By David Addiss
On a hot August morning along a dusty road near Leogane, Haiti, a farmer approached us, holding his sick infant daughter in his arms. His eyes met mine as he pleaded for help. The little girl was suffering from severe diarrhea. As a physician, I could see that she needed urgent hospital care. But my role in Haiti was as a filariasis researcher, not a clinician at the local hospital. I felt shame as a physician: I knew what the girl needed but I was paralyzed by my own insecurities and lack of medical preparedness, my ignorance of the local health system, our pressing research schedule, and the massive social, structural, and economic inequities that separated us.
Caught up with the research, which we hoped would someday benefit the entire population, we gave the man some money to take his daughter to the hospital and went on our way. I never saw them again. I never returned to ask the man about his daughter.
Several years later, in a very different setting, I helped to organize a small gathering of global health leaders at The Carter Center, in Atlanta. The meeting focused on the core values of global health, especially compassion. After two days of deliberations, these leaders concluded that, in its pursuit of health equity and social justice, global health is indeed rooted in compassion.
Global health is grounded in a deep awareness of our interconnectedness, and a concern with the health of all people – not only with the health of our friends or allies.
What happens when these high ideals of global health collide with the realities of global health funding, structural violence, and organizational imperatives – or with the schedule of a busy medical researcher whose narrow focus on a single disease renders him incapable of addressing the suffering of the person in front of him?
What happens when global health programs and organizations, which often focus on the health of populations, lose sight of the “faces” – the dignity and essential humanity – of individuals?
What are the unspoken, subconscious assumptions that underlie the tremendous popularity of short-term medical missions, student research projects, and “voluntourism?”
Why do our efforts to “do good” at the population level so often cause unintended harm to individuals?
Why are we so resistant to acknowledging and learning from these experiences?
How should we balance the many competing demands of the organizations we work for, the people whose health we seek to improve, and our own communities and families?
The field of global health ethics, which is still in its infancy, concerns itself with these and other questions. The extraordinarily broad scope of global health and its inextricable link to the forces of globalization raise crucial questions that go well beyond the purview of bioethics, which focuses on ethical issues in clinical medicine and research.
Global health ethics must also contend with the challenges of inequity, great cultural divides, power imbalances, ecological disaster, and armed conflict, as well as with the benefits and harm of public health interventions. The frameworks most commonly used in bioethics can be a useful starting point, but global health ethics must also draw on other sources, such as peacebuilding, human rights, anthropology, and an understanding of what matters most to individuals and their societies.
As with my encounter with the Haitian farmer illustrates, ethical dilemmas (and failures) are commonplace in global health. It is in the practice of global health that we become aware of ethical challenges and can explore their many facets and complex dimensions, with an eye to understanding and addressing these challenges with skillful means.
The Task Force for Global Health is launching a new Focus Area for Compassion and Ethics to deepen our understanding of ethical issues in global health and infuse our work with a renewed sense of urgency, clarity, and purpose.
In addition to offering seminars and consultations for our internal programs, we plan to build on the extensive experience of The Task Force in collaborating with external partners and convene stakeholders to deliberate on emerging ethical issues – particularly those that threaten progress toward global health goals.
The first such gathering was a workshop on ethical dilemmas in global health fieldwork, held in April 2018 at Agnes Scott College in Decatur, GA, co-sponsored with Agnes Scott College and the Rollins School of Public Health at Emory University. In addition to teaching global health ethics and speaking about the role of compassion in global health, we are conducting collaborative research on ethics and equity, as well as on moral distress, burnout, and resilience in the global health workforce.
We invite you to share your thoughts, experience, and ideas about ethical challenges in global health and on the role of compassion as a core value of our field. Send us your comments at firstname.lastname@example.org and visit www.taskforce.org/face for more information and updates.
David Addiss, MD, heads FACE and is a public health physician whose work has focused on the prevention and treatment of neglected tropical diseases. Addiss started his career as a medical practitioner in a migrant health clinic, and later joined the Centers for Disease Control and Prevention. He has been at The Task Force since 2011.