Philanthropy

Ethical Analysis of Medical Service Trips

Nonprofit and other philanthropic organizations face a lot of ethical dilemmas, are often held to a higher ethical standard, and are prone to more criticism on ethics than their for-profit counterparts. There are numerous ethical questions that are associated with non-profits, foundations, and other philanthropic organizations. All of which make it difficult to truly determine if something is ethical or not and if simply the intent for good is more valid that the outcomes. This essay will analyze the ethical questions that are associated with Medical Service Trips (MCTs), also known as medical missions. This essay will first give background information of MCTs, then it will discuss various volunteer stories of MCTs, and will end with an analysis of MCTs from various ethical perspectives (utilitarian, freedom, and virtue).

Albert Schweitzer in Lambarene, 1964

Background

Medical Service Trips (MCTs), also known as medical missions, are defined as being short trips (1 day to two months) made by medical volunteers usually from high income countries to low-middle income countries in pursuit of delivering medical assistance to the citizens of the low/middle income countries (Sykes, 2014). The majority of MSTs are performed in Africa, Central/South America, and Southeast Asia (Sykes, 2014). MSTs have a historical root in medical missions orchestrated by religious organizations during the 19th and 20th centuries (Olakanmi & Perry, 2006). Although their roots are with religious organizations, today they are facilitated by both secular and religious organizations. One of the most well-known historical missionary figures is Albert Schweitzer who established a hospital in Lambarene/Gabon in Africa due to his belief that that was the location that had the most need of medical services and it was his duty as a Lutheran to help (Olakanmi & Perry, 2006). During this time, there were more religious organizations involving themselves in the Global South in the form of missions. The early missions did have rudimentary medical assistance, but later these medical missions became more professional. It wasn’t until the 20th century that more government entities began to become more involved in health crisis in the Global South with the establishment of the World Health Organization (WHO founded in 1945), Peace Corp (founded in 1960), and Red Cross (Olakanmi & Perry, 2006). Non-government organizations (NGOs) did not appear in the Global South until the 1970’s when Africare was established in West Africa to address the health issues associated with drought and famine (Olakanmi & Perry, 2006). There are also an increasing number of medical academic organizations/institutions that encourage or even expect students to participate in MSTs. Today there are many religious, secular, and academic organizations that facilitate MSTs to locations all around the world. With the increasing number of MSTs occurring, more and more questions about their efficacy, sustainability, and ethicality rise. The increase of MSTs has also brought about a wave of voluntourism, where volunteering and tourism are combined. This phenomena of promoting tourism and volunteerism together has led to many organizations that facilitate MSTs to create trips that put a more touristic emphasis onto the original volunteer trips.

Stories

In an article written by Garrett Matlick (2018), he talks about his time in the Peace Corps and his observations of short term MSTs. Matlick worked in Cambodia for three years as a health educator with the Peace Corps. He recounts of some projects that he participated in that both failed and succeeded. During his stay in Cambodia, he saw the many flaws that come from short term MSTs. In one instance, a MST had their volunteer give patients short term antibiotics and did not have a follow-up plan for after they left (Matlick, 2018). Matlick explains that MSTs that goes to an area that does not have a preexisting structure for healthcare then they have a harder time succeeding. Megan Alcauskas (2006) wrote about her time volunteering in Haiti for 3 weeks before she attended medical school. She worked at a clinic that mainly treated burns in which her job was to clean and badge such wounds. She first began to think of the ethical implications of her actions and the role of the clinic when she realized that the clinic operator did not attend medical school and if the clinic was in the United States he wouldn’t be allowed to do what he does in Haiti (Alcauskas, 2006). Alcauskas then began thinking about her participation and if she had actually done any good while she was there. Jennifer Bellows recounts a story during her time in Peru while she was mentoring a group of medical students. Once word had gotten around that she was a doctor, citizens began to ask to see her. She write about how a man told her that he was given antibiotics (with English instructions) for his abdominal pain by a group of doctors who had stayed in the area for a short time (Bellows, 2014). She states that the antibiotic given should have only been given after lab tests because of the harmful side effects of the medication. In this case, no such lab test was given. In another article, it relayed a story about how an pre-med student had participated in a MSTs in a Central American community and performed a pelvic exam there, a procedure that she would never had been allowed to do if she was in the United States (Cole, 2016). Assistant anthropology professor Melissa Melby responded by saying that the student should held to the same restrictions in foreign countries that she does in her home country. All of these stories show some hidden flaws that MSTs have.   

Immanuel Kant, philosopher

 Ethical Questions and Philosophical Perspectives

Many ethical questions arise when looking at short term MSTs. The first being “are you enacting power over a community that you are not a part of?” This question is pertinent because many of these organizations facilitate MSTs to low- or middle-income countries. Many of which are located in the Global South whereas the medical volunteers are largely from the Global North. Many of the countries that MSTs take place have a history of European colonialization in which the effects are still seen today. Due to the history of colonization, some fear that the involvement from medical volunteers are a form of neo-colonization (Bauer, 2017).  There has also been a history of western doctors believing that their western medicine is far superior to all other types. Another question to arise is “are you the best for the job?” This is a question arises because MST volunteers come from various education and experience levels. Even MST volunteers who are professional medical doctors may work outside of their practice and expertise in these conditions. There have been cases where medical volunteers have done tasks that they are not licensed to in their own countries which brings about a criticism that the patients are being used as experiments. This notion has deep roots in colonization as well in which people of color were seen as “less than” and have been experimented on as test subjects. The question of “are you the best for the job” also pertains to the sustainability of MSTs. It has been shown that the sustainability is low to non-existent when it comes to MSTs.

           According to the utilitarian perspective, the goal is to complete the most amount of good for the most amount of people. In this case, the sheer number of people that are reached by MSTs volunteers would be argued as being ethically “good”. Also, some MSTs are performed in areas where the citizens would not have been able to get medical attention if not for MSTs due to lack of access to healthcare clinic in the area. However, if the unintentional consequences of MSTs are calculated into the perspective, then this would not be ethical in the utilitarian perspective. The freedom/universal rights perspective values the autonomy of people and their universal rights. It emphasizes choice and freedom of choice. From this perspective, the people who are volunteering for these MSTs make that choice of their own free will. If they do make the choice freely and the people they serve also freely choose to use their services then there is no ethical quarrel. However, in the cases that there is a language barrier and the patient is not fully understanding of the situation or the level of experience the health care volunteer has, then the patient’s universal rights are not being respected. The patient’s universal rights are also not valued when the medical volunteer performs their duties that they are not cleared for in their own countries. On the other hand, the volunteers themselves may not have full autonomy over their actions either due to religious or academic obligations in which case they feel obligated or pressured into participating in a MST. Virtue ethics is the perspective that simply seeking to do “good” acts means that you are a “good” person. From this perspective, those who participate in MSTs believe that they are doing good and thus according to virtue ethics it is a good act. However, for those student volunteers who are participating in order to gain more experience or have a more appealing resume, the it would not be considered an act of “goodness”. This also brings to question of whether or not MSTs that promote voluntourism would be considered “good”. According to the virtue perspective, if the intent of the volunteer is still to do good, then it should not matter if they also participate in touristic activities as well.

Conclusion

Medical Service Trips are expensive, short-term, and don’t address the root causes of health care issues in the countries that are visited. There are numerous scholarly articles calling for a termination of MSTs and putting more efforts into making more long-term solutions. Such as helping the low- or middle- income countries visited to enhance their own health care services instead of performing short-term solutions. Some call for the cooperation of the religious, government, non-government, and academic organizations to work together and create long-term solutions. Due to there being no one agency in which all organizations that facilitate MSTs are under, there is a lack of overall unified, appropriate set of guidelines for how the trips should be and who should be allowed to participate. There needs to be more research into how to develop a more efficient and ethical approach to MSTs/medical missions, whether it be a creation of universal guidelines or complete eradication. According to the various ethical perspectives, MSTs are performed with intent for good, but the unintended consequences are what makes them arguably unethical.

References

Alcauskas, M. P. (2006). From Medical School to Mission: The Ethics of International Medical Volunteerism. AMA Journal of Ethics, 8(12), 797–800. https://doi.org/10.1001/virtualmentor.2006.8.12.fred1-0612.

Bauer, I. (2017). More harm than good? The questionable ethics of medical volunteering and international student placements. Tropical Diseases, Travel Medicine and Vaccines, 3. https://doi.org/10.1186/s40794-017-0048-y

Bellows, J. W. (2014, September 5). Medical missions are set up with good intentions, but do little to help developing countries. Washington Post. Retrieved from https://www.washingtonpost.com/opinions/replace-short-term-medical-missions-with-long-term-local-investment/2014/09/05/2c72b232-3232-11e4-9e92-0899b306bbea_story.html

Cole, D. (2016, February 11). The Risks (And Unexpected Benefits) Of Sending Health Students Abroad. Retrieved November 18, 2019, from NPR.org website: https://www.npr.org/sections/goatsandsoda/2016/02/11/465428990/the-risks-and-unexpected-benefits-of-sending-health-students-abroad

Matlick, G. L. (2018). Short-Term Medical Missions: Toward an Ethical Approach. AJN The American Journal of Nursing, 118(4), 11. https://doi.org/10.1097/01.NAJ.0000532052.89405.cb

Olakanmi, O., & Perry, P. A. (2006). Medical Volunteerism in Africa: An Historical Sketch. AMA Journal of Ethics, 8(12), 863–870. https://doi.org/10.1001/virtualmentor.2006.8.12.mhst1-0612.

Sykes, K. J. (2014). Short-Term Medical Service Trips: A Systematic Review of the Evidence. American Journal of Public Health, 104(7), e38–e48. https://doi.org/10.2105/AJPH.2014.301983

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