Ethical Challenges in Short-Term Global Health Training

In the first vignette, he learned that different cultures and communities communicate the "truth" differently. Not all apparent conflicts about "truth telling" turn out to be real conflicts.

In the second vignette, he learned something closely related: In short-term programs abroad, trainees should recognize that who tells the truth can be just as critical as what is contained in the message. Locals and others who know a community well are more likely to know how the truth is communicated; they are also more likely to be trusted by those in the community.

In the final vignette, Jeffrey realized, quite to his surprise, that the themes about truth telling do not just arise with respect to "clinical" diagnoses. How a community understands the truth can affect other parts of short-term programming as well (such as health related educational interventions, as in this case).

Of course, in some instances, a trainee may find him or herself in a situation where the "truth" really is in conflict. Such situations were not examined in this case. Although ensuring these conflicts are real (as noted in vignette one) is a first step, we encourage trainees to work closely with their advisors, sending and host institutions, and sponsors to deal with these difficult situations. They admit of no simple solution.
Nonetheless, trainees, sending and host institutions, and sponsors can help ensure a successful and productive short-term training program by being alert to the complexity of "truth telling."

Please provide feedback on this case: Telling the "Truth"
Completing the brief survey will allow you to print a Certificate of Completion.

Additional Resources

Gostin LO. Informed Consent, Cultural Sensitivity And Respect For Persons. JAMA 1995; 274: 844-845

Guven T. Truth-telling in cancer: examining the cultural incompatibility argument in Turkey. Nurs Ethics. 2010; 17(2):159-66.

Kazdaglis G.A., Arnaoutoglou C., Karypidis D., Memekidou G., Spanos G., Papadopoulos O. Disclosing the truth to terminal cancer patients: a discussion of ethical and cultural issues. East Mediterr Health J. 2010; 16(4):442-7.

Li L., Sun S., Wu Z., Wu S., Lin C., Yan Z. Disclosure of HIV status is a family matter: field notes from China. J Fam Psychol. 2007; 21(2):307-14.

Pang M.C. Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. J Med Ethics. 1999; 25(3):247-53.

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Ethical Challenges in Short-Term Global Health Training
Homepage About the Case Series Cases Developing Cultural Understanding Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Ensuring Personal Safety Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Exceeding Level of Training Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Ensuring Sustainable and Appropriate Benefits Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Addressing "Ancillary Benefits" Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Recognizing Burdens Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Shifting Resources Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Telling the "Truth" Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Selecting a Research Project Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Understanding Informed Consent for Research Introduction Vignette 1 Vignette 2 Vignette 3 Conclusion Additional Resources (pdf) Acknowledgements and Funding Contact Us	CASE 8: Telling the "Truth" Conclusion In this case, Jeffrey has learned just how complex the "truth" can be. In the first vignette, he learned that different cultures and communities communicate the "truth" differently. Not all apparent conflicts about "truth telling" turn out to be real conflicts. In the second vignette, he learned something closely related: In short-term programs abroad, trainees should recognize that who tells the truth can be just as critical as what is contained in the message. Locals and others who know a community well are more likely to know how the truth is communicated; they are also more likely to be trusted by those in the community. In the final vignette, Jeffrey realized, quite to his surprise, that the themes about truth telling do not just arise with respect to "clinical" diagnoses. How a community understands the truth can affect other parts of short-term programming as well (such as health related educational interventions, as in this case). Of course, in some instances, a trainee may find him or herself in a situation where the "truth" really is in conflict. Such situations were not examined in this case. Although ensuring these conflicts are real (as noted in vignette one) is a first step, we encourage trainees to work closely with their advisors, sending and host institutions, and sponsors to deal with these difficult situations. They admit of no simple solution. Nonetheless, trainees, sending and host institutions, and sponsors can help ensure a successful and productive short-term training program by being alert to the complexity of "truth telling." Please provide feedback on this case: Telling the "Truth" Completing the brief survey will allow you to print a Certificate of Completion. Additional Resources Gostin LO. Informed Consent, Cultural Sensitivity And Respect For Persons. JAMA 1995; 274: 844-845 Guven T. Truth-telling in cancer: examining the cultural incompatibility argument in Turkey. Nurs Ethics. 2010; 17(2):159-66. Kazdaglis G.A., Arnaoutoglou C., Karypidis D., Memekidou G., Spanos G., Papadopoulos O. Disclosing the truth to terminal cancer patients: a discussion of ethical and cultural issues. East Mediterr Health J. 2010; 16(4):442-7. Li L., Sun S., Wu Z., Wu S., Lin C., Yan Z. Disclosure of HIV status is a family matter: field notes from China. J Fam Psychol. 2007; 21(2):307-14. Pang M.C. Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. J Med Ethics. 1999; 25(3):247-53. Click Next to proceed…