Setting: A field hospital set up by a team of foreign health care practitioners working with an international non-governmental organization, in the aftermath of a powerful earthquake that destroyed major infrastructure including public buildings and hospitals. The field hospital is situated in a rural area outside the capital and run in collaboration with local staff from a health clinic that was destroyed by the earthquake.
Scenario: It is 3 o’clock in the afternoon. An infant in respiratory distress is brought to the field hospital by her mother. The mother was widowed during the earthquake.
The field hospital has neither the personnel nor the equipment to actively care for the baby due to the acuity of her condition. The physician who assesses the infant determines that she should be transferred to a better-equipped facility in the capital. When this option is raised, the team coordinator reminds the physician that there is a 6 pm curfew in place for the team and its project vehicles and that it is now 3:45 pm. The doctor insists that without the transfer the child is likely to die overnight.
An impromptu team meeting is called to discuss the situation. The baby is receiving oxygen but her condition is worsening. The mother is very worried and becoming agitated. The drive to the hospital in the capital will take 2 to 2-1/2 hours if the roads are clear and there is not too much traffic. Even with good driving conditions, the team members who accompany the baby will not be able to return to the field hospital until the next day. In addition, the stretch of road between the hospitals is considered a dangerous kidnapping area. Using a vehicle to transport the baby would also mean leaving the rural team with a single vehicle overnight. Such an arrangement contravenes unit protocol because one vehicle is insufficient to evacuate all team members in the case of an aftershock or for security reasons.
Analysis: Apply this case to the Humanitarian Healthcare Ethics Analysis Tool (HHEAT). The HHEAT is intended to facilitate discussion and deliberation for those involved in ethically challenging situations and will assist humanitarian healthcare workers in implementing well-considered decisions. The six steps are designed to help you or your team structure reflection and deliberation on the ethical dilemma presented in the case study. You may skip questions that appear less relevant to the issue or explore dimensions pertinent to the context but not listed in the tool.
Disclaimer: Case studies in the ENHA (Ethics Narratives in Humanitarian Aid) series are based on the reflections of humanitarian healthcare workers on ethical challenges experienced in the field. While the stories presented in the cases draw on real events and the accounts of real persons, many stories are composites in which similar experiences are woven together. In all of the stories, details such as names, dates, locations, career and life stage, gender, and profession have been changed, obscured, or omitted. Any resemblance the stories may bear to actual persons, places, and events is co-incidental.
While the stories often aim to show what the protagonist is thinking or feeling, the Humanitarian Healthcare Ethics Research Group’s intent as the stories’ author is not to suggest that the values and assumptions held by a story’s protagonist are those of all or many humanitarian healthcare workers. Similarly, the values, opinions and actions of a protagonist or other actors in a story should not be understood to reflect those of, or be endorsed by, the Humanitarian Healthcare Ethics Research Group.
How to cite: Humanitarian Healthcare Ethics. 2014. ENHA Case Study Series: Conflicting Priorities during a Public Health Emergency. www.humanitarianhealthethics.net.