Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
BMJ Glob Health. 2020 Apr 21;5(4):e002319. doi: 10.1136/bmjgh-2020-002319. eCollection 2020.
An unmet burden of surgical disease exists worldwide and is disproportionately shouldered by low-income and middle-income countries (LMICs). As the field of global surgery grows to meet this need, ethical considerations need to be addressed. Currently, there are no formal guidelines to help inform relevant stakeholders of the ethical challenges and considerations facing global surgical collaborations. The aim of this scoping review is to synthesise the existing literature on ethics in global surgery and identify gaps in the current knowledge.
A scoping review of relevant databases to identify the literature pertaining to ethics in global surgery was performed. Eligible articles addressed at least one ethical consideration in global surgery. A grounded theory approach to content analysis was used to identify themes in the included literature and guide the identification of gaps in existing literature.
Four major ethical domains were identified in the literature: clinical care and delivery; education and exchange of trainees; research, monitoring and evaluation; and engagement in collaborations and partnerships. The majority of published literature related to issues of clinical care and delivery of the individual patient. Most of the published literature was published exclusively by authors in high-income countries (HICs) (80%), and the majority of articles were in the form of editorials or commentaries (69.1%). Only 12.7% of articles published were original research studies.
The literature on ethics in global surgery remains sparse, with most publications coming from HICs, and focusing on clinical care and short-term surgical missions. Given that LMICs are frequently the recipients of global surgical initiatives, the relative absence of literature from their perspective needs to be addressed. Furthermore, there is a need for more literature focusing on the ethics surrounding sustainable collaborations and partnerships.
全球范围内存在着未得到满足的外科疾病负担，而低收入和中等收入国家（LMICs）承担了不成比例的负担。随着全球外科学领域的发展以满足这一需求，需要解决道德问题。目前，没有正式的准则可以帮助向相关利益攸关方告知全球外科学合作所面临的道德挑战和考虑因素。本范围综述的目的是综合现有关于全球外科学伦理学的文献，并确定当前知识中的空白。
对相关数据库进行了范围综述，以确定与全球外科学伦理学相关的文献。符合条件的文章至少涉及全球外科学中的一个道德考虑因素。采用扎根理论方法对内容进行分析，以确定纳入文献中的主题，并指导确定现有文献中的空白。
文献中确定了四个主要的伦理领域：临床护理和服务；教育和培训生交流；研究、监测和评估；以及合作和伙伴关系的参与。发表的文献主要涉及个体患者的临床护理和服务问题。发表的文献大多由高收入国家（HICs）的作者撰写（80%），且大多数文章以社论或评论的形式发表（69.1%）。发表的原创研究文章仅占 12.7%。
全球外科学伦理学文献仍然稀缺，大多数出版物来自 HICs，并且侧重于临床护理和短期外科学任务。鉴于 LMICs 经常是全球外科学倡议的接受者，需要解决其视角下文献相对较少的问题。此外，需要更多的文献关注可持续合作和伙伴关系周围的伦理学。
