Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-24T09:46:29.878Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethics in humanitarian efforts: when should resources be allocated to paediatric heart surgery?

Published online by Cambridge University Press:  18 October 2018

Kathleen N. Fenton ,
Marcelo Cardarelli ,
Frank Molloy Open the ORCID record for Frank Molloy [Opens in a new window]  and
William M. Novick
Kathleen N. Fenton*
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA
Marcelo Cardarelli
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA
Frank Molloy
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA
William M. Novick
Affiliation:
William Novick Global Cardiac Alliance, Memphis, TN, USA
*
Author for correspondence: Kathleen N. Fenton, MD, MS, 14805 Maydale Ct. Silver Spring, MD 20905. Tel: +903 343 4140; Fax: +901 302 5000; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In countries with ample resources, no debate exists as to whether heart surgery should be provided. However, where funding is limited, what responsibility exists to care for children with congenital heart defects? If children have a “right” to surgical treatment, to whom is the “duty” to provide it assigned? These questions are subjected to ethical analysis.

Methods

Examination is initially based on the four principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. Consideration of beneficence and justice is expanded using a consequentialist approach.

Results

Social structures, including governments, exist to foster the common good. Society, whether by means of government funding or otherwise, has the responsibility, according to the means available, to assure health care for all based on the principles of beneficence, non-maleficence, and justice. In wealthy countries, adequate resources exist to fund appropriate treatment; hence it should be provided to all based on distributive justice. In resource-limited countries, however, decisions regarding provision of care for expensive or complex health problems must be made with consideration for broader effects on the general public. Preliminary data from cost-effectiveness analysis indicate that many surgical interventions, including cardiac surgery, may be resource-efficient. Given that information, utilitarian ethical analysis supports dedication of resources to congenital heart surgery in many low-income countries. In the poorest countries, where access to drinking water and basic nutrition is problematic, it will often be more appropriate to focus on these issues first.

Conclusion

Ethical analysis supports dedication of resources to congenital heart surgery in all but the poorest countries.

Keywords

EthicshumanitarianCHD
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 1 , January 2019 , pp. 36 - 39
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Fenton KF, Cardarelli M, Molloy F, Novick WM. (2018) Ethics in humanitarian efforts: when should resources be allocated to paediatric heart surgery?. Cardiology in the Young29: 36–39. doi: 10.1017/S1047951118001713

References

1. Dwyer, J. Global health and justice. Bioethics 2005; 19: 460–475.Google Scholar
2. Lopez, AD, Murray, CCJL. The global burden of disease, 1990–2020. Nat Med 1998; 4: 1241–1243.Google Scholar
3. Lozano, R, Naghavi, M, Foreman, K. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095–2128.Google Scholar
4. Dare, AJ, Grimes, CE, Gillies, R, et al. Global surgery: defining an emerging global health field. Lancet 2014; 384: 2245–2247.Google Scholar
5. Hunter-Smith, D. Equity and participation in outreach surgical aid. ANZ J Surg 2009; 79: 420–422.Google Scholar
6. Meara, JG, Leather, AJM, Hagander, L, et al. The Lancet Commission: Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386: 569–624.Google Scholar
7. Shrime, MG, Dare, A, Alkire, BC, Meara, JG. A global country-level comparison of the financial burden of surgery. BJS 2016; 103: 1453–1461.Google Scholar
8. Meara, JG, Hagander, L, Leather, AJM. Surgery and global health: a Lancet Commission. Lancet 2014; 383: 12–13.Google Scholar
9. United States Census Bureau. Retrieved from: https://www.census.gov/popclock/.Google Scholar
10. Higashi, H, Barendregt, JJ, Vos, T. The burden of congenital anomalies amenable to surgeries in low-income and middle-income countries: a modeled analysis. Lancet 2013; 381 (Suppl 2): S62.Google Scholar
11. Van der Linde, D, Konings, EE, Slager, MA, et al. Birth prevalence of congenital heart disease worldwide: a systemic review and meta-analysis. J Am Coll Cardiol 2011; 58: 2241–2247.Google Scholar
12. Beauchamp, T, Childress, J. Principles of Biomedical Ethics, 6th edn Oxford University Press, NY, USA, 2008.Google Scholar
13. Benatar, S, Brock, G. (eds). Global Health and Global Health Ethics. Cambridge University Press, NY, USA, 2011.Google Scholar
14. Leon-Wyss, JR, Veshti, A, Veras, O, et al. Pediatric cardiac surgery: a challenge and outcome analysis of the Guatemala effort. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2009; 12: 8–11.Google Scholar
15. Mill, JS. Utilitarianism: What Utilitarianism Is https://www.utilitarianism.com/mill2.htm.Google Scholar
16. Meara, JG, Leather, AJM, Hagander, L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Lancet 2015; 386: 569–624.Google Scholar
17. Wright, IG, Walker, IA, Yacoub, MH. Specialist surgery in the developing world: luxury or necessity? Anaesthesia 2007; 62 (Suppl 1): 84–89.Google Scholar
18. Jamison, DT, Breman, JG, Measham, AR, et al. (eds). Disease Control Priorities in Developing Countries, 2nd edn. Washington (DC): The International Bank for Reconstruction and Development/The World Bank. Oxford University Press, New York, 2006.Google Scholar
19. Disease Control Priorities Project: Using Cost-Effectiveness Analysis for Setting Health Priorities. World Bank, 2008, http://www.dcp2.org.Google Scholar
20. Global Program on Evidence for Health Policy. National Burden of Disease Studies: A Practical Guide, edn. 2.0. Geneva: World Health Organization, 2001.Google Scholar
21. Saxton, AT, Poenaru, D, Ozgediz, D, et al. Economic analysis of children’s surgical care in low- and middle-income countries: a systematic review and analysis. PLoS One 2016; 11: e0165480.Google Scholar
22. Pezzella, AT. Volunteerism and humanitarian efforts in surgery. Curr Probl Surg 2006; 43: 848–929.Google Scholar
23. Edwin, F, Tettey, M, Aniteye, E, et al. The development of cardiac surgery in West Africa: the case of Ghana. Pan Afr Med J 2011; 9: 15–21.Google Scholar
24. Disease Control Priorities Project Volume 1: Essential Surgery. World Bank, 2016 www.dcp-2.org.Google Scholar
25. Kant, I. Groundwork of the Metaphysics of Morals. Cambridge University Press, Cambridge, 2011.Google Scholar
26. DeCamp, M. Ethical review of global short-term medical volunteerism. HEC Forum 2011; 23: 91–103.Google Scholar
27. Ott, BB, Olson, RM. Ethical issues of medical missions: the clinician’s view. HEC Forum 2011; 23: 105–113.Google Scholar
28. Dwyer, J. Global health and justice. Bioethics 2005; 19: 460–475.Google Scholar
29. Chao, TE, Sharma, K, Mandigo, M, et al. Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Global Health 2014; 2: e334–e345.Google Scholar
30. Fenton, KN, Hernandez, S, Duarte, C, et al. Cost Effectiveness Analysis of Congenital Heart Surgery in Developing Countries. Sixth World Congress of Pediatric Cardiology and Cardiac Surgery, Cape Town, February 2013.Google Scholar