Navigating Ethical Tensions in

Global Health Practice

Debjani Mukherjee, Ph.D.

Director, Donnelley Ethics Program,

Rehabilitation Institute of Chicago

Associate Professor, Northwestern University Feinberg School of Medicine

Kolkata

Sample of Bengali alphabet

Core Principles of Biomedical Ethics

Beneficence: providing benefit and balancing risks to bring forth the best results

Respect for Autonomy: fostering self-determination and respecting individual differences

Nonmaleficence: doing no harm Justice: upholding concepts of fairness

and equity

Beauchamp TL, Childress JF. Principles of Biomedical Ethics, 6th ed. New York: Oxford University Press; 2009.

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“Global Health Ethics”

Four concepts in addition to Respect for Autonomy, Beneficence, Nonmaleficence and Justice

Humility Introspection Solidarity Social Justice

Pinto, A.D. & Upshur, R.E. (2007). Global Health Ethics for Students. Developing World Bioethics. Vol 9 (1). 1-10.

Global Health Training: Best Practices(Crump & Sugarman, 2010)

Sending and Host institutions Sponsors Trainees

The authors have 14 recommendations for trainees including Demonstrate cultural competency and engage

in appropriate discussions about different perspectives and approaches

Take measures to ensure personal safety and health

International health electives: thematic results…(Petrosoniak et al, 2010)

Ethical implications exist IHE’s may include a component of medical

tourism Awareness of medical tourism is often variable

Ethical issues encountered by medical students (Elit et al, 2011)

1. Uncertainty about how best to help 2. Perceptions of Western medical students as

different 3. Moving beyond one’s scope of practice 4. Navigating different cultures of medicine 5. Unilateral capacity building

Examples/Cases

http://ethicsandglobalhealth.org/

Ethical Challenges in Short-Term Global Health Training

Ten Cases Developing Cultural

Understanding Ensuring Personal Safety Exceeding Level of Training Ensuring Sustainable and

Appropriate Benefits Addressing "Ancillary Benefits" Recognizing Burdens Shifting Resources Telling the "Truth" Selecting a Research Project Understanding Informed

Consent for Research

Example: Privacy

1) differences in norms of spatial privacy 2) western practices can feel intrusive 3) privacy and trust are inextricably linked 4) norms of disclosure also affect the

researcher

“Ethics-as-Process” approach

Mukherjee, D. (2008), Privacy and intrusion in ethnographic health research, in Brinda Jegatheesan (ed.) Access, a Zone of Comprehension, and Intrusion (Advances in Program Evaluation, Volume 12), Emerald Group Publishing Limited, pp.83-96

Questions for Students Prior to Global Health Work (Pinto and Upshur, 2007)

6. Where are the weaknesses of your plan, specifically?

7. Is the work feasible, cost-effective, necessary, focused and justified?

8. Will it work to undermine disparity, or actually contribute to it? Will there be a net benefit to the community?

9. What do you hope to bring back to your community, and whom will you share it with?

Is you work sustainable, and if not, will this leave a negative impact?

Questions for Students Prior to Global Health Work (Pinto and Upshur, 2007)

1. Why do you hope to do this work? 2.What are your objectives, both personal and

structural, short and long-term? 3. What are the benefits and who will receive

them, and what are the costs and who will bear them?

4. In the context of very limited resources for global health needs, is your elective justified? What exists close-by?

5. What do you need to do to prepare for your elective, both practical and personal?

Ethics and emotion: Plutchik's wheel

http://en.wikipedia.org/wiki/Contrasting_and_categorization_of_emotions

Thinkerhttp://www.pbase.com/prantik/image/58399809http://www.pbase.com/prantik/image/58399809