Ethical Considerations in Global Heart Surgery

Abstract

Consideration of the ethical questions that arise in the context of global cardiac surgery can help us to more readily recognize and avoid obstacles to collaborative work and program development. One question that often arises concerns whether and when scarce resources should be allocated to heart surgery, which may seem expensive relative to other interventions. The growing recognition of the excess worldwide mortality that is associated with heart disease and other noncommunicable diseases, in combination with data based on cost effectiveness analysis, can form the scientific basis on which we can build an ethical evaluation of just resource allocation. Once a decision has made to invest in program establishment, ethical guidelines recently established by cardiothoracic surgical organizations can help navigate the working relationships between all stakeholders. These guidelines emphasize responsibilities toward the patients first, of course, but also include those toward local providers, volunteers, donors and other payors. Because establishment of sustainable programs is key to achieving a long term solution, teaching and mentoring local providers, and helping them to succeed, should almost always be the intentional focus of cardiothoracic global health initiatives, and visitors should attempt to avoid being perceived or presented as the “experts” or “heroes” to the detriment of the local health care team. Finally, differences in values and norms, particularly but not only regarding questions of end-of-life care, should be identified and discussed early, openly, and often, rather than being left to a moment of crisis.KeywordsEthicsGlobal healthCardiothoracic surgery