A 2017 update to the World Medical Association Physician’s pledge added language on issues such as respect for patients’ dignity and respect between colleagues. In a recent piece for the AMA Journal of Ethics, the authors outlined how US students of health professions travelling abroad should use the pledge as a foundation for their practice and how the language used in the pledge could be further altered to more clearly delineate the practical application of principles like patient autonomy and dignity abroad.
Although interpretation of the pledge may vary based on the cultural context in which the individual student is working, it offers basic, presumably universal principles that health professions student can follow. These include recognizing patient autonomy, human rights, and civil liberties as important components of patients’ well-being. The authors point out that the opportunity for students to work or study internationally is a privilege and that medical knowledge should be used to protect and further human rights.
The authors contend that students practicing abroad should assume an active role in ensuring respect for patient autonomy and dignity while also considering how cultural differences may act contra to this. This includes declining to participate in “medical tourism,” where patients serve as educational devices for students. Students should also defer to colleagues from their host community and ensure adequate translation services are available. They should also guarantee respect for patient autonomy and informed consent as well as demand institutional accountability if any violations of internationally accepted ethical principles occur.
Additionally, students participating in research abroad should adhere to the same coda of respecting patient autonomy and dignity. If successful, students can use research as a means to engage in dialogues that support local communities while maintaining the human rights and civil liberties of populations living abroad. Because many students participate in research related to health infrastructure, access, and global health education, there is ample room for students to work with mentors on research topics such as global health ethics, health care policy, or advocacy.
By keeping in mind the tenants of the World Medical Association Physician’s pledge, students can use their access and privilege to uphold patient rights and practice advocacy, even when working or studying abroad.
Bowman B, Callender B. Is updating the WMA physician’s pledge enough? AMA J Ethics. 2019;21(9):E796-800.