The patient-physician relationship is based on trust, which can be difficult to achieve in a foreign country in a short encounter; however, it is the responsibility of the otolaryngologist to develop the best possible relationship with the patient, who is entrusting her/his health to someone from another country. Confidentiality of patients’ personal health information can still be important to them, even in rural regions of developing countries. Surgical care should be provided to an individual regardless of gender, religion, race/ethnicity, social status, or personal situation.
Explore this issue:July 2016
In the United States, four ethical principles are integral to patient care—autonomy, beneficence, nonmaleficence, and social justice. We tend to hold autonomy in the highest regard, perhaps reflecting the fact that our country was founded on a belief in personal free will. This is often not the cardinal ethical principle in other countries, where decisions may be made by other family members. While we strive for beneficence in caring for our patients, medical missions require at least an equal emphasis on nonmaleficence—“first, do no harm.” You cannot have a bad outcome on an inappropriately selected surgical patient and then leave the patient to be cared for by others in the host country. Therefore, a good case exists for making nonmaleficence and social justice the primary ethical principles that guide us in our conduct of medical missions. That is not to say we should minimize our efforts to help patients and allow them to make their own health decisions—rather, it is this author’s opinion that we should not leave a person’s health worse than when we arrived to “help.”
Short-term medical missions can be altruistic and contribute to the improvement of health in both treated individuals and a local community. Proper mission planning prior to travel can generate goals and guidelines that will usually lead to a successful mission. Identifying the appropriate host otolaryngologist,
understanding the status of the host facilities and equipment, and learning the capabilities of the facility staff are all very important. The country’s culture and folkways must be studied so that the team will understand the proper manner of interaction with patients, families, and staff. Appropriate patient selection is critical and must be coherent with the expertise of the surgical team and the capabilities of the host facility. At all times, compassion, honesty, integrity, trustworthiness, and professionalism must be foundational to the care of patients. Ethical principles must be adhered to, and the dyad of beneficence and nonmaleficence must be balanced or favored to “do no harm.” Medical missions can be personally and professionally rewarding, potentially changing the lives of individuals who might not otherwise have that opportunity.