Exploring the ethical dilemma of medical volunteerism

In the past two decades, volunteer missions to low- and middle-income countries have gained popularity among medical professionals. Volunteerism is viewed as an important and ethical life choice for medical practitioners. However, these well-intentioned excursions can actually be problematic, as clinicians practice in places where they typically do not understand the context.

Simon Fraser University (SFU) health sciences professor Nicole Berry is advocating for changes in the ways medical professionals understand and implement global health initiatives. Drawing on decades of experience as a medical anthropologist and specifically on fieldwork in Guatemala, Berry explored short-term medical missions through the experiences and perspectives of volunteers. Her research revealed how the intent to do good shaped their everyday understandings of their own actions taken in the global health domain.

Her book, Good Intentions in Global Health: Medical Missions, Emotion, and Health Care Across Borders, published by New York University Press, is the first ethnography written about informal global health initiatives. It uncovers how the glorification of medical volunteerism can obscure the problems that stem from short term missions, and makes the case for paying attention to volunteers’ perceptions of their work, to positively influence global health on the ground.

We spoke to Professor Berry about her work.

Your book introduces the concept of “Do it Yourself” (DIY) global health. Can you explain what this means and why it is important to study?

DIY global health refers to informal, often short-term efforts like medical missions or volunteer brigades that operate outside traditional global health systems. Unlike formal programs, these initiatives lack policies, governance, or accountability, allowing volunteers to “show up” without established partnerships or frameworks. Even though hundreds of thousands of people are participating in DIY opportunities every year and define their activities as global health, scholars have largely ignored the phenomenon and continued to study and prioritize formal sectors of global health.

Can you tell us about some of the issues, concerns or unintended consequences that may be caused by medical missions?

One major issue for missions is communication. Volunteers often do not speak the local language, which makes it hard to talk to patients and keep good medical records. This becomes a big problem when the mission ends, especially for surgery patients who still need follow-up care. Without records or a clear understanding of their treatment, it is tough for patients to get the support they need from local practitioners after a mission ends.

Your book argues that “visceral ethics” often drive the practice of medical volunteering. What is this and how does it play out in context?  

“Visceral ethics” refers to the way medical volunteers rely on their gut feelings to judge whether their actions are ethical. In the context of medical missions, volunteers often feel good about their work, and that feeling becomes proof to them that what they are doing is right. This is shaped by global power dynamics, where North American volunteers see themselves as helpers and define the people they serve as poor or in need, even if those communities don’t see themselves that way. Because missions are short-term and isolated from long-term consequences, volunteers rarely get feedback that challenges their assumptions, allowing visceral ethics to take over.

Based on your research and experience, how would you recommend medical professionals approach a short-term volunteer medical assignment? How can they create value?

Medical professionals on short-term volunteer assignments often run into trouble because they assume someone else has done the necessary due diligence—like ensuring care is needed, legal permissions are in place, and follow-up plans are secure. This lack of personal accountability can lead to unintended harms, such as practicing in ways they wouldn’t at home or leaving patients without proper records or follow-up care. To create real value, volunteers must take responsibility for asking tough questions: Are they truly serving those in need? How do they know? Are they following local laws and ethical standards? How do they know? By doing this work themselves, rather than relying on organizers or assumptions, they can avoid perpetuating harm and ensure their efforts align better with their own intentions.

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