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
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Beneficence: providing benefit and balancing
risks to bring forth the best results
Respect for Autonomy: fostering selfdetermination 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”
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Four concepts in addition to Respect for Autonomy,
Beneficence, Nonmaleficence and Justice
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Humility
Introspection
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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
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The authors have 14 recommendations for trainees
including
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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)
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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)
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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/
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Ethical Challenges in Short-Term
Global Health Training
Ten Cases
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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
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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
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“Ethics-as-Process” approach
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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
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Questions for Students Prior to Global
Health Work (Pinto and Upshur, 2007)
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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)
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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 closeby?
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
Thinker
http://www.pbase.com/prantik/image/58399809http://www.pbase.com/prantik/image/58399809