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Apply standards consistently regardless of where in the world you are

Pre-Note: The URMIA Risk Inventory lists ethical violations under the International category, noting: “Practicing beyond training (especially medical), photography that perpetuates stereotypes.” This article focuses on those ethical risks in international programming.

When “Doing Good” May Not be So Good

Practicing medicine beyond your training, orphanage volunteering, and photos of "helpless" children - these are some of the ethical risks involved with international travel. These concerns can rapidly escalate to individual and institutional harms, both reputational and financial. What happens if an undergraduate student assists with a surgery that doesn't end well? How about if a student who has a history of sexual misconduct volunteers with children abroad? Knowing how to identify ethical risks in international programs and how to address them is an essential responsibility for education abroad and risk management professionals. The goal is to foster awareness, education, and advocacy among campus stakeholders in a way that leads to lasting, meaningful change.

Many of the activities noted above go unquestioned because they are assumed to fall in the "doing good" category. Medical programs or work with children abroad are often classified as volunteer programs and may fall outside typical review processes or receive a free pass simply because students are doing ostensibly good things. A college or university may even view such a program as a favorable public relations opportunity, highlighting the "good" their students are doing in the world.

However, when you flip the narrative, the issues become easier to spot. Imagine students from England studying abroad on your campus for the summer. Would you allow them to set up a free health clinic in the quad? Would you let them volunteer at your youth summer camp without completing a background check? There is no reason we should apply a different standard to programs overseas where our own students are going.

Let's take a closer look at some common program types and activities that carry ethical risks and consider how institutions can begin to address them.

Working in Medical Clinics

People should not be practicing medicine beyond their scope, regardless of where they are in the world. In fact, an argument can be made that a person's effective level of qualification is diminished when they are operating outside their own cultural and linguistic environment, where contextual cues, communication norms, and clinical infrastructure may be entirely unfamiliar. This applies to students, faculty, and even physicians.

This is not merely an ethical concern; it is increasingly a professional one. It was long-standing practice for medical schools to expect applicants to have clinical hours abroad, but that expectation has begun to shift. Many medical schools now look unfavorably upon applicants who engaged in medical care overseas that exceeded their qualification level.

The Community-Based Global Learning Collaborative reinforces this through its Fair Trade Learning framework, which calls for "proactive protection of the most vulnerable populations" — a standard that applies directly to medical settings. Peer-reviewed research has further documented that practicing beyond scope in international volunteer settings leads to two serious problems: harmful treatment and the erosion of ethical standards. Outcomes also cannot be assumed to mirror those at home; malnutrition, limited diagnostic tools, and lack of follow-up care can make even routine interventions risky in ways inexperienced volunteers may not anticipate.

Institutions should also consider legal exposure. If a student is involved in providing medical care abroad and outcomes are negative, could the institution or student face a lawsuit? Possibly. While jurisdiction varies by country, reputational damage can be swift and significant regardless of legal outcome. Program coordinators should clearly define what students are and are not permitted to do in any health-related setting and build those parameters into program agreements, pre-departure orientations, and on-site supervisor expectations.

Volunteering at Orphanages

This type of program deserves particular attention, because the gap between intention and impact can be especially wide; the harm to children can be serious.

Research consistently shows that the overwhelming majority of children in residential care facilities are not orphans in the way most people understand the term. According to the Faith to Action Initiative and the Better Care Network, an estimated 80 percent of children in orphanages globally have at least one living parent. Most children are placed in residential care due to poverty, disability, or lack of access to basic services, not because they have lost their parents.

There is also substantial evidence that the demand for orphanage volunteering has contributed to the growth of orphanages in some regions. In countries such as Cambodia, Uganda, Nepal, and India, the number of residential care facilities has increased alongside the rise of volunteer tourism, even as the number of actual orphans has declined. In some cases, children have been recruited or trafficked from their families to meet that demand.

The developmental harm is also well-documented. Children in residential care have typically experienced some form of family separation. Connection and attachment are critical to healthy emotional development, and a steady parade of well-meaning short-term volunteers arriving, bonding with children, and then leaving can create and reinforce serious attachment disorders. This cycle of connection and abandonment, repeated with every visiting team or individual volunteer, can deepen a child's existing insecurities and erode their capacity to form healthy relationships.

Institutions also face meaningful risk exposure. If a student with a history of sexual misconduct is permitted to volunteer in an orphanage abroad, without the background checks that would be required domestically, the institution's moral, legal, financial, and reputational exposure is real. Child protection policies that exist on campus must be applied consistently when students travel. The same screening standards, the same policies on photographing minors, and the same child safeguarding expectations should follow students abroad.

Framing Language and Imagery

Woven through many of these programs is a narrative problem that deserves its own attention: the framing of US students as saviors and local communities or children as helpless. This language appears in program marketing materials, social media posts, fundraising appeals, and even in the casual ways students talk about their experiences when they return home.

This framing is harmful in multiple directions. It distorts students' understanding of the communities they are entering, can be deeply offensive to those communities, and positions international programs as opportunities for personal transformation rather than genuine partnership and service. Photos of visibly impoverished children used in fundraising or promotional materials, particularly without meaningful consent processes, raise serious ethical and legal questions. Institutions should review what image and language standards are in place domestically and ask whether those same standards are being applied to international programs.

Addressing Ethical Risks: A Path Forward

If you are seeing these issues within your institution, they can be challenging to address. Programs with ethical blind spots have often been running for decades, supported by faculty or staff who are deeply invested in them and celebrated by alumni who participated. Raising concerns can feel like attacking the work and the people involved. The goal is not to shut programs down, but to improve them.

Here are a few practical starting points:

• Inventory what mechanisms you already have. Most institutions already have policies governing health-related activities, working with minors, photo releases, background checks, and program review. The first question is not whether to create new policies, but whether existing ones are consistently applied to international programs. Often, the gap is not in policy, but in application.
• Use education as the entry point. It is far easier to begin with awareness-building than with policy enforcement. Bring in resources — including the Faith to Action Initiative's research on orphanage care or the Community-Based Global Learning Collaborative's Fair Trade Learning framework — and create space for honest campus conversations. Convening stakeholders from across campus who are involved in globally engaged programs can be a powerful way to build shared understanding around values, goals, and risk. In doing so, you may find you already have allies ready to help advocate for change. 
• Build in program-level accountability. Consider adding ethical review criteria to program approval processes, renewal cycles, or site visit protocols. Questions like "What activities are students performing and are they within their qualifications?" and "What child protection policies does this partner organization have?" should be part of standard due diligence.
• Engage faculty and program directors as partners. The most effective advocates for changing a program are often those who care most about it. When faculty and program directors understand the potential for harm, many become champions for improvement. Framing the conversation around protecting the program and the students and community it serves can shift the dynamic considerably.

Offering Protection, Not Limiting Experiences

International programs represent some of the most meaningful experiences students will have during their time at your institution. The goal of raising ethical questions is not to limit those experiences; it is to ensure they are grounded in genuine respect for the communities students are entering, an appropriate scope of practice, and the same standards of care we would apply at home. Holding those expectations consistently protects students, partner communities, and our institutions alike.

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