ACP issues ethical guidance for individuals participating in volunteer medical trips
Physicians who participate in short-term global health experiences such as volunteer medical trips have ethical obligations to the individuals and communities they serve, the American College of Physicians (ACP) advises in a new position paper published today in Annals of Internal Medicine.
"The primary goal of a short-term experience in global health is to improve the health and well-being of the individuals and communities where they occur," said ACP President Dr. Jack Ende, MD, MACP. "This paper mostly addresses practicing physicians, but it also applies to other health care professionals and students, and should inform how institutions, organizations, and others structure short-term global health experiences."
Potential benefits for clinicians and learners who participate in volunteer medical trips can include increased awareness of global health issues, new medical knowledge, enhanced physical diagnosis and clinical problem solving skills when practicing in low technology settings, and enhanced professional satisfaction and learning experiences. However, ethical challenges can also be raised, including issues such as respecting different cultural norms, avoiding potential unintended harms, protecting privacy, working within one's scope of practice or educational level, and managing limited resources.
In "Ethical Obligations Regarding Short-term Global Health Clinical Experiences," short-term experiences range from a few days to several months. Global health experiences refer to circumstances when physicians at different levels of training or medical students from high-income countries travel to low- or middle-income countries (or to high-income countries with underserved areas) for care of vulnerable populations in underserved settings. ACP presents five core positions focused on ethics and the clinical care context and provides case scenarios to illustrate the positions.
ACP advises that to fulfill the primary ethical obligation of a short-term experience in global health to improve health and well-being, physicians should advocate for sustainable, mutual benefit; a fair and equitable distribution of resources; and partnerships that respect the individuals and communities served. The ethical principle of justice requires partnering with local leaders to ensure that the potential burdens participants can place on local communities abroad are minimized and preparing for limited material resources.
Individuals who participate in short-term global health experiences must be sensitive to and respectful of cultural differences. Pre-departure preparation should incorporate preparation for logistical and ethical aspects of a short-term experience in global health, including the potential for ethical challenges and moral distress.
"By fulfilling these responsibilities and participating with organizations whose short-term global health experiences are consistent with ethics and professionalism as exemplified in ACP's positions, physicians can help maintain trust in the medical profession, protect patient well-being, and improve health equity at home and abroad," Dr. Ende said.