Is it ethically permissible to allow untrained practitioners to perform IONM? An African perspective

Intraoperative neurophysiological monitoring (IONM) is often used in surgical procedures to limit harm. However, South Africa currently experiences an acute shortage of trained personnel and qualified specialists to perform IONM (Ukachukwu et al. , 2023). This gap results in poor regulatory oversight with untrained persons providing IONM services. This article interrogates this. Specifically, it explores from an underexplored African perspective whether untrained personnel ought to be allowed to perform IONM. Is it ethically permissible to allow untrained practitioners to perform IONM? This normative ethics article employs a philosophical analytic method to interrogate this research question. It does this by drawing on the moral norms (reciprocal relationships, positive obligations and collective responsibility) derived from solidarity, rooted in African moral philosophy. A surgeon's dependence on valuable feedback to ensure a successful surgery requires IONM practitioners to respect reciprocal relationships by returning feedback backed by competency-honouring interdependence. Reliable feedback results when positive obligations arise from deliberate actions that reflect a capacity to recognize one’s role in reducing patients' potential suffering. Collective responsibility requires practitioners to contribute equally towards a shared goal of good postoperative outcomes. Untrained personnel violate the value of solidarity by failing to display the competencies necessary to actively promote patients' well-being and honour positive obligations, effectively collaborate within teams, and contribute towards a shared goal. • Risks of allowing untrained individuals to perform intraoperative neurophysiological monitoring (IONM), particularly in South Africa. • Worsening interpretative ambiguity whilst untrained. • Hindering the proper development of IONM practice. • While the issue is acute in Sub-Saharan Africa, the paper notes that even high-resource regions face challenges due to a shortage of skilled IONM professionals. • Solidarity requires trained professionals to act in ways that promote patient well-being, respect interdependence, and foster collaboration within surgical teams.