Resources and constraints for addressing ethical issues in medical humanitarian work: Experiences of expatriate healthcare professionals

Abstract

International nongovernmental organizations frequently provide emergency assistance in settings where armed conflict or natural disaster overwhelm the capacity of local and national agencies to respond to health and related needs of affected communities. Healthcare practice in humanitarian settings presents distinct clinical, logistical, and ethical challenges for clinicians and differs in important ways from clinical practice in the home countries of expatriate healthcare professionals. The aim of this research was to examine the moral experience of healthcare professionals who participate in humanitarian relief work. I conducted a qualitative research study using interpretive description methodology. Fifteen Canadian healthcare professionals and three human resource or field coordination officers for nongovernmental organizations were interviewed. In this article, I present findings related to expatriate healthcare professionals' experiences of resources and constraints for addressing ethical issues in humanitarian crises. Resources for ethics deliberation and reflection include the following: opportunities for discussion; accessing and understanding local perspectives; access to outside perspectives; attitudes, such as humility, open-mindedness, and reflexivity; and development of good moral "reflexes." Constraints for deliberation and reflection relate to three domains: individual considerations, contextual features of humanitarian relief work, and local team and project factors. These findings illuminate the complex nature of ethical reflection, deliberation, and decision-making in humanitarian healthcare practice. Healthcare professionals and relief organizations should seek to build upon resources for addressing ethical issues. When possible, they should minimize the impact of features that function as constraints.