Newborns in crisis: An outline of neonatal ethical dilemmas in humanitarian medicine

Abstract

Newborn infants are among those most severely affected by humanitarian crises. Aid organisations increasingly recognise the necessity to provide for the medical needs of newborns, however, this may generate distinctive ethical questions for those providing humanitarian medical care. Medical ethical approaches to neonatal care familiar in other settings may not be appropriate given the diversity and volatility of humanitarian disasters, and the extreme resource limitations commonly faced by humanitarian aid missions.In this paper, we first systematically review existing guidelines relating to the treatment and resuscitation of newborns in humanitarian crises, finding little substantive ethical guidance for those providing humanitarian healthcare. We next draw on paradigm cases and published literature to identify and describe some of the major ethical questions common to these settings. We divide these questions into quality of life considerations, allocation of limited resources, and conflicting cultural norms and values. We finally suggest some preliminary recommendations to guide ethical decision‐making around resuscitation of newborns and withdrawal of treatment in humanitarian settings.

Conceptualizing Ethical Issues of Humanitarian Work: Results From a Critical Literature Review

“…(p.183) Persistent ethical problems discussions on ethical typologies already developed by other authors, namely Hunt (35) and Schwartz (47). Not surprisingly, some authors rely on theoretical foundations previously developed by other authors (7,33,46). Some are based on (explicitly or implicitly) identifiable philosophical theories, such as deontological ethics or consequentialism (8,46), while others authors base their ethical discussions on various codes of ethics governing humanitarian work (65,69).…”

“…Not surprisingly, some authors rely on theoretical foundations previously developed by other authors (7,33,46). Some are based on (explicitly or implicitly) identifiable philosophical theories, such as deontological ethics or consequentialism (8,46), while others authors base their ethical discussions on various codes of ethics governing humanitarian work (65,69). Still others conceive the morality of humanitarian actions according to their adherence or opposition to certain human values, such as justice or autonomy, and believe that actions are immoral if they violate such values (26,65,68,69).…”

Ethical Issues Arising in Humanitarian Work and Possible Responses to Them: Results from a Critical Literature Review

“…Further, Ayimpam et al discuss intercultural tension in conducting humanitarian research: "a first type of difficulty associated with field investigation is the experience of (psychologically risky) intercultural tension, [experienced in] managing [...] the distance and proximity relationships in daily interactions" (36, p.25; our translation). Harroff-Tavel addresses the need for humanitarian workers to respect local populations and their cultures, and to remain self-conscious about their potential limitations (maintain a humble perspective) (43; for similar ideas see also17,24,44,46,48,51). In the same vein, Bruno and Haar note that, regarding cultural differences, workers ought to gain a "strong appreciation, humility, and understanding of local culture" (40, p.13).…”