The questions arise in light of an immense gap between available resources and widespread and elevated needs. This gap is likely unavoidable in large-scale crises and may be a source of ethical distress for both local and international responders. The analysis of ethical questions associated with crisis response can advance discussions about how relief efforts can best be designed and implemented to minimise ethical distress and improve assistance to local populations.

Despite the increase in and evolving nature of armed conflicts, the ethical issues faced by military physicians working in such contexts are still rarely examined in the bioethics literature. Military physicians are members of the military, even if they are non-combatants; and their role is one of healer but also sometimes humanitarian. Some scholars wonder about the moral compatibility of being both a physician and soldier. The ethical conflicts raised in the literature regarding military physicians can be organized into three main perspectives: 1) moral problems in military medicine are particular because of the difficulty of meeting the requirements of traditional bioethical principles; 2) medical codes of ethics and international laws are not well adapted to or are too restrictive for a military context; and 3) physicians are social actors who should either be pacifists, defenders of human rights, politically neutral or promoters of peace. A review of the diverse dilemmas faced by military physicians shows that these differ substantially by level (micro, meso, macro), context and the actors involved, and that they go beyond issues of patient interests. Like medicine in general, military medicine is complex and touches on potentially contested views of the roles and obligations of the physician. Greater conceptual clarity is thus needed in discussions about military medical ethics.Malgré l’augmentation des conflits armés et des changements qui les caractérisent, les enjeux éthiques auxquels font face les médecins militaires sont très peu traités dans la littérature en bioéthique. Les médecins militaires sont des membres du corps militaire, même s’ils sont non combattants, et ils jouent un rôle de soignant tout en pouvant être appelés à agir comme aide humanitaire. Certains auteurs se sont même interrogés sur la compatibilité morale d’être à la fois médecin et soldat. Les conflits éthiques soulevés dans la littérature sur les médecins militaires peuvent être organisés autour de trois perspectives : 1) les problèmes moraux en médecine militaire seraient particuliers compte tenu des difficultés à respecter les principes bioéthiques traditionnels; 2) les codes d’éthique médicaux et les lois internationales seraient trop restrictifs ou inadéquats pour le contexte militaire; et 3) les médecins sont des acteurs sociaux qui devraient être pacifistes, défenseurs des droits de la personne, politiquement neutres ou promoteurs de la paix. Une revue des divers dilemmes rencontrés par les médecins militaires identifiés dans la littérature nous montre que ces perspectives se situent à des niveaux d’analyse différents (micro, méso, macro), que les contextes et les acteurs impliqués sont souvent différents et que les dilemmes vont bien au-delà des enjeux liés strictement à l’intérêt du patient. Tout comme la profe...

Vulnerability is a central concept in humanitarian aid. Discussions of vulnerability in disaster response literature and guidelines for humanitarian aid range from considerations of a universal human vulnerability, to more nuanced examinations of how particular characteristics render individuals more or less at risk. Despite its frequent use, there is a lack of clarity about how vulnerability is conceptualized and how it informs operational priorities in humanitarian assistance. Guided by interpretive description methodology, we draw on the feminist taxonomy of vulnerability presented by Mackenzie, Rogers and Dodds (2014) to examine perspectives of 24 expatriate and Haitian decision-makers and health professionals interviewed between May 2012 and March 2013. The analysis explores concepts of vulnerability and equity in relation to the humanitarian response following the 2010 earthquake in Haiti. Participants’ conceptualizations of vulnerability included consideration for inherent vulnerabilities related to individual characteristics (e.g. being a woman or disabled) and situational vulnerabilities related to particular circumstances such as having less access to health care resources or basic necessities. Participants recognized that vulnerabilities could be exacerbated by socio-political structures but felt ill-equipped to address these. The use of the taxonomy and a set of questions inspired by Hurst’s (2008) approach to identifying and reducing vulnerability can guide the analysis of varied sources of vulnerability and open discussions about how and by whom vulnerabilities should be addressed in humanitarian responses. More research is required to inform how humanitarian responders could balance addressing acute vulnerability with consideration of systemic and pre-existing circumstances that underlie much of the vulnerability experienced following an acute disaster.

Introduction TikTok is a rapidly growing social media platform that allows users to develop and share short videos. We hypothesized that a library of videos developed through TikTok (TikToks) would support the recruitment of committed hematopoietic stem cell donors from needed demographic groups (i.e. young, male, from diverse ancestries). Methods Members of the community of practice (CoP) in stem cell donor recruitment in Canada (facebook.com/groups/stemcellclub) were activated to develop TikToks. Training was provided during e-meetings of the CoP (8/2020, 1/2021, 5/2021) and in a video published online (stemcellclub.ca/training), highlighting the principles of effective TikTok design. These principles included the use of engaging hooks, music, and calls to action; short duration (< 30s); high educational value; and appeal to diverse donors. The training also outlined how to: record content, adjust clip lengths, apply audiovisual effects, and share across social media platforms. A CoP TikTok committee was formed to develop and review TikToks prior to publication. Following launch, we evaluated stakeholder perspective on these TikToks and the impact 1) across social and traditional media and 2) on eligible donors' knowledge and attitudes towards donation. Results Between 9/2020-7/2021, a network of TikTok channels was launched by CoP members, including a national donor recruitment TikTok library (tiktok.com/@stemcellclub). A total of 217 TikToks were produced across these channels (median length 17s, range 4-52s), covering a range of educational topics, designed for use in specific recruitment campaigns, and featuring unique video effects (Fig. A). The TikToks accumulated over 234,000 Views, 42,000 Likes, 3,000 Comments, and 14,200 Shares on TikTok, were republished by Canadian media outlets (e.g. CBC [twitter.com/cbcnewsbc/status/1361511367426080773], CTV News [ctvnews.ca/health/meet-the-women-hoping-to-recruit-more-stem-cells-donors-from-black-communities-1.5314038, ctvnews.ca/health/pride-month-tiktok-drive-encourages-stem-cell-donations-from-gay-bi-men-1.5475113], Victoria News [vicnews.com/news/most-black-canadians-wont-find-a-stem-cell-donor-in-time-this-group-is-working-to-change-that]) and were highlighted by major medical organizations (e.g. Canadian Blood Services [blood.ca/en/stories/meet-stem-cell-club, blood.ca/en/stories/stem-cell-club-volunteers-aim-save-lives-pride-month-campaign], American Association of Blood Banks [aabb.org/news-resources/news/article/2021/02/01/twitter-tiktok-aabb-virtual-journal-club-assesses-use-of-multimedia-resources-for-donor-recruitment]). 33 CoP members from 6 provinces across Canada, with a median of 2 years of recruitment experience, completed a post-launch survey. The majority felt that TikToks promote donation in an attention-grabbing way (94%), engage younger donors (100%), and teach key points in a short time period (94%). The majority were confident in their ability to make TikToks (63%), but felt they would benefit from additional training (63%). 46 eligible stem cell donors (from 12 different non-Caucasian ancestral groups; living in 5 provinces across Canada) completed surveys evaluating the impact of TikToks on their knowledge and attitudes towards donation. No participants were registered as donors and only four had a personal connection to an individual who needed a stem cell transplant. After being shown a series of TikToks, mean scores on a 6-question stem cell donation knowledge test improved from 59% to 73% (p=0.0012) (Fig. B); mean scores on a modified Simmons Ambivalence Scale decreased from 52% to 30% (p<0.0001) (Fig. C); and participants were more willing to register as donors (70% vs. 39%, p=0.0011). Participants reported that viewing TikToks positively impacted on their decision to register (87%), helped them understand stem cell donation (89%), and would help them talk about stem cell donation with friends/family (78%). Conclusions We report the first published experience using TikToks in a donor recruitment context. Our TikToks achieved significant social and traditional impact in a short period of time, and supported recruitment of committed stem cell donors from needed demographic groups. Our work is relevant to recruitment organizations worldwide seeking to modernize their recruitment approaches. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Military physicians can experience ethical tensions and encounter important dilemmas when acting at the same time as healers, soldiers and humanitarians. In the literature, these are often presented as the result of pressures, real or perceived, from the military institution or role and obligation conflicts that can divert physicians from their primary duty towards their patients. In this article, I present the ethical experiences of 14 Canadian military physicians who participated in operational missions, particularly in Afghanistan. Interestingly, although some dilemmas discussed in the academic literature were raised by Canadian physicians, ethical tensions were less frequent and numerous than what might have been expected. Instead, what emerged were distinctions between the ethical experiences of physicians: generalists experienced more frequent and different ethical challenges than specialists, and these also varied by context, that is, garrison versus on deployment. The main dilemmas during deployment were similar to those encountered by humanitarian physicians and concerned inequalities in the provision of care between coalition soldiers and Afghans (soldiers and civilians), as well as the lack of resources. Surprisingly, participants were evenly divided with regards to how they perceived their professional identity: one group clearly prioritised the medical profession (ie, doctor first and foremost), while the other group identified themselves as military physicians, but without prioritising one profession over the other.