Ethical Challenges in Short-Term Global Health Training

Cheyenne later learns that Dr. Siti has a medical condition for which treatment is unavailable locally. Click image to start video.

CASE 7: Shifting Resources

Vignette 2: After some discussion with Dr. Siti and the local community, it became clear that individuals would be unable to just use their "spare time," and that for now, a tobacco use intervention project was unlikely to be an efficient or sustainable priority. Dr. Siti had considered it out of concern the money would otherwise "go to waste."  Instead, Cheyenne and her advisor at her home institution identify another way to spend the funds on a tobacco use intervention study elsewhere.

As Dr. Siti and Cheyenne come to know each other better, Cheyenne learns that Dr. Siti has a medical condition for which treatment is unavailable locally. Dr. Siti asks Cheyenne if she can make a referral to a physician back in her home country, where the necessary treatment is widely available.

How should Cheyenne respond?

It depends on how expensive the treatment is.
Cost might be the main issue for availability in Dr. Siti’s home country, but this is not the main issue here. This would be an inappropriate basis upon which to decide. Choose a different answer.
It would never be appropriate to refer Dr. Siti; doing so shows disrespect to locals for whom no such professional connection makes a referral possible.
Although it might show disrespect to other community members, the local community might also support such a referral for their beloved health care provider. Choose a different answer.
Cheyenne should promise Dr. Siti that she will find a way to get her the treatment she needs.
Making a promise she might not be able to keep would be unwise.  Choose a different answer.
Cheyenne should not promise anything but should agree to take the medical records back with her.
Although Cheyenne acts rightly by not making overt promises, she should be cautious in how this action could be interpreted. Dr. Siti might still see it as a promise. Choose a different answer.
None of the above.
This is correct. Rather than any of the above, Cheyenne should consider discussing this issue as soon as possible with her advisor at home for further advice. In the interim she should avoid making false promises or rejecting Dr. Siti’s request outright.


© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)