As a humanitarian medical organization, Médecins Sans Frontières (MSF) intervenes in places around the world affected by conflict and crisis. Although we are guided by humanitarian principles, our medical teams are often confronted with complicated dilemmas. In a chapter from a new book called Humanitarian Action and Ethics (Zed Books), current and former MSF field workers consider some of the ethical challenges that form an inevitable part of MSF's medical humanitarian action, and how the organization can better enable our staff and front-line field workers to address them.
Dans le ghetto de Varsovie, contre l’horreur et la déchéance, au-dessus d’un commissariat où l’on pratiquait la torture, la soif de connaissance et de dignité humaine réussirent encore à s’exprimer avec force.
Chiara Lepora and Robert Goodin invite us to join their insightful ‘conversation’ on complicity and compromise. Their book makes a dense, utterly precise and rewarding reading, as one proceeds stepwise through the logic of their philosophical arguments. For those unfamiliar with the relatively new discipline of ‘humanitarian ethics’, it might be disconcerting at first to see humanitarian actions brought to illustrate theories on complicity, with the Rwandan refugees crisis of 1994 and the tortured patient taken as two exemplary cases.
We challenge the assertion made by Govind Persad and Ezekiel Emanuel (Aug 27, p 932) that “expanding access to less effective or more toxic [antiretroviral] treatments rather than requiring the worldwide best treatment in all settings” is ethically justifiable.
On Oct 10, 2015, Médecins Sans Frontières (MSF) rejected Pfizer's proposed donation of 1 million doses of its branded pneumococcal conjugate vaccine (PCV). The news caused a stir in the global health community; after all, free essential health goods might be considered something to be celebrated.
Medical humanitarian organizations don’t generally deal well with death. This may come as a surprise, since it’s a sombre reality of this line of work that frontline staff are often witness to death and dying. Contrary to the humanitarian’s general propensity for self-aggrandizement, it’s not always possible to save lives. So what then of the oft-cited dual imperative to alleviate suffering and preserve dignity?
The West African Ebola epidemic has set in motion a collective endeavour to conduct accelerated clinical trials, testing unproven but potentially lifesaving interventions in the course of a major public health crisis. This unprecedented effort was supported by the recommendations of an ad hoc ethics panel convened in August 2014 by the WHO.
The 2014–2015 Ebola crisis in West Africa has highlighted the practical limits of upholding human rights and common ethical principles when applying emergency public-health measures. The role of medical teams in the implementation of quarantine and isolation has been equivocal, particularly when such measures are opposed by communities who are coerced by the temporary suspension of civil liberties. In their encounters with Ebola victims, outreach teams face moral dilemmas, where the boundaries are unclear between coercion, persuasion and appeals for self-sacrifice.
Media representations of suffering bodies from medical humanitarian organisations raise ethical questions, which deserve critical attention for at least three reasons. Firstly, there is a normative vacuum at the intersection of medical ethics, humanitarian ethics and the ethics of photojournalism. Secondly, the perpetuation of stereotypes of illness, famine or disasters, and their political derivations are a source of moral criticism, to which humanitarian medicine is not immune.