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

Abstract

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.

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

“…They state that in general [health care workers] sent to disaster settings are not properly trained specifically for disasters…Some of them state that lack of proper education makes it difficult to be benevolent to victims. (Civaner et al 2017) Independence and supporting a locally led response When local groups are on one side or the other of a conflict, an organization supporting a locally led response could be perceived as no longer fully independent.…”

“…At this stage, two major additions were made to the codebook. In the "ethical obligations" category, the obligation of appropriate acquisition and management of assets (including financial, material, and human assets) was added as a node (Civaner et al 2017;Hunt 2008). In the "humanitarian principles" category, the principle of "solidarity" was added as a node, as it was noted to be an emerging humanitarian principle.…”

“…In our review, the most commonly identified challenges to providing the highest attainable quality of care and services involved logistical obstacles such as disruptions or shortages of food or medical supplies, personnel, or care services and difficulties getting medicine and providers to front lines to meet communities' needs. Challenges to this obligation, founded on the ethical principle of beneficence, include disparities in the availability of facilities and supplies in conflict settings as compared to that of many workers' home contexts (Baskett 1994;Bernthal et al 2014;Civaner et al 2017;Hunt 2008;Hunt et al 2014), the existence of counterfeit or low-quality supplies and medications (Burkle Jr. et al 2017;Michael and Zwi 2002), and policies restricting the administration of care to select populations and blocking access to certain locations (Al-Moujahed et al 2017;Civaner et al 2017;Clarinval and Biller-Andorno 2014;Fouad et al 2017). Our findings also highlight an additional dimension to the duty to provide high-quality care: accountability.…”

“…Our findings also highlight an additional dimension to the duty to provide high-quality care: accountability. Fulfilling the obligation to provide high-quality care requires explicit evaluation of outcomes, without which the quality cannot be assured (Al-Moujahed et al 2017;Burkle Jr. et al 2017;Civaner et al 2017;Clarinval and Biller-Andorno 2014;Fouad et al 2017).…”

“…Moreover, there were concerns that humanitarian aid could destabilize established in-country health and other support systems and create unsustainable programs that result in support gaps when aid programs depart (Hunt 2009;Jaspars and O'Callaghan 2010;Rieffer-Flanagan 2009). Lack of training for workers (especially in disaster-or conflictspecific competencies) was cited as leading to inadequate or inappropriate care for vulnerable populations and forcing workers to make ad hoc decisions about triage and prioritization of patients and treatments-resulting in suboptimal care (Civaner et al 2017;Fouad et al 2017;Joshi et al 2008).…”