What can help us make a decision?
This step draws attention to the ethical approaches which are available in humanitarian healthcare aid including:
- professional moral norms and guidelines for healthcare practice
- human rights and international law
- ethical theory
- local norms, values and customs.
Each of these approaches provides insight on how to approach ethical issues, though none may be sufficient on its own to respond to the complexity of any one ethical issue. It may thus be helpful to draw on a variety of different sources in order to arrive at a more comprehensive response.
Professional Moral Norms and Guidelines for Healthcare Practice
Many humanitarian organizations expect their staff to look to professional codes of ethics and professional moral norms for guidance in the field. Most healthcare professionals are members of professional organizations with ethical codes of conduct and standards for professional practice. Clinicians rely on these parameters, grounded in national law, and social and professional consensus, to determine ethical action. However, application of professional codes of conduct and professional norms may be limited in humanitarian contexts where expectations, standards of care, and clinical realities may differ.
International professional agencies offer guidelines to orient healthcare professionals with respect to their individual duties and obligations. In recent years, humanitarian guidelines have been developed to improve recognition of ethical principles and promote accountability in humanitarian healthcare work. The Sphere Project represents one of the most widely recognized efforts to establish common principles and minimum standards in humanitarian response. The Humanitarian Charter and Minimum Standards in Disaster Response emphasize the right of disaster-affected populations to a life with dignity and the humanitarian duty to provide protection and assistance. It also stresses the importance of the active participation of affected populations. The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief (1994) is a voluntary code of conduct with over 500 NGOs as signatories. The IFRC Code of Conduct is aimed at maintaining standards of ethical conduct and describes 10 principles humanitarians should abide by in disaster response.
Human Rights and International Law
Humanitarianism has increasingly turned to the language of human rights for ethical justification. Rights based approaches to health emphasize the duty and obligations we owe others based on a shared and universal human dignity. Rights to health are embedded in several UN declarations, many of which assume some minimum standard of health as a precondition for ensuring human dignity. Special attention has been given to the rights of children and women to freedom from suffering and the freedom to exercise health choices.
The ideas of a right to life and essential human dignity are captured in humanitarian principles and in international humanitarian and human rights law. International humanitarian law provides a set of rules to guide and limit the effects of armed conflict. In contrast to international humanitarian law, human rights law is more complex and includes regional treaties. Human rights law applies in peacetime, and provisions may be suspended during an armed conflict. There is considerable debate surrounding the nature, scope and applicability of human rights and international law and considering how best to honour human rights can at times be complex. However, basic familiarity with human rights and international humanitarian law is important because it familiarizes you with legal standards of right and wrong conduct, and can be important for advocacy and negotiation efforts.
Deontology, consequentialism, principlism, and virtue ethics are ethical theories (see pages 21-27 HHEAT Handbook) which have been the most widely used in discussions of humanitarian healthcare aid. Considering an issue with these theories in mind might help you to justify why you think a particular action is good, or the best thing to do, under the circumstances. It might also help you think through some potential limitations or objections to your approach and allow you to respond to them.
Ethics Expanded: Local Values, Principles and Customs
Values, beliefs and moral norms are shaped by cultural and religious practices/traditions and informed by different worldviews. For instance, individuals and communities may have diverse views regarding the scope, nature and values related to healthcare including: decision-making autonomy, privacy and control of confidential information, the role of the individual/family/community, and truth telling, amongst others. Respecting the culture, beliefs and practices of others is essential and requires an open and thoughtful engagement with local cultural, religious, social and community insights and practices. This type of engagement may reveal that moral practices and beliefs that appear distinct on the surface are not in fact indicative of fundamental or irreconcilable ethical differences. Where substantial and significant differences in moral norms and principles do occur, it is important to identify and engage with them in a fair and balanced manner. From an ethical standpoint, respecting cultural difference is not incompatible with reasoned criticism about why some beliefs or values might be more justifiable than others. Moral justification requires this investment in understanding and discussion, which is a sign of mutual respect.
More detail can be found on pages 19-27 of the HHEAT Handbook.
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