0 comments on “Justice in the Humanitarian Context – Maxwell Smith”

Justice in the Humanitarian Context – Maxwell Smith

msmithMaxwell J. Smith, PhD, MSc

Banting Postdoctoral Fellow, Institute for Health and Social Policy, McGill University

During the 2009-2010 H1N1 influenza pandemic I began working as a research coordinator with the ‘Canadian Program of Research on Ethics in a Pandemic’ (CanPREP).  Hosted at the University of Toronto’s Joint Centre for Bioethics, this program of research involved engaging the Canadian public on ethical issues in pandemic preparedness and response (e.g., the use of restrictive measures like quarantine;1 physicians’ duty to care;2 setting priorities for scarce resources;3 and issues pertaining to global governance4).  What became apparent to me when examining the ethics discourses in pandemic planning and response was that a common and unsubstantiated assumption exists; namely, that the ethics of global public health emergency preparedness and response is perceived as being distinct from the way we think about ethics in what might be considered ‘quotidian’ public health.  For example, Kirkwood suggests that “there must be an ‘escalator clause’ in the utilitarian aspect [of resource allocation] that suggests that in the event of an extensive threat to the existence of a population, the force of this utilitarian aspect becomes the primary consideration in proportion to the threat…the greater the threat, the greater the moral force of utilitarianism in making public health decisions”.5  As another example, Veatch asks whether, in public health emergency preparedness and response, we should “retreat to the utilitarian ethic, making an exception to the ethic of justice that generally prevails in American ethics”.6  Do we tend to be more utilitarian in the way we think about preparing for and responding to public health emergencies as compared to the way we make public health decisions in non-emergency contexts?

This question motivated me to focus my doctoral research on examining the extent to which the perspectives of Canadian public health policy-makers involved in public health emergency preparedness and response are similar or different than those involved in other areas of public health, like chronic disease prevention, specifically in regards to how social justice is conceptualized and negotiated in their work.  Using qualitative interview methods, I found that the perspectives of my study’s participants appeared to be influenced by the perceived goals and contextual features that belong to the programmatic area of public health in which they practiced.  For instance, policy-makers involved in public health emergency preparedness and response described this area’s principal aims as saving the most lives and producing the ‘greatest good’.  Justice-based considerations, interpreted almost entirely in terms of equity, were perceived as being external, or even as being impediments, to these consequentialist, if not utilitarian, aims.  Policy-makers involved in chronic disease prevention, on the other hand, described this area’s central aims in terms of equity and justice; its purpose involves understanding and targeting the unique needs of different populations in order to produce equitable outcomes.  On my interpretation, my study’s findings indicate that the perceived role of social justice considerations in public health emergency preparedness and response may be distinct from how their perceived role in chronic disease prevention; where justice-based considerations are perceived to be part and parcel of the aims of chronic disease prevention, they are perceived as external to, if not constraints upon, the ‘prior’ aim of public health emergency preparedness and response, which is to minimize morbidity and mortality for the greatest number.  The findings of this study have led me to consider whether the way we think about justice in the humanitarian context might be distinct from how we think about justice in public health and global health more generally, and if so, whether this is ethically justifiable.

  1. Smith MJ, Bensimon CM, Perez D, Sahni S, Upshur REG. (2012). Restrictive Measures in an Influenza Pandemic: A Qualitative Study of Public Perspectives. Canadian Journal of Public Health, 103(5): 348-352.
  2. Bensimon CM, Smith MJ, Pisartchik D, Sahni S, Upshur REG. (2012). The Duty to Care in an Influenza Pandemic: A Qualitative Study of Canadian Public Perspectives. Social Science & Medicine, 75(12): 2425-2430.
  3. Silva DS, Gibson JL, Robertson A, Bensimon C, Sahni S, Maunula L, Smith MJ. (2012). Priority Setting of ICU Resources in an Influenza Pandemic: A Qualitative Study of the Canadian Public’s Perspectives. BMC Public Health, 12: 241-252.
  4. Thompson A, Smith MJ, Bensimon CM, McDougall C, Perez DF. (2015). “With Human Health it’s a Global Thing”: Canadian Perspectives on Ethics in the Global Governance of an Influenza Pandemic. Journal of Bioethical Inquiry, 12(1): 115-127.
  5. Kirkwood, K. (2010). In the Name of the Greater Good? Emerging Health Threats Journal, 2(E12), 1-3.
  6. Veatch, R. (2005). Disaster Preparedness and Triage: Justice and the Common Good. The Mount Sinai Journal of Medicine, 72(4), 236-241.

Max Smith is a Banting Postdoctoral Fellow at the Institute for Health and Social Policy at McGill University. 

1 comment on “Policy & Well Being – Leigh-Anne Gillespie”

Policy & Well Being – Leigh-Anne Gillespie

img_30091Leigh-Anne Gillespie, PhD candidate

Health Policy Program, Political Studies Stream

gilleslb@mcmaster.ca

The lasting impression of participating in a medical mission to Olongapo City, Philippines in 2008 inspired me to pursue a PhD in Health Policy. Policy is far-reaching: the ability of good health policy to improve the well-being of large groups of people – and of poor health policy to degrade it – is humbling.

Since joining the Health Policy PhD Program at McMaster University, I have been immersed in policy analysis and theory. My research, conducted under the guidance of Dr. Lisa Schwartz, focuses specifically on the nature of ethical challenges arising from humanitarian aid agency policies during disaster and conflict response. In-depth, qualitative interviews with organizational members from international aid agencies have shed light on how policy both helps and hinders in various contexts. With keen anticipation of their contributions to the humanitarian sector, I am looking forward to disseminating these findings shortly.

 The interdisciplinary nature of the Health Policy PhD Program has allowed me to flourish. It has pushed me to create my own path and transcend disciplinary boundaries, while at the same time develop a shared language by which to communicate with colleagues. I am grateful for the collaborative approach the program has instilled in me, and look forward to continued opportunities to help advance humanitarian healthcare ethics.

0 comments on “Geneva & Back Again – Julia Pemberton’s Reflections on Interning at the WHO”

Geneva & Back Again – Julia Pemberton’s Reflections on Interning at the WHO

Julia Pemberton, PhD candidate
Health Research Methodology Program, Field of Interest: Global Health
pemberj@mcmaster.ca

img_8967This past summer I had the incredible opportunity to join the World Health Organization (WHO) as a Research Intern for three months. At WHO I joined the Global Health Ethics Unit, which is part of the larger Research, Ethics, Knowledge Management Department. The majority of my internship focused on the creation and execution of a qualitative descriptive research study. Entitled “Ethical Issues Associated with Implementation Research: A Descriptive Qualitative Analysis of the WHO Experience from 2005-2015,” this study consists of a document analysis followed by two focus group sessions, one with WHO Technical Officers, and one with past and present WHO Ethics Research Committee (ERC) members. The purpose of this study is to identify and understand the ethical issues identified by the WHO ERC in its review of  Implementation Research (IR) projects submitted for ethical review at WHO. The results from this study will be used to raise awareness on the ethical issues arising in IR and to build capacity of researchers and ethics committees involved in the conduct and review of IR, respectively. The results will also potentially be used to inform a global guidance document on ethical review of IR. In addition to this research project I also was a member of the WHO Intern Board as an Intern Advocate, where I helped connect interns with WHO staff to engage in professional development and networking opportunities. Finally, I was also responsible for the creation of an Intern Alumni platform for the Global Health Ethics Unit, as well as the Global Health Ethics newsletter. In summary, I used my time in Geneva to expand my professional network, and had productive meetings with the International Committee of the Red Cross, Médecins sans frontières, the Council on Health Research and Development (COHRED), and the Geneva Centre for Education and Research in Humanitarian Action (CERAH).

The research activities described above directly relate to my doctoral work. The topic of my dissertation is global health research governance. Governance, or the way political, ethical, administrative, and financial authority applies to a health research system, is an important part

of how these systems are organized and managed, and how they perform. The purpose of my doctoral thesis is to examine how global health research governance is being understood, developed and currently used in the Canadian national health research system. Briefly, my thesis will generate an inductively derived, reflexive, global health research governance model for Canada. Through this work I intend to identify specific value criteria that are indicative of good global health research governance. Foregrounded will be the contribution of global health research ethics to governance beyond research ethics review, and discerning how values are known and reflected in the governance of national health research systems. Once this model of Canadian global health research governance is known, I will be conducting a case study of a global health research partnership (Canada and Zambia) to determine the current reflexivity of the Canadian model and determine what, if any, recommendations for policy and health systems strengthening could be made.

Julia Pemberton is a 3rd year student in the Health Research Methodology PhD at McMaster University, a CIHR Banting & Best Canadian Graduate Scholar, and a recipient of both the CIHR Douglas Kinsella Award in Bioethics and the CIHR Michael Smith Foreign Study Supplement Award.

0 comments on “On “Doing Ethics” – Dr. Ali Okhowat”

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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Foundations – Gautham Krishnaraj

Foundations.

Perspectives from a new Global Health Student and Humanitarian Health Care Ethics Research Group Trainee

Gautham Krishnaraj, MSc Global Health Candidate (McMaster University)

From Montreal…

In September 2014, at the peak of the Ebola outbreak that inundated the minds of media and global citizens alike, I found myself in an unlikely situation. I, as a third year Microbiology & Immunology student at McGill University, was working as part of a global coalition of health professionals to research, compile and brand training protocols for the International Medical Corps (IMC). Here, I was able to see the laboratory techniques and virology concepts I was learning in the classroom be applied in real time by the IMC’s Multi-Agency Training Collaboration (MATCO) to support the Ebola response in West Africa. As an aspiring Humanitarian Health Care Professional, it was an exciting first exposure to this fast paced, international, and interdisciplinary sector.

…to Hamilton,

Two years later, I find myself in Hamilton Ontario, in a ‘classroom’ that seems to defy all classical connotations of the word. The program, McMaster University’s 12 month Masters of Science (MSc) in Global Health, is a wildly successful (2015 CIBE Program of Excellence) experiment in international collaborative education. This morning’s lecture is a prime example of why; it’s happening 6,000 kilometres away at the University of Maastricht – and next week, students from the Netherlands will tune into our classroom here in Hamilton. Each lecture is followed by a chance to virtually connect with our global groups to work on assigned policies with real-world relevance and impact.

Working through time zones, language barriers, and diverse motivations, we face real challenges and prepare for the rigours of pursing a profession in this sector. One of the first ethical challenges we must consider is the language of correspondence itself; how are we (native english speaking Canadian students) placed in a position of power within our global teams? How does this influence the sharing of ideas and accessibility of information, and how can we work with our peers to dismantle these structures and enable full participation? Furthermore, how do language and regionality impact where, how and to whom humanitarian aid is delivered? With our expert mentors and a plethora of toolkits at our disposal, we will work together to tackle these challenges in pursuit of a greater understanding of this diverse sector. As a trainee in the Humanitarian Health Ethics Group, I hope to delve even deeper into the ethical underpinnings of humanitarian aid, and the impact of working in austere environments on the provision and providers of palliative care. Indeed, we must strive to keep the humanity in our humanitarian workers.

…India…

Perhaps one of the most anticipated elements of McMaster’s MSc. in Global Health is the two-week Learning Symposium at Manipal University, in the Karnataka State of India. Field-based training has been identified as an invaluable asset in the professional development of humanitarian health professionals, and despite having travelled quite extensively, I eagerly anticipate the opportunity to do so under academic/professional auspices. Students from partnering universities will come together from around the world to receive a unique field orientation and engage in critical dialogue surrounding our theses and scholarly papers. In preparation for this international experience, I have looked to Global Health Training – Ethics and Best Practices Guidelines for Training Experiences (Crump et al., 2010) for preliminary ethical considerations to guide my journey through the Program. Crump, Sugarman and the Working Group on Ethics Guidelines for Global Health Training (WEIGHT) identify three main populations in Global Health Training; Sending/Host Institutions, Trainees, and Sponsors, each with unique responsibilities and recommendations.

Focusing on the trainees for the purposes of this discussion, the first responsibility of the trainees is to “Recognize that the primary purpose of the [international] experiences is global health learning and appropriately supervised service.” This may come partly in response to countless case studies such as those presented by Dr. Robert Huish (2012) in a special issue of the Journal of Global Citizenship and Equity Education. Huish draws attention to the various complex ethical conundrums faced by an increasing number of medical students undertaking International Health Electives. Major challenges included “Navigating different cultures [of medicine], moving beyond one’s scope of practice, and unilateral capacity building” (Huish, 2012) (Elit et al., 2011). These situations not only place the trainee under immense stress, but also increase the liabilities of the institutions and diminish the quality of care received by the local populations.

The McMaster program appears to address these challenges and reflect the priority of learning by means of a tightly facilitated curriculum with a diversity of mentors to guide personal, professional and academic growth. Furthermore, being immersed in the Symposium’s academic setting should allow deeper engagement with cultural and local contexts, ideally allowing us to “demonstrate cultural competency and engage in appropriate discussions about different perspectives” (Crump et al., 2010).

…and beyond.

It remains to be seen if the two-week Symposium will provide sufficient field exposure for students to concatenate theoretical to practical competencies, and then demonstrate them during our practicums and thesis research. The fields of Global Health and Humanitarian Health Care not only share inherent ethical challenges, but also both suffer from a lack of professionalization and standardized competency based-training (Johnson, 2013). McMaster’s blended (online, in-class, field-based) classroom model is also particularly adaptable to the mobility needs of Humanitarian Health Care Professionals. I anticipate that this program will continue to evolve with each passing cohort, and provide valuable insight into the future of ethical Global Health and Humanitarian Health Care training for years to come.

References:

Crump, J. A., Sugarman, J., & Working Group on Ethics Guidelines for Global Health Training (WEIGHT. (2010). Ethics and best practice guidelines for training experiences in global health. The American Journal of Tropical Medicine and Hygiene, 83(6), 1178-1182.

Elit, L., Hunt, M., Redwood‐Campbell, L., Ranford, J., Adelson, N., & Schwartz, L. (2011). Ethical issues encountered by medical students during international health electives. Medical education, 45(7), 704-711.

Huish, R. (2012). The ethical conundrum of international health electives in medical education. Journal of Global Citizenship & Equity Education, 2(1).

Johnson, K., Idzerda, L., Baras, R., Camburn, J., Hein, K., Walker, P., & Burkle, F. M. (2013). Competency-based standardized training for humanitarian providers: making humanitarian assistance a professional discipline. Disaster medicine and public health preparedness, 7(04), 369-372.

0 comments on “Our global complicity in torture? Palliative Care & Ethics”

Our global complicity in torture? Palliative Care & Ethics

Original Title: mmills_medicalsupplies0021.tif

by Brett Sutton

When I was first introduced to palliative care as a medical student, it struck me as a rather mysterious medical specialty. Remarkable in its acceptance of death and dying, when all the rest of us were battling to save lives, almost as an end in itself. Doctors always out to ‘cheat death’, regardless of means and sometimes wilfully disregarding the suffering incurred along the way. Palliative care practitioners in stark contrast appeared to me to be amazingly resilient,with depths of compassion and a unique medical perspective. I still think that.

Now, though, after a twenty year career in emergency medicine and later public health, I don’t see palliative care through that mysterious lens anymore. After work in Afghanistan, Ethiopia, Timor-Leste and beyond, I can’t conceive of it as a kind of ‘add-on’ medical specialty, reserved for a very few for whom “nothing more can be done”. Ah, yes. Nothing more can be done. I hate that saying. As if curative treatment is the only thing that counts. That pain relief means nothing. That loving kindness and relief of suffering are nothing. So very much can be done in the last days of a person’s life; it can mean the world to them and their family.

I wish I’d had better palliative care skills when I worked in Afghanistan, for Médécins Sans Frontières (MSF). One of my patients with tuberculosis was dying, probably from drug-resistant TB, following years of inadequate, ad hoc, unsupervised treatment. It was typical for the very poor to buy only as many TB drugs as they could afford at the time, perhaps lasting a week or two. They’d get better, then relapse and weeks or months later buy some more. And instead of taking four different TB drugs together to prevent resistance, they’d take just one. All freely available, without prescription, to anyone willing to pay. She was only in her twenties and she was dying, despite MSF’s dedicated and robust TB program. We simply didn’t have the second-line drugs she needed; they cost one hundred times more and were – at the time – pretty toxic.

Her husband and I were sitting in the back of the MSF car, having just been at home with her to try to understand why she was worsening. I’d concluded she was dying (and probably thought nothing more can be done) but I didn’t know how to tell him, this devoted man who had no doubt hoped to begin a family and have a long life with her. He turned to me and said something in Farsi, and so I looked at the translator, expectantly. The translator looked down, silent for a time, and then told me that he’d asked: “Shall I buy a shroud?”

“A what?” I said.

“A shroud. You know, for her…burial” said the translator.

“Oh…um…she…” I mumbled. I looked at this already grieving man as he held my gaze intently. “Yes…” I said.

In many ways this young woman was lucky. We provided some basic support to her. She wasn’t in pain. Her treatment, although futile, was free. She wasn’t alone as her husband lovingly cared for her in the mud brick shelter of the internally displaced person’s camp. She died two days later. For many in the world today dying occurs in much more bleak circumstances; sometimes in hellish circumstances.

In the MSF-supported hospital in Herat, Afghanistan, other women were manifestly less fortunate. The obstetric ward would receive many women who finally arrived after days of obstructed labour in their remote village. They needed Caesarean Sections to deliver their children; children who were invariably, tragically, already dead. Without ketamine, a wonder drug which can be used safely for surgery in developing and developed countries alike, these women received only intravenous diazepam (Valium). It doesn’t provide pain relief, only sedation. So as they awoke, not only were they hurriedly presented with their dead child to take home and bury, but they awoke in physical agony. Not allowed more than five minutes on the bed, due to the sheer pressures of arriving women, they were discharged home. And what pain relief were they given then? Acetaminophen; better known as Tylenol. Two tablets, then home. What you and I would take for a mild headache, they took for major surgery.

Opioid painkillers – such as morphine – are what these women should have received. Cheap, effective and safe, morphine should be readily available across the world, yet it is still highly restricted in so many places. In part due to an absurd ‘war on drugs’ and also because of an irrational fear of fomenting addiction, opioids remain grossly underutilized. The UN General Assembly Special Session on Drugs (UNGASS) closed in New York this April with lip service to a public health-focused strategy on the drugs wars. With such global intransigence and lassitude apparent, some countries are pressing ahead with liberalization reform for illicit drugs. Yet there’s little progress on the availability of opioid medication in places where it is most needed, such as Afghanistan and India.

Most of us have experienced severe, uncontrolled pain for minutes, perhaps hours. A few of us are unfortunate enough to suffer chronic pain, but at least we can seek expert advice and relief of some kind. And we’re not dying. Yet palliative care is still unavailable for far too many at the end of life. In 2009, Human Rights Watch estimated that in India more than one million patients with advanced cancer suffered severe pain in any given year. They estimated that fewer than 4% of patients had access to appropriate pain treatment (that’s code for opioids). This was a consequence of restrictive drug regulation, poorly trained doctors and poor integration of palliative care into health services.

Some have debated as to whether allowing patients to suffer intolerable pain amounts to cruel, inhuman or degrading treatment. Even torture. Torture, however, implies a wanton and malicious desire to inflict pain. I don’t believe that occurs in the vast majority of individuals who suffer without access to adequate pain relief, even when it’s withheld deliberately. Yet debates regarding our legal and ethical obligations are important – indeed essential. They just shouldn’t be left entirely to legal arguments in Courts of Human Rights. There is a moral imperative here to address complicity through inaction in suffering on a global scale, especially for those at the end of life. Semantics and legal nit-picking take us away from the pressing need to address the circumstances that we all agree are indefensible – leaving someone in intolerable pain when relief from suffering is easy, safe and affordable.

Imagine you were dying and suffering from constant, severe pain that made you wish for death. Treatable pain. Opioid medication could readily alleviate it, but it wasn’t given to you. Cruel? Inhuman? Degrading? Torture? What would you call it?

Dr Brett Sutton is a public health doctor, co-chair and co-founder of Palliative Care in Humanitarian Emergencies (PCHE).

This blog was originally published on Brett Sutton’s LinkedIn page: https://www.linkedin.com/pulse/our-global-complicity-torture-brett-sutton?trk=prof-post

Photo credit: CDC/ Amanda Mills

0 comments on “Why I go to low- and middle-resource countries”

Why I go to low- and middle-resource countries

by Laurie Elit

Members of the Humanitarian Health Ethics group have varied motivations for their involvement in low resource settings. Some people travel to these settings for academic reasons trying to study the situation in order to improve things. Some travel to provide health care for people who would otherwise not be able to access such services. I was asked to comment on the motivation that has kept me involved in short-term missions. My first out-of-Canada low resource mission was a 5-month stint as a medical student in the highlands of Papua New Guinea. Over the years I have found myself in various contexts such as medical educator (Guyana), surgeon (Kenya, Nepal, Haiti, Bangladesh, Pakistan), researcher (Brazil) and implementer of a national cervical screening program (Mongolia). It was in Mongolia that I was asked the same question that Humanitarian Health Ethics asked me to comment on here.

I have learned that we can look at our world from various vantage points (or worldviews). Worldviews change over time and across societies. There are worldviews particular to oral (tribal), peasant (low hot flat coastal areas/high rugged mountains), modern (first global culture or rationalist), post-modern (advanced capitalist, glocal) societies. Biblical refers to the human understanding of the world from God’s perspective as given in scripture. As a physician, I have been trained under the assumptions put forward in the modern and late modern perspective. As a Christian, I continually have to reckon this with the biblical worldview.

2 comments on “The Rising Humanitarian Tide”

The Rising Humanitarian Tide

by John Pringle

(version français à la suite)

“Every ship is unsinkable, until it sinks” (Crawley, 2010). So it is with human rights: inviolable until they are denied. The right to protection from war, the right to maritime rescue, the right to seek asylum, the right to life’s necessities, the right to health care, and the right to be treated humanely and with dignity: the words are failing the very people they were written to protect. Who would have thought, that in the 21st century, we would have to argue defensively for pulling drowning people from the sea. The humanity principle – that people are entitled to assistance and to be treated humanely simply by virtue of being human – is not and never has been a given. Lives are not valued equally, some not at all.

That human lives are undervalued may come as a shock. Unless you are an aid worker. As an aid worker, you may have seen a child die for lack of a ten cent measles vaccine – measles kills about 400 children every day (WHO, 2015). You may have seen a patient suffer for lack of an available treatment – diseases of poverty are invisible to pharmaceutical companies (Access Campaign, 2015). As an aid worker, you will have witnessed how the global economic system values people for their wealth. And it values profit. Apart from that, it sees nothing of value (Patel, 2010).

The Global Refugee Crisis is a stark reminder that we live in a world of disparity. The old mantra, “a rising tide lifts all boats”, argues that what is good for the economy is good for everybody. But in the context of a Mediterranean graveyard, the rising tide cliché is not just ironic but grotesque. After decades of neoliberal economic policies, the tide has lifted only luxury yachts and military patrol vessels.

0 comments on “The Humanitarian Politics of Cecil the Lion”

The Humanitarian Politics of Cecil the Lion

by Lauren Wallace

Two weeks ago Stephen Harper kicked off the election campaign. But it wasn’t clear if many Canadians were paying attention. Because the killing of Cecil the celebrity lion had already broken the Internet.

In case you missed it, in late July, Walter Palmer, a dentist from Minnesota, beheaded Cecil, a lion living in Hwange National Park in Zimbabwe. Within days of news of the murder breaking, the public’s violent backlash sent Mr. Palmer into hiding. Major airlines, including Air Canada, banned shipments of hunting trophies from Africa; a global petition demanding justice accumulated over 300,00 signatures; PETA called for the killer to be hanged to death; and, donations were made to erect a life size bronze statue of the martyr lion.

1 comment on “hhe members author ALNAP blog on palliative care in humanitarian crises”

hhe members author ALNAP blog on palliative care in humanitarian crises

Elysée Nouvet and Lisa Schwartz co-authored a blog post for ALNAP on July 10, 2015 entitled:

Is palliative care in humanitarian crises a luxury?

If there is one thing the Ebola crisis has generated these past 18 months, it is widespread recognition that globally we could be better prepared for responding swiftly and ethically to complex pandemics. Ethical issues that surfaced in the panicked first months of the last Ebola crisis have ranged from debates on whether or not healthcare workers in non-Ebola affected countries have a duty to respond and assist their colleagues in other affected countries, to the absence of a standard of care for treatment of affected patients. As members of the Humanitarian Healthcare Ethics Group, we were surprised that another big question was not, and still is not, receiving the deliberation it merits: What are the responsibilities of humanitarian healthcare teams, if any, vis a vis the palliative needs of patients?

Visit the ALNAP blog to find the full post.