This post, written by Reverend Professor Luboga, is in response to a series of discussions about ethical dilemmas in global health, with responses from one global health leader in the Global South and one in the Global North. Please leave us your feedback in the comments section below, and send us ethical dilemmas you would like to see discussed, or your responses to those already posted.
Compiled by Dr. Majid Sadigh, Trefz Family Endowed Chair in Global Health at WCHN and Director of Global Health at UVMLCOM, and edited by Mitra Sadigh, Editor of Global Health Diaries.
Thank you for sharing these ethical dilemmas. If I may comment:
In regard to the first ethical dilemma in which the visiting student watches a patient endure spasms while approaching a death that could be prevented by a drug that is unavailable and/or unaffordable: It is always difficult for anyone to watch a patient, especially a young one, die. However, it can be particularly emotionally traumatic for a visiting student. I believe the student should desist from doing any such thing as prescribing medication. The student should, however, be given an opportunity for emotional support, counsel, and adequate debriefing. These structures of support help put this experience in perspective within the challenging context of a resource-limited environment.
In regard to the second ethical dilemma in which the visiting student encounters a young patient with a disease that can be cured by being admitted to the Intensive Care Unit (ICU), but doing so would render the family bankrupt: I would, as the attending medical specialist, explain to the patient’s relatives what would be done for the patient in the ICU and what benefits and limitations would be expected for the patient in that setting, as well as the costs that would be incurred. I would then inform them of the palliative care option and leave them to make a decision as to whether or not to incur the cost of the ICU. I would avoid appearing as if I am discouraging them from putting their loved one in the ICU, as such discouragement may leave patient relatives with the impression that we physicians are insensitive and do not have the patient’s well-being at heart.
Both cases offer an excellent opportunity to ponder these very difficult ethical issues. Thank you.