The Ethics of Medical Brigades in Honduras: Who are we helping?

The current thesis poses a focused critique and ethical analysis of medical brigades as they currently operate in Honduras. The first chapter defines the concept of medical brigades and provides an account of their presence and actions within Honduras. The second chapter addresses the need for a theoretical framework with which to ethically analyze the endeavors of these brigades. Due to an insufficient amount of attention and scrutiny, no authoritative standard yet exists for evaluating the ethics of developed countries providing health care interventions in developing countries. In order to overcome this challenge, the current thesis creates a hybrid framework by looking to established codes of conduct from several pre-existing models of engagement with potentially vulnerable populations, all of which have already addressed some pertinent aspect of medical brigades. Through examining the principles, ethics and relevance of the doctor-patient relationship, Standard of Care debates and Community-Based Participatory Research, this thesis places certain obligations on medical brigade participants and their affiliated organizations, which must to be fulfilled in order for their actions to be considered ethical. In the third chapter, I maintain that medical brigades fail to fulfill these obligations based on the harms they pose to the communities and community members they serve. Fundamentally, these brigades pose a risk because of their short-term nature that does not provide accountability or follow-up care, nor addresses community-relevant health care needs. Finally, the fourth chapter demonstrates the ways in which the developed world can improve upon this model and carry out ethical health care interventions in the developing world, specifically by avoiding these harms and fulfilling the aforementioned obligations. To facilitate this discussion, I will present the Shoulder to Shoulder model, the Community-Oriented Primary Care model and SEED-SCALE as ethical alternatives to the medical brigade model. These examples collectively provide a solid platform on which to base a much needed change in the current medical brigade model, and a bright future for the direction of health care provided by volunteers in developing countries