Summary:
Dr. Arman Asadour is a Canadian physician who got sent by the non-governmental organization to a town in South Sudan in order to participate in a global vertical aid anti-cholera program. The purpose of the program is designed to treat targeted cohort group with cholera disease. The dilemma raised because while the medical care staff from NGOs are only supposed to treat for one specific disease, refugees also demand other health care items from the stuff due to the scarcity of treatment locally. The physician would need to make a clear decision based on his legal and ethical obligation.
The legal obligation
To understand the issue concerning this topic, it is important to understand the definition of vertical programs. They are called so because they are “directed, supervised, and executed, either wholly or to a great extent, by a specialized service using dedicated health workers”. (Atun, Bennett, Duran) In this case, the physician is directed to work in South Sudan to reach the purpose of eradicating the cholera from the area. By the nature of the vertical aid program, its goal would be to achieve a concrete goal. It would be good for the funders to be aware that their funding would be bringing some changes to the problem. Also, because of the legal obligation bearing on the physician, the right thing to do would be to follow the project rules and obligation, making sure the resources are allocated to the targeted group.
Flaw of Vertical program
It could also argue that vertical program waste resource as it allows the inefficiency to happen within the system. Unable to utilizing the resource because of untargeted sickness is unfair and unjustifiable for the needed. Allocating health resource to one specific illness could reduce the health system effectiveness. Furthermore, the voices and priorities of the locals are also often overlooked rather than to achieve the main goal of the program. (Thomas, Waluchow, and Gedge, 268) Although NGOs would have investigated the demand of people before entering for service, the need for health care could always change in time and vary in situation. While the health care service could be particularly rewarding to the certain targeted group, its policy would reject the treatment of people coming with various risks(such as HIV and cholera at the same time).
The ethical right thing
After all, the main purpose of the project is to aid the humanitarian purpose of the NGO. Leaving people in a worse-off condition without medical treatment would be against the mission. A physician’s duty would be to the patient he faces rather than the sponsor of the program even if the decisions are not legally correct. Balancing the legal obligation and the ethical right thing, Dr. Arman Asadour should follow his obligation first and then the obligation as the employee of the NGO.
Reference:
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print
Atun, Rifat A., Sara Bennett, and Antonio Duran. When do vertical (stand-alone) programmes have a place in health systems? Geneva: World Health Organization, 2008.
I really enjoyed reading your post and I agree that there is a difficult balance between both the legal and ethical issues that Dr. Arman Asadour faces. Even though we might want Dr. Asadour to help everyone, it is not necessarily possible. There is no way to please everyone in this situation. As is explained, vertical initiatives can be effective in challenging a particular medical issue (such as cholera in this situation), but the overall effect on the health of people in poverty can be called into question. The Health, Poverty, Action website claims that, “Vertical initiatives risk diverting attention from, or even undermining, broader health systems established to prevent and treat all forms of poor health”. However, vertical initiatives have brought in serious amounts of money towards the benefit of global health. Vertical initiatives and health systems need to work together in order to create better outcomes. Dr. Asadour must make a tough decision in whether or not to participate and possibly deciding in what patients he should and should not treat. Due to limited resources, the decisions become more and more difficult as people’s live are continuously put at risk.
Works Cited:
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print
“Vertical and Horizontal funding for health.” Health Poverty Action. N.p., n.d. Web. 15 Apr. 2017.
Hi Tianqi,
Thanks for mentioning some interesting points in your blog post. Although, as you state, “the main purpose of a project is to aid the humanitarian purpose of the NGO,” I think there are more implications to Dr. Asadour’s actions than the pure ethicality of it that must be considered in this case. What if, in giving supplies freely away as those in need ask for them, the NGO loses money and resources to be able to continue sending people out to perform “cholera clinics”? Giving away some medicine and nutrients may not have an immediate impact on the program itself, but in the long run may have a more detrimental impact. If Dr. Asadour’s actions are found to violate policy of the NGO crucial to funding, as listed by precedent in cases from the Global Policy Forum, there could be financial and legal penalties for the NGO itself to deal with, preventing them from providing care to others. Dr. Asadour, in this circumstance, might potentially obstruct healthcare. There is no good way out of a situation like this, because patients will suffer no matter what he decides. The best he can do is minimize collateral damage and treat as many as he can within his realm of authorization.
Thanks,
Elisabeth Crusey
Global Policy Forum. “Global Policy Forum.” Funding for NGOs. GPF, 2005. Web. 20 Apr. 2017. .
Tianqi,
Thanks for the post, as it ties well with what we discussed in class today. While vertical aid programs can be effective, especially when the primary objective is to minimize cost, they tend to oversimplify the health problems of countries in need. The primary issue with vertical aid programs is that they take the stance that one approach can solve all the problems in developing countries, and it overlooks the bigger structural problems that give rise to poor health conditions. In the case with Dr. Asadour, he mentioned there were many people who were contracting diseases other than cholera. This means there are bigger issues going on other than a cholera outbreak that needs to be addressed. Furthermore, there is no guarantee of the impact vertical aid programs will have compared to taking a more holistic approach to healthcare. While there are some benefits to vertical aid programs, they should be put into context compared to other alternatives.
Citation:
Jimenez, Yilena B. “VERTICAL VS. HORIZONTAL APPROACH: THE DRAWBACKS OF EACH AND A NEED FOR A MERGING OR “DIAGONAL” APPROACH.” ANTH 1310 S01 International Health Anthropological Perspectives. N.p., 22 Oct. 2015. Web. 21 Apr. 2017.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study Approach to Health Care Ethics. N.p.: Broadview, 2014. Print