A Call to Action: The Need to Address the Ethical Challenges in Short-Term Global Health Training Programs
While a great deal of attention has focused on the ethics of international clinical research, much less has been given to the ethical issues associated with education and service initiatives of global health programs. In a Commentary published in the September 24th issue of the Journal of the American Medical Association, Jeremy Sugarman, MD, MPH, MA, of Johns Hopkins University and John Crump, MB ChB, of Duke University, call upon leaders of increasingly popular academic global health programs to address the important ethical considerations inherent in sending individuals from a wealthy country for training and service experiences to countries with very limited resources.
Dr. Jeremy Sugarman is the Harvey M. Meyerhoff Professor of Bioethics and Medicine at Johns Hopkins School of Medicine and is Deputy Director for Medicine for the Johns Hopkins Berman Institute of Bioethics. Dr. John Crump, is Director of Duke Tanzania Operations, Duke Global Health Institute, and Assistant Professor of Medicine, Division of Infectious Diseases and International Health.
Drs. Sugarman and Crump point out that in many international settings that involve the education and training in global health there can be benefits and burdens for all of those involved. Those involved include patients, trainees, the host institution and the sending institution. “Each of these stakeholders will face and have to wrestle with ethical challenges,” says Dr. Sugarman. “We have flagged some of these issues for attention to ensure that these well-intentioned experiences don't create unintended adverse consequences.”
The authors point out a range of ethical considerations with the aim of helping to enhance such programs. While patients may benefit from having trainees involved in their care patients can face burdens as well. For example, trainees from a wealthier country may have inflated ideas about the value of their skills and yet may be unfamiliar with more appropriate approaches to patient treatment that are common in settings with limited laboratory capacity.
When discussing implications for trainees, Sugarman and Crump point out that in some resource-poor settings, trainees may be thrust into patient-care settings or other health-related activities for which they are not yet prepared. Although the experience may be exciting, it can result in stress and guilt over actions taken. Trainees may also place their own health at risk.
Dr. Sugarman says he wants to make it clear that he believes the goals for global health programs and short-term experiences are laudable and important. Sugarman says the purpose of this Commentary is to “call for systematic descriptions of the types of issues people face, so that we can gather data to help inform those choices, and also to make a call for the development of explicit approaches to the ethical issues that are encountered in these settings.” Dr. Sugarman says future work in this area can take many forms: formal guidelines, formal training, and development of international codes. He also stresses that “Any future effort will need to be deeply collaborative with representation from each of the stakeholder groups.”
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