Voices from the field: Ethical challenges in humanitarian medicine

Disasters typically do not allow time for prolonged moral reflection or ethical deliberation; yet, clinicians who volunteer in the wake of disasters routinely encounter ethical challenges, sometimes accompanied by mental anguish and moral distress. While accounts of these challenges are often shared with fellow clinicians, they have entered the ethics and public health literature mostly as anecdotes and have not been systematically reported or analyzed. In this presentation, I will share results from a series of cognitive interviews and focus groups conducted with clinicians who have volunteered their time and skill in the aftermath of disasters. The details of these rich first-person accounts vary widely depending, for example, on the type and extent of the disaster, the specific population being treated, and the nature of the medical interventions being delivered. Nevertheless, common ethical themes emerge, such as: allocation of scarce resources, managing the competing interests of identified versus statistical lives, and defining the extent of professional obligations. Using case studies to illustrate, I will present a typology of ethical challenges in humanitarian medicine and identify perceived barriers to ethical action. My findings suggest the need to improve the ethical competence and confidence of clinicians in the field. Potential policy implications, including disaster relief-specific education and inclusion of clinician-ethicists in disaster response teams, will be considered briefly.