Advertisement

HEC Forum

, Volume 23, Issue 2, pp 115–127 | Cite as

Ethical Concerns Regarding Operations by Volunteer Surgeons on Vulnerable Patient Groups: The Case of Women with Obstetric Fistulas

  • L. Lewis Wall
Article

Abstract

By their very nature, overseas medical missions (and even domestic medical charities such as “free clinics”) are designed to serve “vulnerable populations.” If these groups were capable of protecting their own interests, they would not need the help of medical volunteers: their medical needs would be met through existing government health programs or by utilizing their own resources. Medical volunteerism thus seems like an unfettered good: a charitable activity provided by well-meaning doctors and nurses who want to give of their time, skills, and resources to help those who would not otherwise be able to take care of their medical needs. In this article, I argue that if medical volunteerism is to be “good,” however, it must always meet certain basic ethical requirements. These requirements may be (and perhaps often are) overlooked in the rush to organize and carry out short-term medical missions. I illustrate my point with special reference to short-term medical missions designed to provide surgical repair of obstetric vesico-vaginal fistula, a condition in which the tissues that normally separate the bladder from the vagina are destroyed by obstetric trauma, leading to continuous and unremitting incontinence in the affected woman.

Keywords

Ethics Medical missions Medical volunteerism Obstetric fistula Surgical ethics 

References

  1. Coleman, C. H. (2009). Vulnerability as a regulatory category in human subject research. Journal of Law, Medicine, and Ethics, 37(1), 12–18.CrossRefGoogle Scholar
  2. Council for Organizations of Medical Sciences (CIOMS). (2002). International ethical guidelines for biomedical research involving human subjects. http://www.cioms.ch/frame_guidelines_nov_2002.htm. Accessed 28 Jan 2010.
  3. Daniels, N. (2007). Just health: Meeting health needs fairly. Cambridge, MA: Cambridge University Press.Google Scholar
  4. Dumont, A., de Bernis, L., Bouvier-Colle, M. H., Breaart, G., & The MOMA Study Group. (2001). Caesarean section rate for maternal indication in sub-Saharan Africa: A systematic review. Lancet, 358(9290), 1328–1333.CrossRefGoogle Scholar
  5. Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), 1686–1691.CrossRefGoogle Scholar
  6. Fineman, M. A. (2008). The vulnerable subject: Anchoring equality in the human condition. Yale Journal of Law and Feminism, 20(1), 1–23.Google Scholar
  7. Gilligan, J. (1997). Violence: Reflections on a national epidemic. New York: Vintage Books edition.Google Scholar
  8. Kipnis, K. (2004). Vulnerability in research subjects: An analytical approach. In D. C. Thomasma & D. N. Weisstub (Eds.), The variables of moral capacity (pp. 217–231). Boston: Kluwer.Google Scholar
  9. Kottow, M. H. (2003). The vulnerable and the susceptible. Bioethics, 17(5–6), 460–471.CrossRefGoogle Scholar
  10. Nussbaum, M. (2001). Women and human development. Cambridge, MA: Cambridge University Press.Google Scholar
  11. Rawls, J. (1999). The idea of an overlapping consensus. In S. Freeman (Ed.), John Rawls: Collected papers (pp. 421–448). Cambridge, MA: Harvard University Press.Google Scholar
  12. Waaldijk, K. (1994). The immediate surgical management of fresh obstetric fistulas with catheter and/or early closure. International Journal of Gynecology and Obstetrics, 45, 11–16.CrossRefGoogle Scholar
  13. Wall, L. L. (2002). Fitsari ‘Dan Duniya: An African (Hausa) praise-song about vesico-vaginal fistulas. Obstetrics and Gynecology, 100, 1328–1332.CrossRefGoogle Scholar
  14. Wall, L. L. (2006). Obstetric vesicovaginal fistula as an international public health problem. Lancet, 368(9542), 1201–1209.CrossRefGoogle Scholar
  15. Wall, L. L., Arrowsmith, S. D., Briggs, N. D., Browning, A., & Lassey, A. T. (2005). The obstetric vesicovaginal fistula in the developing world. Obstetrical and Gynecology Survey, 60(Supplement 1), S1–S55.CrossRefGoogle Scholar
  16. Wall, L. L., Arrowsmith, S. D., & Hancock, B. (2009). Ethical aspects of urinary diversion for women with irreparable obstetric fistulas in developing countries. International Urogynecology Journal, 19(7), 1027–1030.CrossRefGoogle Scholar
  17. Wall, L. L., Arrowsmith, S. D., Lassey, A. T., & Danso, K. A. (2006). Humanitarian ventures or ‘fistula tourism’? The ethical perils of pelvic surgery in the developing world. International Urogynecology Journal, 17(6), 559–562.CrossRefGoogle Scholar
  18. Wall, L. L., Wilkinson, J., Arrowsmith, S. D., Ojengbde, O., & Mabeya, H. (2008). A code of ethics for the fistula surgeon. International Journal of Gynecology and Obstetrics, 101, 84–87.CrossRefGoogle Scholar
  19. World Medical Association. (2008). Declaration of Helsinki: ethical principles for medical research involving human subjects. http://www.wma.net/en/30publications/10policies/b3/index.html. Accessed 28 Jan 2010.

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Department of Obstetrics & GynecologyWashington University School of MedicineSt. LouisUSA

Personalised recommendations