Check out this World Health Organization site containing some valuable resources and points of reflection on ethical issues arising during public health outbreaks and pandemics.
Consider exploring some of the questions coming out of that site through Case Studies or by applying the Humanitarian Health Ethics Research Tool (HHEAT).
We look forward to hearing your thought! Contact us here.
Cut and paste the WHO site in your browser: http://www.who.int/ethics/topics/outbreaks-emergencies/en/
As presented by Matthew Hunt at the 10th World Research Congress of the European Association of Palliative Care (EAPC) 24-26 May 2018 in Bern, Switzerland.
As presented by Olive Wahoush at the 1st World Congress on Migration, Ethnicity, Race and Health (MERH), 17-19 May 2018 in Edinburgh, Scotland.
As presented by Lisa Schwartz at the 1st World Congress on Migration, Ethnicity, Race and Health (MERH), 17-19 May 2018 in Edinburgh, Scotland.
Follow this link to the blog authored by Sekou Kouyate on the opportunities and challenges of becoming an anthropologist and a qualitative researcher in post-Ebola Guinea.
Kouyate is the research assistant and coordinator for HHERG’s two R2HC funded studies in Guinea: on perceptions of research and on the provision of palliative care during the 2014-16 Ebola Virus Disease outbreak.
Though ethicists have examined the ethics of humanitarian priority-setting–including around the initiation of humanitarian projects–to our knowledge, none have undertaken a focused examination of the ethics of closing humanitarian projects.
It is critical to examine the ethical implications of closing projects and consider how closure can be accomplished in ways that are consistent with humanitarians’ ethical commitments including minimizing harm, being accountable, upholding impartiality and neutrality, and demonstrating respect.
In partnership with Médecins du Monde-Canada, the team is made up of Matthew Hunt, Ryoa Chung, Lisa Eckenwiler and John Pringle.
Find out more about the project here:
https://humanitarianhealthethics.net/ethics-and-the-closure-of-humanitarian-healthcare-projects/
The latest edition of the HumEthNet newsletter is now available.
Reflections editors:
Sonya de Laat & Jhalok Talukdar
Our email address is:
humethnet@gmail.com
Our mailing address is:
Humanitarian Health Ethics Research Group
McMaster University, 1280 Main St. W., CRL-202
Hamilton, On, Canada L8S 4K1
Film Review
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Bending the Arc
Director/Producer: Kief Davidson
Director/Editor: Pedro Kos
2017, 2 hrs 30 mins
Available at: http://bendingthearcfilm.com
“Bending the Arc” tells the story of Paul Farmer, his colleagues at Partners in Health, and how a tiny NGO in rural Haiti came to push the boundaries of what was possible in global health.
The film is based on the book “Mountains Beyond Mountains” by Tracy Kidder. It offers a chronological history of Partners in Health and highlights how Farmer and his colleagues approached healthcare for the poor from a unique philosophical position.
In the film, Farmer offers many critiques of the way traditional development work and global health are framed saying, “appropriate technology just means shit for poor people and good things for rich people.” He continually pushes viewers to challenge assumptions about healthcare for the poor. The film also presents the claim that neo-liberalism and World Bank imposed austerity programs that have been forced upon low-resource countries have devastated the social and health infrastructure of these countries. At one point, Farmer expresses frustration with the often-quoted platitude, “it is better to teach a man to fish” because, as he says, “their ships are sunk”! He seems to be saying, we cannot solve the healthcare problems of rural Haiti by training healthcare workers or increasing health literacy when the healthcare system as a whole is devastated by austerity programs.
Ethical challenges in providing pediatric medical care in humanitarian contexts
by Rachel Yantzi
Many humanitarian aid organizations prioritize healthcare interventions for children under five years old. This is due to their increased vulnerability, the high mortality rates in this age group, and because many childhood illnesses are easily treated. Providing medical care to children in the context of a humanitarian crisis brings with it a number of ethical challenges. Some are unique to pediatrics and unique to humanitarian contexts, while others are very familiar to healthcare providers who tend to work in non-crisis settings. During the nine months that I worked as a nurse in the Central African Republic (CAR), I encountered many ethical challenges, some that I anticipated and others that were completely unexpected.
My primary role in CAR was as nurse supervisor at a large referral hospital in a community recovering from years of civil war. The overwhelming ethical challenge we faced in CAR was the reality that many of the children who died in our hospital would have almost certainly survived had they been in Canada. As a pediatric ICU nurse, I am used to having all manner of modern technology at my fingertips. I remember watching a little three-year old boy with pneumonia struggling to breathe for hours. All he needed was BiPAP, or possibly to be placed on a ventilator for a couple of days and he likely would have been fine. Instead, there was little we could do as he struggled for air and eventually succumbed to a simple infection. It was incredibly difficult to see how easily a child could be lost in CAR. In Canada, a huge team of nurses, doctors, specialists, as well as state of the art technology and medications would be summoned to save such a child’s life. The discrepancy was hard to stomach.
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Joan Marston is based in South Africa and comes from a background in Nursing and Social Science. She is the Global Ambassador of the International Children’s Palliative Care Network (ICPCN) having served as its Chief Executive. She was one of the founding members of the original ICPCN Steering Committee in 2005. More recently, she has also been part of the group that developed the new Guidelines for Persisting Pain in Children, as well as Guidelines for Disclosure in Children for the World Health Organization.
With twenty-nineyears of experience in palliative care for children, she has provided this specialized care in the roles as Executive Director of Bloemfontein Hospice and as founder of the Sunflower Children’s Hospice in 1998 in Bloemfontein, South Africa, alongside her work in a regional network for life-limited children, the St. Nicholas Bana Pele Network in 2009. As the national paediatric development manager for the Hospice Palliative Care Association of South Africa from 2007 to 2010, Joan and her team developed a strategy for a national network of services, promoting the considerable growth of the number of paediatric palliative care services for children in South Africa. During that time she was the Project Manager for a programme to develop children’s palliative care Beacon centres in Tanzania, Uganda and South Africa.
A committed advocate for children’s right to palliative care and pain relief, Joan has also worked towardsresponsive palliative care for children and adultsduring acute and protracted humanitarian crises. When asked about some of the ethical dilemmas humanitarian healthcare workers might face when confronting terminally ill or injured children, she said, these include prioritising of scare resources such as personnel, time and medicines when saving lives is critical, especially when palliative care is seen as non-essential. Withholding or withdrawing treatment that could prolong life, spending time with a dying child when personnel are needed to deal with acute emergencies, and developing/using comforting child-relevant communication are additional ethical issues. Practically, lack of training in and understanding of palliative care and pain relief in children by humanitarian first responders—as few have paediatric formations—and a lack of palliative care workers in humanitarian situations is a main contributing factor to the development of ethical dilemmas. Humanitarian healthcare workers may also find themselves overwhelmed by the number of adults needing care, or by the reality that adults may leave an ill or injured child due to their own inability to face the issue of children dying. Undoubtedly tragic choices along the lines of those listed will need to be made in harrowing circumstances, but collaboratively making those decisions is part of the work Joan Marston and the larger networks she is involved in continue to work on in order to mitigate and minimize their difficulty.
Joan Marston is an active member of the Anglican Church and a Lay Minister in the Cathedral in Bloemfontein. She is also an Honorary Lay Canon of Blackburn Cathedral in Lancashire, England. She can be reached at joanmarymarston@gmail.com
[Sources: http://www.icpcn.org/joan-marston/, and personal communication]
