A Bioethical Critique of Short-Term Medical Service Trips


Short-term Medical service trips (MSTs) involve students with minimal medical training travelling abroad to gain healthcare experience and improve the health of the host community (HC). They have become increasingly popular in the United States and Canada, with approximately one third of medical graduates having completed a MST. MSTs are marketed as both charitable missions and experiential learning opportunities. Because these trips are seen as an act of charity, their ethical implications are often left unexamined. However, many practices involved in MSTs may directly oppose the principles of biomedical ethics. Due to communication barriers and the inherent power differential between volunteers and patients, volunteers may undermine the autonomy of patients. Additionally, although volunteers have the intention to benefit patients, their lack of training may lead them to inadvertently harm patients. Finally, the short-term nature of many MSTs, and the pressures they place on host countries may reinforce barriers to global healthcare equity. This essay argues that MSTs should not be considered inherently ethical, but rather that they deserve careful critique.


1. Wallace LJ. Does Pre-Medical “Voluntourism” Improve the Health of Communities Abroad? [Internet]. Journal of Global Health Perspectives. 2012 [cited 2017 Mar 15]. Available from: http://jglobalhealth.org/article/does-pre-medical-voluntourism-improve-the-health-of-communities-abroad-3/

2. Dental and Medical Mission Trips for Volunteers | International Medical Relief [Internet]. International Medical Relief. [cited 2017 Apr 1]. Available from: http://www.internationalmedicalrelief.org/

3. Medical Internships Abroad - Gap Medics [Internet]. Gap Medics US. [cited 2017 Apr 1]. Available from: https://www.gapmedics.com/

4. International Opportunities | UCLA Volunteer Center [Internet]. [cited 2017 Apr 1]. Available from: http://volunteer.ucla.edu/international-opportunities

5. Maki J, Qualls M, White B, Kleefield S, Crone R. Health impact assessment and short-term medical missions: a methods study to evaluate quality of care. BMC Health Serv Res. 2008 Jun 2;8:121.

6. Huish R. The Ethical Conundrum of International Health Electives in Medical Education. Journal of Global Citizenship & Equity Education [Internet]. 2012 Apr 27 [cited 2017 Mar 16];2(1). Available from: http://journals.sfu.ca/jgcee/index.php/jgcee/article/viewArticle/55/30

7. All Schools Reports - Graduation Questionnaire (GQ) - Data and Analysis - AAMC [Internet]. [cited 2017 Mar 16]. Available from: https://www.aamc.org/data/gq/allschoolsreports/

8. WHO | A Universal Truth: No Health Without a Workforce. 2014 Jun 3 [cited 2017 Mar 16]; Available from: http://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/

9. DeCamp M. Ethical review of global short-term medical volunteerism. HEC Forum. 2011 Jun;23(2):91–103.

10. Roberts M. A piece of my mind. Duffle bag medicine. JAMA. 2006 Apr 5;295(13):1491–2.

11. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. OUP USA; 2013. 480 p.

12. McLennan S. Medical voluntourism in Honduras: “Helping” the poor? Prog Dev Stud. 2014;14(2):163–79.

13. Kumwenda B, Dowell J, Daniels K, Merrylees N. Medical electives in sub-Saharan Africa: a host perspective. Med Educ. 2015 Jun;49(6):623–33.

14. Green T, Green H, Scandlyn J, Kestler A. Perceptions of short-term medical volunteer work: a qualitative study in Guatemala. Global Health. 2009 Feb 26;5:4.

15. Holland T. First, Do No Harm: A Qualitative Research Documentary [Internet]. Vimeo. Vimeo; 2011 [cited 2017 Mar 19]. Available from: https://vimeo.com/22008886

16. Pinto AD, Upshur REG. Global health ethics for students. Dev World Bioeth. 2009 Apr;9(1):1–10.

17. Stone GS, Olson KR. The Ethics of Medical Volunteerism. Med Clin North Am. 2016 Mar;100(2):237–46.

18. Snyder J, Dharamsi S, Crooks VA. Fly-By medical care: Conceptualizing the global and local social responsibilities of medical tourists and physician voluntourists. Global Health. 2011 Apr 6;7:6.

19. Shah S, Wu T. The medical student global health experience: professionalism and ethical implications. J Med Ethics. 2008 May;34(5):375–8.

20. McCall D, Iltis AS. Health care voluntourism: addressing ethical concerns of undergraduate student participation in global health volunteer work. HEC Forum. 2014 Dec;26(4):285–97.

21. Petrosoniak A, McCarthy A, Varpio L. International health electives: thematic results of student and professional interviews. Med Educ. 2010 Jul;44(7):683–9.

22. Montgomery LM. Short-Term Medical Missions: Enhancing or Eroding Health? Missiology. 1993;21(3):333–41.

23. Sykes KJ. Short-term medical service trips: a systematic review of the evidence. Am J Public Health. 2014 Jul;104(7):e38–48.

24. Angell M. The ethics of clinical research in the Third World. N Engl J Med. 1997 Sep 18;337(12):847–9.

25. Perold H, Graham LA, Mavungu EM, Cronin K, Muchemwa L, Lough BJ. The colonial legacy of international voluntary service. Community Dev J. 2013 Apr 1;48(2):179–96.

26. Crump JA, Sugarman J, Working Group on Ethics Guidelines for Global Health Training (WEIGHT). Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010 Dec;83(6):1178–82.