ABOUT THIS BOOK

In recent years, international medicine has become a growth industry. International aid organizations, religious organizations, and medical schools all provide opportunities for health care workers to travel to developing countries to provide needed medical care to the world’s poorest citizens. Ethics for International Medicine explores the many challenges faced by these medical aid workers from the West: They serve in settings with limited medical supplies, facilities, and personnel. Their patients speak different languages, have different cultures, and may even have different interpretations of disease. With limited time in which to provide medical care to hundreds of people or more, ethical dilemmas abound, and many health care practitioners, both novice and expert, are unprepared to manage them. This volume uses a series of cases studies to provide medical aid workers with a method for identifying, analyzing, and resolving ethical issues within the context of international medicine. It is an invaluable tool for individuals and health organizations seeking to serve in developing countries throughout the world.

AUTHOR BIOGRAPHY

ANJI E. WALL, MD, PhD, is a resident in general surgery at Vanderbilt University. She earned her PhD in health care ethics at St. Louis University, with a focus on clinical ethics and international medicine. She has participated in international medical experiences in Guatemala and Jamaica.

REVIEWS

“Dr. Wall has given us an eminently readable, practical, and relevant guide to thinking ethically about international medical missions.”—Family Medicine

TABLE OF CONTENTS

Acknowledgments • INTRODUCTION: Approaching Ethical Issues in International Medicine • International Medicine • The Context of International Medicine • What Is an Ethical Issue? • Approaching Ethical Issues • Applying the Approach • MEDICAL FACTS • Different Medical Conditions • Case 1.1: Vesico-Vaginal Fistula Repair Surgery - Language Differences • Case 1.2: Informed Consent for Tubal Ligation Surgery - Communication Barriers • Case 1.3: Fall from a Mango Tree - Different Medical Beliefs • Case 1.4: Sorcery and Tuberculosis -Traditional Healers • Case 1.5: Bush Thoracotomies • GOALS AND VALUES • Different Goals • Case 2.1: Aggressive Neonatal Resuscitation - Different Organizational Goals • Case 2.2: Research Participation - Conflicting Values among Stakeholders • Case 2.3: An Infant with Cholera - Conflicting Individual Values • Case 2.4: Evacuating a Dangerous Area - Competing Cultural Values • Case 2.5: Providing Supplies for Female Genital Mutilation • NORMS, Disagreements about Bioethical Norms • Case 3.1: Veracity and the Dying Patient - The Challenge of Justice • Case 3.2: A Young Boy with AIDS - Competing Professional Norms • Case 3.3: Medical Student Involvement - Different Professional Norms • Case • 3.4: Rural Outreach Clinics - Different Legal Norms • Case 3.5: Amputation for Sharia Law • LIMITATIONS • Limited Resources • Case 4.1: Chronic Hypertension - Limited Access to Health Care • Case 4.2: Treating Tuberculosis - Limited Medical Personnel • Case 4.3: Protracted and Obstructed Labor - Limited Time • Case 4.4: Ear Camp - Multiple Limitations • Case 4.5:Postoperative Care for Cleft Lip and Palate Surgery • EPILOGUE • The Complexity of International Medicine • Practical Use of Case Methodology • Preparation and Reflection • A Note on Organizational Structure • The Promise of International Medicine • Notes • Bibliography • Index