Questioning the Universality of Medical Ethics: Dilemmas Raised Performing Surgery Around the Globe (Essays‪)‬

Performing surgery in the developing world presents unique challenges and dilemmas for the visiting physician from an industrialized country. Language barriers, widespread, profound pathology, and lack of adequate facilities are obvious hurdles. A more subtle problem, though every bit as significant, is that the principles and procedures we routinely utilize at home to uphold ethical standards of care and to aid us in decision-making are often poorly applicable in the developing world. Acknowledging that cultural factors play a primary role in every aspect of their interaction with patients, physicians must scrutinize and even modify the tools they employ when attempting to deliver ethical care in foreign environments. Over the past two decades, I have routinely taken time from clinical practice to teach, practice, and perform eye surgery in remote locations. I've enjoyed the privilege of vastly broadening both my professional skills and global perspective while working with some of the most devoted and selfless health care workers I've encountered in my career. From Mongolia to points along the ancient Silk Route, to the deep Himalayas, to Southeast Asia, to sub-Saharan Africa, many of the locations where I've worked lack basic facilities including potable water, reliable electricity, and proper sanitation. Nearly all lack what an ophthalmologist considers requisite for even the most basic intraocular surgery: adequate illumination and magnification. If available at all, the precise instrumentation necessary to manipulate tissue within the eye is usually worn or broken due to overuse and repeated repair. Cutting instruments are blunt; forcep tips no longer meet. Disposable equipment acquired through donation is meticulously cleaned and reused far beyond its intended lifespan, and medications are routinely expired or implicitly understood to be the "best available." Surgical gloves and sutures are resterilized and used as long as possible. Dressings are ingeniously fashioned from material of every imaginable sort. Indeed, resourcefulness and ingenuity are the unique and necessary attributes of doctors and their staff throughout the developing world.