Navigating Ethical Tensions in Global Health Practice

1. 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

2. Kolkata

3. Sample of Bengali alphabet

4. 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.

5. “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.

6. 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

7. 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

8. 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

9. Examples/Cases

10. 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

11. 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

12. 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?

13. 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?

14. Ethics and emotion: Plutchik's wheel http://en.wikipedia.org/wiki/Contrasting_and_categorization_of_emotions

15. Thinker http://www.pbase.com/prantik/image/58399809http://www.pbase.com/prantik/image/58399809