5. Ethics in global health

Table of Contents
Headshot of Joanna Breems, Clinical Assistant Professor
Joanna Breems
Clinical Assistant Professor
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At this point in the course, it should be evident that global health work is a complex and multidisciplinary endeavor that tackles interdependent social and physical conditions and involves differences in priorities, power, and resources; there are inherent ethical concerns. “Global health ethics” is a poorly defined term that can refer to human rights (such as access to medical services), to responses to health concerns affecting the global population (such as distribution of COVID vaccines), and to responding to historical colonialism. But for the purposes of this module, the focus will also be on ethical considerations that are especially relevant to the medical trainee: ethical considerations in engagement in global health activities, including research collaborations and short-term immersion experiences.

Learning objectives

  • Identify and discuss resolutions to common ethical issues and challenges that arise in working within diverse economic, political, and cultural contexts as well as working with vulnerable populations and in low resource settings to address global health issues
  • Define cultural relativism and cultural humility
  • Review key human rights concerns as it relates to global health and discuss some of the central treaties and conventions related to human rights
  • Social justice and human rights principles in addressing global health problems

Pre-module prompt

Before you begin this module, take a moment to reflect on your thoughts related to this topic and answer the following:

    1. What do you think is the likelihood that a medical student will experience an ethical dilemma while participating in an international clinical or research elective? (Likert 0–100%)
    2. How prepared do you feel to appropriately manage an ethical dilemma while participating in an International Clinical Elective? (Likert)
    3. What ethical dilemmas do you think are most encountered by medical students participating in international clinical or research electives?

On the Slack discussion board:

  1. Find a clinical research study authored by persons from HIC that was performed in a LIC. Analyze the paper for its ethical standards:
    • social value
    • scientific validity
    • fair subject selection
    • acceptable risk/benefit ratio
    • informed consent
    • respect for enrolled subjects
  • What ethical issues are posed regarding standard of care, post-trial benefits, ancillary care?
  • How was the research presented in the publication? How were credit/authorship/acknowledgments communicated?

 

  1. Select 1–2 questions from the following (list modified from the Global Health Education Competencies Toolkit, 2nd ed.):
      • If you have had any experience (in whatever form) in global health, reflect on that experience in light of the readings. In what ways was were sustainable and ethical partnerships promoted? In what ways were they not?
      • How might the educational and professional expectations at your home institution differ from those on an international away health elective in a resource limited region, and how might those conflicts be managed?
      • Are there other articles or resources that you have found that explain these topics better and/or offer innovative ideas/responses?
      • Do a search for international away/global health electives for medical students. What do the websites or recruitment materials communicate about the commitment to global health equity in the opportunity? Is the role of the community partner described? Is the role of the learner clearly described; what benefit (if any) is proposed from the service learning opportunity? What else do you notice? (You might use the Vann Nabi article in Additional readings/activities below to guide your analysis.)

Ethical Challenges in Short-Term Global Health Training: Online module with interactive cases to explore common and/or important ethical situations related to short-term global health training.

    • Complete the modules and submit completion certificate via email.
  • Reynolds CW, Kolars JC, Bekele A. Ten Questions to Guide Learners Seeking Equitable Global Health Experiences Abroad. Acad Med. 2023 Apr 21. doi: 10.1097/ACM.0000000000005255. Epub ahead of print. PMID: 37094281.
  • Vann Nabi, H., & Estes Brewer, P. (2021). Communicating Ethical Engagement Abroad: A Content Analysis of Service-Learning Study Abroad Third-Party Provider Websites. Frontiers: The Interdisciplinary Journal of Study Abroad, 33(2), 17–34. https://doi.org/10.36366/frontiers.v33i2.555
  • September 2019 Journal of Ethics: The entire issue is dedicated to global health ethics, specifically questions related to short term immersion experiences. Recommended articles listed below
    • Table of Contents:
      • Ethical Issues in Global Health Education and “Immersion” Experiences
      • Case and Commentary
        • How Should We Decide Whether and When Some Care Is Better Than No Care? 
        • What Are Criteria for Considering Technologies’ Uses and Influences in LMICs’ Health Care Infrastructures?
      • Medical Education
        • How the Social Contract Can Frame International Electives
        • Facilitating Critical Self-Exploration by Global Health Students
        • How Should Academic Medical Centers Administer Students’ “Domestic Global Health” Experiences?
      • Policy Forum
        • Are Patients’ and Communities’ Poverty Exploited to Give Health Professions Students Learning Experiences?
      • Art of Medicine
        • Anatomy of a Medical Student
        • Personal Narrative Voluntourism

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Unless otherwise noted, images are from Adobe Stock.

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