Ethics in Practice: Difficult Questions

This weekend, I gave a joint talk with a colleague entitled, “What is Our Responsibility? Global Health Ethics in Practice” at the McGill Global Health Conference.

The talk was based upon the fact that we do engage in global health activities as medical students and physicians, yet we rarely will openly and bravely question our intentions and impact. We put forth the following difficult questions. Through holding mental space for these issues, we may not solve the ethical dilemmas, but at least we may take steps to mitigate potential harm and clarify purpose.

1.In overseas medical electives, how do we ensure that we are not a drain on the system? Are we impeding the training of local medical students and health professionals?

2. Should we use our power as physicians to advocate for global health from within Canada? And if not, why are we not interested in this approach?

3. Are you involved locally in refugee and community development issues? If not here, then why internationally?

4. If we are driven to ‘help’ a particular community, do we need to actually be a part of that community? And is that possible?

5. Should we consider engaging in international relief over development if we are only available short-term?

6. Should we measure the outcome of our student’s overseas activities? How do we ensure that in the long-term we don’t cause harm to the communities we work in?

7. Are short-term clinical exchanges the best way to learn about the global health challenges facing us all?

We concluded with the following: It is unfair to unleash students and physicians into communities when there is the unaddressed potential to impart harm by accident. Let us remember, we are not global health experts and we must take personal and institutional responsibility in our global health endeavours.

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~ by kcanderson on May 5, 2008.

3 Responses to “Ethics in Practice: Difficult Questions”

  1. Those are the questions that international development practitioners ask themselves (hopefully) all the time. Instead of creating new systems to work with local communities, why not seek out partnerships that have been established and are already on a sustainable path? There are so many organizations out there that have a framework setup, that are mature and take into account the risks as well as benefits of developoment, and that have the infrastructure and systems setup. Why not look at ways to collaborate with them and find mutual benefit and insertion points instead of creating smaller and less sustainable initiatives that really only work if you are part of the community? In an international context, a newcomer is not going to be as easily integrated into smaller grassroots, local initiatives, especially in a short period of time.

  2. These are very important questions. I see more and more of a push within our university for students (in health and non-health faculties) to do something ‘global’ for their dissertations, summer internships etc. But if there is not a corresponding push to mentor students, and make their time abroad beneficial (or at least not outright harmful) to the local population, global health degenerates into some special kind of tourism or voyeurism. (Special, because it adds more punch to your CV.) Did you read the article by Pinto and Upshur in Developing World Bioethics on this subject? They have some useful points in there. Cheers, Stuart

  3. Thanks for your comments Stuart and Jia. The article that andrew pinto wrote was definitely on the right track. I find the concepts difficult to put directly into practice, especially for those not immediately inclined towards humility and introspection. My colleagues and I have been wondering how to put these ethical principles into practice for students (and physicians), and moreover, how to solidify them empirically.

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