CASE 5: Addressing "Ancillary Benefits"

Conclusion
As Dara’s case demonstrates, questions of "ancillary benefits" – benefits that are needed but might be outside the intended scope of a short-term training experience – are likely to arise during such experiences. The simple fact that the benefits are outside the scope of a training experience does not imply they should not be considered. But, trainees should also be aware that inappropriately offering ancillary benefits can create burdens on, or long-lasting harms to, the local community.

This brief case cannot cover all possible ethical issues that might arise in relation to "ancillary benefits".  Awareness that ethical issues do occur is the first step toward dealing with them. Thus we can offer a brief framework, under the acronym AAA: anticipate, ask, and act.

Trainees, sending and host institutions, and sponsors should all anticipate that these issues will arise - often unexpectedly. When they do, trainees should ask local advisors and colleagues about how best to proceed. This demonstrates mutual respect through collaboration. As Dara learned, locals often have faced the same issue before and might have a solution in hand. When solutions do not yet exist, trainees might act with the local community to develop a long-term solution.

Additional Resources

This case has focused on "ancillary benefits" in short-term work abroad in the practice or service setting. Participants in this series might be interested in a similar issue in the research setting, which has been termed “ancillary care”. We purposely chose "ancillary benefits" to differentiate the practice questions from those encountered in research, although the two often intermingle. In contrast to "ancillary benefits", "ancillary care" focuses on delivering care when doing so is not necessary for the scientific validity of a project, for ensuring safety, or for dealing with research-related injuries. Many of the issues raised are similar, though the research context is obviously different.

Some relevant resources to pursue this topic in depth include:

• Belsky L. and Richardson HS. Medical researchers' ancillary clinical care responsibilities. BMJ. (2004) 19;328(7454):1494-6.


• Dickert N. and Wendler D. Ancillary care obligations of medical researchers. JAMA 2009; 302(4): 424-428.  


• Brownsword R. et al. The ancillary-care obligations of medical researchers working in developing countries. PLoS Med. 2008; 20:5(5):e90.


• Merritt M.W., Taylor H.A., Mullany L.C., Ancillary Care in Community-Based Public Health Intervention Research. Am J Public Health 2010; 100:211–216.