Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work

Abstract

Expatriate health care professionals frequently participate in international responses to natural disasters and humanitarian emergencies. This field of practice presents important clinical, logistical and ethical challenges for clinicians. This paper considers the ethics of health care practice in humanitarian contexts. It examines features that contribute to forming the moral landscape of humanitarian work, and discusses normative guidelines and approaches that are relevant for this work. These tools and frameworks provide important ethics resources for humanitarian settings. Finally, it elaborates a set of questions that can aid health care professionals as they analyse ethical issues that they experience in the field. The proposed process can assist clinicians as they seek to establish their moral bearings in situations of ethical complexity and uncertainty. Identifying and developing ethics resources and vocabulary for clinical practice in humanitarian work will help health care professionals provide ethically sound care to patients and communities.

New trends of short-term humanitarian medical volunteerism: professional and ethical considerations

“…Furthermore, these resources are usually designed for certified clinicians rather than trainees, and are usually not comprehensive in scope, focusing on topics such as volunteer safety, recommended vaccinations, programme specifications, travel and malpractice insurance and local culture 10 22 43 75–78. Handbooks containing more practical knowledge have been produced by NGOs formed to address the need for education and ethical standards in humanitarian aid, such as those by the Sphere project and Humanitarian Accountability Partnership International,30 41–43 79 but these often lack discussion of professionalism and medical ethics. Major organisations offer a few resources, such as a manual by WHO, a few publications endorsed by the American Medical Association, and an epidemiology course by the US Center for Disease Control,80–81 but there is insufficient development of educational resources, promotion of these resources to humanitarian and academic institutions, and support of preparatory education as an important issue by major national and international organisations 73.…”

“…Without collaboration with local healthcare systems and governments, foreign aid can take pressure off of local systems to improve healthcare. Local residents may also view the care provided by foreign HCPs as superior, potentially creating distrust or non-reliance on local healthcare systems 1 5 30. Furthermore, providing medical and surgical services, medications, or medical devices that are locally unavailable or with which local providers are unfamiliar, may create complications that local healthcare systems are unable to manage.…”

“…When humanitarian medical aid is viewed only as an act of charity, it might be acceptable to send any HCP who is available, interested and has time and funding to travel abroad, because otherwise patients would be ‘worse off’. However, this approach risks exploiting the vulnerability of populations in need, establishing power-imbalanced patient–provider relationships, removing pressure from local governments, and creating distrust of local healthcare systems 1 3 10 30 53 55 56. Though Western standards of care may not be appropriate or attainable, the highest quality of care should be strived for.…”

The Development of a Humanitarian Health Ethics Analysis Tool

“…6 Feedback from these forums was used to refine the tool. The HHEAT was then presented to six reviewers with expertise in decision-making models and clinical ethics, public health ethics, and humanitarian medicine and nursing, who pro vided feedback on the structure and content of the tool, prompting further refinement ( Figure 1).…”

The Challenge of Allocating Scarce Medical Resources during a Disaster in a Low Income Country: A Case Study from the 2010 Haitian Earthquake

“…8 He identifies specific challenges that impact the uncertainty of the ethical decision-making in acute emergencies that include 1-the level of achievable care is much lower than health care providers are used to; 2 -in contexts of resource scarcity, increased instability, and widespread health needs, population health concerns abound; 3 -in humanitarian settings the volume and urgency of needs of the local population are elevated and providers often work extremely long shifts causing exhaustion and have limited opportunity to debrief. ; 4 -important differences exist between cultural frameworks in how health, wellness, disease and disability are understood and experienced; 5 -imbalances of power occur between providers and patients; and 6 -there is less regulatory oversight and professional accountability in the field than at home.…”