Ethical Considerations and Guidelines for Cardiothoracic Surgery Global Health Initiatives

1. Responsibility to the patient is paramount and requires that surgeons should:

  1. offer procedures to patients who have a reasonable chance of benefitting from them, based not only on their diagnosis and condition but also on the resources and personnel available;
  2. operate within their normal scope of practice, and ensure that other practitioners do so as well;
  3. if performing the operation, personally evaluate the patient before surgery, explain the surgery (with a competent interpreter if necessary), and care for the patient after surgery;
  4. respect decisions made by family members or community leaders rather than the patient in areas of the world where such decision making is the cultural norm.

2. Responsibility to the local providers and to all other local stakeholders requires that the visiting medical team should:

  1. emphasize teaching and empowering the local staff;
  2. allow a limited number of visiting trainees (usually one or two) to participate as observers, but participate actively only if no appropriate local personnel are available;
  3. provide service-only initiatives without efforts at teaching or program building only in unusual circumstances;
  4. clearly outline program organization and goals in advance for all stakeholders, including local providers, ministries of health, and others, and should develop plans in keeping with local needs and priorities;
  5. respect local norms, priorities, and customs.

3. Responsibility to volunteers and other participants requires that the visiting team leaders should:

  1. clarify for all members of the visiting team the time investment and sources of funding for travel expenses and any needed salary support;
  2. make available information that allows participants to align their own priorities and goals with those of both the humanitarian organization and the specific cardiothoracic surgery global health initiatives;
  3. provide volunteers with pre-departure education that includes information regarding logistics, available resources, local personnel, and cultural norms;
  4. identify staff or seasoned volunteers who can serve as resources for questions and concerns while in the country;
  5. debrief staff and volunteers after the trip whenever possible.

4. Responsibility to donors and other payers requires that surgeons within the cardiothoracic surgery global health initiatives organization should ensure that:

  1. fund-raisers give prospective donors honest and transparent information in advance regarding local needs, goals, and expected results, including both patient outcomes and program building;
  2. all sponsors are informed of the results after completion of each cardiothoracic surgery global health initiatives, including clinical outcomes, local team education, and lessons learned; sponsors should be provided with links to or copies of local media reports of the initiative.


Adopted: November 13, 2019 (STS Executive Committee)