Bioethical challenges to rheumatology in resource poor areas: a review

Abstract

Objective: To outline the bioethical challenges specific to rheumatology in resource poor areas.

Data source: Published articles and selected personal communications on bioethical challenges and education in rheumatology.

Study design: A narrative commentary.

Data extraction: Online searches using PubMed and Google Scholar and personal experiences (Michele Meltzer, Amy Price).

Conclusion: Autonomy emphasizes respect for the individual and selfdetermination. We discuss how this can be dealt with because of lack of medical literacy. Moreover, conflict of interest should be revealed to the patient. Beneficence includes affirmative steps to improve public health and the role rheumatologists can play in advocating for increased public education and access to care for their patients. Nonmaleficence, encompasses the premise of doing no harm. Physicians need to be competent, but many parts of the world lack trained rheumatologists to teach the special skills required to diagnose and treat not only complex musculoskeletal disease but also chronic multifaceted pain conditions. Finally, we consider justice when fair allocation of scarce resources is difficult. Among other choices related to justice, physicians must decide how to allocate their time because of scarcity.