AMA Code of Medical Ethics' Opinions on International Health and Research

Although the AMA Code of Medical Ethics provides guidance primarily to physicians practicing in the US, these physicians are expected to uphold the Code's standard of professionalism when working internationally. Accordingly, the Code specifically addresses ethical issues related to physicians' conducting biomedical or behavioral research outside the US. By the same token, physicians practicing in the US are expected to uphold the Code's standard of professionalism regardless of their patients' national origins, and the Code specifically addresses safely discharging patients who are noncitizen immigrants. Opinion 2.077, "Ethical Considerations in International Research" [1], provides guidelines for physicians participating in research in countries with differing cultural traditions, health care systems, and ethical standards. Physicians have ethical obligations to ensure protection of research participants in several ways: first, they must ensure that the research protocol has been developed according to a sound scientific design. In fact, with certain exceptions, US investigators must obtain approval for such protocols from institutional review boards (IRBs) What are the specific participant protections addressed by Opinion 2.077? Opinion 2.077 specifies that IRBs-particularly, physicians who serve on them-must determine that the "ratio of risks to benefits is favorable to participants." The opinion states that when making this evaluation, the IRB "should obtain relevant input from representatives from the host country and from the research population." As with any research protocol, IRBs are required to protect the welfare of individual participants by ensuring that an appropriate and effective informed consent process will take place. In order for the information presented to be meaningful to the participants, it needs to be communicated in ways that are consistent with local language and customs. Opinion 9.121, "Racial and Ethnic Health Care Disparities" [3], while not discussing research per se, also touches on this point by noting that Participatory decision making should be encouraged with all patients. This requires trust, which in turn requires effective communication. Physicians should seek to gain greater understanding of cultural or ethnic characteristics that can influence patients' health care decisions

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• Medical Deportations and Racial Narratives of the Burdensome Migrant

  Open Access•Lisa Sun-Hee Park•American Behavioral Scientist•2022

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