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Volunteers in Plastic Surgery Guidelines for Providing Surgical Care for Children in the Less Developed World: Part II. Ethical Considerations

Schneider, William J. M.D.; Migliori, Mark R. M.D.; Gosain, Arun K. M.D.; Gregory, George M.D.; Flick, Randall M.D., M.P.H.

Plastic and Reconstructive Surgery: September 2011 - Volume 128 - Issue 3 - p 216e–222e
doi: 10.1097/PRS.0b013e31822213b4
Special Topics: Special Topic

Background: Many international volunteer groups provide free reconstructive plastic surgery for the poor and underserved in developing countries. An essential issue in providing this care is that it meets consistent guidelines for both quality and safety—a topic that has been addressed previously. An equally important consideration is how to provide that care in an ethical manner. No literature presently addresses the various issues involved in making those decisions.

Methods: With these ethical considerations in mind, the Volunteers in Plastic Surgery Committee of the American Society of Plastic Surgeons/Plastic Surgery Foundation undertook a project to create a comprehensive set of guidelines for volunteer groups planning to provide this type of reconstructive plastic surgery in developing countries. The committee worked in conjunction with the Society for Pediatric Anesthesia on this project.

Results: The Board of the American Society of Plastic Surgeons/Plastic Surgery Foundation has approved the ethical guidelines created for the delivery of care in developing countries. The guidelines address the variety of ethical decisions that may be faced by a team working in an underdeveloped country. These guidelines make it possible for a humanitarian effort to anticipate the types of ethical decisions that are often encountered and be prepared to deal with them appropriately.

Conclusions: Any group seeking to undertake an international mission trip in plastic surgery should be able to go to one source to find a detailed discussion of the perceived needs in providing ethical humanitarian care. This document was created to satisfy that need and is a companion to our original guidelines addressing safety and quality.

Knoxville, Tenn.; Minneapolis and Rochester, Minn.; Cleveland, Ohio; and San Francisco, Calif.

From Fort Sanders Regional Medical Center; Abbott Northeastern Hospital; the Department of Plastic Surgery, Case Western Reserve University; the Departments of Pediatrics and Anesthesia, University of California, San Francisco; and the Department of Anesthesiology, Mayo Clinic College of Medicine.

Received for publication December 18, 2010; accepted January 28, 2011.

Disclosure: The authors have no financial interests or commercial associations related to this study. No outside sources of funding were required.

Arun K. Gosain, M.D.; Department of Plastic Surgery, Case Western Reserve University, University Hospitals of Cleveland, MS 5044, 11100 Euclid Avenue, Cleveland, Ohio 44106,

©2011American Society of Plastic Surgeons