Ethics and the closure of humanitarian healthcare projects

 

It is thus 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.

Context:

Non-governmental organizations routinely make and enact decisions to close humanitarian health projects. Doing so is unavoidable, and a necessary component of humanitarian action. However, ethical questions may arise related to why a project is selected to be closed and how closure is implemented. Different models of closing projects have been utilized, including phasing down (gradually decreasing the project in size, sometimes leaving a small presence in place in case the project needs to be reactivated in the future), phasing over (gradually shifting it to local actors), handing over (transfer of the project to local actors), and ‘cut and run’ (sudden termination of a project). While many project closures unfold smoothly, in other cases they are contested and give rise to ethically challenging situations for humanitarian organizations, their partners, and local communities. Considerations include clarifying what is owed to communities with whom an organization has been working, the intrinsic as well as instrumental value of humanitarian projects, and the structured nature of health vulnerabilities during war, disaster or public health emergency. It is thus 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. 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.

 

Project:

Our interdisciplinary research team (with expertise in global bioethics, political philosophy, humanitarian action, medicine, nursing, rehabilitation and qualitative research methods) has been working collaboratively with knowledge users from Médecins du Monde-Canada to answer the following research question: What values and approaches support ‘ethical closure strategies’ when humanitarian organizations elect to close a project?

We’ve used an integrated study design that combines qualitative interviews and a literature review, with normative ethical analysis in order to develop a set of ethics guidance notes about humanitarian project closure. This approach allowed us to work ‘up’ from experiences of individuals with first-hand experience of the phenomenon of interest (as expatriate and national staff of international humanitarian organizations)* and to work ‘down’ from normative theories.

The combination of these approaches supported the development of ethical guidance that is grounded in experience, and that is also informed and inspired by theory and careful normative analysis.

Our hope is that through this project we will spark further discussion and debate around this important topic within and across humanitarian organizations, and that the study outputs will support organizations as they make and implement decisions to close humanitarian projects.

* in future research, we plan to conduct case studies of project closures that will enable us to engage directly with members of communities and other stakeholders in locales where projects are being closed or have been closed.”

 

Ethics guidance:

Based on the interviews, review of gray and academic literature, and wider reading in the areas of bioethics, humanitarian ethics, political philosophy and political science, we created a guidance note related to ethics and project closure. The guidance note was refined through a second round of interviews and during a feedback workshop. Based on these discussions, we elected to create two versions of the document (a condensed and extended version) and a one-pager that excerpted key questions. These documents are accessible here:”

Ethics of closing humn projects_Aug 2019_condensed

Ethics of closing humn projects_Aug 2019_extended

Ethics of closing humn projects_Aug 2019_excerpted questions

 

Literature review:

As part of the project, we conducted a literature review of gray and academic sources. The full text of the review will be posted here once it is available. The following document includes a list of all the articles that were selected for inclusion in the review”

The review has been published in the International Journal of Humanitarian Action. It is available open-access from https://link.springer.com/article/10.1186/s41018-019-0064-9

Ethics of closing humanitarian projects_scoping lit review_full reference list

The team:

Matthew Hunt, Ryoa Chung, Lisa Eckenwiler, John Pringle, Nicole Pal and Shelley-Rose Hyppolite

Partner:

Médecins du Monde-Canada

medecindumonde

Funding:

RRSPQ Public Health Ethics Axis, 2018-19

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