Hunt Matthew R
Centre for Research on Ethics (CREUM), University of Montreal, Montreal, Quebec, Canada.
Am J Disaster Med. 2009 Sep-Oct;4(5):261-71.
International nongovernmental organizations frequently provide emergency assistance in settings where armed conflict or natural disaster overwhelm the capacity of local and national agencies to respond to health and related needs of affected communities. Healthcare practice in humanitarian settings presents distinct clinical, logistical, and ethical challenges for clinicians and differs in important ways from clinical practice in the home countries of expatriate healthcare professionals. The aim of this research was to examine the moral experience of healthcare professionals who participate in humanitarian relief work.
I conducted a qualitative research study using interpretive description methodology.
Fifteen Canadian healthcare professionals and three human resource or field coordination officers for nongovernmental organizations were interviewed.
In this article, I present findings related to expatriate healthcare professionals' experiences of resources and constraints for addressing ethical issues in humanitarian crises. Resources for ethics deliberation and reflection include the following: opportunities for discussion; accessing and understanding local perspectives; access to outside perspectives; attitudes, such as humility, open-mindedness, and reflexivity; and development of good moral "reflexes." Constraints for deliberation and reflection relate to three domains: individual considerations, contextual features of humanitarian relief work, and local team and project factors.
These findings illuminate the complex nature of ethical reflection, deliberation, and decision-making in humanitarian healthcare practice. Healthcare professionals and relief organizations should seek to build upon resources for addressing ethical issues. When possible, they should minimize the impact of features that function as constraints.
在武装冲突或自然灾害使地方和国家机构应对受影响社区的卫生及相关需求的能力不堪重负的情况下，国际非政府组织经常提供紧急援助。人道主义环境中的医疗实践给临床医生带来了独特的临床、后勤和伦理挑战，并且在重要方面与外派医疗专业人员本国的临床实践有所不同。本研究的目的是考察参与人道主义救援工作的医疗专业人员的道德体验。
我采用解释性描述方法进行了一项定性研究。
采访了15名加拿大医疗专业人员以及3名非政府组织的人力资源或实地协调官员。
在本文中，我呈现了与外派医疗专业人员在人道主义危机中处理伦理问题的资源和限制体验相关的研究结果。用于伦理审议和反思的资源包括以下方面：讨论机会；获取和理解当地观点；获取外部观点；诸如谦逊、开放心态和反思性等态度；以及培养良好的道德“反应能力”。审议和反思的限制涉及三个领域：个人因素、人道主义救援工作的背景特征以及当地团队和项目因素。
这些研究结果揭示了人道主义医疗实践中伦理反思、审议和决策的复杂本质。医疗专业人员和救援组织应寻求利用解决伦理问题的资源。在可能的情况下，他们应尽量减少作为限制因素的特征的影响。
