This Code does not aim to Introduction Providing a simple, straightforward answer to these issues is difficult and often impossible. The proposed ethical framework strives to a) stress certain values that guide humanitarian action, b) recommend a ten-step approach that strengthens humanitarian aid workers capacity to identify and address ethical issues when making decisions, and c) suggest a model (hub and spokes) that helps define the organizational resources needed to implement the framework. Table 2: A ten-step approach to ethical decision-making in humanitarian aid In the course of this work, clinicians are frequently exposed to complex ethical issues. Programs should also be regularly monitored and evaluated in order to avoid causing unnecessary and unjustified harm. Results of their study further show that political factors are as important as the prevailing needs. The budget of these more long-term operations is usually annually reviewed and adjusted. What are Humanitarian Principles? Blackwell Publishing. 5. protection are misused, politicized, or coopted by other interests, or Nous pensons quune conceptualisation correcte des problmes thiques auxquels les travailleurs humanitaires peuvent tre confronts peut fournir des pistes pour mieux y rpondre. However, as soon as values conflict with each other, humanitarian aid workers are likely to face a dilemma. Rather, ethical problems tend to be reduced to matters of geopolitics or management. As humanitarian organisations mobilise to build covid-19 treatment centres, and . Darcy J., Hofmann C. According to need? En effet, mme si seul un petit nombre dauteurs dfinit explicitement les mots quils utilisent pour parler dthique, la grande quantit de mots que nous avons dcouverts dans les documents semble suggrer des terrains vastes et riches sur lesquels aborder les questions thiques. Slim H. Relief agencies and moral standing in war: principles of humanity, neutrality, impartiality and solidarity. Key features of some of these tools[3] are: Situation analysis involving all concerned actors 8 Members and certificants recognize that the principle of humanity, As illustrated in this case, repeated budget cuts in practice are likely to be carried out at central headquarter level. Reynolds K., Klepp K., Yaroch A. Members and certificants promise to uphold this Code and act 7 as an extraordinary activity in situations when the authorities EndNote, Papers, Reference Manager, RefWorks, Zotero, ENW Defining the limits of emergency humanitarian action: where, and how, to draw the line? The work to bring menstruation into sexual and reproductive health and rights, gender, education and humanitarian settings continues ahead of Menstrual Health Day (28 May) at the Africa Menstrual Health Symposium: Achieving Menstrual Justice through a Grassroots and Multisectoral Approach from 24-25 May hosted by the African Coalition for . 2.1. Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their Decision-making Processes, Tweets about "#plosc_disasters OR @plosc_disasters OR \"PLOS Currents Disasters"\ OR \"PLOSCurrentsDisasters\" OR currents.plos.org/disasters lang:en", Situation analysis involving all concerned actors, Critical examination of the legal, factual and ethical issues, Describe options and their potential and forecasted, Weighing of options in the light of the identified arguments, Define measures to improve successful implementation, Monitoring of indicators assessing the decisions impact, Description of the key values at stake and their potential conflict, Critical examination of the arguments at stake, Description of options and their potential and forecasted consequences on each actor. These features include high transmissibility, widespread co-morbidities, and a lack of intensive care capacity [ 1 ]. Holland S. Public Health Ethics. Some of these are hierarchical, and some are fraught with cross-cultural issues. Louis Pierre Ct would like to thank Guy Trpanier, librarian specializing in the arts and humanities at the Roy-Denomm Library of the Universit du Qubec Trois-Rivires (UQTR), for his valuable assistance in reviewing the literature. [3] As long as this process of ethical decision-making is neglected, operational decisions might be made in a discriminatory way, potentially skewing assessments and affecting programmatic outcomes. This ten-step approach is applicable at a macro-, meso- and micro-level. Justifying the choice of the optionEnsure transparency of the choice including reasons and justificationsDefine limits of the decisions Finally, we propose certain organizational measures that aim to support humanitarian aid organizations in their effort of implementing the framework and securing well-argued and fair decision-making in their daily work. The ethical framework of the International Association of The organizations primary goal in distributing food aid was not to improve the local populations nutritional status, but, instead it was to increase access to local leaders. Finally, an ethicist should oversee the discussion, ensuring that all participants have equal opportunity to express their viewpoints. The purpose of humanitarian action is to protect life and health and ensure respect for the human being. 36. . The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. They are central to. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. Humanitarian practice and ethics are solidly founded on four "humanitarian principles": humanity, neutrality, impartiality, and independence. Public Health Nutrition Strategies for Intervention at the Ecological Level. Distilling relevant experiences and insights from both public health ethics and clinical ethics and adjusting them to the context of humanitarian aid may allow the young field of ethics of humanitarian action to advance in an efficient way, while benefitting from achievements in neighboring fields. In this paper, we emphasize that ethical issues are inherent in humanitarian action. Questions related to Professionals in Humanitarian Assistance and Protection (PHAP) begins Meso-level (country/region): Aid workers mere means instead of ends in themselves? Public Health Ethics. Neutrality: Humanitarian actors must not take sides One reason for this situation may be that managers in charge of humanitarian operations are unlikely to be trained in ethics. avoid jeopardizing lasting improvements of a situation or bringing Overall, the resource allocation processes seem to lack structure and transparency, hindering a comprehensive evaluation of the impact of aid. Depending on the level at which ethical consultation is needed, either the experienced ethicists or the ethics resource leader constitute a committee including key stakeholders as participants. Guiding humanitarian aid workers in their difficult task to make decisions and allocate resources21, requires skilled professionals especially in challenging contexts. Humanitarian aid "seeks to save lives and alleviate suffering of a crisis-affected population. Critical examination of the arguments at stake Elaborating decisions Cross-cutting values 2005 May;31(5):256-61. In public health ethics, the focus is on eventual dilemmas arising between individual rights and community benefit12. Should some projects be treated preferentially, while others are downsized or discontinued? that humanitarian action is not driven by positions of a political, Framing budget allocation issues is a matter of justice rather than merely a technical matter of finance. As such, organizations can monitor and evaluate the operational implementation of the program and retrospectively assess the portrayed options and whether another decision would have been a better one. In the context of clinical settings, complex decisions, including the allocation of limited resources, have to be made frequently. The purpose of humanitarian action is to protect life and Ethical issues around these topics have recently received more attention. The meso-level case described above provides a useful example in which this approach would have been beneficial. J Law Med Ethics. PubMed PMID:21410748. International Committee of the Red Cross. However, the allocation of aid to more chronic contexts in the state of deterioration, stabilization, or imminent recovery also needs scrutiny, because the respective populations might be over- or underserved. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship. To do so, this paper looks at ethics in humanitarian work in its experiential and subjective dimension, what is about any other negative effects. However, food aid is also provided in areas where populations are not necessarily food insecure. The aim of the ethical framework is to raise such concerns and demand specific justifications in such cases. humanitarian actors should be disengaged from policy discussions in 1. This is especially relevant because humanitarian action remains a challenging field involving multiple actors that adhere to different sets of principles in often highly complex and volatile environments. We conducted a systematic literature review to synthesize the lessons learned regarding the ethics of research in humanitarian crises. The study generated preliminary insight into the ethical deliberation processes of humanitarian health workers and highlighted different types of ethics support that humanitarian workers might find helpful in supporting the decision-making process. In disaster affected contexts the needs faced by populations oftentimes outweigh personal and material resources1. The humanitarians' tragedy: escapable and inescapable cruelties. But the recent work of the AAA's Ethics Task Force has sought to avoid this temptation, encouraging a view of ethics as adaptively flexible enough to adjust to a "wide range of contexts of anthropological practice" in nonanticipatory ways. PubMed PMID:22458465. ethical dilemmas are best answered by thoughtful consideration of In the field of humanitarian action, making ethically justified decisions is challenging. Critical examination of the legal, factual and ethical issuesIdentify the ethical conflict precisely Specifying values, norms or principles 2009: 2 (2): 184-194. As such, tools that have already proven useful for addressing dilemmas in the clinical setting are applied to a humanitarian aid context for the first time. Humanitarian work related with refugee "crises" is understood as a contract between governments and international, . less time to think hard about what it means to show humanity to non-human environments and animals in the Movement's humanitarian norms and work . The experienced ethicists train all ethics resource leaders to ensure that skilled humanitarian aid workers are available and able to act as ethicists at all levels. PubMed PMID:11090498. Having a defined procedural process can improve the transparency, accountability, and quality of decisions. Hunt MR. Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work. A qualitative study was conducted to consider this question. efforts, and should where possible facilitate such efforts. Listen 4:15. It is a set of values centered on importance of work and manifested by determination or desire to work hard. In public health, a number of ethical frameworks have been proposed 14. 1.2. Moral Entanglement and the Ethics of Closing Humanitarian Projects - Matthew Hunt and Jingru Miao 3. Towards a Normative Framework for Public Health Ethics and Policy. For example, assisting populations in contexts with limited access must consider the critical trade-off between the principles of beneficence and justice. Second, all participants acknowledge that various interests may affect the decision-making process, such as those of organizations themselves, the donor community, local or regional governments, and others. Yet, humanitarian action is embedded in substantive and procedural values of ethical relevance. Harroff-Tavel M. Neutrality and Impartiality: The importance of these principles for the International Red Cross and Red Crescent Movement and the difficulties involved in applying them. [1] The macro-, meso- and micro-levels chosen in this context represent the three main levels of decision-making within a humanitarian organization, partially excluding a social ecological27. Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland. Therefore, decision-making processes of aid agencies are stifled and run the risk of adding further damage to their beneficiaries. A justification for this intervention could have been that in the context of armed conflict, involving all parties in the conflict is acknowledged as paramount to promoting acceptability of the humanitarian organization and its staff, which will in turn contribute to their safety and security. As such, drawing parallels to current public health ethics frameworks is reasonable when responding to the needs caused by disasters. consistent ethical conduct. 6 This includes ensuring that integrity is maintained, laws are followed, policies are adhered to, and client . They recognize that upholding human dignity requires supporting the For instance, deciding who should receive limited relief goods requires weighing ethical principles such as beneficence and non-maleficence, or equality and needs. Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context. Third, to address those processes, we propose a ten-step approach that is based on clinical ethics models. Canadian Journal of Bioethics / Revue canadienne de biothique, Louis Pierre Ct and Marie-Jose Drolet, 2021. This status quo, where precarity is the norm and everyone is looking for a way out, is not maintainable. This is a qualitative study drawing on Grounded Theory analysis of 20 interviews with health care professionals who have provided humanitarian assistance. continually faces obstacles resulting from other powerful interests. This has increasing relevance in areas where the populations are food insecure. Part Two: A ten-step approach to ethical decision-making in humanitarian aid. Furthermore, while a commitment to neutrality endeavors to ensure Specific values in hostilities or engage in controversies of a political, racial, 2012. 6) All affected parties have been treated impartially. Members and certificants recognize the limits of humanitarian action ECHO. The impact of ongoing violence continues to threaten the lives and futures of families and children, leaving basic services cut off and many health facilities closed, damaged . The second case looks at meso-level issues that need to be solved at a country or regional level. At present, however, identifying conflicting values is not part of many organizations decision-making culture, which is predominantly marked by a geopolitical discourse. The humanitarian principles of humanity, neutrality, impartiality and independence provide the foundation for humanitarian action. 2005: 3. University Publishing Group. 2010: 14. Louis Therefore, ethicists play an important role in guiding organizations through the decision-making process. TransparencyScrutiny A New Ethics of Professionalism in the Humanitarian Sector: A Review of "Necessary Risks" by Abby Stoddard. Case: A humanitarian organization wishes to remain present in a specific context and opts for a capacity-building program for surgeons. We may claim that the principle of humanity is a niche ethic for calamitous human situations which rightly trumps wider ethical considerations in extremis, but this is neither true nor realistic. How should the committee allocate the budget? 9 Ownership and autonomy: You . Alongside her direct humanitarian work, Dr. Lepora has published in leading philosophy journals to engage with foundational . implications. Bull World Health Organ. Programs that deploy highly qualified staff such as surgeons and have the goal of implementing projects bearing high risks to the affected population need to be thoroughly evaluated in regard to potential harms and benefits, as well as their distribution. During this period, it is unlikely that the nutritional status of the targeted populations will improve significantly, because effective food aid requires a prolonged intervention, supported by surveillance. The incident is reported to the organizations managers, who agree that no further steps are needed to address the situation, accepting the harm as a kind of collateral damage for an otherwise useful program. Dilemmas arise frequently (but not exclusively) in the context of resource allocation, particularly since humanitarian aid is a limited resource, with programmatic decisions being based on unmet needs7. We analysed 61 documents, as part of a literature review, which revealed that there truly is a need, amongst the authors and in humanitarian work, to discuss ethics. That includes political and public participation, which is essential to promoting democratic governance, economic development, social inclusion, and more. Our suggested ethical framework is an attempt to engage the humanitarian community in the discourse of identifying ethical issues in the context of humanitarian action and to provide tools to strengthen the decision-making process of humanitarian aid workers. At present, the decision-making structures do not explicitly insist on carrying out an in-depth review of the benefits or risks that certain operations have on the beneficiaries. Ethical Considerations in Social Work. Moreover, measures would be taken to mitigate the harm of any operational program on the beneficiaries. and guide, but must also be balanced within the context and complexity action is rooted in a set of core principles, which form the foundation NPR's Leila Fadel talks to Reuters journalist Maggie Michael about the deaths of at least 50 children at a state-run orphanage in Sudan since fighting began weeks ago in Khartoum. In many cases, these values cannot simply be implemented, but need to be specified and possibly weighed against each other. PubMed PMID:22442647. Based on the assumption that decision-makers are aware of the need to a) identify ethical issues in the humanitarian context as such, and that b) the organization embraces values, norms, or principles that can serve to justify a response, we suggest a ten-step approach that supports aid workers at macro-, meso- and micro-levels alike in their difficult task of making ethically sound decisions. However, before initiating the first step, the following preconditions should be met. This model provides a structure and promotes transparency of the decision-making process, which allows for a comprehensive monitoring and evaluation of humanitarian programs. Activity It However, it cannot simply be assumed that high-risk actions potentially resulting in significant harm to patients are justified for the sake of remaining present in certain contexts, at least if this means pursuing a political rather than a purely humanitarian goal. This approach was designed so that it can evolve further and be adjusted to specific needs in the field. As COVID-19 continues to spread, it is affecting everyone across the world, and has led to sudden changes in how humanitarian actors are able to operate. humanitarian action to be carried out. Poverty reduction Sustainability For instance, the roles and responsibilities of the expatriate in charge and the local physicians need to be clarified at the outset11. implemented. This provides the AT the same time, well-intentioned humanitarian actors focus on meeting those needs. The proposed tools also foster exchange through mediated discussions involving all stakeholders, which in turn promotes coherence in decisions and outcomes. 2. 5 Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. 2007. p. ix, 188. Bachelor of Social Work. Background Several features of infectious disease outbreaks in humanitarian contexts may produce swift, disruptive, and fatal crises. This Code of Ethics and Professional Conduct must be embraced and BibTeX, JabRef, Mendeley, Zotero, Conceptualizing Ethical Issues of Humanitarian Work: Results From a Critical Literature Review, Canadian Journal of Bioethics / Revue canadienne de biothique, Conceptualizing Ethical Issues of Humanitarian Work: Results From a Critical , The Challenge of humanitarian aid: an overview, Inventory modelling for complex emergencies in humanitarian relief operations, Complex humanitarian emergencies: A major global health challenge, Conflict and health: public health and humanitarian interventions: developing the evidence base, Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey, Beyond emergency care: challenges to health planning in complex emergencies, The Realm-Individual Process-Situation (RIPS) Model of ethical decision-making, Psychological distress, depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study, Models for humanitarian health care ethics, Ethical challenges in the provision of mental health services for children and families during disasters, Moral experiences of humanitarian health professionals caring for patients who are dying or likely to die in a humanitarian crisis, Les enjeux thiques en radaptation. race, gender, religious belief, class, or political opinions. The available budget is clearly insufficient to cover all the proposed interventions; in fact, it is ten percent smaller than last year. ethically and professionally above and beyond the baseline requirements Join IASC members in collaboration with PHAP for a series of events starting on 17 April on how to strengthen accountability to affected populations (AAP) and bring about the Participation Revolution as envisaged by the Grand Bargain. Fig. Indeed, even if only a small number of authors define explicitly the words they use to discuss ethics, the great quantity that we have uncovered in the documents seem to suggest vast and rich grounds upon which to address ethical issues. 2011 Jul;35(3):606-22. creating dependencies and other impediments to recovery and development Fink G. Determinants of International Emergency Aid-Humanitarian Need Only?2011. This, of course, can work both ways, as group-think and its various negative consequences have demonstrated. Research team: Humanitarian Health Ethics Research Group humanitarianhealthethics.net 2. which defines the purpose of humanitarian action, underscores that Both Marie-Jose Drolet and Louis Pierre Ct wish to extend their kindest regards to Prof. Matthew Hunt, at McGill University, for his precious insights and advice. Importantly, regardless of the detail in the structures and processes, they must be conceived as a learning system that begins imperfectly but aims at continuous improvement. 2012 Apr;5(1):56-66. key findings from a drafting and consensus generation meeting of the Working Group on Disaster Research and Ethics (WGDRE) 2007, Dfis thiques et risques pratiques du ter-rain en situation de dveloppement ou durgence humanitaire, The ethical dilemmas of international human rights and humanitarian NGOs: Reflections on a dialogue between practitioners and theorists. credibility and reputation of humanitarian work, which is shaped by the Micro level(Local level) Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. It is now generally agreed that an effective protection response demands adequate professional competence, and that a concerted effort is required to ensure that protection work by humanitarian and human rights actors meets commonly agreed, NEW YORK/GENEVA/AMMAN, 30 May 2023 - As the conflict in Sudan passes the six-week mark, over 13.6 million children are in urgent need of lifesaving humanitarian support, the highest number ever recorded in the country. For example, one-off food distributions involve times when food rations are allocated to certain populations over a short period of one or two months. For example, repeated budget allocations would not occur without involving the program managers in the field, who are directly concerned with such decisions. It is only a matter of time before covid-19 gains a foothold among refugees, internally displaced persons, and other vulnerable populations living in humanitarian settings. Public health ethics theory: review and path to convergence. We believe it to be important that the ethical issues of humanitarian work are increasingly addressed in the literature and argue that it would be helpful for the vocabulary used by authors to be employed and developed even more rigorously, so that their discussions show more precision, coherence, relevance, exhaustiveness, and sufficiency. Pierre Overall, the proposed framework has been based on the experiences of several humanitarian fieldworkers and was tested and deemed useful by humanitarian aid workers and donor agencies. Clarinval, C. Humanitarian Values: a neglected debate. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. We believe it to be important that the ethical issues of humanitarian work are increasingly addressed in the literature and argue that it would be helpful for the vocabulary used by authors to be employed and developed even more rigorously, so that their discussions show more precision, coherence, relevance, exhaustiveness, and sufficiency. Without violating the Code, each member and certificant also The Fundamental Principles of the Red Cross. Completing an undergraduate degree in social work is considered one of the best ways to prepare for a humanitarian career. Polity Press Cambridge. This might entail a round-table discussion similar to ethical consultations in a clinical setting. No follow-up of the patient is possible by the physician who should act as trainer. Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland; Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts, USA. 4. Review your work. it is found. Apart from a few new interventions, most of programs have run for several years. Lee LM. A challenge in addressing ethical issues in public health is that much policy-making remains in silos, which hinders the joint effort at forming cross-sectoral public policy15. or holding certifications issued by the Association, whether they are It examines features that contribute to forming the moral landscape of humanitarian work, and discusses normative guidelines and approaches that are relevant for this work. Un tat des lieux de la conceptualisation de notions thiques, Argument-based medical ethics: A formal tool for critically appraising the normative medical ethics literature, Constructing a systematic review for argument-based clinical ethics literature: the example of concealed medications, He who helps the guilty, shares the crime? 2014 Apr;14(1):47-55. MacRae S, Chidwick P, Berry S, Secker B, Hbert P, Shaul RZ, Faith K, Singer PA. Clinical bioethics integration, sustainability, and accountability: the Hub and Spokes Strategy. BMJ. Gathering evidence Dr. Chiara Lepora has spent more than a decade providing medical care throughout the Middle East and Africa, working with Medicines sans Frontiers (MSF, Doctors Without Borders) and other agencies to increase access to care in some of the most volatile circumstances. that we uphold this Code. In this section, we propose such a framework, drawing on resources that have been developed in the fields of public health and clinical ethics. Subsequently, the committee either decides to proceed according to the principles stated in the ethical framework proposed here or agrees to a set of core principles for future reference and to shape the decision-making process. While addressing those needs, these actors promote values such as independence, impartiality, saving lives, prevention and preparedness, providing aid, promoting health and well-being24,26. 2012: 5-19. PubMed PMID:23279367. 2 Objectives Consider the ethical dimensions of Global health Humanitarian assistance Health care practice and humanitarian work - Moral experience of HCPs in humanitarian work - Approaches and resources for thinking about moral dimensions of humanitarian work - Considerations for clinical electives in developing countries In such programs, expatriate physicians or other healthcare professionals train and build the capacity of local providers, which requires meeting a certain set of preconditions. Substantive adhere to the following general standards of professional conduct: Copyright 2021 - Professionals in Humanitarian Assistance and Protection (PHAP). Finally, Marie-Jose Drolet acknowledges the contribution of the Social Sciences and Humanities Research Council of Canada (SSHRC) for the grant awarded to the project. Part Three: Institutional requirements for high ethical standards in humanitarian aid organizations. Clinical ethicists have developed various tools that assist decision-makers in this difficult task. For example, in contexts where a value such as saving lives conflicts with personal security, aid workers may choose to refrain from engaging in assisting distressed populations due to the lack of security on the ground 5 . is for the sake of all crisis-affected people, now and in the future, Populations affected by disasters are subjected to arbitrary budget allocations and may or may not benefit from external aid, depending on who voices their concerns most effectively. Hence, ethical issues remain unidentified and therefore unaddressed. Weighing of options in the light of the identified arguments and available evidence Covid-19 in humanitarian settings: addressing ethics to reduce moral distress. Changing this would require altering the structure of aid organizations. action. As with clinical practice, humanitarian contexts are often highly challenging and ideally require a fully trained ethicist to assist and act as a mediator who guides the decision-making process. May 28, 2020. Likewise, humanitarian aid workers care for individuals and populations affected by disasters and may therefore be confronted with similar issues. Such dilemmas may arise in the humanitarian context, since programs aim to assist populations in a way that might affect individual rights. Dev World Bioeth. The major contribution of this book is to demystify the subject of ethics, to provide a clear and logical explanation of the ethical framework guiding humanitarian action, and to offer insight on how to balance competing principles or values according to the operating context on the ground. Disasters. from the political, economic, military, or other objectives that any 1. Disasters and dilemmas: aid agency recruitment and HRD in post-tsunami Sri Lanka, The Politics of rescue: Yugoslavias wars and the humanitarian impulse, Le dilemme invitable de laction humanitaire, Playing God because you have to: Canadian health professionals experiences of rationing care in humanitarian and development work, Doing the right thing: relief agencies, moral dilemmas and moral responsibility in po-litical emergencies and war, The challenges and ethical dilemmas of a military medical officer serving with a peace-keeping operation in regard to the medical care of the local population, Humanitarian medical aid to the Syrian people: Ethical implications and dilemmas, Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 20142015 Ebola outbreak: a qualitative study, Moral experience of Canadian health care professionals in humanitarian work, Ethical challenges in conducting research in humanitarian crisis situations, Ethical considerations in crisis and humanitarian interventions, Ritual dynamics in humanitarian assistance, Choices more ethical than legal: the international committee of the red cross and human rights. During crisis [3]These tools are described in Fletchers Introduction to Clinical Ethics 13, Beauchamp and Childress, Principles of Biomedical Ethics22, Singer23, Bioethics at the bedside: a clinicians guide, Wall24, Ethics for International Medicine: A Practical Guide for Aid Workers in Developing Countries. Terry F. The International Committee of the Red Cross in Afghanistan: reasserting the neutrality of humanitarian action. 1979. Funding: My aims Consider how tragic choices arise in humanitarian pracGce by examining two prominent examples: Dilemmas of competency Dilemmas of paGent selecGon Propose avenues for responding to tragic choices in humanitarian health work 2012 Spring;40(1):85-98. Petrini C, Gainotti S. A personalist approach to public-health ethics. Achieving humanitarian aims in this complex world depends on the
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