Ethical issues in global health placements: Reflections on personal experience

Benjamin Tassie1, Bronwen Morrell2,

1 St Vincent’s Hospital, Sydney, 390 Victoria Street, Darlinghurst, Sydney 2010
2 Centre for Values, Ethics and the Law in Medicine, Level 1, Medical Foundation Building, K25, University of Sydney, NSW 2006

In recent years global health ethics has begun to address ethical issues emerging from short-term global health placements of health practitioners. This includes issues arising from short-term medical volunteerism by doctors and other health professionals, medical student global health electives, and other forms of global health outreach work. For over a decade St Vincent’s Hospital Sydney has been sending Senior Resident Medical Officers to Gizo Hospital, Solomon Islands as part of a joint initiative with the Honorary Consul for the Solomon Islands. In 2015 I spent 10 weeks in Gizo Hospital as part of this initiative. The experience was educational, inspirational, and incredibly challenging. In this presentation I will describe my experiences, outline the challenges and complexities I faced in my day-to-day life and work in the Solomon Islands, and discuss the ways in which these experiences highlight the ethical issues of such programs. I will then promote discussion amongst conference attendees about these ethical issues, the ways in which practitioners participating in these programmes might be best prepared and supported, and the role such programmes might play in promoting global health advocacy.


Biography

Over the last four years, Benjamin has been working as a medical officer at St Vincent’s Hospital in Sydney. He has recently returned from a 10 week placement in Gizo Hospital, Solomon Islands where he managed the emergency department and conducted outreach clinics. He is currently completing his masters in bioethics at the University of Sydney.

Bioethics, advocacy and activism

Wendy Rogers 1, Heather Draper 2, Jackie Leach Scully 3, Greg Moorlock2

1 Macquarie University, NSW 2109, wendy.rogers@mq.edu.au
2 University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

3 Newcastle University, Newcastle upon Tyne, Tyne and Wear NE1 7RU, UK

In this paper, we explore what counts as advocacy and activism in bioethics, and why academic bioethicists may be reluctant activists. There are several recent and current examples of human rights and other abuses within biomedicine and public health, such as credible and mounting evidence that Chinese prisoners of conscience are reverse matched and killed on demand for their organs. How do, and should, bioethicists who become aware of such events respond?

Activism and advocacy may include: i) overt activism in which an individual’s standing as an academic bioethicist adds credibility to their whistle blowing, such as Carl Elliott’s advocacy for the late Dan Markingson, or Peter Singer’s animal rights work and recent effective altruism advocacy; ii) stealth advocacy, e.g. by quietly promoting gender equity policies within one’s institution; and iii) advocacy and activism conducted as a private citizen.

Given the emotive nature of many of the topics tackled by bioethics there is surprisingly little overt advocacy (type i). Why might this be so? First, some issues are framed as political rather than bioethical, apparently ruling them out of scope. Second, professional fatigue or burn out may discourage individuals from taking up bioethical as opposed to other kinds of advocacy as private citizens. Third, institutional pressures generated by conflicts of interest can be powerful dissuaders. There may be concerns about real or perceived loss of academic distance and impartiality if identified as activist, or fear that one’s academic credibility may be undermined. Fourth, advocacy seems a poor fit with prevailing metrics for evaluating academic performance. Finally, there is a potential tension between scholarship and advocacy, given the prima facie commitment of professional bioethicists to explore ideas and concepts without prior commitment to particular outcomes.

We will conclude, with some provisos, that bioethics should include elements of advocacy and activism.


Biography

Wendy Rogers works across a range of topics in clinical, research and philosophical bioethics. Her current research interests include the definition of disease and the ethics of overdiagnosis, the ethics of surgical innovation and research, and vulnerability. Her interest in bioethics advocacy stems her grounding in feminist ethics, and includes concerns about conflicts of interest in medical research and clinical care, and more recently, organ harvesting.

Decision-making on behalf of a person with dementia? How do surrogates do it?

Deirdre Fetherstonhaugh1, Linda McAuliffe1, Michael Bauer1, Christopher Shanley2, Elizabeth Beattie3

1 La Trobe University, Bundoora, Victoria 3086 d.fetherstonhaugh@latrobe.edu.au
2 University of New South Wales, Kensington, New South Wales 2052
3 Queensland University of Technology Victoria Park, Kelvin Grove, 4059 Brisbane, QLD, Australia.

As the severity of dementia increases the decision-making capacity of a person with dementia has been shown to decrease. The person with dementia will eventually reach a stage where they are no longer able to make decisions for themselves. At this point, major decisions (e.g. moving into residential care, being transferred to hospital from residential care, consenting to an operation, and deciding on end-of-life care) become the responsibility of someone else, typically a family member or a legally appointed surrogate.

The research reported here explored: how surrogate decision-makers make decisions on behalf of a person with dementia (that is respecting the person’s precedent autonomy or determining their current best interests); whether they feel they need support in making these decisions and; if so, what types of support and means of support delivery are preferred.

The study was informed by Grounded Theory Methodology. Thirty-four semi-structured interviews were undertaken with surrogate decision-makers of a person with dementia (either legally appointed or else recognised as the ‘person responsible’) who had already made a major life decision on behalf of a person with dementia.

A mix of surrogate decision-making methods was reported, and included both the substituted judgement and the best interest standard, which were applied to a range of situations in which a major decision had been made.

Surrogate decision-makers use a variety of ways to make decisions on behalf of a person with dementia most often in the absence of an advance care directive. The research highlighted a need for greater support to assist surrogate decision-makers through what is often a complex and confronting process. This presentation will also discuss recommendations on how surrogate decision-makers of people with dementia can be better supported in their role.


Biography

Dr Deirdre Fetherstonhaugh is the Director of the Australian Centre for Evidence Based Aged Care (ACEBAC) at La Trobe University, Melbourne, Australia. Her research focuses on: the translation and implementation of research evidence into practice; the ethical implications of clinical practice; decision-making in dementia; sexuality and dementia; clinical risk in residential aged care; and the reality of person-centred care. Deirdre is also a member of several human research ethics committees.

About the Association

The Australasian Association of Bioethics and Health Law (AABHL) was formed in 2009.

It encourages open discussion and debate on a range of bioethical issues, providing a place where people can ask difficult questions about ideas and practices associated with health and illness, biomedical research and human values.

The AABHL seeks to foster a distinctive Australasian voice in bioethics, and provide opportunities for international engagement through its membership, journal and conferences.

Members come from all the contributing humanities, social science and science disciplines that make up contemporary bioethics.

Many members have cross-disciplinary interests and all seek to broaden the dialogues in which all members of the wider community ultimately have an interest.

The AABHL is a supportive, creative and challenging community that provides a rich source of continuing academic refreshment and renewal.

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