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Ethics in the Delivery of Humanitarian Health Assistance: Learning from the Narratives of Health Workers

Author(s): l. J. Schwartz*1, M. Hunt1, C. Sinding2, L. Elit3, L. Redwood-Campbell4, N. Adelson5, L. Luther6,  QS. DeLaat7, J. Ranford8
Affiliation(s): 1Clinical Epidemiology and Biostatistics, 2Social Work, 3Obstetrics and Gynecology, 4Family Medicine, McMaster University, Hamilton, 5Anthropolgy, York University, 6independent consultant, Toronto, 7School of Nursing, McMaster University, 8OAPN, Juravinski Cancer Centre, Hamilton, Canada
Keywords: Ethics, humanitarian assistance, crisis, development, health care professionals, NGOs
Background:

Health care practitioners (HCPs) encounter ethical challenges while providing care during times of humanitarian crisis and when providing development assistance. The key questions of our study were aimed at learning: 1 - What types of ethical challenges HCPs encounter in extreme conditions such as war, disaster and deprivation?; 2 - How have HCPs responded?; and 3 – What kinds of preparation/resources have been helpful, or would be helpful, in supporting HCPs to respond to these ethical dilemmas?

Methods:

Qualitative study using Grounded Theory analysis of 26 interviews with health professionals and medical students who have provided humanitarian assistance.

Results/Conclusions: We conducted semi-structured interviews with 20 health care professionals (HCPs) including doctors, nurses, therapists and technicians, and 6 interviews with medical students who have done electives in development contexts. The study revealed that the HCPs identified many ethical challenges encountered while working in the field. Four broad, overarching themes were identified: a) Political, structural or organizational challenges; b) Resource limitations; c) Socio-Cultural expectations; and d) Professional identity: roles and responsibilities. While the sorts of challenges described by respondents are in many ways similar to ethical challenges described in their home settings, there are crucial differences in the way they are played out and in the responses HCPs had to the issues. We will present a description of the categories of ethical challenges reported by the respondents, and illustrate cases from our participants’ own experiences. Furthermore, we review some of the resources used by the HCPs for responding to ethical challenges, and their recommendations on preparation and assistance for managing ethical challenges while in the field. This study was funded by The Canadian Institute for Health Research (CIHR).

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