Ethical Concerns in Medical Volunteering
Why volunteering abroad in a health setting may not always be ethical
By Rose Greer
Having a desire to travel abroad and serve others is oftentimes part of an altruistic desire to “give back” - but when untrained pre-professional medical students participate in medical procedures they are not trained in nor licensed to perform, they are causing more harm than good. These actions are often justified by the thought that in developing countries, any amount or quality of medical care is better than nothing. This view is not only wrong, but extraordinarily dangerous and has led to enormous growth in unethical medical volunteering.
A booming industry has sprung up around volunteer travel opportunities, commonly referred to as “voluntourism.” These types of trips draw in individuals who, generally speaking, have a desire to help others or gain experience for their future career that they cannot gain in their home country. Many of these trips are medically focused, aimed at addressing the vast and complex issue of inadequate health care that persists in many developing countries. Some of these organizations advertise with a line that goes something like: “all you need is the desire to help!” While the desire to travel and serve a community during a short-term trip is honorable, one must be cognizant of the potential impacts of working with an organization that may not follow ethical medical volunteering practices. Otherwise, the results of these types of short-term medical volunteer trips can be counterproductive, and even cause harm to the very people they are claiming to help.
One of the most notable and widely recognized ethical issues surrounding short-term medical trips is allowing unqualified volunteers, be they students or professionals, to work in clinical settings and perform medical exams, give vaccines, and at times even deliver babies.
The ethical violations in situations like these are abundant. Allowing untrained and unqualified volunteers to practice medical procedures on vulnerable populations is never ethical. Not only does it relegate those patients to a lower quality care, it can cause great harm. Misdiagnoses and inexpert treatment lead to a greater potential for complications and the need for further medical treatment--treatment that may not be available to them. Even licensed medical professionals from other parts of the world run the risk of causing harm through misdiagnosis due to lack of familiarity with the context, culture, and language. Medical professionals who intend to practice medicine while abroad should be licensed or authorized by their host government and ideally should practice in collaboration with or under the supervision of local medical professionals who know the local diseases, culture, language, and medical care contexts.
In addition, allowing volunteers from western nations to deliver medical care abroad disregards the local health systems already in existence. Ultimately, the short-term medical missions detract from the development of long-term, consistent, locally-responsive, accountable, and sustainable medical care and the resources used to fund these trips could be more appropriately spent investing in the local healthcare infrastructure.
While volunteering, including in the realm of global health, can be a great way to immerse yourself in another culture, gain a deeper understanding of the world, or positively impact those living in the region, not all volunteer trips are created equal. Here are some tips to help identify if a trip you’re considering is going to help the community in an impactful and sustainable way.
What to look for before going abroad with a volunteer organization:
- The volunteers are providing human resources or technical knowledge not otherwise available to the communities they’re working with. This might take the form of teaching the staff a computer program that helps manage patient information, researching public health outreach techniques, or piloting a public health initiative designed with the community.
- The work the volunteers are doing builds off their personal skills and experiences that they bring to the table. In other words, they are qualified to be doing the work they are doing.
- The organization emphasizes and utilizes the strengths and knowledge of the local community. The work they’re doing builds on and improves upon the existing health systems already providing care to the community.
- The organization educates its volunteers in regional history, medical challenges, global health disparities, and cultural differences to give volunteers a rounded understanding of the environment in which they are working.
- The organization has a sustained commitment to the community they are working in, providing continuity of care and services. They treat the people they’re working with as equals in a reciprocal relationship.
- The organization does not permit volunteers to perform any medical task they are not licensed to perform in their country of service.
Signs that you might want to look into another volunteer organization:
- The organization allows volunteers to perform medical procedures for which they are not properly trained or qualified (i.e. giving vaccinations or performing medical exams)
- The organization allows volunteers to engage in any behavior that would be illegal for them to do in the US. It’s okay (awesome actually!) for volunteers to do things they don’t have the opportunity to do in the US, but it’s unethical to do things they are unqualified to do at home.
- The organization focuses primarily on the benefits the volunteer will receive, and not on how the work will benefit the community.
- The organization focuses primarily on short-term “results” (i.e. the number of procedures performed) without measuring the actual impact over longer periods of time.
- The organization pays no attention to how short-term volunteers impact the local health system.
Ethically speaking, the quality of care provided to individuals living in countries with minimal health care infrastructure should be no lower than for those of us living in countries with more resourced highly developed healthcare systems. Hence, students, aspiring pre-meds, and even doctors practicing outside of their scope of focus should not be allowed to provide medical care as an act of charity. The crossing of international borders does not justify otherwise illegal and unethical practices, even if the intent to help is genuine. If you’re considering going on a medical volunteer trip, be sure to scope out the organization so you know that your time and effort are helping create lasting change.
If you are a professor working with students eager to go abroad and gain experience in the medical field, The Working Group on Ethics Guidelines for Global Health Training has established guidelines for field-based learning that are useful as you advise students. Additionally, Foundation for Sustainable Development is featured in Global Health Experiential Education, From Theory to Practice, which features best practices for ethical and safe international experiences in global health.