Ackers Helen Louise - The ethics of educational healthcare placements in low and middle income countries: first do no harm?

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Internationalisation has emerged as an increasingly important metric in UK university league tables and marketing. Indeed most, if not all, UK universities now actively promote an Internationalisation Strategy (Coey ). In recent years, the internationalisation of education has become more firmly associated with the selling of educational programmes to international fee-paying consumers. The importance of English to these consumers, coupled with the relatively poor linguistic skills of young people in the UK, has influenced mobility flows and shaped the outward mobilities of UK undergraduates. In more recent years, and in some respects linked to the international offer, with the intention of making UK courses more relevant and attractive to foreign consumers, attention has shifted to incorporate an international dimension into teaching. And, linked to this but perhaps rather differently motivated, the broadening of curricula and educational experiences has been viewed as essential to the future employability, resilience, connectedness and culture competence of graduates. Additionally, as evidenced by Health Education Englands interest in funding the Ethical Educational Placement (EEP) project, internationalisation has been recognised as a mechanism for accessing new knowledge which students who participate in study and work abroad programmes can bring back to enrich home institutions.

It is difficult to talk about internationalisation without acknowledging and placing it within the context of globalisation (De Wit et al. ).

Brooks and Waters () identify three features of the relationship between globalisation and higher education. In the first instance, this concerns the role that universities play in the commodification of programmes. Here, demographic trends are significant with student (consumer) flows showing a marked directional imbalance (from the global South-East to the global North-West). Secondly, the authors point to the rapid emergence of private, for profit universities, particularly in Asia and Latin America. And finally, they refer to new ways of delivering international higher education programmes through e-learning, franchise operations, satellite campuses and split-site arrangements.

Clearly, the global context within which higher education institutions operate is changing and internationalisation comprises an increasingly wide range of initiatives (De Wit ).

The elective, an optional form of study spent away from a students Higher Education Institution, usually for a period of 6 to 12 weeks (Banerjee ).

The term ethics refers to the moral principles that govern individual or organisational behaviour. There are thought to be three schools of ethical thought in Western philosophy: first, derived from Aristotle, the virtues of charity, justice and generosity are believed to be dispositions to act in ways that benefit the individual (agent) and the society in which an individual is placed. Second, influenced by Kant, ethics comprise duty, morality, rationality and the imperative to respect other (rational) beings. And, third, the Utilitarian position on ethics is that the guiding principles of conduct should be of the greatest benefit to the greatest number in a society. These schools of thought share a common focus on the moral responsibility of an individual or organisation to act in a manner which does not cause harm to other members in society. The phrase First do no Harm ( Primum non nocere ) is a guiding principle for physicians in their practice and forms part of the Hippocratic Oath, the moral code for ethical conduct and practice in medicine. Derived from this is the principle of non-maleficence (Sharp .

The second major ethical concern is with impacts in host (low resource) settings. Central to our discussion is a consideration of how sending institutions and students can avoid causing harm to host institutions and the communities they serve. In other words, we are concerned with the ethics and ethical practices of electives when there are power differentials between high and low resource settings. The aims of the book therefore are twofold; firstly, through our analysis of rich qualitative data generated with students, sending institutions and host institutions in Uganda and India, we provide new knowledge of the learning and impacts of international educational placements. Secondly, we present the Ethical Educational Placement Project (EEP) as a model embodying a set of guiding principles for ethical policy and practice in international educational placements across multiple disciplines. We now introduce the reader to the idea of the elective, its conceptualisation and the different forms they take before examining the EEP concept.