Author: Humanitarian Health Ethics Research Network

Paul Bouvier is working with the International Committee of the Red Cross (ICRC) as the coordinator of the HELP course – Health Emergencies in Large Populations – and chair of the group on ethics in the practice of humanitarian action. The former ICRC Senior Medical Advisor, he is a medical doctor with specialization in pediatrics and public health, and Associate Lecturer at the Institute of Global Health, University of Geneva, where he has carried out research and prevention programs on child sexual abuse and violence. His work at the ICRC focuses on ethical issues in humanitarian action and training humanitarian professionals worldwide in public health and ethics to respond to humanitarian crises.

Along with his medical and training activities, Dr. Bouvier has also applied the perspectives he developed through his various roles and field experience in crises into various philosophical reflection and medical humanities activities. From published reflections on “small things and humanity” on the part of delegates visiting people in detention (2012), to an art history lesson on Francisco Goya’s Disasters of War prints in prefiguring Dunant’s Solferino relief efforts by several decades (2011), Dr. Bouvier has demonstrated his skills as a rich and diverse thinker on issues of suffering, morality and what it means to be human. A further complement to his professional work, and his intellectual writing, he has consulted on exhibitions at the International Red Cross and Red Crescent Museum<https://www.redcrossmuseum.ch/en> in Geneva including the main “Humanitarian Adventure” halls, and the most recent publication “Prisoners’ Objects<https://www.redcrossmuseum.ch/en/product/prisoners-objects/>.”

When considering the shaping of a new generation of humanitarian actors, Dr. Bouvier stresses the importance of developing literacy and practical skills in ethics, to improve decision making in the field. Humanitarian actors, he explains, have lived with the idea that their activities responded in the best possible ways, to their high ethical aims. Some start to realize that in front of complex situations and dilemmas, bearing strong humanitarian values, principles and good will is not enough. We are faced in the field with very challenging, sometimes tragic situations; we have to make very difficult choices, with limited time and resources in front of high needs, and major operational obstacles, including violence and security threats. In order to make ethical decisions in such circumstances we need to recognize and analyze the ethical dimensions and bearings of our decions; and to initiate and ethical deliberation in our teams and institutions, in order to support the decision. This is the task of practical ethics, or practical wisdom in the field.

The humanitarian sector is still far away from such ethical good practice. Ethics in humanitarian action is taken for granted, Dr Bouvier says. A striking example is given by a recent report from an influential think-tank, on operational decision-making in humanitarian response. The review provides interesting analysis of decision-making procedures and protocols, and more informal ways to intuitive, improvised or makeshift decisions, it does not, however, mention the ethical dimensions of difficult decisions in the field: ethics still seems to be implicit and present in all our activity; or perhaps is it conceived as a separate field, for the specialist philosopher and ethicists? either ways, our experience shows that this attitude leads to ethical tensions, sometimes leading to crises, at individual or group level, and when ethical drifts or errors do occur, they represent a major risk for the staff and team in the field, and the institution as a whole. Yet, this risk is still overlooked and ignored.

In order to respond to these needs, training in practical ethics is essential. In 2008, a workshop on practical ethics in humanitarian action was introduced in the ICRC staff integration course, followed by the HELP courses. Since then, the learning approach has been simillar, starting with group sharing and reflection on ethical challenges experienced by participants in their own professional activity. Then the group would choose one case to share with all. This case would be analyzed following a process of ethical analysis and decision-making, before summarizing ethical values and principles in humanitarian action, and the process of ethical decision-making. This approach, starting from situations brought by the participants, proved to be very successful in very different contexts, with different ethical background and traditions, including Switzerland, Qatar, China, Mexico, Kenya, Cuba, Iran, Lebanon, Benin, and the USA.

Based on this fruitful experience, the HELP course recently introduced the Humanitarian Health Ethics Analysis Tool – HHEAT – and used cases from the HHE collection. This approach proves to be also very successful. Key success factors of the HHEAT approach is that, firstly, the cases from the collection bring ethical difficult decisions from the field; secondly, it invites the participants to reflect by their own, to share their reflection in group, and open a deliberation with others, in order to reach a decision; and, most importantly, it does not propose a solution to the case, so leaving a space for reflection and sharing experience. This approach of practical ethics certainly needs skills, experience, and time also, in facilitating the sessions. Managing these learning sessions obviously need strong background on practical ethics, with clear understanding of humanitarian ethical values and principles, as well as good knowledge of, and openness to other cultures and ethical traditions, combined with a clear view of ethical duties and absolute limits, across cultures, notably in front of extreme violence.

Using the HHEAT cases and tool, Dr Bouvier concludes, has some advantages in this respect, from the fact that they wre developed in the context of an international collaboration between academic and humanitarian institutions, in which the ICRC took part. This initiative is deemed to play a very active role in developing ând promoting practical ethics in humanitarian action. The scope of this approach should not be limited to health care, Dr Bouvier suggests, but will very soon expand to the other dimensions of the humanitarian response, including assistance and protection.

[Sources: http://www.icpcn.org/joan-marston/, and personal communication]