Ethical Issues in Humanitarian Work: Perceptions of Humanitarian Ethics Experts, Workers, and Non-Governmental Organization Members
DOI:
https://doi.org/10.7202/1124206arKeywords:
moral problem, tension, dilemma, humanitarian aid, ethical silence, neocolonialism, empirical research, qualitative researchLanguage(s):
EnglishAbstract
This study aims to empirically document the perceptions and experiences of diverse humanitarian actors, including humanitarian workers, NGO members, and humanitarian ethics experts, regarding ethical issues in humanitarian work. We conducted 15 interviews with participants, from which we extracted four categories of ethical issues: value-based tensions, resource scarcity, political considerations, and neocolonialism. The category of value-based tensions encompasses ethical issues involving intercultural conflicts, balancing care with security and collaboration, addressing emergency versus long-term care, and navigating ethical silence. Resource scarcity includes issues such as a lack of financial and material resources, insufficient preparation, and inadequate ethical resources, all of which contributing to operational difficulties. The category of political considerations highlights ethical issues related to NGO operations, including the disconnect between organizational decisions and field practices, the unequal treatment of local workers and expatriates, and instances of authoritarianism, racism, and corruption within NGOs and their partners. Ethical issues pertaining to neocolonialism highlights how Western ideologies and power dynamics persist in humanitarian organizations, manifesting in issues like paternalism, control of decision-making by white individuals, and power imbalances between NGOs and local governments, perpetuating a sense of Western superiority over non-white individuals. As well, having identified ethical silence and neocolonialism as key ethical issues in this study (i.e., undiscussed in prior empirical literature reviewed), we propose a reflection on structural injustices and the systemic inequities in humanitarian work.
References
1. Rose J, O’Keefe P, Jayawickrama J, O’Brien G. The challenge of humanitarian aid: an overview. Environmental Hazards. 2013;12(1):74-92.
2. Terry F. The paradoxes of humanitarian aid. Agenda: A Journal of Policy Analysis and Reform. 1998;5(2):135-46.
3. Banatvala N, Zwi AB. Conflict and health: public health and humanitarian interventions: developing the evidence base. BMJ. 2000;321(7253):101-5.
4. Civaner MM, Vatansever K, Pala K. Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey. PLoS one. 2017;12(3):e0174162.
5. Côté LP, Drolet MJ. Conceptualizing ethical issues of humanitarian work: results from a critical literature review. Canadian Journal of Bioethics/Revue canadienne de bioéthique. 2021;4(1):152-67.
6. Swisher LL, Arslanian LE, Davis CM. The realm-individual process-situation (rips) model of ethical decision-making. HPA Resource. 2005;5(3):1-8.
7. Slim H. Humanitarian Ethics: A Guide to the Morality of Aid in War and Disaster. London: Hurst; 2015.
8. Giannou C, Baldan M. War Surgery: Working With Limited Resources in Armed Conflict and Other Situations of Violence. Vol. 1. ICRC; 2009.
9. Haver K. Tug of War: Ethical Decision-Making to Enable Humanitarian Access in High-Risk Environments. Humanitarian Practice Network. 9 Nov 2016.
10. Hunt M, Chénier A, Bezanson K, et al. Moral experiences of humanitarian health professionals caring for patients who are dying or likely to die in a humanitarian crisis. Journal of International Humanitarian Action. 2018;3(1):12.
11. Hunt M, Pal NE, Schwartz L, O’Mathúna D. Ethical challenges in the provision of mental health services for children and families during disasters. Current Psychiatry Reports. 2018;20(8):60.
12. Lopes Cardozo B, Gotway Crawford C, Eriksson C, et al. Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study. PLoS one. 2012;7(9):e44948.
13. Schwartz L, Hunt M, Sinding C, et al. Models for humanitarian health care ethics. Public Health Ethics. 2012;5(1):81-90.
14. Côté LP, Drolet MJ. Ethical issues arising in humanitarian work and possible responses to them: results from a critical literature review. Canadian Journal of Bioethics/Revue canadienne de bioéthique. 2023;6(3-4):16-32.
15. Meldrum H. Spirituality in medical practice: how humanitarian physicians draw their boundaries with patients. Integrative Medicine. 2011;10(3).
16. Asgary R, Lawrence K. Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers. BMJ Open. 2020;10(9):e039463.
17. Draper H, Jenkins S. Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 2014–2015 Ebola outbreak: a qualitative study. BMC Medical Ethics. 2017;18:77.
18. Funk KL, Rayes D, Rubenstein LS, et al. Ethical challenges among humanitarian organisations: insights from the response to the Syrian conflict. In: Ahmad A, Smith J, editors. Humanitarian Action and Ethics. London: Zed Books; 2018. p. 133-45.
19. Schwartz L, Sinding C, Hunt M, et al. Ethics in humanitarian aid work: learning from the narratives of humanitarian health workers. AJOB Primary Research. 2010;1(3):45-54.
20. Sinding C, Schwartz L, Hunt M, et al. “Playing God because you have to”: health professionals’ narratives of rationing care in humanitarian and development work. Public Health Ethics. 2010;3(2):147-56.
21. Gustavsson ME, Juth N, Arnberg FK, von Schreeb J. Dealing with difficult choices: a qualitative study of experiences and consequences of moral challenges among disaster healthcare responders. Conflict and Health. 2022;16:24.
22. Rubenstein LS, Robinson WC. Reality Makes Our Decisions: Ethical Challenges in Humanitarian Health in Situations of Extreme Violence. Center for Public Health and Human Rights; 2019.
23. Fraser V, Hunt MR, De Laat S, Schwartz L. The development of a humanitarian health ethics analysis tool. Prehospital and Disaster Medicine. 2015;30(4):412-20.
24. Gotowiec S, Cantor-Graae E. The burden of choice: a qualitative study of healthcare professionals’ reactions to ethical challenges in humanitarian crises. Journal of International Humanitarian Action. 2017;2:2.
25. Hunt M, Nouvet E, Chénier A, et al. Addressing obstacles to the inclusion of palliative care in humanitarian health projects: a qualitative study of humanitarian health professionals’ and policy makers’ perceptions. Conflict and Health. 2020;14:70.
26. Hunt M. Ethics beyond borders: how health professionals experience ethics in humanitarian assistance and development work. Developing World Bioethics. 2008;8(2):59-69.
27. Hunt M. Moral experience of canadian healthcare professionals in humanitarian work. Prehospital and Disaster Medicine. 2009;24(6):518-24.
28. Hunt M, Eckenwiler L, Hyppolite SR, et al. Closing well: national and international humanitarian workers’ perspectives on the ethics of closing humanitarian health projects. Journal of International Humanitarian Action. 2020;5:16.
29. Michael M, Zwi AB. Oceans of need in the desert: ethical issues identified while researching humanitarian agency response in afghanistan. Developing World Bioethics. 2002;2(2):109-30.
30. DePoy E, Gitlin LN. Introduction to Research: Understanding and Applying Multiple Strategies. St. Louis, Missouri: Elsevier; 2020.
31. Hammell KW, Carpenter C, Dyck I, editors. Using Qualitative Research: A Practical Introduction for Occupational and Physical Therapists. Edinburgh: Churchill Livingstone; 2000.
32. Husserl E. The train of thoughts in the lectures. In: Polifroni EC, Welch M, editors. Perspectives on Philosophy of Science in Nursing. New York: Lippincott; 1999. p. 247-62.
33. Husserl E, David. The Crisis of European Sciences and Transcendental Phenomenology: An Introduction to Phenomenological Philosophy. Evanston, USA: Northwestern Univ. Press; 1984.
34. Fortin MF, Gagnon J. Fondements et étapes du processus de recherche: méthodes quantitatives et qualitatives. Montréal: Chenelière Éducation; 2022.
35. Bogdan R, Biklen SK. Qualitative Research for Education: An Introduction to Theory and Methods. Boston: Allyn and Bacon; 2006.
36. Drolet MJ, Girard K. Les enjeux éthiques de la recherche en ergothérapie : un portrait préoccupant. Canadian Journal of Bioethics/Revue canadienne de bioéthique. 2020;3(3):21-40.
37. Thomas SP, Pollio HR. Listening to Patients: A Phenomenological Approach to Nursing Research and Practice. New York: Springer Publishing Company; 2004.
38. Giorgi A. De la méthode phénoménologique utilisée comme mode de recherche qualitative en sciences humaines: Théories, pratique et évaluation. In: Poupart J, Groulx, L. H., Deslauries JP, editors. La recherche qualitative: enjeux épistémologiques et méthodologiques. Montréal: Gaëtan Morin; 1997. p. 341-64.
39. Glaser JW. Three Realms of Ethics: Individual Institutional Societal: Theoretical Model and Case Studies. Lanham: Rowman and Littlefield; 1994.
40. Mills CW. The Racial Contract. Ithaca and London: Cornell University Press; 1997.
41. Mills CW. Black Rights/White Wrongs: The Critique of Racial Liberalism. New York: Oxford University Press; 2017.
42. Nixon SA. The coin model of privilege and critical allyship: implications for health. BMC Public Health. 2019;19(1):1637.
43. Applebaum B. “Listening silence” and its discursive effects. Educational Theory. 2016;66(3):389-404.
44. Pohlhaus Jr G. Relational knowing and epistemic injustice: toward a theory of willful hermeneutical ignorance. Hypatia. 2012;27(4):715-35.
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