Going Global? How to Do Global Health Ethically

Written by Thomas Davis

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For those participating in short-term global health experiences, the American College of Physicians has issued a position paper to guide ethical decision making.   

Why does this matter?
As participation in global health experiences has grown over the years, our thinking about roles and responsibilities must grow as well.  In particular, we need to grow beyond the idea that “something is better than nothing.”  The unfortunate reality is that sometimes our best intentions have unintended consequences as told in this excellent recent documentary Poverty, Inc.  This ACP position statement pushes us to think more purposefully about our short-term efforts abroad.

A short checklist before your short trip abroad

  1. The primary goal is to advance the health of the communities we visit.  Learning is a secondary objective.
  2. Ensure that the local community desires the presence of the intervening organization.
  3. Be aware of unintended harms.  For example, be careful not to detract from local clinicians and resources as your presence may be distracting.
  4. Maintain ethical standards.  For example, WHO advises against donating medicines that will expire within 1 year.  And do not work beyond your scope of practice, even if local regulations are less restrictive.
  5. Express cultural humility. But you don’t need to shirk your ethical duties either.
  6. Therefore, prepare ahead of time for ethical dilemmas and how you may respond.
  7. Remember, local communities may be supporting your presence as an expression of solidarity rather than for the benefits you bring.
  8. Work with organizations that uphold ethical standards.  As a short-term participant, your organizational clout is minimal.  Therefore, it’s easier to maintain your professionalism when the organization does the same.
  9. A good organization should be committed to evaluating its impact by using process measures (e.g. number of patients cared for), outcome measures (e.g. health outcomes), and full-cost accounting methods.

Source
Ethical Obligations Regarding Short-Term Global Health Clinical Experiences: An American College of Physicians Position Paper.  Ann Intern Med. 2018 Mar 27. doi: 10.7326/M17-3361. [Epub ahead of print]

Another Spoonful
NPR has an insightful analysis of this article.

Peer reviewed by Clay Smith

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