Ethical considerations in global surgery: a scoping review

Abstract

IntroductionAn unmet burden of surgical disease exists worldwide and is disproportionately shouldered by low-income and middle-income countries (LMICs). As the field of global surgery grows to meet this need, ethical considerations need to be addressed. Currently, there are no formal guidelines to help inform relevant stakeholders of the ethical challenges and considerations facing global surgical collaborations. The aim of this scoping review is to synthesise the existing literature on ethics in global surgery and identify gaps in the current knowledge.MethodsA scoping review of relevant databases to identify the literature pertaining to ethics in global surgery was performed. Eligible articles addressed at least one ethical consideration in global surgery. A grounded theory approach to content analysis was used to identify themes in the included literature and guide the identification of gaps in existing literature.ResultsFour major ethical domains were identified in the literature: clinical care and delivery; education and exchange of trainees; research, monitoring and evaluation; and engagement in collaborations and partnerships. The majority of published literature related to issues of clinical care and delivery of the individual patient. Most of the published literature was published exclusively by authors in high-income countries (HICs) (80%), and the majority of articles were in the form of editorials or commentaries (69.1%). Only 12.7% of articles published were original research studies.ConclusionThe literature on ethics in global surgery remains sparse, with most publications coming from HICs, and focusing on clinical care and short-term surgical missions. Given that LMICs are frequently the recipients of global surgical initiatives, the relative absence of literature from their perspective needs to be addressed. Furthermore, there is a need for more literature focusing on the ethics surrounding sustainable collaborations and partnerships.

Global Surgery Education and Training Programmes—a Scoping Review and Taxonomy

“…The presence of HIC surgical trainees may undoubtedly in some circumstances provide significant benefit to the LMIC host institution [48,82]. However this apparent lack of reciprocity in travel, as similarly identified elsewhere [83], may also give us cause for concern. It is incumbent upon us as practitioners in a field dedicated to "achieving health equity for all people worldwide who are affected by surgical conditions" [3], to consider how much satisfying HIC demand for LMIC surgical placements should be a priority for the global surgical community.…”

Establishing Surgical Care Sustainability in Sub-Saharan Africa for Global Child Health: Insights From Pediatric Cardiac Surgical Capacity-Building Programs in Ethiopia and Côte d'Ivoire

“…To improve surgery in LMICs, the surgical education system must be strengthened. However, according to a rapid review of academic global surgery programs, the existing academic global surgery programs are highly skewed toward HIC residents (22), and concerns have been raised that similar opportunities for LMIC medical staff are not frequently available (12). Furthermore, LMIC medical personnel must acquire learning autonomy and eventually replace visiting faculty.…”

Telesimulation for remote simulation and assessment

“…Lastly, while the ethical considerations of global surgical education have received relatively little attention in the literature compared to issues surrounding direct patient care, there are numerous issues to keep in mind when utilizing TS to deliver education in low‐ and middle‐income countries 38 . Perhaps one of the most important considerations is the ability of the host country to sustain the program on their own 39 .…”