Abstracts
Abstract
This article presents results of a critical review of the literature discussing the ethical issues arising in humanitarian work, following the method proposed by McCullough, Coverdale and Chervenak. Our aim was primarily to focus on how the ethical issues arising in humanitarian work are conceptualized within the literature we reviewed. We think that properly conceptualizing the ethical issues which humanitarian workers may face can provide avenues to better respond to them. We analysed 61 documents, as part of a literature review, which revealed that there truly is a need, amongst the authors and in humanitarian work, to discuss ethics. Indeed, even if only a small number of authors define explicitly the words they use to discuss ethics, the great quantity that we have uncovered in the documents seem to suggest vast and rich grounds upon which to address ethical issues. We believe it to be important that the ethical issues of humanitarian work are increasingly addressed in the literature and argue that it would be helpful for the vocabulary used by authors to be employed and developed even more rigorously, so that their discussions show more precision, coherence, relevance, exhaustiveness, and sufficiency. The review of the literature, as well as the resulting analysis in this article, is part of a broader project to suggest a way to conceptualize the ethical issues of humanitarian work based on the strengths and innovations of this and other studies.
Keywords:
- ethical issues,
- humanitarian work,
- conceptualization,
- typologies
Résumé
Cet article présente les résultats d’une revue critique de la littérature traitant des questions éthiques soulevées par le travail humanitaire, suivant la méthode proposée par McCullough, Coverdale et Chervenak. Notre objectif était principalement de nous concentrer sur la façon dont les questions éthiques soulevées par le travail humanitaire sont conceptualisées dans la littérature que nous avons examinée. Nous pensons qu’une conceptualisation correcte des problèmes éthiques auxquels les travailleurs humanitaires peuvent être confrontés peut fournir des pistes pour mieux y répondre. Nous avons analysé 61 documents, dans le cadre de la revue de la littérature, qui révèlent qu’il existe réellement un besoin, chez les auteurs et dans le travail humanitaire, de discuter de l’éthique. En effet, même si seul un petit nombre d’auteurs définit explicitement les mots qu’ils utilisent pour parler d’éthique, la grande quantité de mots que nous avons découverts dans les documents semble suggérer des terrains vastes et riches sur lesquels aborder les questions éthiques. Nous pensons qu’il est bon que les questions éthiques du travail humanitaire soient de plus en plus abordées dans la littérature et qu’il serait pertinent que le vocabulaire utilisé par les auteurs soit employé et développé de manière encore plus rigoureuse, afin que leurs discussions soient plus précises, cohérentes, pertinentes, exhaustives et suffisantes. La revue de la littérature, ainsi que l’analyse qui en découle dans cet article, s’inscrit dans un projet plus large visant à proposer une manière de conceptualiser les enjeux éthiques du travail humanitaire en se basant sur les forces et les innovations de cette étude et d’autres.
Mots-clés :
- problèmes éthiques,
- travail humanitaire,
- conceptualisation,
- typologies
Download the article in PDF to read it.
Download
Appendices
Acknowledgements / Remerciements
Louis Pierre Côté would like to thank Guy Trépanier, librarian specializing in the arts and humanities at the Roy-Denommé Library of the Université du Québec à Trois-Rivières (UQTR), for his valuable assistance in reviewing the literature. Both Marie-Josée Drolet and Louis Pierre Côté wish to extend their kindest regards to Prof. Matthew Hunt, at McGill University, for his precious insights and advice. Finally, Marie-Josée Drolet acknowledges the contribution of the Social Sciences and Humanities Research Council of Canada (SSHRC) for the grant awarded to the project.
Louis Pierre Côté tient à remercier chaleureusement Guy Trépanier, bibliothécaire spécialisé en arts et en sciences humaines à la bibliothèque Roy-Denommé de l’Université du Québec à Trois-Rivières (UQTR), pour son aide précieuse dans la revue de la littérature. Marie-Josée Drolet et Louis Pierre Côté tiennent à remercier le professeur Matthew Hunt, de l’Université McGill, pour ses précieux conseils. Enfin, Marie-Josée Drolet reconnaît la contribution du Conseil de recherches en sciences humaines du Canada (CRSH) pour la subvention accordée à ce projet.
Bibliography
- 1. Mills CW. The Racial Contract. Ithaca: Cornell University Press; 1997.
- 2. Rose J, O’Keefe P, Jayawickrama J, O’Brien G. The Challenge of humanitarian aid: an overview. Env Haz. 2013;12(1):74-92.
- 3. Beamon BM, Kotleba SA. Inventory modelling for complex emergencies in humanitarian relief operations. International Journal of Logistics: Research and Applications. 2007;9(1):1-18.
- 4. Brennan RJ, Mandy R. Complex humanitarian emergencies: A major global health challenge. Emergency Medicine. 2001;13:147-156.
- 5. Banatvala N, Zwi AB. Conflict and health: public health and humanitarian interventions: developing the evidence base. BMJ: British Medical Journal. 2000;321(7253):101-5.
- 6. Civaner MM, Vatansever K, Pala K. Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey. PLOS One. 2017;12(3):23.
- 7. Geale SK. The ethics of disaster management. Disaster Prevention and Management: An International Journal. 2012;21(4):445-62.
- 8. Haver K. Tug of War Ethical Decision-Making to Enable Humanitarian Access in High-Risk Environments. London, UK: Humanitarian Practice Network (HPN); 2016.
- 9. Sondorp E, Kaiser T, Zwi AB. Beyond emergency care : challenges to health planning in complex emergencies. Tropical Medicine and International Health. 2001;6(12):965-70.
- 10. Swisher LL, Arslanian LE, Davis CM. The Realm-Individual Process-Situation (RIPS) Model of ethical decision-making. HPA Resource. 2005;5(3):1-8.
- 11. Slim H. Humanitarian Ethics: A Guide to the Morality of Aid in War and Disaster. New York: Oxford University Press; 2015.
- 12. Cardozo BL, Gotway Crawford C, Eriksson C, et al. Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study. PLOS One. 2012;7(9):13.
- 13. Schwartz L, Hunt M, Sinding C, et al. Models for humanitarian health care ethics. Public Health Ethics. 2012;5(1):81-90.
- 14. Hunt M, Pal NE, Schwartz L, O’Mathúna D. Ethical challenges in the provision of mental health services for children and families during disasters. Current Psychiatry Reports. 2018;20(60):10.
- 15. Hunt M, Chénier A, Bezanson K, Nouvet E, et al. Moral experiences of humanitarian health professionals caring for patients who are dying or likely to die in a humanitarian crisis. Journal of International Humanitarian Action. 2018;3(12):1-13.
- 16. Glannou C, Baldan M. War Surgery: Working with Limited Resources in Armed Conflict and Other Situations of Violence. Vol.1. Geneva: ICRC; 2009.
- 17. Goulet M, Drolet MJ. Les enjeux éthiques en réadaptation. Un état des lieux de la conceptualisation de notions éthiques. Canadian Journal of Bioethics/Revue canadienne de bioéthique. 2018;1(3):9-21.
- 18. McCullough LB, Coverdale JH, Chervenak FA. Argument-based medical ethics: A formal tool for critically appraising the normative medical ethics literature. American Journal of Obstetrics and Gynecology. 2004;191:1097-102.
- 19. McCullough LB, Coverdale JH, Chervenak FA. Constructing a systematic review for argument-based clinical ethics literature: the example of concealed medications. Journal of Medicine and Philosophy. 2007;32:65-76.
- 20. Buth P, de Gryse B, Healy S, et al. “He who helps the guilty, shares the crime”? INGOs, moral narcissism and complicity in wrongdoing. Journal of Medical Ethics. 2018;1-6.
- 21. Chung R, Hunt M. Justice and health inequalities in humanitarian crises: structured health vulnerabilities and natural disasters. In: Straehle C, Lenard P, editors. Health Inequalities and Global Justice. Edinburgh: Edinburgh University Press; 2012. p. 197-212.
- 22. Harroff-Tavel M. La diversité culturelle et ses défis pour l’acteur humanitaire. Cultures & Conflits. 2005;60(15):63-102.
- 23. Landman WA. Médecins sans Frontières Under the Spotlight. Developing World Bioethics. 2006;6(2):iii–iv.
- 24. Meldrum H. Spirituality in medical practice: how humanitarian physicians draw their boundaries with patients. Integration Medecine. 2011;10(3):26-30.
- 25. Tarvydas VM, Lopez Levers L, Teahen PR. Ethical guidelines for mass trauma and complex humanitarian emergencies. Journal of Counseling & Development. 2016;95:260-8.
- 26. Aarcharya RP, Tiwari S, Shrestha TM. Ethics in humanitarian services: report on the earthquake in Nepal. Indian Journal of Medical Ethics. 2017;2(1):25-9.
- 27. Asgary R, Junck E. New trends of short-term humanitarian medical volunteerism: professional and ethical considerations. Journal of Medical Ethics. 2013;39(10):625-31.
- 28. Bhan A. Ethical issues arising in responding to disasters: need for a focus on preparation, prioritisation and protection. Asian Bioethics Review. 2010;2(2):143-7.
- 29. Binns CW, Lee MK, Tang L, Yu C, Hokama T, Lee A. Ethical issues in infant feeding after disasters. Asia-Pacific Journal of Public Health. 2012;24(4):672-680.
- 30. Eckenwiler L, Hunt M. Counter-terrorism, ethics and global health. Hastings Center Report. 2014;44(3):12-13.
- 31. Fraser V, Hunt M, de Laat S, Schwartz L. Development of the humanitarian health ethics analysis tool. Prehospital and Disaster Medicine. 2015;30(4):412-20.
- 32. Gasper D. Ethics and the conduct of international development aid: charity and obligation. Forum for Development Studies. 1999;26(1):23–57.
- 33. Gotowiec S, Cantor-Graae E. The burden of choice: a qualitative study of healthcare professionals’ reactions to ethical challenges in humanitarian crises. Journal of International Humanitarian Action. 2017;2:2.
- 34. Greenough PG, Chan JL, Meier P, Bateman L, Dutta S. Applied technologies in humanitarian assistance: report of the 2009 Applied Technology Working Group. Prehospital and Disaster Medicine. 2009;24(2):s206–s209.
- 35. Hunt M. Ethics beyond borders: how health professionals experience ethics in humanitarian assistance and development work. Developing World Bioethics. 2008;8(2):59-69.
- 36. Hunt M. Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work. Disasters. 2011;35(3):606-622.
- 37. Hunt M, Pringle J, Christen M, Eckenwiler L, Schwartz L, Davé A. Ethics of emergent information and communication technologies in humanitarian medical assistance. International Health. 2016;8:239-45.
- 38. Jayasinghe S. Faith-based NGOs and healthcare in poor countries: a preliminary exploration of ethical issues. Journal of Medical Ethics. 2007;33(11):623-626.
- 39. Lebouc M-F. L’éthique et la complexité de l’intervention humanitaire. In : Verna G, Piron F, editors. Éthique des rapports Nord-Sud : regards croisés. Québec: Presses de l’Université Laval; 2010. p. 37-57.
- 40. Leider JP, DeBruin D, Reynolds N, Koch A, Seaberg J. Ethical guidance for disaster response, specifically around crisis standards of care: a systematic review. American Journal of Public Health, Law and Ethics. 2017;107(9):e1-9.
- 41. Maxwell D, Bailey S, Harvey P, Walker P, Sharbatke-Church C, Savage K. Preventing corruption in humanitarian assistance: perceptions, gaps and challenges. Disasters. 2012;36(1):140-60.
- 42. Michael M, Zwi AB. Oceans of need in the desert: ethical issues identified while researching humanitarian agency response in Afghanistan. Developing World Bioethics. 2002;2(2):109-30.
- 43. Moley N. Confronting the challenges of ethical accountability in international human rights lawyering. Stanford Journal of International Law. 2014;50(2):359-92.
- 44. Moodley K, Hardie K, Selgelid MJ, et al. Ethical considerations for vaccination programmes in acute humanitarian emergencies. Bull World Health Organ. 2013;91(4):290-297.
- 45. Remer JS. Bribery and its ethical implications for aid workers in the developing world. Science and Engineering Ethics. 2017;23:227-241.
- 46. Schnall J, Hayden D, Wilkinson D. Newborns in crisis: An outline of neonatal ethical dilemmas in humanitarian medicine. Developing World Bioethics. 2019;19(4):196-205.
- 47. Schwartz L, Sinding C, Hunt M, et al. Ethics in humanitarian aid work: learning from the narratives of humanitarian health workers. AJOB Primary Research. 2010;1(3):45-54.
- 48. Sheather J, Shah T. Ethical dilemmas in medical humanitarian practice: cases for reflection from Médecins Sans Frontières. Journal of Medical Ethics. 2011;37(3): 162-65.
- 49. Sumathipala A, Jafarey A, De Castro LD, et al. Ethical issues in post-disaster clinical interventions and research: a developing world perspective. key findings from a drafting and consensus generation meeting of the Working Group on Disaster Research and Ethics (WGDRE) 2007. Asian Bioethics Review. 2010;2(2):124-142.
- 50. Vaux T. Humanitarian trends and dilemmas. Development in Practice. 2006;16(3-4):240-54.
- 51. Ayimpam S, Chelpi-den Hamer M, Bouju J. Défis éthiques et risques pratiques du ter-rain en situation de développement ou d’urgence humanitaire. Anthropologie et développement. 2014;40-41:21-41.
- 52. Bell DA, Carens JH. The ethical dilemmas of international human rights and humanitarian NGOs: Reflections on a dialogue between practitioners and theorists. Human Rights Quarterly. 2004;26(2):300-29.
- 53. Brauman R. Les dilemmes de l’action humanitaire dans les camps de réfugiés et les transferts de populations. In : Moore J, editor. Des choix difficiles: les dilemmes moraux de l’action humanitaire. Paris: Gallimard; 1999. p. 233-256.
- 54. Ford N, Zachariah R, Mills E, Upshur R. Defining the limits of emergency humanitarian action: where, and how, to draw the line? Public Health Ethics. 2010;3(1):68-71.
- 55. Harris S. Disasters and dilemmas: aid agency recruitment and HRD in post-tsunami Sri Lanka. Human Resource Development International. 2006;9(2):291-98.
- 56. Hassner, Pierre. De guerre et paix à violence et intervention. In : Moore J, editor. Des choix difficiles: les dilemmes moraux de l’humanitaire. Paris: Gallimard; 1999. p. 23-48.
- 57. Le Coconnier ML, Pommier B. Exigence éthique. In : L’action humanitaire. 2nd ed. Paris: Presses universitaires de France; 2009. p. 101-109.
- 58. Pasic A, Weiss TG. The Politics of rescue: Yugoslavia’s wars and the humanitarian impulse. Ethics & International Affairs. 1997;11:105-31.
- 59. Schloms M. Le dilemme inévitable de l’action humanitaire. Cultures & Conflits. 2005;60:85-102.
- 60. Scott-Smith T. Humanitarian dilemmas in a mobile world. Refugee Survey Quarterly. 2016;35(2):1-21.
- 61. Sinding C, Hunt M, Redwood-Campbell L, Ranford J. “Playing God because you have to”: Canadian health professionals’ experiences of rationing care in humanitarian and development work. Public Health Ethics. 2010;3(2):147-56.
- 62. Slim H. Doing the right thing: relief agencies, moral dilemmas and moral responsibility in po-litical emergencies and war. Disasters. 1997;21(3):244-57.
- 63. Tobin J. The challenges and ethical dilemmas of a military medical officer serving with a peace-keeping operation in regard to the medical care of the local population. Journal of Medical Ethics. 2005;31(10):571-74.
- 64. Zarka S, Farhat M, Gidron T. Humanitarian medical aid to the Syrian people: Ethical implications and dilemmas. Bioethics. 2018;33(2): 302-308.
- 65. Draper H, Jenkins S. Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 2014–2015 Ebola outbreak: a qualitative study. BMC Medical Ethics. 2017;18(77):13.
- 66. Hunt M. Moral experience of Canadian health care professionals in humanitarian work. Prehospital and Disaster Medicine. 2009;24(6):518-24.
- 67. Mftuso-Bengo J, Masiye F, Muula A. Ethical challenges in conducting research in humanitarian crisis situations. Malawi Medical Journal. 2008;20(2):45-49.
- 68. Sommers-Flanagan R. Ethical considerations in crisis and humanitarian interventions. Ethics & Behavior. 2007;17(2):187-202.
- 69. Richards P. Ritual dynamics in humanitarian assistance. Disasters. 2010;34(S2):S138-46.
- 70. Forsythe DP. Choices more ethical than legal: the international committee of the red cross and human rights. Ethics & International Affairs. 1993;7:131-51.