Principles of Health Care Ethics often clash or contradict one another. In an article reported by NPR, an American missionary with no medical training went to Uganda and set up a clinic for malnourished children. (Gharib, Aizenman, 2019) Although her motivations for trying to help children in the poverty-stricken rural areas of Jinja were no doubt beneficent, she arguably did more harm than good in assuming the duties of a health professional. In this aspect, she was in violation of another ethical principle: malfeasance.
The (then) 20-year-old missionary who took it upon herself to provide medical assistance is Renee Bach, who is currently being sued in Ugandan civil court. She allegedly admitted 940 malnourished children into her clinic and treated them to the best of her high school graduate abilities, resulting in 105 deaths. Many of the children had serious comorbidities that made treating them a delicate and challenging matter; a matter that should’ve only been undertaken by a hospital. (Gharib, Aizenman, 2019)
Bach regularly wrote about her missionary work in a blog that contributed to her donations. In her blog she writes, "I hooked the baby up to oxygen and got to work. Took her temperature, started an IV, checked her blood sugar, tested for malaria, and looked at her Hb count. I was attempting to diagnose the many problems that could potentially be at hand. Got it: Malaria: positive. H.B. 3.2. ... a big problem ... most likely fatal. ... She needed a blood transfusion. And fast." (Gharib, Aizenman, 2019, para. 33) When interviewed, she told NPR that when she had written “I,” she was referring to the medical personnel that she had hired. However, a supporter who had been taking photos in the clinic had captured an image of Bach inserting an IV catheter into a child herself.
This article brings into focus that beneficence and malfeasance don’t always go hand-in-hand. Bach showed beneficence in wanting to help malnourished children in Uganda. However, in choosing to ignore her lack of medical training to serve the population, she opposed malfeasance, and did, in fact, do harm.
Gharib, M., Aizenman, N. (2019, August 9) American with no medical training ran center for malnourished Ugandan kids. 105 died. NPR’s All Things Considered.Retrieved from https://www.npr.org/sections/goatsandsoda/2019/08/09/749005287/american-with-no-medical-training-ran-center-for-malnourished-ugandan-kids-105-d
I remember when this NPR news story aired. What is so devastating about what Ms. Bach did was not only did she impersonate healthcare personnel, but she was liable for the deaths of 105 individuals. Though many of the patients seeking refuge in this clinic were not in good physical shape, they made an autonomous decision to put their trust in Ms. Bach for medical treatment she was not ethically, morally, or more importantly licensed to provide. Ms.Bach did not provide just care and did not provide the Ugandan people a fair distribution of the advantage and disadvantage of an actual clinic with trained personnel.
ReplyDeleteMs. Back was quoted as saying "It was a very, very profound feeling and experience. It's kind of hard to even describe in words," she says. "Like there was something that I was supposed to do" (Gharib, Aizenman, 2019). Ms. Bach's "calling from God" (Gharib, Aizenman, 2019) to set up a charity in Jinja to feed stabilized malnourished people initially seemed promising for the individuals who were sent to her charity in good faith that they were stabilized and on the verge of recovery with a balanced and sustainable diet. However, once Ms. Bach started receiving patients who were not only malnourished but who were clearly suffering from other illnesses, she had a responsibility to send those patients to the right place for treatment. Instead, she opened up an unlicensed medical clinic. When you think of the biomedical principles, everything Ms. Bach did was wrong. She thought she was bringing utility to the Ugandan people, however she deceived them by pretending to be a medical care provider and giving false hope that these people stood a chance in her care. Though her intentions were beneficent, Ms. Bach failed to disclose, failed to provide non-malfeasance, did not provide justice to those she was serving and took advantage of the autonomy of desperate individuals who were at Bach's "clinic" under false pretenses. For someone who wanted to do God's work by helping others, she in my opinion based on her violation of the ethical principles did just the opposite.
Wow, I did not hear about this story when it aired but it is awful to think that this could happen today. I agree with Christa, that Ms Bach directly violated non-malfeasance, despite that being her intention. Than you Alexandra for your comment, it helped to contextualize the Ms Bach's mindset for her decision making. Despite this being a"calling from God" (Gharib, Aizenman, 2019), a passion should never avoid or disregard the proper steps put into place to keep people safe. For instance, the proper step being working to go to medical/nursing/PA school first. It was selfish of her to assume that she was an exception. Also, I wonder how she was able to fund the project?Who also financially helped her start a medical practice without a degree and were there people in Ms Bach's life that tried to stop her? This is an excellent example of separating beneficence and non-malfeasance through the acts of ignorance. Thanks Christa!
ReplyDeleteThe is a tragic story about a woman who went beyond her medical abilities to try to save lives. While I do not think what Ms. Bach did was right, I also do not think is as black and white as it might appear to be.
ReplyDeleteUganda’s healthcare system is ranked 186th out of 191 nations by the world health organization (WHO, 2009). In 2017, the average life expectancy was 55.9 years old (The World Factbook, 2017). In comparison, Rwanda’s and Kenya’s life expectancies were 64.3 year old (The World Factbook, 2017). This is almost a full ten more years for countries that share borders with Uganda. Ms. Bach originally went to Uganda to help children who were malnourished. However, when confronted with children who might not have access to treatment elsewhere, I understand her desire to do something more.
Central Intelligence Agency, The World Factbook (2017). Retrieved September 22, 2019, from https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html
World Health Organization (2009). Retrieved September 22, 2019, from https://www.who.int/gho/publications/world_health_statistics/en/