Do No Harm: Applying Medical Ethics to the Way we “Aid” the Third World

In looking back at the article written by Teju Cole, The White-Savior Industrial Complex, as well as classroom discussions about medical voluntourism, it struck me that a more sweeping solution may be needed to correct the errors in western views of charity. Ironically, I believe one possible answer lies right in front of us: we must apply traditional medical ethics to charity. Although somewhat clique, the values of Autonomy, Justice, Beneficence, and Non-maleficence can be more rigorously applies, not only to medical volunteerism, but to foreign aid as a whole.

The first value, Autonomy, is perhaps the most abused. While observing the plethora of volunteer organizations dedicated to aid in the third world, I have only rarely seen input from those who supposedly benefit. To be fair, autonomy does not mean ignoring the needs of other and abandoning them to fate. Rather, it implies that those supposedly benefiting from aid be given the freedom to make their own decisions regarding how much is required and to what extent. In some ways, this goes against the traditional narrative of aid. Decision making is typically left to “experts” from organizations like the International Monetary Fund who claim to know what is best for developing countries, despite their poor record. Not all organizations are equal in this sense and many of them, even the IMF, have had success endeavors that have improved the lives of millions of people for the better. However, the failures of the past cannot be ignored, especially when the warnings were coming from those being harmed by such practices.

The second value, Justice, has often been routinely ignored. In the medical sense, Justice implies that the benefits of ones labors will be equitably distributed across all sectors of society. In truth, the foreign aid given to developing countries often helps certain segments of the population while ignoring or harming others. In the aftermath of the devastating earthquakes that ravaged Haiti in 2010, the US donated massive amounts of food aid to the country, particularly in rice and powdered milk. While these efforts undoubtedly saved lives and thwarted starvation, the aid also crippled Haiti’s agricultural sector. The flooding of cheap, American rice and milk into the country made it impossible for the corresponding Haitian industries to compete. Many farmers lost everything and untold amounts of foodstuffs were wasted. Although such cause-and-effect relationships are hard to predict, I believe large-scale efforts to thwart humanitarian crisis should have contingency plans in place should their efforts yield unintentionally adverse side effects..

Perhaps most important of all are the twin values of Beneficence and Non-maleficence. Beneficence implies that any action undertaken is for the good of the recipient while non-maleficence is the famous directive to “do no harm.” In Scientific America’s article, The Trouble with Medical “Voluntourism” by Noelle Sullivan, a volunteer, known as Mary to protect her identity, egregiously violated both of these tenets. Mary lied about her medical experience and “violated obstetrics best practices, doing unnecessary episiotomies (cutting the skin between the vaginal opening and anus to make room for the baby’s head) and pulling breech babies (babies positioned bottom instead of head-first in the birth canal).” (Noelle) Not only did she lie about her inexperience for her own selfish interests, a violation of beneficence, she also performed unnecessary and dangerous procedures that were known for high complication rates, potentially causing undo harm to her patients.

Giving aid to ones fellow man is a noble endeavor. However, we cannot allow good intentions to blind us to consequences of our actions, particularly when they can have malicious outcomes. I don’t claim to be an expert in this field, nor do I know how to best implement the values I have listed above. All I can tell is what we are doing right now isn’t working and we must change the way think about charity to prevent dire situations from becoming worse.

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