Political Science
Hironmoy Golder — Student, ASA University
Hritohri Islam — Humanist; Activist; Student
Humanist Society of New Zealand
Humanist Union of Greece
Ian Bushfield — Executive Director British Columbia Humanist Association
Imad Iddine Habib — Atheist and Secularist Activist; Founder, Council of Ex-Muslims of Morocco
Imran H Sarkar — Spokesperson, Gonojagoron Moncho
Imtiaz Mahmood — Advocate, Supreme Court of Bangladesh
International Crimes Strategy Forum
Iqbal Nouyed — West Virginia University
Irtishad Ahmad — Professor, Florida International University
Jacques Rousseau — Chair: Free Society Institute, South Africa
James Croft — Leader in Training, Ethical Society of St. Louis
Jane Donnelly — Human Rights Officer, Atheist Ireland
Jaseeb Ara Siddiqui — Creative writer; Painter
Jawshan Ara — Ph.D. Researcher in Neuroscience, University of Maryland; writer, Mukto-mona
Jay Grime — Atheist Blogger
Jesmin Chowdhury — Teacher and Writer
Jillian Hsieh — Humanist, Florida
Jin-oh Choi — President, Launceston Skeptics Inc.
Joakim Ströberg — local chairman, Swedish Humanist Association
Joann Robertson — President, British Columbia Humanist Association
Jodie Ginsberg — CEO, Index on Censorship
John Hamill — Secretary, Atheist Alliance International and Atheist Ireland
Jonas Nordström — Boardmember, Swedish Humanist Organisation
Josh Kutchinsky — Membership Organiser, Central London Humanists
Julia Julstrom-Agoyo — Secretary, Americas Working Group, IHEYO; Liaison to FES, Ethical Humanist Society of Greater Chicago
Julie Begum — Chair, Swadhinata Trust, UK
Juyel Raj — Journalist, Blogger
Kaberi Gayen — Professor, Dept of Mass Communication and Journalism, University of Dhaka
Kajalie Shehreen Islam — Assistant Professor, University of Dhaka/Doctoral Candidate, SOAS, London
Kaji Tamanna Keya — Activist; Student, Brandeis University, USA
Kallol Mahalanabis — Mumbai,India
Kallol Mustafa — Activist; Executive editor, Sarbojonkotha; Member, National Committee to Protect Oil, Gas and Mineral Resources, Power and Port; Professor
Kamrul Hasan Tushar — Gonojagoron Moncho, UK
Kamrus Salam Shangshad — Former Vice President, Bangladesh Students’ Union
Kaveh Moussavi — Academic, University of Oxford
Kazi A. Mamun — Assistant Dean, Undergraduate Business Programs, School of Business Administration, University of California
Kazi Mahboob Hassan — Medical Researcher; Writer; Member, CFI
Khan Muhammad Bin Asad — PhD researcher, Astrophysics
Khorshed Azam — Writer
Khushi Kabir — Activist, Dhaka, Bangladesh
Kristina Ekman — Humanisterna, Sweden
Law’nence Miller — Trustee, New York Society for Ethical Culture
Lawrence M. Krauss — Foundation Professor, Arizona State University, School of Earth And Space Exploration, Physics Department; Director, The Origins Project
Leesa Gazi — Cultural Activist
Leicester Secular Society
Leon Korteweg — Board Member, Dutch Freethinkers Association, De Vrije Gedachte
Magnus Kvist — Humanisterna, Sweden
Magnus Timmerby — Board member, Swedish Humanist Association
Mahbub Azad — Blogger; Moderator, Sachalayatan.com
Mahbub Rubaiyat — Sarbojonkotha editor, Activist, Teacher
Mahmud Hussein — Founder and CEO, L.E.A.D.; Associate Professor, San Francisco State University
Mahmud Hussein — Founder, Global Secular Humanist Movement
Mahmudul Haque Munshi — Blogger; Organizer, Shahbag protest
Mahmuduzzaman Babu — Columnist, Singer, Activist
Maidul Islam — Asst Professor in Political Science, Presidency University, Calcutta
Mallarika Sinha Roy — Jawaharlal Nehru University, Centre for Women’s Studies, Delhi, India
Manisha Chakravarty — Student, Dhaka
Maria Greene — Executive Director, Unitarian Universalist Humanist Association
Marie Alena Castle — Communications Director, Atheists For Human Rights
Maruf Rosul — Blogger; Activist, Gonojagoron Monch
Mary Bergin — member, Humanist Society of Victoria, Australia
Maryam Namazie — One Law for All, Council of Ex-Muslims of Britain, and Fitnah – Movement for Women’s Liberation
Masuda khan — Student, USA
Mats Linde — Teacher and humanist, Sweden
Max Farrar — Emeritus Professor, Leeds Beckett University, UK
Mazidur Rahman — Civil Servant and Unionist
Md Habibur Rahman Salman — PhD Student
Md Ibrahim Faisal — Computer Engineer, Chandler, Arizona, USA
Mervyn Thomas — Chief Executive, Christian Solidarity Worldwide
Michael De Dora — Director of Public Policy, Center for Inquiry
Michael Nugent — Chairperson, Atheist Ireland
Miraj Ul Islam — Physician, Columnist
Mohammad Haroon — Secretary, Coalition on Rights & Responsibilities of youth , Peshawar, Pakistan
Mohammad Jawed Iqbal — Activist
Mohammad Tanzimuddin Khan — Sarbojonkotha editor, Associate Professor, Dhaka University, Bangladesh
Mohonlal Siddiquee — (Pen name) Advocate, Supreme Court of Bangladesh
Moinul Hossain — Secular activist
Moira Clarke — President, Reason Road Inc.
Mostafa Farook — Activist, London, UK
Mozibul Hoque Moni — Vice-President, JASOD-UK
Muhammad Golam Sarowar — Blogger; Activist
Muhammad Syed — President, Ex-Muslims of North America
Muktangon Blog, nirmanblog.com
Mukto-Mona
Muntakim Haque — Blogger; Activist
Mynga Futrell — Bright; Civic Pluralism Activist
Nabeel Ashraf Ali — International Centre for Diarrhoeal Disease Research, Bangladesh
Nafisa Asif — Humanist; Researcher, University of Sydney
Nagorik Blog, nagorikblog.com
Nancy Drew — Atheist activist; Blogger, Question With Boldness
Nani Jansen — Legal Director, Media Legal Defence Initiative
Nasreen Rahim — President, Bangladesh-American Democratic Coalition, BADC
Naushaba Rashid — Activist; Financial Advisor, Wells Fargo
Nazmul Ahmed — Physician & Political Activist
Nicola Young Jackson — President, International Humanist and Ethical Youth Organisation
Nijhoom Majumdar — Lawyer and Blogger, Member ICR Foundation
Nina Sheth — Law Student NYU Law
Nira Yuval-Davis — Professor and Director, Centre for Research on Migration, Refugees and Belonging, University of East London, UK
Nowrin Tamanna — Academic, University of Reading; justice activist
Olof Stroh — local chairman, Swedish Humanist Association
Ontario Humanist Society
Ophelia Benson — Blogger; Columnist
Oscar Ekman — Humanisterna, Sweden
P Das Babu — Activist
Paul Chiariello — Educator, Managing Editor Applied Sentience
Paul Sating — Creator and Host of Quranify Me Podcast & Atheist Apocalypse Podcast
Paul V Dudman — Archivist and Refugee and Migrants Rights Activist, University of East London, UK
Peter Harrison — President, New Zealand Association of Rationalists and Humanists
Peter Tatchell — Human rights campaigner; Peter Tatchell Foundation
Petri Karisma — Chairman, Union of Freethinkers of Finland; Co-founder, eroakirkosta.fi
PG Petzen — Swedish Humanist Association
Pierre Galand — President, European Humanist Federation
Pradip Deb — Melbourne, Australia
Predrag Stojadinović — Vice-president, ‘Atheists of Serbia’
Probir Kumar Sarkar — Senior Sub editor, Dhaka Tribune
Prof. Dr. Frieder Otto Wolf — Humanistischer Verband Deutschlands, HVD
Prof. Udo Schuklenk — Ontario Research Chair, Queen’s University
Pushpita Gupta — Activist, Secular Bangladesh Movement
PZ Myers — Blogger; Biologist, University of Minnesota Morris
Rafee Shams — Social Worker, Mrittika
Rafida Bonya Ahmed — Author; Mukto-Mona Editor
Raihan Abir — Editor, Mukto-Mona
Rajarshi Debnath — Financial Consultant
Rajib Halder — Student, Mathematics Department, Govt. BM College, Barisal
Rajib Sarkar — Humanist, USA
Rakibul Hasan — Filmmaker, Activist & Blogger
Rana Yasmin — Blogger; Member, International Crimes Strategy Forum-ICSF
Rashad Ullah — Academic, Mukto-Mona Member, Washington, DC
Rasheda Khan — Social Scientist, International Centre for Diarrhoeal Disease Research, Bangladesh
Ratan Kumar Samadder — ICORN Guest Writer
Rayhan Rashid — Academic, Rights Activist; Blogger; Member, International Crimes Strategy Forum-ICSF, Bangla Community Blogs’ Alliance-BCBA
Rayhana Sultan — Activist, Council of Ex-Muslims UK
Rebecca Hale — President, American Humanist Association
Rebecca Jane Prescott — Atheist, Blogger, Isle of Man, Great Britain
Rein Zunderdorp — First Vice-President, International Humanist and Ethical Union
Renate Bauer — President, Dachverband Freier Weltanschauungsgemeinschaften e.V., Germany
Riaz Osmani — IT Professional, LGBT and ex-muslim activist
Richard Carrier — Historian and Philosopher, FreethoughtBlogs
Roar Johnsen — Treasurer, International Humanist and Ethical Union
Robyn Pennacchia — Atheist, Blogger at The Frisky
Roger Moody — Nostromo Research
Rolf Söderlund — Retired, IT Professional
Romanian Secular-Humanist Association
Ron Soloman — Vice-President, International Humanist and Ethical Union
Roy Brown — Past President, International Humanist and Ethical Union
Roy Speckhardt — Executive Director, American Humanist Association
Rumana Hashem — Activist-Sociologist and Post-doctoral Researcher, University of East London
Rumman Mahmud — Justice Activist; Software Engineer, Cisco Systems
Russell Blackford — philosopher and author, University of Newcastle, Australia
Ryan Croom — Student, USA
Ryan Evans — Student, USA
S D Mistree — Poet
Sabbir Hossain — Coordinator, Bangladesh Liberation War Library and Research Centre; Convenor Member, Forum for Secular Bangladesh and Trial of War Criminals of 1971
Sabine Remling — MSc Marketing Manager, Sweden
Sachalayatan, sachalayatan.com
Saki Chowdhury — Activist
Sakti Das MD — Blogger; Member, Foundation for Freedom
Saleh Mustafa Jamil — Teacher and Human Rights Activist
Salmin Sultana — Justice Activist; Archivist; Member, International Crimes Strategy Forum
Samina Luthfa — Teacher, Dhaka University
Samira Rahman — Civil Servant and Community Worker
Samira Shackle — Assistant Editor, New Humanist Magazine
Sangita Ghosh — Journalist, Bangladesh
Sara Hosain — Barrister
Sarah Haider — Co-founder, Ex-Muslims of North America
Sarto Blouin — President, Humanist Foundation of Quebec
Sazedul Waheed — Student
Scott Sharrad — President, Council of Australian Humanist Societies inc.
Sean Jones — Humanist, USA
Sean McGuire — Blogger, My Secret Atheist Blog
Semanti Ghosh — Associate Editor, Anandabazar Patrika, India
Shabnam Nadiya — Writer
Shaheen Sultana — Community worker
Shahid Khan — Vice-Chairperson, Global Minorities Alliance, UK
Shaista Erum — Secretary, Global Minorities Alliance, Glasgow, UK
Shamim Ahmed — Development Economist
Shamim Ahmed Lasker — Blogger; Online Activist; Assam, India
Shane Squires — Physicist, USA
Shawan Mahmud — Member Secretary, Martyr Altaf Mahmud Foundation
Sheila Ayala — Secular Ontario
Shelby Perez — Human Rights Activist, USA
Shimon Sharmin — Blogger; Translator
Shohini Ghosh — Sajjad Zaheer Professor, AJK Mass Communication Research Centre, Jamia Millia Islamia, New Delhi
Shuvo Shaha — Student, Dept. of Civil Engineering, Bangladesh University of Engineering and Technology
Sidmennt, The Icelandic Ethical Humanist Association
Smrity Azad — Chair, Docklands Light Theatre, UK
Sohail Chowdhury — Blogger; Writer
Sonia Dattaray — Atheist, USA
Sonja Eggerickx — Past President, International Humanist and Ethical Union
Sotiris Angel — Entrepreneur, UK
Soumen Halder — Businessman, India
Stephen Stuart — Secretary, Humanist Society of Victoria
Steve Hayes — Prophetcast
Stewart Henderson — Blogger; Treasurer, Council of Australian Humanist Societies
Suhana Zaman — Humanist, London
Sumon Nath — Blogger
Suraiya Rahman — Student, Dhaka
Suranjit Das — Activist; Business man
Susan Sackett — Vice-President, International Humanist and Ethical Union
Sushanta Das Gupta — Blogger
Swakkhar Shatabda — Teacher
Swami Manavatavadi, Sadhvi Asha Manav, and Dr. Sabita Mishra — Manavatavadi Vishwa Sansthan, The International School of Humanitarian Thoughts and Practice, Kurukshetra India
Syeda Najnin Sultana Shikha — Women’s Right Activist, Nari Chetona
Tahsin Tabbassum Kotha — Student, Govt. College of Commerce, Chittagong
Tanuja Bhattacharjee — Poet; Blogger; Engineer
Tarek Fatah — Author
Taslima Nasreen — Author; Physician; Blogger
Tasnim Hossain — Software Engineer
Tejmur Šihmamedov — President, The Secular Circle’
The Board of Directors of Humanist Canada
Trisha Ahmed — Student, USA
Ulf Gustafsson — Blogger, Swedish Humanist Association
Unione degli Atei e degli Agnostici Razionalisti — NGO, Italy
Uttam Niraula — Executive Director, (Society for Humanism) SOCH Nepal
Valter Eriksson — Physiotherapist, Sweden
Veronica Abbass — Editor-in-Chief, Canadian Atheist
Vidya Bhushan Rawat — Social Development Foundation, Delhi
Vishwajeet Samuel Gain — Student, La Martiniere Calcutta, India
Yamen Hoque — Blogger; Humanist; State College, PA, USA
Zoe Hamilton — Atheist, USA

Ethical Progress on the Abortion Care Frontiers on the African Continent

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