Ethics and Emergency Disaster Response. Normative Approaches and Training Needs for Humanitarian Health Care Providers

Health care professionals who travel outside their familiar contexts to provide humanitarian health aid after disasters encounter ethical challenges that are both familiar and distinct from those they experience in their home settings. Few however, are given ethics training, preparation or resources for managing these situations in ways which can help them cope with moral distress and support ethical action as they attend to the needs of those they aim to assist. In a qualitative study we collected and analysed the stories of ethical challenges and moral experience of humanitarian health care professionals who travelled to settings around the globe where needs are widespread and elevated due to extreme poverty, large scale violence, or in the aftermath of natural disaster. Their stories illustrated how health care decision-making in disaster contexts is often beset by complicating factors such as resource scarcity, security conflicts and disparate cultural expectations.It is not always obvious how the skills and ethical norms of western health care professions can be applied to provide the best care for people in humanitarian crises or those living in extreme poverty in low-resource settings. The consequences of the ethical challenges meant patients and communities did not always receive what respondents perceived to be appropriate standards of care, and this had profound impact on the personal and professional identities of the health care providers. With feelings of powerlessness came increased stress and burn-out. The results of the study indicate that there are training needs for disaster response workers to help them develop their skills for managing moral dilemmas before they enter the field where they are confronted with challenging ethical issues. In this paper we describe some of the ethical tensions field workers expressed, and propose strategies, both theoretical and practical, that may help prepare humanitarian health care providers to manage ethical conflicts that threaten to interfere with care.