Setting: A rural region of a South Asian country

Scenario: An expatriate obstetrician/gynecologist is working for an international medical non-governmental organization (NGO) in a small rural hospital in a country in South Asia. One day, a young pregnant woman with severe pre-eclampsia is brought to the hospital by her husband. The obstetrician examines the patient and finds her to have significant hypertension, renal failure, and pulmonary edema. The obstetrician realizes that the life of the young woman and the fetus are in imminent danger unless an emergency Caesarean section is performed. With the assistance of an interpreter, the obstetrician explains the seriousness of the situation to the patient and her husband. However, the patient’s husband responds by adamantly refusing any type of surgery for his wife, insisting that the risks and financial costs of such a procedure are too high for them to bear.

The obstetrician feels compelled to proceed with the emergency Caeserean despite the husband’s wishes, but is quickly pulled aside by two local colleagues working for the medical NGO. They explain that according to local custom and law, a female patient cannot receive medical intervention without first obtaining the consent of a close male relative. Although they understand the obstetrician’s concern for the young woman’s life, they warn that contravening the husband’s decision could lead to conflict with the local community and jeopardize the NGO’s capacity to operate in the area. In light of this advice from her colleagues, the obstetrician now feels deeply conflicted about what to do.

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.

Download PDF and Worksheet

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: Tensions between Western Professional Ethics and Local Gender Norms. www.humanitarianhealthethics.net.

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