McMaster University

McMaster University

Faculty of
Health Sciences

Ethical dilemmas upset humanitarian workers: McMaster study

Published: September 30, 2010
Sonya De Laat, Naomi Adelson, Chris Sinding, Jennifer Ranford, Lynda Redwood-Campbell, Lisa Schwartz, Matthew Hunt, Sonya De Laat, Naomi Adelson, Chris Sinding, Jennifer Ranford, Lynda Redwood-Campbell, Lisa Schwartz and Matthew Hunt
From left: Sonya De Laat, research assistant in the School of Nursing at McMaster University, Naomi Adelson, associate professor in the Department of Anthropology at York University, Chris Sinding, associate professor in the Department of Health, Aging and Society at McMaster, Jennifer Ranford, program coordinator in the School of Nursing at McMaster, Lynda Redwood-Campbell, associate professor in the Department of Family Medicine at McMaster, Lisa Schwartz, associate professor in the Department of Clinical Epidemiology and Biostatistics at McMaster, and Matthew Hunt, post-doctoral fellow in the Department of Clinical Epidemiology and Biostatistics at McMaster

What would you do?

Lisa Schwartz
Lisa Schwartz, associate professor in the Department of Clinical Epidemiology and Biostatistics

A doctor in a rural hospital in northeast Africa works with one oxygen machine, choosing which current patients receive treatment and how to limit care so the generator-run machine is available for future, possibly sicker, patients.

A physiotherapist brings funds from Canada to Central America where she then must choose which disabled child will get a chair with the limited donations, and which child will not.

A Canadian nurse working in a Caribbean hospital watches as staff have to turn away premature babies because limited resources require the care available is saved for newborns most likely to survive.

And, in many cases, local professionals entreat Canadians to take these stories home and tell people about the struggles.

Canadian health care professionals providing support and treatment to thousands of people suffering the consequences of man-made and natural disasters recently approached McMaster University ethicist Lisa Schwartz with stories like these and concerns about the ethical dilemmas they faced while undertaking humanitarian work.

Their stories led Schwartz and her multidisciplinary research team to undertake what is believed to be the first analysis of its kind of ethical struggles faced by humanitarian health workers. The study is funded by the Canadian Institutes of Health Research (CIHR).

Schwartz is the Arnold L. Johnson Chair in Health Care Ethics and associate professor in the Department of Clinical Epidemiology and Biostatistics. The multidisciplinary team includes Chris Sinding, Matthew Hunt, Naomi Adelson, Jennifer Ranford and Sonya DeLaat, and two physicians with extensive experience in humanitarian work Laurie Elit and Lynda Redwood-Campbell.

Laurie Elit
Laurie Elit, professor in the Department of Obstetrics and Gynecology

The study, Ethics in Humanitarian Aid Work: Learning From the Narratives of Humanitarian Health Workers, has recently been published in the journals, American Journal of Bioethics (AJOB) Primary Research and in Public Health Ethics. Tomorrow Schwartz will speak in Toronto on the issue of ethics in humanitarian health care at the fall conference of the Centre for Clinical Ethics.

Schwartz said ethical dilemmas faced by humanitarian workers frequently deter them from offering their skills overseas again. It’s been said that for some agencies it means 50 per cent of their volunteers never return to fieldwork.

"The sense of not being able to make (enough of a) difference as a health care professional threaded through the narratives," the study said.  "Respondents spoke of their awareness of how far short their care fell of people’s health needs, and sometimes lamented the mismatch between what they had to offer and what people needed."

An innovative new approach is needed to prepare health care professionals before they leave to work internationally, Schwartz said. "To date, little ethical analysis has been made of challenges encountered by expatriate health care professionals in the field. The findings demonstrate a need to provide practical ethics support for humanitarian health care workers."

For their analysis, researchers listened to ethical dilemmas faced by 20 Canadian-trained health care professionals who have provided care in acute disasters, conflict zones, given post-disaster and development assistance, and worked with extreme poverty in developing countries.

They included physicians, nurses, nurse practitioners, physiotherapists, public health specialists, consultants, midwives and lab technicians. Some were newly qualified and others had practiced for 40 years. Their field experience ranged from one to 12 missions, with most averaging four.  Combined they took part in 33 missions to African countries, 15 to Asia, six to Central America, four to Eastern Europe and two to the Caribbean.

After analyzing Canadian health professionals stories, researchers found four main ethical challenges emerged: scarce resources; dealing with long-standing political; social and commercial structures; restrictive policies and agendas of aid agencies; perceived norms about the various roles of health professionals and how they interact with each other.

Twelve medical students who have done international health electives were also interviewed. A presentation on the student data will be given at a conference in October.

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