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The Development of a Humanitarian Health Ethics Analysis Tool

Published online by Cambridge University Press:  11 June 2015

Veronique Fraser*
Affiliation:
Centre for Clinical Ethics, St-Joseph’s Health Centre, Toronto, Ontario, Canada University of Toronto Joint Centre for Bioethics, Toronto, Ontario, Canada
Matthew R. Hunt
Affiliation:
School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
Sonya de Laat
Affiliation:
Faculty of Information and Media Studies, Western University, London, Ontario, Canada
Lisa Schwartz
Affiliation:
Clinical Epidemiology and Biostatics, McMaster University, Hamilton, Ontario, Canada
*
Correspondence: Veronique Fraser, RN, MSc Centre for Clinical Ethics St-Joseph’s Health Centre 30 The Queensway Toronto, Ontario M6R 1B5 Canada E-mail: Veronique.fraser@mail.mcgill.ca

Abstract

Introduction

Health care workers (HCWs) who participate in humanitarian aid work experience a range of ethical challenges in providing care and assistance to communities affected by war, disaster, or extreme poverty. Although there is increasing discussion of ethics in humanitarian health care practice and policy, there are very few resources available for humanitarian workers seeking ethical guidance in the field. To address this knowledge gap, a Humanitarian Health Ethics Analysis Tool (HHEAT) was developed and tested as an action-oriented resource to support humanitarian workers in ethical decision making.

While ethical analysis tools increasingly have become prevalent in a variety of practice contexts over the past two decades, very few of these tools have undergone a process of empirical validation to assess their usefulness for practitioners.

Methods

A qualitative study consisting of a series of six case-analysis sessions with 16 humanitarian HCWs was conducted to evaluate and refine the HHEAT.

Results

Participant feedback inspired the creation of a simplified and shortened version of the tool and prompted the development of an accompanying handbook.

Conclusion

The study generated preliminary insight into the ethical deliberation processes of humanitarian health workers and highlighted different types of ethics support that humanitarian workers might find helpful in supporting the decision-making process.

FraserV, HuntMR, de LaatS, SchwartzL. The Development of a Humanitarian Health Ethics Analysis Tool. Prehosp Disaster Med. 2015;30(4):19.

Type
Original Research
Copyright
© World Association for Disaster and Emergency Medicine 2015 

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References

1. Hunt, MR, Schwartz, L, Elit, L. Ethics support and training for health professionals in international aid work. Public Health Ethics. 2012;5(1):91-99.Google Scholar
2. The Community Ethics Network. The Community Ethics Toolkit. http://www.jointcentreforbioethics.ca/partners/cen.shtml Published 2008. Accessed October 22, 2014.Google Scholar
3. Thompson, AK, Faith, K, Gibson, JL, et al. Pandemic influenza preparedness: an ethical framework to guide decision making. BMC Med Ethics. 2006;4(7):12.CrossRefGoogle Scholar
4. Schaffer, MA, Cameron, ME, Tatley, EB. The value, be, do ethical decision-making model: balancing students’ needs in school nursing. J Sch Nurs. 2000;16(5):44-49.Google Scholar
5. Clarinval, C, Biller-Adorno, N. Challenging operations: an ethical analysis framework to assist humanitarian aid workers in their decision-making processes. PLoS Curr. 2014;23:6.Google Scholar
6. Hunt, MR. Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work. Disasters. 2011;35(3):606-622.Google Scholar
7. Barnett, M. Empire of Humanity: A History of Humanitarianism. New York, New York USA: Cornell University Press; 2011.Google Scholar
8. Fassin, D. Humanitarian Reason: A Moral History of the Present. Los Angeles, California USA: University of California Press; 2011.Google Scholar
9. Terry, F. Condemned to Repeat? The Paradox of Humanitarian Action. Ithaca, New York USA: Cornell University Press; 2002.Google Scholar
10. Anderson, MB. Do No Harm: How Aid Can Support Peace or War. Boulder, Colorado USA: Lynne Rienner Publisher; 1999.CrossRefGoogle Scholar
11. Sheather, J, Shah, T. Ethical dilemmas in medical humanitarian practice: cases for reflection from Medecins Sans Frontieres. J Med Ethics. 2011;37(3):162-165.CrossRefGoogle ScholarPubMed
12. Asgary, R, Junck, E. New trends of short-term humanitarian medical volunteerism: professional and ethical considerations. J Med Ethics. 2013;39(10):625-631.Google Scholar
13. Wall, LL, Arrowsmith, SD, Lassey, AT, et al. Humanitarian ventures or ‘fistula tourism:’ the ethics perils of pelvic surgery in the developing world. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):559-562.Google Scholar
14. Schwartz, L, Sinding, C, Hunt, MR, et al. Ethics in humanitarian aid work: learning from the narratives of humanitarian health workers. AJOB Prim Res. 2010;1(3):45-54.Google Scholar
15. International Federation of Red Cross and Red Crescent Societies. World Disasters Report: Focus on Ethics in Aid. http://www.ifrc.org/en/publications-and-reports/world-disasters-report/wdr2003/. Published 2003. Accessed August 13, 2014.Google Scholar
16. Hunt, MR. Ethics beyond borders: how health professionals experience ethics in humanitarian assistance and development work. Dev World Bioeth. 2008;8(2):49-69.Google Scholar
17. Elpern, EH, Covert, B, Kleinpell, R. Moral distress of staff nurses in a medical intensive care unit. Am J of Crit Care. 2005;14(6):523-530.CrossRefGoogle Scholar
18. Austin, W, Bergum, V, Goldberg, L. Unable to answer the call of our patients: mental health nurses’ experience of moral distress. Nurs Inq. 2003;10(3):177-183.Google Scholar
19. International Council of Nurses. Code of Ethics for Nurses. http://www.icn.ch/about-icn/code-of-ethics-for-nurses/. Published 2012. Accessed August 13, 2014.Google Scholar
20. World Medical Association. International Code of Medical Ethics. http://www.wma.net/en/30publications/10policies/c8/. Published 2006. Accessed August 13, 2014.Google Scholar
21. The Sphere Project. The Humanitarian Charter and Minimum Standards in Disaster Response. http://www.sphereproject.org/resources/downloadpublications/?search=1&keywords=&language=English&category=22. Published 2004. Accessed September 14, 2014.Google Scholar
22. International Federation of Red Cross and Red Crescent Societies. The Code of Conduct for the International Red Cross and Red Crescent Movement and NGOs in Disaster Relief. http://www.ifrc.org/en/publications-and-reports/code-of-conduct/. Published 1994. Accessed August 13, 2014.Google Scholar
23. Oberle, K, Raffin-Bouchal, S. “A framework for ethical decision making in nursing.” In: Obere K, Raffin-Bouchal S, (eds). Ethics in Canadian Nursing Practice: Navigating the journey . Toronto, Ontario, Canada: Pearson Prentice Hall; 2009: 59-80.Google Scholar
24. Garcia, J, Froehlicj, R, McGuire-Kuletz, M, et al. Testing a transcultural model of ethical decision making with rehabilitation counselors. J Rehabil. 2008;74(3):21-26.Google Scholar
25. Garcia, J, Froehlic, R, McGuire-Kuletz, M, et al. Comparing two training strategies to increase competence in solving ethical dilemmas. Rehabilitation Education. 2009;23(2):223-232.Google Scholar
26. Cameron, ME, Schaffer, M, Park, HA. Nursing students’ experience of ethical problems and use of ethical decision-making models. Nurs Ethics. 2001;8(5):432-447.CrossRefGoogle ScholarPubMed
27. Hunt, MR. Moral experience of health care professionals in humanitarian work. Prehosp Disaster Med. 2009;24(6):518-524.Google Scholar
28. Litosseliti, L. Using Focus Groups in Research. New York, New York USA: Continuum; 2003.Google Scholar
29. Morgan, DL. Focus Groups as Qualitative Research 2nd ed. Thousand Oaks, California USA: Sage Publications; 1997.Google Scholar
30. Denzin, NK, Lincoln, YS. Collecting and Interpreting Qualitative Materials. Thousand Oaks, California USA: Sage Publications; 1998.Google Scholar
31. Humanitarian Health Ethics Web site. http://humanitarianhealthethics.net/. Accessed August 13, 2014.Google Scholar
32. Thorne, S. Data analysis in qualitative research. Evid Based Nurs. 2000;3:68-70.CrossRefGoogle Scholar
33. Burnor, R, Raley, Y. Ethical Choices: An Introduction to Moral Philosophy with Cases. New York, New York USA: Oxford University Press; 2011.Google Scholar
34. Rodney, P, Pauly, B, Burgess, M. “Our theoretical landscape: complementary approaches to health care ethics.” In: Storch J, Rodney P, Starzomski R, (eds). Toward a Moral Horizon: Nursing Ethics for Leadership and Practice. 2nd ed. Toronto, Ontario, Canada: Pearson Canada; 2012: 537-538.Google Scholar
35. Hilhorst, D, Schmiemann, N. Humanitarian principles and organizational culture: every day practice in Medecins Sans Frontieres-Holland. Development in Practice. 2002;12(3-4):490-500.Google Scholar
36. Derenzo, E, Strauss, M. A feminist model for clinical ethics consultation: increasing attention to context and narrative. HEC Forum. 1997;9(3):212-227.Google Scholar
37. Slim, H. Doing the right thing: relief agencies, moral dilemmas, and moral responsibility in political emergencies and war. Disasters. 1997;21(3):224-257; 246.Google Scholar
38. Santiago, C, Abdool, S. Conversations about challenging end-of-life cases: ethics debriefing in the medical surgical intensive care unit. Dynamics. 2000;22(4):26-30.Google Scholar
39. Cottone, RA, Claus, RE. Ethical decision-making models: a review of the literature. J Couns Dev. 2000;78:275-283.Google Scholar