To the Editor:
Although your excellent February issue on global health presents a comprehensive picture of the work that North American academic health centers (AHCs) are doing worldwide, it would have benefited from a discussion of ethical issues in global health and the AHC's responsibilities.
Earlier this year, Weill Cornell Medical College (WCMC) sponsored a seminar entitled Health Care & Human Rights: A World in Need,1 exploring the role of AHCs in relation to the 60th anniversary of the Universal Declaration of Human Rights, which enshrines health care as a universal right.2
At WCMC, we have increasingly seen our responsibilities in global terms, with programs in Haiti, Tanzania, and other developing countries. In addition, we just conferred Cornell medical degrees upon the first graduating class at our WCMC branch in Doha, Qatar.3 Students from over 30 nations study medicine there as a scientific and humanistic discipline.3,4
The problems that North American AHCs encounter in advancing global health are vast. While extreme poverty, oppression, and lack of education are the very factors that inspire our commitment, they also create ethical dilemmas that warrant scholarly debate, including how to distribute scarce resources and enfranchise patient choice in cross-cultural settings.5
Lee Jong-wook, the late World Health Organization Director-General, once said that “[b]oth technical excellence and political commitment have no value … unless they have an ethically sound purpose.”6 Because extreme conditions challenge our ability to translate principles into practice, we must engage in ethical reflection so that vulnerable populations can be protected.5 Academic Medicine can lead in this reflective process by stimulating scholarship on the ethical responsibilities of AHCs in the face of globalization.
Joseph J. Fins, MD
Chief, Division of Medical Ethics, Weill Cornell
Medical College, New York, New York;
Oliver T. Fein, MD
Associate dean, Office of Affiliations and Global Health Education, Weill Cornell Medical College,
New York, New York
Antonio M. Gotto, Jr., MD, DPhil
The Stephen and Suzanne Weiss Dean, Weill Cornell Medical College, New York, New York
4 Fins JJ, Rodriguez del Pozo P. The globalization of education in medical ethics and humanities: Evolving pedagogy at Weill Cornell Medical College in Qatar. Acad Med. 2005;80:135–140.
6 Lee JW. Science and the health of the poor. Bull World Health Organ. 2003;81:473.