A Qualitative Interview Study Exploring Ethical Issues Associated with International Surgical Teaching Collaborations in Ophthalmology
Saturday, September 21, 2024
11:30 AM – 12:30 PM CT
Location: Regency Ballroom B (First Floor)
Abstract: To address global health disparities, ophthalmologists have become involved in international surgical teaching collaborations (ISTCs), which are sustainable educational partnerships between visiting physicians from high-income countries (HICs) and local physicians from low- and middle-income countries (LMICs). This study will raise awareness of ethical issues associated with ISTCs and ways of addressing them. We conducted interviews with 18 ophthalmologists from the United States that have worked with ISTCs. Participants’ views on ethical issues associated with ISTCs clustered around three themes: patient autonomy, governance by organizations facilitating the ISTC, and competence of visiting providers from HICs. Related to patient autonomy, participants reported different levels of moral distress with adopting local cultural norms regarding informed consent, which is rooted in the larger discussion of moral universalism versus pluralism or relativism. We recommend recognizing that the Western understanding of patient autonomy can be expanded to include the patient’s decision to limit their own role in decision-making. We also encourage physicians to opt for medical maternalism, where the provider makes decisions based on a reasonable understanding of the patient’s values, instead of medical paternalism. For the governance theme, liability coverage was frequently unknown. For the competence theme, participants reported awareness and criticisms of incompetent physicians from HICs joining ISTCs with primary intentions other than reducing health disparities. This study, for the first time, synthesizes the experiences of American ophthalmologists involved in ISTCs reported in qualitative interviews. Through sharing these views, we hope to act as a catalyst for open communication among ophthalmologists involved in ISTCs.
Learning Objectives:
After participating in this conference, attendees should be able to:
Analyze and apply ethical considerations regarding the relationship between culture and patient autonomy for consent in certain low- and middle-income countries.
Understand the role of bi-directional learning and how to contribute to rather than compete with the existing health infrastructure in low- and middle-income countries during international teaching collaborations.
Evaluate the implications of incompetent physicians from high-income countries participating in international teaching collaborations and how organizations can better assess for competency.
Masih Ahmed, M.D. – Residency Program Director; Assistant Professor, Ophthalmology, Baylor College of Medicine; Cherie Fathy, M.D. – Ophthalmology – Wills Eye Hospital; Mary Majumder, J.D., Ph.D. – Dalton Tomlin Professor of Medical Ethics and Health Policy, Center for Medical Ethics and Health Policy, Baylor College of Medicine; Priya Sarlashkar, B.S. – Medical Student, UT Southwestern; Alex Young, M.D. – Ophthalmology – Boston University School of Medicine; Zaina Al-Mohtaseb, M.D. – Baylor College of Medicine