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Short-Term Surgical Mission (STSM) trips originated as relief trips wherein surgeons and doctors from high-income countries observed the great burden of surgical disease in low- and middle-income countries (LMICs) and traveled to provide essential surgical care before returning to their regular practice. While these trips have historically served to “do good” by providing surgical care to populations in which surgical providers are scarce, these trips are fraught with sustainability and ethical challenges as well. This session discussed the gaps in access to safe and affordable surgical care and our moral obligation to address these gaps, whether STSMs should play a role in providing surgical care in LMICs, and the ethics of bringing complex surgical procedures to LMICs.

During this session, Bethany Hedt-Gauthier, PhD discussed Global Surgery Needs and Moral Obligation. Rashi Jhunjhunwala, MD, MA explored the Ethics of Short-term Surgical Missions (STSM). Michelle Joseph, MBBS, MSc, PhD, FRCS covered Complex Surgical Procedures in Low- and Middle-Income Countries (LMICs): Yes, No, or Maybe. John Meara, MD, DMD, MBA moderated the session.

Speakers
	Bethany Hedt-Gauthier, PhD Associate Professor Global Health and Social Medicine Harvard Medical School Associate Professor Department of Biostatistics Harvard T.H. Chan School of Public Health
	Rashi Jhunjhunwala, MD, MA Surgical Resident Beth Israel Deaconess Medical Center Senior Fellow Program in Global Surgery and Social Change Harvard Medical School
	Michelle Joseph, MBBS, MSc, PhD, FRCS Instructor Global Health and Social Medicine Harvard Medical School
Moderator
	John Meara, MD, DMD, MBA Professor of Surgery Harvard Medical School Plastic Surgeon-in-Chief Department of Plastic and Oral Surgery Boston Children's Hospital

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Using a case presentation, this session debated the proposition that surgical reconstruction of an infant with atypical genitalia is ethically justified. In addition, the standard types of gender-affirming procedures were reviewed, followed by the process for identifying and addressing key ethical, legal, and contextual issues through discussion with hospital, local, and community entities and stakeholders. Primary issues included age-appropriateness and age limits, obtaining informed consent and assent, recruitment of ancillary services for comprehensive care delivery, education of staff, and addressing existing access inequities for transgender and gender non-binary patients.

During this session, David A. Diamond, MD and Jonathan Marron, MD, MPH reviewed the Ethical Considerations in the Surgical Treatment of Infants with Atypical Genitalia. Amir Taghinia, MD, MPH, MBA explored the Ethical Considerations in Establishing a (Trans-)Gender Affirming Surgical Center at Boston Children's Hospital. Douglas W. Hanto, MD, PhD, MBE moderated the session.

Speakers
	David A. Diamond, MD Professor of Urology and Pediatrics University of Rochester Medical Center
	Jonathan Marron, MD, MPH Attending Physician, Pediatric Hematology/Oncology Dana-Farber Cancer Institute Instructor in Pediatrics Harvard Medical School Attending Physician, Cancer and Blood Disorders Center Clinical Ethicist Boston Children's Hospital Teaching Faculty Harvard Medical School Center for Bioethics
	Amir Taghinia, MD, MPH, MBA Staff Surgeon Department of Plastic and Oral Surgery Boston Children's Hospital Associate Professor of Surgery Harvard Medical School
Moderator
	Douglas W. Hanto, MD, PhD, MBE Chair, Surgical Ethics Working Group Harvard Medical School Center for Bioethics Lewis Thomas Professor of Surgery Emeritus Harvard Medical School

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Innovation adds another dimension of risk to the dangers of surgery. Heroic patients, parents, and surgeons have bravely participated in these innovative efforts to advance surgical treatment. This session outlined the process of using new devices in the operating room, from development to the documentation of outcomes. In addition, the session covered some of the ethical challenges that have been accepted in the operating room and recommended management approaches based on experiences at the institutional and national professional society level.

During this session, Richard Whyte, MD, MBA discussed the Implementation of New Technology. Theresa Williamson, MD explored the Implementation of New Devices. John E. Mayer, Jr., MD and Martin F. McKneally, MD, PhD described Collaborative Development and Introduction of New Procedures. Louise P. King, MD, JD moderated the session.

Speakers
	Richard Whyte, MD, MBA Vice Chair of Quality Safety and Clinical Affairs Beth Israel Deaconess Medical Center Professor of Surgery Harvard Medical School
	Theresa Williamson, MD Assistant Professor of Neurosurgery Massachusetts General Hospital Course Instructor Vice Chair, Surgical Ethics Working Group Harvard Medical School Center for Bioethics
	John E. Mayer, Jr., MD Senior Associate in Cardiac Surgery Boston Children’s Hospital Professor of Surgery Harvard Medical School
	Martin F. McKneally, MD, PhD Founding Chair and Member Surgical Ethics Working Group Harvard Medical School Center for Bioethics Lecturer on Surgery Beth Israel Deaconess Medical Center Professor Emeritus of Surgery Member of Joint Centre of Bioethics University of Toronto
Moderator
	Louise P. King, MD, JD Assistant Professor, Director of Research, Minimally Invasive Gynecologic Surgery Associate Program Director, Fellowship in Minimally Invasive Gynecologic Surgery Brigham and Women's Hospital Director of Reproductive Bioethics Co-Director, Ethics, Essentials of the Profession Harvard Medical School Center for Bioethics Affiliated Faculty, Petrie-Flom Center Harvard Law School

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Health care disparities, including differences in access and outcomes due to factors such as race and ethnicity, are well documented across multiple surgical procedures. These disparities in surgical care are caused by social determinants of health rooted in slavery and structural racism. Approaches to mitigating these disparities and our moral obligations to reduce surgical disparities will be discussed. This session will also examine the ways in which the principle of justice is competing with that of patient autonomy and reflect on potential pitfalls and benefits.

During this session, Douglas W. Hanto, MD, PhD, MBE will explore the Disparities in the Care of Black, Indigenous, Latinx, and People of Color (BILPOC). Theresa Williamson, MD will examine Racism and Bias in Surgical Training. Piroska Katalin Kopar, MD, FACS will discuss How We Can Achieve Social Justice in Health Care and Surgery. Theresa Williamson, MD will moderate the session.

Speakers
	Douglas W. Hanto, MD, PhD, MBE Chair, Surgical Ethics Working Group Harvard Medical School Center for Bioethics Lewis Thomas Professor of Surgery Emeritus Harvard Medical School
	Theresa Williamson, MD Assistant Professor of Neurosurgery Massachusetts General Hospital Course Instructor Vice Chair, Surgical Ethics Working Group Harvard Medical School Center for Bioethics
	Piroska Katalin Kopar, MD, FACS Assistant Professor of Surgery Director of Center for Humanism and Ethics in Surgical Specialties, Section of Acute and Critical Care Surgery Washington University School of Medicine
Moderator
	Theresa Williamson, MD Assistant Professor of Neurosurgery Massachusetts General Hospital Course Instructor Vice Chair, Surgical Ethics Working Group Harvard Medical School Center for Bioethics