Global Health Education Institute, University of Toronto, Toronto, and Department of Surgery, McMaster University, Division of General Surgery, Hamilton, Ontario, Canada.
World Neurosurg. 2013 Dec;80(6):751-8. doi: 10.1016/j.wneu.2013.02.087. Epub 2013 Mar 5.
Contributing to medical practice in developing countries has become increasingly prevalent. Primary care and preventative health initiatives have been most visible, although attention has recently shifted to surgical disease, which represents a large burden in resource-poor settings. Typically dominated by individual efforts, there is now a more concerted approach, with surgical care being included in the comprehensive primary health care plan set by the World Health Organization. Although ethical dilemmas in international surgery have been discussed sporadically in the context of specific missions from the visiting surgeon/team perspective, we are missing a comprehensive evaluation of these issues in the literature. Here we have chosen to systematically categorize ethical issues confronted while teaching and operating in a developing country into 2 broad categories: venue (i.e., host) and visitor related.
For each category, topics within follow an ordinal sequence that one might use when designing a surgical education mission. Illustrative examples are provided, as well as a depiction of the ethical principles or theories involved.
This article provides a discussion written from visiting and host surgeon perspectives on diverse ethical challenges for which there is limited literature, including location selection, unmet needs at home, role of sponsors, and personal gain. In addition to candid discussion and a solutions-focused approach, the reader is provided with an "ethical checklist" for international surgical education, akin to the World Health Organization surgical safety checklist, to serve as a framework for the design of surgical missions that avoid ethical pitfalls.
参与发展中国家的医疗实践变得越来越普遍。初级保健和预防保健举措最为明显，尽管最近的注意力已转移到外科疾病上，因为在资源匮乏的环境中，外科疾病负担很大。过去主要以个人努力为主，现在则有了更协调的方法，将外科护理纳入世界卫生组织制定的综合初级卫生保健计划中。尽管国际外科手术中的伦理困境在从访问外科医生/团队的角度讨论具体任务时曾零星地讨论过，但我们在文献中缺少对这些问题的全面评估。在这里，我们选择系统地将在发展中国家教学和手术时遇到的伦理问题分为两大类：主办国（即东道主）和来访者相关。
对于每一类，都会按照在设计外科教育任务时可能使用的顺序列出其中的主题。本文提供了从访问外科医生和主办国外科医生的角度对各种伦理挑战的讨论，这些挑战的相关文献有限，包括地点选择、国内未满足的需求、赞助商的角色和个人利益。除了坦诚的讨论和以解决方案为导向的方法外，还为读者提供了一份国际外科教育的“伦理检查表”，类似于世界卫生组织的外科安全检查表，作为设计避免伦理陷阱的外科任务的框架。
