Ethical Challenges in Short-Term Global Health Training

Sam then receives a call from a friend who is interested in donating an old reverse osmosis machine. Click image to start video.

CASE 4: Ensuring Sustainable and Appropriate Benefits

Vignette 3: Sam has learned three important lessons so far about appropriate benefits:

  1. Whether a perceived benefit will be an actual benefit for a patient may be difficult to discern.

  2. Benefits should be responsive to local circumstances.

  3. In some cases, knowing how best to distribute benefits can be challenging. For example, Sam struggled with whether to give non-standard ciprofloxacin to the child rather than saving it, e.g., for a different patient with diarrhea.

Sam realizes his knowledge is growing, particularly when a friend calls to tell him that he’d like to donate an old reverse osmosis machine to aid with water sanitation in the area.

Sam asks his friend a few insightful questions. All of them are appropriate, except for one. Choose the INAPPROPRIATE answer.

"Have we asked the local community about this?"
This is an appropriate question. Remember that it is important to ensure the community desires a particular donation. Choose a different answer.
"Is this technology appropriate? Electrical power is inconsistent here." 
This is an appropriate question. Sam is worried that the reverse osmosis machine is not feasible for use in this community. Choose a different answer.
"Does the machine meet donor country safety standards? I am worried about setting a double standard." 
This is an appropriate question. Sam is worried that the donated “old” item no longer meets accepted standards in the donor country. While one might accept some variations in quality, those involving safety and efficacy are generally inappropriate (e.g., expired or outdated drugs). Choose a different answer.
"Is it free?"
This is an inappropriate question. Although cost might be important, the main issue here is not whether it is free. In fact, local communities might desire to pay a share for certain donated items. Sam should avoid this preconceived notion.
"How can we ensure its sustainability? Don’t these machines require frequent membrane changes?"
This is an appropriate question. Sam astutely questions whether the benefit is sustainable for the local community. Choose a different answer.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)