Ethical Dilemmas in Global Plastic Surgery

This interactive panel of world leaders in ethics and global surgery will explore dilemmas in global plastic surgery outreach through the ethical framework of justice, autonomy, non-maleficence, and beneficence.  The free panel will present different perspectives on a variety of humanitarian models including short-term mission trips, disaster relief, educational outreach, and research collaboration.

Learning Objectives:

  1. Increase awareness of divergent perspectives on the ethics of global plastic surgery outreach.
  2. Understand the need for a collaborative framework for understanding ethical dilemmas in humanitarian outreach.
  3. Discuss real life examples of diverse ethical dilemmas in global plastic surgery outreach.


Introduction: What is Global Surgery (10 min.)

Amanda Gosman, MD, FACS (Co-Moderator)
VIPS Committee Chair
Professor and Chief UCSD Division of Plastic Surgery

Redeeming Global Surgery - The Ethical Dilemma of Short Term Surgical Missions (10 min.)

Prem Yohannan, MBBS, MS (Ortho), FCS (ecsa), FACS
   Senior Specialist Surgeon, Ministry of Health, Mozambique
Director of Post Graduate Education in Orthopaedic Surgery

Dr. Prem Yohannan studied at the Armed Forces Medical College, University of Pune, India, from where he completed his MBBS degree in 1996. He did his Masters in Orthopaedic Surgery at the King George’s Medical College, Lucknow. At the turn of the millennium, he volunteered to work in Mozambique. He works for the Ministry of Health, Government of Mozambique and teaches Orthopaedic Surgery at the Eduardo Mondlane School of Medicine. His interests are in Joint Replacements, Trauma surgery, Surgical Education and Global Surgery. He represented Mozambique on the College of Surgeons of East Central and Southern Africa (COSECSA) Council from 2013 to 2019 and regularly examines on behalf of the College.

He is the first editorial board member from the Southern African Development Community (SADC) for the Annals of African Surgery. He is the winner of the 2018 International Surgical Education Scholar award, given by the American College of Surgeons.

A Basic Ethical Framework of Principles and its Application to Global Surgery (10 min.)

Michael Dunn, BA, MA (Cantab.), PhD, PGDipLaTHE, SFHEA
Associate Professor, Nuffield Department of Population Health, University of Oxford; Director of Undergraduate Medical Ethics and Law Education, Clinical School; Director of the Ethox Centre's Graduate Research Training Programme in Bioethics; Research Fellow, Wellcome Centre for Ethics and Humanities, University of Oxford

Professor Michael Dunn has worked at the Ethox Centre since 2009. He was awarded a BA in geography from the University of Cambridge and he received his PhD in 2009. His doctoral research was undertaken in the Department of Psychiatry, also at Cambridge, and focused on the law, ethics and practice of residential care work for adults with intellectual disabilities.

He works on ethics in health care, social care and research. His current research interests focus predominantly on various ethical aspects of community-based and long-term care practice, policy and law- in the UK and internationally. He has authored over 80 peer reviewed journal articles and chapters.

Ethical Dilemmas in Global Plastic Surgery: Divergent Perspectives of Local and Visiting Surgeons, Results of an International Survey (10 min.)

Anna Schoenbrunner, MD, MAS
Plastic and Reconstructive Surgery Resident, PGY 4, The Ohio State University Wexner Medical Center

Anna Schoenbrunner is a PGY4 plastic and reconstructive surgery resident at The Ohio State University. Dr Schoenbrunner has research experience categorizing the ethical dilemmas of global plastic surgery collaborations. She plans to pursue a Masters in Bioethics to further support her research interests on this topic.

Discussion Panel  (15 min.)


Ethical Dilemmas in Quality, Scope of Practice and Global Standard of Care (10 min.)

Roba Khundkar, MA(Camb), BMBCh(Oxf), MRCS(Eng), FRCS(Plast), DipHandSurg(EBHS)
Senior Clinical Lecturer in Global Surgery, Nuffield Department of Surgical Sciences, University of Oxford; Consultant Plastic and Reconstructive Surgeon; Associate Oxford University Medical Education Fellow

Dr. Roba Khundkar is a Consultant Plastic and Reconstructive Surgeon and Senior Clinical Lecturer in Global Surgery. After graduating from Oxford University, she completed her core and higher surgical training in the Southwest and Oxford Deaneries respectively. She has undertaken additional fellowship training in Oxford, India and Japan in Sarcoma, Limb Reconstruction, Microsurgery and Super-microsurgery.

Khundkar has a specialist interest in sarcoma epidemiology and management. As a founding member of the Global Anaesthesia, Surgical and Obstetric Collaboration (GASOC), she served as Secretary to the committee. She has a special interest in supporting surgical training programmes in LMICs. She is involved with research and training collaborations with surgical and academic units in Tanzania, South Sudan, the Middle East, Egypt and Bangladesh. She is currently involved in surgical care in active conflict zones and displaced populations.

Ethical Dilemmas in Global Disaster Relief Efforts (10 min.)

Nobhojit Roy, MBBS, MS, MPH
Chief of Surgery, BARC Hospital; Commissioner on the Lancet Commission for Global Surgery; Professor for Public Health

Nobhojit Roy (MD, MPH, PhD) trained as a general and trauma surgeon in Mumbai, India, and the UK. He also holds a MPH from John Hopkins University in Baltimore, USA, and a PhD from the Karolinska Institutet in Stockholm, Sweden, on injury epidemiology, trauma registries and health systems in resource-poor settings.

Roy was Professor and Chief of Surgery at BARC Hospital, HBNI University (Government of India), which provides universal health care to 100,000 people in suburban Mumbai. His department is the designated WHO Collaborating Centre for research in surgical care delivery in the LMICs (SEARO region), which focuses on accessibility, burden of disease, preventable deaths and outcomes of NCDs.

Thereafter, he was the National Advisor, Public Health Planning and Evidence, at the think tank of the Indian Ministry of Health & Family Welfare (MoHFW) of the National Health Systems Resource Centre (NHSRC).

Currently, Roy is the Director of the Health Systems Strengthening team at CARE-India, which is the technical support and resource unit to the Health Department of the state of Bihar with a population of 110 million. He has been one of the Lancet commissioners for Global Surgery (2013-2015) (www.lancetglobalsurgery.org) and for NCD and Injuries for the poorest billion (2015-2020) (ncdipoverty.org).

Ethical Dilemmas in Global Academic Collaboration and Research (10 min.)

Faith Muchemwa, MBCHB, PhD, FCS, COSECSA
Consultant Plastic Surgeon Harare, Zimbabwe; Founding Member of Women in Surgery Africa (WISA)

Dr. Faith Muchemwa is one of only two plastic surgeons in Zimbabwe. Her primary areas of academic interest are skin cancers, congenital conditions and body contouring. Dr. Muchemwa earned a bachelor of medicine and surgery (MBCHB) at the University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. She has earned a PhD in molecular biology at Kumamoto University in Japan. Dr Muchemwa is a fellow of the College of Surgeons East Central and Southern Africa (FCS, COSECSA) with a specialty in plastic surgery.

Discussion Panel (15 min.)


Collaborative Development of an Ethical Framework for Global Surgery (10 min)

Regan Guilfoyle, MBCHB, PhD, FCS, COSECSA
Assistant Director, Office of Global Surgery in the Department of Surgery, Division of Plastic Surgery, University of Alberta

Dr. Regan Guilfoyle is a pediatric plastic surgeon and director of the Office of International Surgery. She grew up in Manitoba but lived in both the Caribbean and South America prior to her undergraduate studies. She completed a degree in environmental sciences at McGill University and then returned to Manitoba to complete her medical degree at the University of Manitoba. She trained as a resident in plastic surgery at the University of Alberta and later trained as a fellow in pediatric plastic surgery at the University of British Columbia.

Guilfoyle has in interest in community and service development in under-served populations. She worked for one year as a volunteer assistant coordinator for literacy project in Georgetown, Guyana and volunteered at drop-in center for children, in downtown Winnipeg, during her medical school training. She is very excited to be involved in developing the international surgery program at the University of Alberta.

Summary and Discussion (10 min.)

Next steps
Additional Education: Shared articles and resources

Moderator Bios

Amanda A. Gosman, MD, is a board-certified plastic surgeon who specializes in pediatric and adult craniofacial surgery. Dr. Gosman is Chief of the Division of Plastic Surgery at UC San Diego School of Medicine, where she also directs the the Craniofacial Fellowship Program.  Dr. Gosman completed her fellowship in craniofacial and pediatric plastic surgery and her residency training at the University of Texas Southwestern.

She also completed a one-year fellowship in international plastic surgery with ReSurge International. She earned her bachelor’s degree from Cornell University and her medical degree from Case Western Reserve University.  Dr. Gosman has extensive experience providing health care and education around the world. In 2010 Dr. Gosman created a non-profit organization, ConnectMed International to improve access to surgical care and support sustainable healthcare through education, partnerships, telemedicine, and research.

She has authored multiple publications and given lectures internationally on craniofacial surgery, cleft lip and palate surgery, and international health.  She has served in many national leadership roles including the Chair of the Ethics Committee and Chair of the Judicial Committee for the American Society of Plastic Surgeons.

Joyce McIntyre, MD, is a board-certified plastic surgeon and Assistant Professor of Surgery, Pediatrics and Neurosurgery in the Division of Plastic Surgery at the University of Massachusetts Medical School and Associate Program Director of the UMass Integrated Plastic Surgery Residency.

McIntyre's clinical interests include complex craniofacial disorders in children and adults and quality and outcome measures in global plastic surgery.  Her practice at UMass includes the robust use of telemedicine to care for patients who otherwise would have limited access to reconstructive plastic surgery.

McIntyre received her undergraduate degree from Harvard College and earned her medical degree from the University of Massachusetts Medical School. She completed an integrated plastic surgery residency at the University of Massachusetts Medical School and the craniofacial and pediatric plastic surgery fellowship at Rady Children’s Hospital San Diego and the University of California San Diego.

More To Explore