What form should bioethics take in the years to come? It’s clear the status quo is not enough.
This is true for humanitarian health ethics. Although there are valuable foundations, pathways, ideas to build on – or so we hope – there is a need for new directions identified by different perspectives. When we started down this way as researchers, it was with the goal of creating and contributing to shared spaces to reflect upon and discuss ethical dimensions of health-related humanitarian action. And also, to disrupt the plain transposition of existing norms and standards of Western bioethics to humanitarian response. Alongside a recognition of the merits of existing work, we were aware of and sought to understand the ill-fit and tensions with what the varied contexts of humanitarian action might bring. There are many examples that could illustrate these issues of disalignment, such as how meanings and methods of triage might vary if a sudden onset disaster occurs in a setting with a highly resourced healthcare system or in a setting where the health system is already precarious and lacking in infrastructure, human resources and supplies. When humanitarian response enters the frame to address population needs during a crisis, sometimes what is outside the parameters of that frame are missed. In our work, we have sought to understand the ethical tensions this might create, or at least demonstrate that the frame is porous and created by events and people.
We started with what came to us, including our team’s own experiences: exploring the ethical challenges of international health responders, identifying, cataloguing cases in order to help clarify ethical issues encountered by people working in humanitarian response. At least by some. We acknowledge the lopsided and partial aspect of this approach. Over time, we have sought to widen our field of inquiry and approaches to it. This includes whose perspectives we sought out in our research, as well as our approach to collaboration, working more directly with members of the communities that met with humanitarian response, seeking to incorporate a wider set of perspectives in how we set about our research and structured our analyses. We have sought to incorporate capacity-engagement in our work (not just capacity development, but respectful collaboration with experienced local researchers). It is a start, and has involved remarkable researchers in collaborations that we hope are responsive to a wider set of views and viewpoints. Important steps in our scholarship, but we feel still not enough on our parts.
The world has been shaken several times since we launched our research program in this field of inquiry – the West African Ebola outbreak, conflicts, massive migration, acceleration of climate change, and now the pandemic. Understandings about structural racism and the urgency of decolonization have gained much needed momentum in guiding ethical practice across all health settings. Imagining a twenty-first century approach to bioethics and humanitarian health ethics requires new language, critique of the analyses and tools presented, including by us, and an open dialogue about what needs to be rethought and reappraised, and crucially more inclusive ways going forward.
In 2012, we hosted a research forum that led to the development of a research agenda paper for humanitarian health ethics. It was published in 2014 and we anticipated that it was the start of a conversation we hoped would continue about research priorities in this domain. Now at the end of 2021, facing two years of a world shaken by pandemic and the undeniable evidence of the effects of structural racism and historical injustices, we are encouraged by the possibility of reimagining humanitarian health ethics as a domain of research, learning and discussion. There is much to be explored, reviewed and challenged. New pathways, people and places can shed light on the ethical challenges and moral experience that emerge in the process of varied modes of humanitarian response, as well as raising questions about the ethical dimensions, structures and orientations shaping the field of humanitarianism and the humanitarian sector. We look forward to participating in this process.
In our work on health-related humanitarian action, we have drawn from the interstitial spaces between global health, clinical and public health ethics, as well as long held debates about humanitarianism. Questioning what was applicable from what is available, never fully positioning our work on this topic in any of these sectors. We recognize social justice, decolonization, epistemic deconstructions, new approaches to practice are all needed to help reimagine humanitarian health ethics going forward, and we hope to use the platform of the www.humanitarianhealthethics.net website to open a space to explore, engage with and nurture diverse perspectives, new ideals and new ideas, and demonstrate how humanitarian health ethics can ‘build forward’ in greater, broader justice. We begin by inviting engagement in creating a renewed vision for a humanitarian health ethics agenda 2.0, to spark conversation and debate around priority research topics. Please see the changes to the hhe website and consider contributing a blog or participating in upcoming events through which we hope to keep this momentum growing.