On “Doing Ethics” – Dr. Ali Okhowat

ali-okhowat-new-photo-jpg-196x275I began my PhD, in part, for the same reason that I felt compelled to move to Montreal: to learn French. I’d scrounged up the courage to walk over to the then unpronounceable Pavillon Marguerite-d’Youville de l’Université de Montréal shortly before registration closed on an afternoon in late autumn. I’d always been interested in bioethics and dabbled in it during my schooling but the thinking tools that I’d been taught had been uniform and uninspiring, akin to using a paintbrush to solve a Rubik’s cube. As I signed the registration paper, I imagined myself graduating in record time and emerging in a couple years with a memorized copy of Candide. Oh, the plans des souris et des hommes …  

I learned a great deal as I worked through my courses and I quickly came to understand the gist of most discussions. As my readings progressed and the classes became more focused, I found myself wanting to get more experience in issues related to humanitarian and military ethics. Around the same time, my co-supervisors, Drs. Bryn Williams-Jones and Matthew Hunt, were establishing a new research project, the Ethics in Military Medicine Research Group (EMMRG), and I joined the team and eventually formulated my PhD proposal around one aspect of this larger study.

Following the proposal defence, I signed on as a doctor with the International Committee of the Red Cross (ICRC) and was assigned to work as the ICRC’s first doctor stationed in the Gaza Strip and assigned to work specifically on health care in places of detention. As I was in the thesis writing phase of my PhD at this time, I felt motivated by the idea that I would merge my goal of being deployed as a doctor in humanitarian contexts with the parallel goal of finishing my thesis. However, the prelude to and unravelling of the 2014 war in Gaza brought with it a host of unexpected events that delayed my formal writing about ethics yet was informed my understanding of how ethical issues are structured, manifest and evolve in humanitarian settings. The topics that I had until then only explored theoretically came to life with startling – and, at times, devastating – clarity. Issues relating to resource allocation and standards of care, dual-loyalty conflicts, and operational challenges in times of war interspersed with events that news reports from the period documented as mass hunger strikes, allegations of ill-treatment, forced-feeding legislation, and dual-use technologies.

During my mission in Gaza, I continued writing and remained connected to the academic ethics community. For example, I was invited to present at the 2014 International Congress of Military Medicine’s annual Ethics in Military Medicine conference regarding a project undertaken by the Ethics in Military Medicine Research Group (EMMRG), of which I and my PhD supervisors (Bryn Williams-Jones and Matthew Hunt) and other researchers are members. During the question and answer session of my presentation, one of the audience members noted that “ethics, like military training, becomes better with practice.” In the ensuing months, this statement echoed in my mind as I came to appreciate its importance through practice. I realized that while we may use conceptual frameworks, tools, and guides to help us frame ethical issues, clarify discussions and generate possible resolutions, in the absence of directed study, reflection, and debate, ethics training without practice renders us ill-equipped for the real task: to become better at ethics by ‘doing ethics’. This engagement is critical and I understood in retrospect, as my mission carried on, that my colleagues and I needed more tailored ethics training and practice to resolve the ethical issues that we were immersed in. This led to a period of reflection about professional ethics in the humanitarian sector and the drafting of several internal documents on this issue.

Following the end of my mission in Gaza, I returned to Canada and resumed working in earnest on the completion of my PhD. Yet personal events and professional opportunities took me to a country that had always fascinated me: Afghanistan. As the Health in Detention Program Manager for Afghanistan, I was tasked with overseeing all of ICRC’s health programmes in detention-related settings. In this role, I became engrossed in an environment and culture that was familiar yet foreign. Though I was familiar with the language and customs of the region, my experiences there presented me with a larger scale of professional and ethical challenges. During this time, I travelled extensively within and beyond Afghanistan’s borders, jumping on ICRC and UN flights in cramped, propeller-driven aircraft on an almost weekly basis, from Kabul and Bagram to Kandahar and Herat to Mazar-e-Sharif and Dushanbe, Tajikistan and beyond. I debated about the ethics of our programmes and the actions of the wider humanitarian community with colleagues within the humanitarian sector and friends back home. In interacting with them, I came to realize that our humanitarian space was constrained, at times shrinking, and required constant reinforcement — all issues that I came to understand better as a consequence of my ethics training.   

 Towards the end of 2015, I was recruited to work at the World Health Organization’s Eastern Mediterranean Regional Office as a member of the inaugural Emergency Operations team. Working at a regional level in contexts confronted with various categories and levels of emergencies, I travelled extensively in the region and was responsible for assisting my emergency response colleagues in countries such as Syria, Iraq, Somalia, Afghanistan, Iraq, Yemen, and Libya, among others. Throughout my work and travels, ruminations on issues that crossed boundaries between humanitarian, professional, organizational, and public health ethics swirled in the back of my mind while the foreground of my experiences framed them in vivid detail. Given my supervisor’s encouragement to join her in exploring issues using our common training in ethics, we began to increasingly include ethical considerations and analyses in our review of programs and policies.

These experiences bring me now to the present, a moment that is well beyond my original projection of how long it would take to “quickly wrap up my thesis” and far from the level of French mastery that I’d hoped to attain. Still, as I approach the final stages of this journey, I don’t find myself regretting the detours I’ve taken; instead, I realize that my writing ‘about ethics’ has been enriched by my attempts to ‘do ethics’.

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