The American College of Physicians (ACP) has released a new position paper detailing the ethical obligations of physicians who participate in volunteer medical trips. The position paper, and an accompanying editorial examining the role of the new guidance, were published in the Annals of Internal Medicine.1,2

Matthew DeCamp, MD, PhD, an assistant professor at the Johns Hopkins Berman Institute of Bioethics and the division of general medicine in Baltimore, Maryland, and colleagues, penned the position paper on behalf of the ACP Ethics, Professionalism, and Human Rights Committee. The paper shares 5 position statements highlighting the ethical duties and obligations that are required of all physicians participating in what the committee calls “short-term experiences in global health.”

“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 Jack Ende, MD, MACP, president of the ACP, in a press release.3 “This paper mostly addresses practicing physicians, but it also applies to other healthcare professionals and students, and should inform how institutions, organizations, and others structure short-term global health experiences.”

The 5 position statements, framed using the accepted principles of healthcare ethics — beneficence, nonmaleficence, justice, and respect for autonomy — are as follows:1

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Position 1. The primary ethical obligation in short-term global health experiences is to improve the health and well-being of the individuals and communities they visit.

Position 2. The ethical principle of justice requires partnering with local leaders to ensure that potential participant burdens placed on local communities are minimized.

Position 3. The ethical principle of respect for persons, including sensitivity and respect for cultural differences, is essential to short-term global health experiences.

Position 4. Pre-departure preparation is an ethical obligation. It should incorporate preparation for logistical and ethical aspects of short-term global health experiences, including potential ethical challenges and moral duress.

Position 5. Physicians should participate with organizations whose short-term global health experiences are consistent with the ethical and professional standards laid out in these positions.

In the accompanying editorial,2 Judith N Wasserheit, MD, MPH, of the University of Washington in Seattle, and colleagues, applaud the authors of the position paper for filling a “major gap in the literature [as well as] raising challenging ethical questions.”

“Throughout the position paper, the authors emphasize the salience of the host country and community perspectives. We wholeheartedly agree that this is foundation[al] for all collaborations,” Dr Wasserheit and colleagues wrote. “The ethical considerations presented offer an excellent framework for approaching short-term clinical experiences.”

Dr Ende concluded his statement3 by emphasizing that short-term global health experiences can help physicians make significant strides towards improving health equity both at home and abroad.

To read the full text of the ACP position paper, please visit the ACP website.

References

  1. DeCamp M, Lehmann LS, Jaeel P, Horwitch C, for the ACP Ethics, Professionalism, and Human Rights Committee. Ethical obligations regarding short-term global health clinical experiences: an American College of Physicians position paper [published online March 26, 2018]. Ann Intern Med. doi:10.7326/M17-3361
  2. Farquhar C, Nduati RW, Wasserheit JN. Ethical obligations in short-term global health clinical experiences: the devil is in the details [published online March 26, 2018]. Ann Intern Med. doi:10.7326/M18-0566
  3. American College of Physicians issues ethical guidance for individuals participating in volunteer medical trips [news release]. Philadelphia, PA: American College of Physicians. Published March 26, 2018. Accessed March 26, 2018.