Setting: A remote health clinic in the Horn of Africa
Scenario: A 25-year-old woman who has been in a coma for the past three days is brought to a rural health clinic by her husband. The expatriate physician working at the clinic diagnoses the patient with Type 1 Diabetes. The clinic has a small emergency stock of injectable insulin on hand, and treatment is initiated.
As the insulin supply begins to dwindle, the expatriate physician calls the head office of the international medical NGO that operates the clinic. The physician explains the patient’s situation and requests a shipment of insulin for her treatment. However, the head office refuses to send the needed supplies, saying it is not within the mandate of the organization to treat chronic resource-intensive diseases such as Type 1 Diabetes. They are concerned that the patient will be unable to afford insulin and syringes when she eventually returns home, and may not have access to a refrigerator for storage of her medicines. The head office instructs the physician to stop treating this patient, and to reserve the remaining insulin stock for future emergency cases.
The clinic staff has developed a close relationship with the patient, her husband and young children, and do not want to send her home to inevitably die from a treatable disease. Their frustration is compounded by the fact that the international medical NGO provides funding and resources to the clinic to treat certain chronic resource-intensive diseases such as HIV/AIDS.
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: Balancing Priorities in a Medical Emergency. www.humanitarianhealthethics.net.