Ethical Obligations Regarding Short-Term Global Health Clinical Experiences: An American College of Physicians Position Paper

Abstract

This American College of Physicians position paper aims to inform ethical decision making surrounding participation in short-term global health clinical care experiences. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and should inform how institutions, organizations, and others structure short-term global health experiences. The primary goal of short-term global health clinical care experiences is to improve the health and well-being of the individuals and communities where they occur. In addition, potential benefits for participants in global health include increased awareness of global health issues, new medical knowledge, enhanced physical diagnosis skills when practicing in low-technology settings, improved language skills, enhanced cultural sensitivity, a greater capacity for clinical problem solving, and an improved sense of self-satisfaction or professional satisfaction. However, these activities involve several ethical challenges. Addressing these challenges is critical to protecting patient welfare in all geographic locales, promoting fair and equitable care globally, and maintaining trust in the profession. This paper describes 5 core positions that focus on ethics and the clinical care context and provides case scenarios to illustrate them.

Are Patients' and Communities' Poverty Exploited to Give Health Professions Students Learning Experiences?

“…The American College of Physicians (ACP) offers guidance about how to protect both students and patients, locally and globally. 9 But, in our view, the ACP's emphasis on mitigating power imbalances and on respectful partnerships treats cultural differences mainly as a challenge to students' preparation for international immersion experiences and not as influencing their responses to a patient's health status or their understanding of a health problem or what to do about it. We further suggest that the ACP's emphasis on distributive justice 9 is too limited.…”

Facilitating Critical Self-Exploration by Global Health Students

“…Pre-and post-STEGH educational sessions can help ameliorate such untoward consequences, 18 just as writing narrative essays and attending to ethical guidelines for global health experiences can aid in personal and professional development. 19,20,21,22,23 However, the key to growing self-awareness in relation to global health is critical self-explorationthe mindful, imaginative, and enduring practice of identifying and challenging one's assumptions and actions in light of new information arising from exposure to new surroundings and the passage of time. 24,25,26 On the basis of my more than 30 years' work as a clinician-educator serving in US safety-net clinics and on several international engagements, I contend that developing self-awareness by practicing critical selfexploration is crucial for health professions students and trainees taking part in STEGHs.…”

Contributions of academic institutions in high income countries to anesthesia and surgical care in low- and middle-income countries: are they providing what is really needed?

“…Les membres de l'équipe peuvent être pris par surprise devant l'étendue de la pauvreté, du manque de ressources et être involontairement insensibles à la culture, à la langue ou aux coutumes locales. 7,8 Le choc des cultures, et dans une plus grande mesure le choc des cultures inversé sont des problèmes sous-estimés parmi les travailleurs du domaine de la santé. 9 Les analyses des données de missions médicales non urgentes ont insisté sur le besoin de sensibiliser préalablement les membres de l'équipe aux problèmes culturels et contextuels.…”

“…Team members may be taken by surprise by the extent of poverty, shortage of resources, and unintentionally insensitive to the local culture, language, or customs. 7,8 Culture shock, and to a greater extent, reverse culture shock, are underestimated issues among healthcare workers. 9 Reviews of data on elective medical missions have emphasized the need for sensitizing the team members to the cultural and contextual issues beforehand.…”