The Development of a Humanitarian Health Ethics Analysis Tool

Fraser, Véronique; Hunt, Matthew; Laat, Sonya de; Schwartz, Lisa

doi:10.1017/s1049023x1500480x

Cited by 52 publications

(21 citation statements)

References 25 publications

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“…humanity, neutrality, impartiality, and independence) the sector rarely engages with them, even where they permeate strategic and operational choices and the day to day activities of frontline humanitarians. Research shows that humanitarians are often unaware that some of the dilemmas they face require ethical deliberation, and that ethics training and support could be a resource for them [ 9 ]. Typical humanitarian management training covers the humanitarian principles but not ethics in relation to operational decision-making, and aid agencies produce hundreds of guidelines on all components of programming but have produced few ethics guidelines; ethics guidelines that do exist typically come from academics who lack an understanding of the lived reality of frontline humanitarian workers let alone frontline staff working in the context of an infectious disease outbreak.…”

Section: Ethics Guidance For Frontline Humanitarian Workersmentioning

confidence: 99%

“…the anguish and psychological instability precipitated by understanding the correct moral action to take yet being prevented from acting by institutional barriers or priorities [ 12 ]. Though the literature from the past 10–15 years shows evidence of increasing attention to the experience of moral distress amongst frontline humanitarian staff [ 9 ], much uncertainty about how to address it remains.…”

Section: Ethics Guidance For Frontline Humanitarian Workersmentioning

confidence: 99%

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Preparing humanitarians to address ethical problems

et al. 2020

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Infectious disease outbreaks represent potentially catastrophic threats to those affected by humanitarian crises. High transmissibility, crowded living conditions, widespread co-morbidities, and a lack of intensive care capacity may amplify the effects of the outbreak on already vulnerable populations and present humanitarian actors with intense ethical problems. We argue that there are significant and troubling gaps in ethical awareness at the level of humanitarian praxis. Though some ethical guidance does exist most of it is directed at public health experts and fails to speak to the day-to-day ethical challenges confronted by frontline humanitarians. In responding to infectious disease outbreaks humanitarian workers are likely to grapple with complex dilemmas opening the door to moral distress and burnout.

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Section: Ethics Guidance For Frontline Humanitarian Workersmentioning

confidence: 99%

Section: Ethics Guidance For Frontline Humanitarian Workersmentioning

confidence: 99%

Preparing humanitarians to address ethical problems

et al. 2020

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“…Supporting a locally-led response is an obligation based on the idea of fair decision-making processes. The collapse of in-country health systems (Al-Moujahed et al 2017;de Waal 2010;Michael and Zwi 2002); difficulty in identifying and trusting local leaders (Black 2003;Cobey et al 1993;Fouad et al 2017;Haver 2016;Weiss 2016); and tensions arising between organizational, individual, and local beliefs and norms (Civaner et al 2017;Egeland et al 2011;Fegley 2009;Fraser et al 2015) all make fulfilling this obligation challenging.…”

Section: Ethical Obligations and Challengesmentioning

confidence: 99%

“…Understanding that range is essential for developing strategies to better manage them, but existing systematic reviews have not focused on ethical issues specifically (Chaudhri et al 2019). In addition, whether existing frameworks for ethical decision-making in humanitarian action (Clarinval and Biller-Andorno 2014;Fraser et al 2015) might apply or be useful in settings where health care workers and facilities are themselves subject to persistent attack remains unknown. To begin filling these knowledge gaps, we conducted a systematic literature review of the ethical and humanitarian challenges experienced by humanitarian health organizations in conflict settings.…”

Section: Introductionmentioning

confidence: 99%

Challenges to ethical obligations and humanitarian principles in conflict settings: a systematic review

Broussard

Rubenstein

Robinson

et al. 2019

Int J Humanitarian Action

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Background: Humanitarian health care organizations and health workers working in contexts of armed or violent conflict experience challenges in fulfilling ethical obligations and humanitarian principles. To better understand the types of challenges experienced in these contexts, we conducted a systematic literature review. Methods: A broad search strategy was developed for English language publications available in PubMed, Ovid/ EMBASE, and Scopus. The search relied upon three key concept blocks: conflict settings, humanitarian or relief organizations, and non-clinical or non-military ethics. To be included, publications had to (1) refer implicitly or explicitly to ethics and/or humanitarian principle(s), (2) relate to non-military relief work in active conflict or conflictaffected settings, (3) relate to organizational mission and/or delivery of services, and (4) relate to events after 1900. Records were qualitatively analyzed using an emergent thematic analysis approach that mapped challenges onto recognized ethical obligations and humanitarian principles. Results: A total of 66 out of a possible 2077 retrieved records met inclusion criteria. The most frequently noted ethical challenges for organizations working in conflict settings were (1) providing the highest attainable quality of care, (2) protecting workers, and (3) minimizing unintended harms. The humanitarian principle most frequently noted as challenging to uphold was neutrality (the duty that humanitarian actors must not take sides in a conflict). Ethical challenges and humanitarian principles were commonly co-coded. For example, the challenge of providing the highest attainable quality of care frequently intersected with the humanitarian principle of humanity. Conclusions: By categorizing the types of ethical challenges experienced by humanitarian care organizations, this review can help organizations anticipate issues that might arise in conflict settings. The identified relationships between ethical challenges and humanitarian principles suggests that frameworks and guidance for ethical decision-making, if adapted for conflict settings, could support organizational capacity to fulfill ethical and humanitarian commitments.

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“…There is also a need for a consensus on a virtue-based, yet practical ethical approach to medical care under such extreme conditions, as Holt suggested [39]. There are some suggestions in the literature formulated for decision-making [40–42]. In addition, Lepora suggests usage of checklists for HCWs as a practical tool for “what to do when, what to discuss, what not to do” [43].…”

Section: Discussionmentioning

confidence: 99%

Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey

2017

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BackgroundNatural disasters, armed conflict, migration, and epidemics today occur more frequently, causing more death, displacement of people and economic loss. Their burden on health systems and healthcare workers (HCWs) is getting heavier accordingly. The ethical problems that arise in disaster settings may be different than the ones in daily practice, and can cause preventable harm or the violation of basic human rights. Understanding the types and the determinants of ethical challenges is crucial in order to find the most benevolent action while respecting the dignity of those affected people. Considering the limited scope of studies on ethical challenges within disaster settings, we set upon conducting a qualitative study among local HCWs.MethodsOur study was conducted in six cities of Turkey, a country where disasters are frequent, including armed conflict, terrorist attacks and a massive influx of refugees. In-depth interviews were carried out with a total of 31 HCWs working with various backgrounds and experience. Data analysis was done concurrently with ongoing interviews.ResultsSeveral fundamental elements currently hinder ethics in relief work. Attitudes of public authorities, politicians and relief organizations, the mismanagement of impromptu humanitarian action and relief and the media's mindset create ethical problems on the macro-level such as discrimination, unjust resource allocation and violation of personal rights, and can also directly cause or facilitate the emergence of problems on the micro-level. An important component which prevents humanitarian action towards victims is insufficient competence. The duty to care during epidemics and armed conflicts becomes controversial. Many participants defend a paternalistic approach related to autonomy. Confidentiality and privacy are either neglected or cannot be secured.ConclusionIntervention in factors on the macro-level could have a significant effect in problem prevention. Improving guidelines and professional codes as well as educating HCWs are also areas for improvement. Also, ethical questions exposed within this study should be deliberated and actualized with universal consensus in order to guide HCWs and increase humane attitudes.

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The Development of a Humanitarian Health Ethics Analysis Tool

Abstract: The study generated preliminary insight into the ethical deliberation processes of humanitarian health workers and highlighted different types of ethics support that humanitarian workers might find helpful in supporting the decision-making process.

Cited by 52 publications

References 25 publications

Preparing humanitarians to address ethical problems

Preparing humanitarians to address ethical problems

Challenges to ethical obligations and humanitarian principles in conflict settings: a systematic review

Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey

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