Setting: Refugee camp located in a South Asian country
Scenario: An international humanitarian aid organization is engaged in providing primary care to refugee camp residents. The “host” country’s Ministry of Health runs the tuberculosis (TB) treatment program within the camp and is responsible for treatment and overall follow-up of patients. TB testing and diagnosis, however, is the responsibility of the international humanitarian aid organization, as it operates the lab where TB testing is done.
Local staff of the aid organization discover that patients diagnosed with TB are experiencing gaps of several weeks in their treatment because the national Ministry of Health is having trouble supplying these medications to the camp.
The treatment for TB is usually 6 to 12 months of continuous therapy and involves 2 to 4 drugs. Patients experiencing gaps in treatment are at risk of developing anti-tuberculosis drug resistance. Patients who develop active disease with a drug-resistant TB strain can transmit this form of TB to other individuals.
As the situation progresses, the United Nations High Commissioner for Refugees (UNHCR) enters negotiations with the Ministry of Health to improve the supply of drugs. During these negotiations a decision is taken by the aid organization’s program leader and medical co-ordinator to stop doing lab work and to stop providing nutritional support to TB patients. They justify this decision by asserting that diagnosing TB when adequate treatment cannot be ensured is ethically wrong.
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: To Test or Not to Test? www.humanitarianhealthethics.net.