Ethical Challenges in Short-Term Global Health Training

Dara is a medical resident who is doing a two-week rotation at an HIV clinic in the Caribbean. Click image to start video.

CASE 5: Addressing "Ancillary Benefits"

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This case will help trainees think through the ethical issues that arise when being asked to provide "ancillary benefits" – that is, benefits that might not be related to the original purpose of the training experience.

Consider the following vignette.

Vignette 1: Dara is a medical resident who is spending two weeks at an HIV clinic in the Caribbean. During a clinic session, a woman arrives with her husband. She appears to have a foot ulcer related to diabetes. She and her husband walked 3 miles to the clinic, and Dara notices that she does not have any shoes.

In this case, Dara is working at an HIV clinic, but notices that a woman with a foot ulcer needs shoes. She offers her own extra pair, which happens to fit the woman.

Do you think Dara should offer her shoes?

No. Dara works in an HIV clinic, and this falls outside the scope of her work.
Although compelling, identifying a single medical domain during a short-term training experience (for example, HIV) can be difficult. Most short-term experiences involve multiple goals, such as clinical care, infrastructure development, capacity building, and in some cases research. Therefore scope alone is unlikely to provide an answer for Dara. Choose a different answer.
No. This woman is probably not the only one who needs shoes. By giving her shoes, Dara set a bad precedent and builds expectations of all outside visitors to "donate".
This answer correctly identifies a real worry – that Dara might cause long-term consequences to her team and the local community long after she leaves. However, worry over precedent alone should not prevent Dara from considering the very real need identified in this case. She may be able to meet the need in a more reasonable manner. Choose a different answer.
Yes. Dara can meet this need at little cost to herself. She should give away her shoes.
It is true that the cost of shoes to Dara might be minimal compared to the need. Nonetheless she should consider how best to accomplish this task. Choose a different answer.
Perhaps. But before she does so, she should consider asking her local advisor how best to accomplish her goal.
This is the best answer. Before simply giving away her shoes, Dara should consult with her local advisors and collaborators regarding how such an action could be construed.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)