Ethical Considerations for Clinical Care on Short Term Medical Missions in Low- And Middle-Income Countries: A Scoping Review

Abstract

Intro: Despite short term medical missions (STMMs) to low- and middle-income countries (LMIC) becoming increasingly popular, ethical considerations for the provision of clinical care on STMMs are poorly defined. Clinicians are often unprepared to adapt care and ethical precepts to resource limited environments. There may be discord in interpretation of ethical principles between visiting providers and hosts. Clinical care provision has direct impact on the health of patients and communities and there is a need for guidelines regarding ethical clinical care. Methods: Scoping review of the literature published from 2001-2021 restricted to English language identified 3072 records discussing ethical considerations of provision of clinical care on STMMs. Records were screened by title, abstract and finally full text by independent reviewers resulting in 40 records for inclusion. Results: Thirteen themes were identified as important considerations for provision of ethical clinical care on STMMs. These themes included: collaboration/longitudinal relationship, education, lack of follow up, cultural barriers, needs assessment/goal setting, capacity building, outcome evaluation, pre-departure preparation, scope of practice, resources allocation, detriment to local systems, bidirectionality, and formal ethical review. From these themes a list of guidelines is outlined. Conclusion: While ideally clinical care on STMMs would be regulated by formal ethical review boards this is difficult to develop and enforce. Independent STMMs must evaluate their approach to clinical care in LMICs. Care should be given to focusing on collaboration, education, follow up, cultural barriers, and performing a needs assessment/goal setting. These efforts may be guided by the checklist included within.