Ethical experiences and dilemmas of career medical aid workers; Characteristics and determinants

Humanitarian medical volunteerism has grown significantly over the past decades. Increasingly, humanitarian workers and their organizations have faced important challenges regarding public health and medical ethics. However, limited data exists on ethical experiences and concerns of humanitarian workers. We conducted comprehensive, semi-structured interviews, containing open-ended questions with 45 experienced humanitarian aid workers, to evaluate their ethical experiences and perspectives in humanitarian situations. We identified important ethical dilemmas that are relevant to the humanitarian setting including: unintended impacts of programs on local communities and health system, providing inadequate healthcare or double standards of care, turning away patients due to lack of resources, resource diversion by donors or communities, compromising quality of care for access, low levels of cultural competency and sensitivity among humanitarian workers, lack of program planning for continuity and long-term sustainability, and adverse socio-political effects of foreign aid. Contributing factors included inadequate ethical preparation, the complexity of context, ideological and socio-cultural differences, difficulties or confusion with the principles of clinical and social justice, and volunteer burnout. To address these ethical challenges there is a need for ethical guidelines and better ethical preparation by individuals and organizations. This should include character-building for aid workers and organizations that focuses on reflection and humility, creating platforms and strategies for open discussion of ethical challenges, providing better support and communication channels for humanitarian workers, improving understanding of local perspectives at the personal and societal levels, and critically addressing the broader overarching socio-political challenges in humanitarian operations.