Hostname: page-component-77c89778f8-vpsfw Total loading time: 0 Render date: 2024-07-17T14:07:58.008Z Has data issue: false hasContentIssue false
  • English
  • Français

“How Far Do You Go and Where Are the Issues Surrounding That?” Dilemmas at the Boundaries of Clinical Competency in Humanitarian Health Work

Published online by Cambridge University Press:  26 July 2013

Matthew R. Hunt ,
Lisa Schwartz  and
Veronique Fraser
Matthew R. Hunt*
Affiliation:
School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; and Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
Lisa Schwartz
Affiliation:
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Veronique Fraser
Affiliation:
Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
*
Correspondence: Matthew R. Hunt, PT, PhD School of Physical and Occupational Therapy McGill University Hosmer House 3630 prom Sir-William-Osler H3G 1Y5 Montreal, Quebec, Canada E-mail matthew.hunt@mcgill.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

You go from here to there, and here you're specialized in one particular sort of thing, there you may be asked to do all sorts of things outside your specialty. How far do you go and where are the issues surrounding that?

Canadian physician discussing experiences in humanitarian aid work

Health professionals working in humanitarian relief projects encounter a range of ethical challenges. Applying professional and ethical norms may be especially challenging in crisis settings where needs are elevated, resources scarce, and socio-political structures strained. Situations when clinicians must decide whether to provide care that is near the margins of their professional competency are a source of moral uncertainty that can give rise to moral distress. The authors suggest that responding ethically to these dilemmas requires more than familiarity with ethical codes of conduct and guidelines; it requires practical wisdom, that is, the ability to relate past experience and general guidance to a current situation in order to render a morally sound action. Two sets of questions are proposed to guide reflection and deliberation for clinicians who face competency dilemmas. The first is prospective and intended to aid clinicians in evaluating an unfolding situation. The second is retrospective and designed to support debriefing about past experiences and difficult situations. The aim of this analysis is to support clinicians in evaluating competency dilemmas and provide ethical care and services.

HuntMR, SchwartzL, FraserV. “How Far Do You Go and Where Are the Issues Surrounding That?” Dilemmas at the Boundaries of Clinical Competency in Humanitarian Health Work. Prehosp Disaster Med. 2013;28(5):1-7.

Keywords

competencyethicshealth care professionalhumanitarian aidscope of practice
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 5 , October 2013 , pp. 502 - 508
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hunt, MR. Ethics beyond borders: how health professionals experience ethics in humanitarian assistance and development work. Dev World Bioeth. 2008;8(2):56-69.CrossRefGoogle ScholarPubMed
2.Hunt, MR. Moral experience of Canadian health care professionals in humanitarian work. Prehosp Disaster Med. 2009;24(6):518-524.CrossRefGoogle ScholarPubMed
3.Schwartz, L, Sinding, C, Hunt, M, et al. Ethics in conditions of disaster and deprivation: learning from health workers’ narratives. AJOB Prim Res. 2010;1(3):45-54.CrossRefGoogle Scholar
4.Schwartz, L, Hunt, M, Sinding, C, et al. Western clinical health ethics: How well do the travel to humanitarian contexts?. In: Abu-Sada C, ed. Dilemmas, Challenges and Ethics of Humanitarian Action. Montreal, QC: McGill Queen's University Press; 2012.Google Scholar
5.Sheather, J, Shah, T. Ethical dilemmas in medical humanitarian practice: cases for reflection from Médecins Sans Frontières. J Med Ethics. 2011;37(3):162-165.CrossRefGoogle ScholarPubMed
6.Kirsch, TD, Moon, MR. The Line. JAMA. 2010;303(10):921-922.Google ScholarPubMed
7.Fox, RC, Goemaere, E. They call it “patient selection” in Khayelitcha: the experience of Médecins Sans Frontières-South Africa in enrolling patients to receive antiretroviral treatment for HIV/AIDS. Camb Q Healthc Ethics. 2006;15(3):302-312.Google ScholarPubMed
8.Sinding, C, Schwartz, L, Hunt, M, et al. “Playing god because you have to”: Canadian health professionals’ experiences of rationing care in humanitarian and development work. Public Health Ethics. 2010;3(2):147-156.CrossRefGoogle Scholar
9.Schwartz, L, Sinding, C, Hunt, M, et al. Ethics in conditions of disaster and deprivation: learning from health workers’ narratives. AJOB Prim Res. 2010;1(3):51.CrossRefGoogle Scholar
10.Terry, F. Condemned to Repeat?: The Paradox of Humanitarian Action. Ithaca, NY: Cornell University Press; 2002:216.Google Scholar
11.Janneck, L, Cooper, N, Frehywot, S, Mowafi, H, Hein, K. Human Resources in Humanitarian Health Working Group Report. Prehosp Disaster Med. 2009;24(Suppl 2):s184-s193.CrossRefGoogle ScholarPubMed
12.Hunt, MR. Ethics beyond borders: how health professionals experience ethics in humanitarian assistance and development work. Dev World Bioeth. 2008;8(2):65.Google ScholarPubMed
13.Hunt, M. Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work. Disasters. 2011;35(3):606-622.CrossRefGoogle ScholarPubMed
14. The Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. The Sphere Project 2011. http://www.sphereproject.org/resources/download-publications/?search=1&keywords=&language=English&category=22. Accessed May 10, 2012.CrossRefGoogle Scholar
15. The International Federation of Red Cross and Red Crescent Societies and the ICRC: The Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief. http://www.ifrc.org/en/publications-and-reports/code-of-conduct/. Accessed May 10, 2012.Google Scholar
16. World Medical Association. WMA International Code of Medical Ethics. http://www.wma.net/en/30publications/10policies/c8/. Accessed May 10, 2012.Google Scholar
17. International Council of Nurses. The ICN Code of Ethics for Nurses. http://www.icn.ch/about-icn/code-of-ethics-for-nurses/code-of-ethics-for-nurses-629.html. Accessed May 10, 2012.Google Scholar
18.Schwartz, L, Hunt, M, Sinding, C, et al. Models for humanitarian health care ethics. Public Health Ethics. 2012;5(1):81-90.CrossRefGoogle Scholar
19.Annas, GJ. Standard of care: In sickness and in health and in emergencies. N Engl J Med. 2010;362(22):2126-2131.CrossRefGoogle ScholarPubMed
20. Institute of Medicine. Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. http://www.nap.edu/catalog.php?record_id=13351. Accessed May 10, 2012.Google Scholar
21. World Medical Association. WMA Declaration of Montevideo on Disaster Preparedness and Medical Response. http://www.wma.net/en/30publications/10policies/d3/ Accessed May 10, 2012.Google Scholar
22. General Medical Council. Good Medical Practice. www.gmc-uk.org/guidance/good_medical_practice.asp. Accessed May 10, 2012.Google Scholar
23. Canadian Nursing Association. Code of Ethics for Registered Nurses. http://www2.cna-aiic.ca/cna/documents/pdf/publications/Code_of_Ethics_2008_e.pdf. Published 2008:46. Accessed May 10, 2012.Google Scholar
24. Canadian Medical Association. Code of Ethics. http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf. Published 2004: section 18. Accessed May 10, 2012.Google Scholar
25.Aristotle. The Nicomachean Ethics. Ross D-trans. Ackrill JL, Urmson JO-revis. Oxford, UK: Oxford University Press; 1980.Google Scholar
26.Carnevale, FA. The birth of tragedy in pediatrics: a phronetic conception of bioethics. Nurs Ethics. 2007;14(5):576.CrossRefGoogle Scholar
27.Nussbaum, MC. The Fragility of Goodness: Luck and Ethics in Greek Tragedy and Philosophy. New York, NY: Cambridge University Press; 2001.CrossRefGoogle Scholar
28.Pictet, J. Development and Principles of International Humanitarian Law. Dordrecht, The Netherlands: Martinus Nijhoff Publishers; 1985.Google Scholar
29.Hilhorst, D, Schmiemann, N. Humanitarian principles and organisational culture: everyday practice in Médecins Sans Frontières Holland. Dev in Practice. 2002;12(3-4):490-500.Google Scholar
30.Hunt, MR. Resources and constraints for addressing ethical issues in medical humanitarian work: experiences of expatriate healthcare professionals. Am J Disaster Med. 2009;4(5):261-271.CrossRefGoogle ScholarPubMed