Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs”

Introduction

Humanitarian aid highlights tensions in the utilitarian perspective between long- and short-term consequences of actions and policies, and many humanitarian aid workers find themselves acutely torn between deontological and utilitarian ethical perspectives. In this case, Dr. Asadour is a physician attached to a non-governmental organization whose mandate is to participate in a global vertical aid anti-cholera program. Cholera has broken out in a town in South Sudan and the NGO has set up a temporary work station with a Memorandum of Understanding to treat cholera only. Patients with other conditions must be sent to the local hospital, though it is already beyond capacity (Thomas, Waluchow, and Gedge 267).

The Question

As patients line up at the admissions tent, Dr. Asadour must decide whether or not to admit them. Some patients have symptoms that might or might not be cholera, but this cannot be determined unless they are admitted; once admitted, if they do not have cholera, they could nevertheless be treated easily without transfer to the local hospital. The NGO has emergency medical supplies that could save lives of those with non-cholera conditions, such as meningitis. Is it ethical to violate the mandate and treat?

Application:

Challenges Emerging From Resource Scarcity and the Need to Allocate Them

I came across “Ethics in Humanitarian Aid Work: Learning from the Narratives of Humanitarian Health Workers,” a qualitative study drawing on Grounded Theory analysis of 20 interviews with health care professionals who have provided humanitarian assistance; I found the predicaments that it presents to be applicable to this case.

The study reveals that respondents persistently were confronted by situations in which the resources available were insufficient or inadequate—insufficient to sustain life, or inadequate in relation to people’s needs. The choices that scarce resources presented were a recurring source of ethical struggle. Describing her work at an urban hospital in the Caribbean, R19 (RN) said:

“Whenever you see so many sick [people] and you realize that there are some that have to be turned away then you do say okay well we need to triage and we need to decide you know who we’re going to treat” (Schwarz et. al.).

She raised questions about the rightness of vertical aid, yet explained that over time she came to believe that refusing care to some was justified to ensure care for others. In many instances, professionals chose to offer resources to the people perceived to have the best chance of survival (Schwarz et. al.).

Challenges of resource allocation were most acute when patients’ lives were at stake. But care resources for chronic conditions were also scarce. Here, too, respondents faced situations in which they had to choose who would receive care. The deciding itself was often morally difficult, as were the consequences of the decisions. R10 (physical therapist), for instance, brought funds from friends at home to support the health needs of the people in Central America with whom she worked. In one way, she said, money gave her options for problem solving—she might purchase the services of a local person to create a chair that allowed a child with a disability to sit upright, for instance. But in another way, “It created more problems because people had given me all this money in the faith I would do the right thing with it and I didn’t know exactly what the right thing was” (Schwarz et. al.).

Challenges Emerging From Aid Agency Policies and Agendas

Treating people’s chronic conditions is outside the remit of some agencies. In vertical programs, treatment is only provided to individuals who have specified health conditions that match pre-established priorities. Even where adhering to the agency policy was judged on balance to be the ethically correct act, it could still be difficult to do (Schwarz, et. al.).

What about Beneficence?

As we have discussed in class, beneficence demands that we actively promote the well-being of others and prevent or remove harm to them (Vaughn 10). Accordingly, there is little doubt that the health care professionals have such a duty to advance patients’ welfare, promote their well-being, and prevent or remove harm to them. To what extent does the principle of beneficence justify violation of the mandate?

In the Media

TEDxHamburg – Linda Polmann – “What’s Wrong With Humanitarian Aid? A Journalist’s Journey”

This is a general discussion provided by TEDx on the ethical dilemmas associated with humanitarian aid. What, then, is the solution?

Conclusion

Sometimes, refusing care to some is justified to ensure care for others.

In some instances the policy, or following it, is felt to be too significant a violation of other ethical obligations.

The desire to help a particular patient—a woman with diabetes, for example—outweighs an agency directive against providing treatment deemed unsustainable in the context, a situation that tests perceived duties of beneficence against policies on scarce resource allocation.

Works Cited

Schwarz, Lisa, et. al. “Ethics in Humanitarian Aid Work: Learning From the Narratives of Humanitarian Health Workers.” AJOB Empirical Bioethics, 2010, 1(3): 45-54. Web. 9 April 2017.

Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. “Case 8.2: “Ethics and Humanitarian Aid: Vertical Aid Programs.” Well and good: a case study approach to health care ethics. Peterborough, Ontario: Broadview Press, 2014. Print.

Vaughn, Lewis. Bioethics: Principles, Issues, and Cases. New York: Oxford University Press, 2010. Print.