Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada.
Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada.
J Med Ethics. 2017 Sep;43(9):613-617. doi: 10.1136/medethics-2015-102896. Epub 2017 Feb 24.
Situations of disaster that prompt international humanitarian responses are rife with ethical tensions. The 2010 Haiti earthquake caused great destruction and prompted a massive humanitarian response. The widespread needs experienced by the population and the scale of the response inevitably rendered priority-setting difficult, and gave rise to ethical challenges.
This paper presents four ethical questions identified in the analysis of a study on vulnerability and equity in the humanitarian response to the 2010 Haiti earthquake.
Using interpretive description methodology, the interdisciplinary research team analysed 24 semi-structured in-depth interviews conducted with expatriate and Haitian health workers and decision-makers involved in the response.
Ethical questions identified through the analysis were: (1) How should limited resources be allocated in situations of widespread vulnerability and elevated needs? (2) At what point does it become ethically problematic to expend (considerable) resources to sustain expatriate disaster responders? (3) How ought rapid and reactive interventions be balanced with more deliberated and coordinated approaches? (4) What trade-offs are justified when interventions to address acute needs could contribute to long-term vulnerabilities?
The questions arise in light of an immense gap between available resources and widespread and elevated needs. This gap is likely unavoidable in large-scale crises and may be a source of ethical distress for both local and international responders. The analysis of ethical questions associated with crisis response can advance discussions about how relief efforts can best be designed and implemented to minimise ethical distress and improve assistance to local populations.
引发国际人道救援的灾难情况充满了伦理紧张局势。2010 年海地地震造成了巨大破坏，引发了大规模的人道救援。灾民广泛的需求和救援规模不可避免地使优先事项的设定变得困难，并引发了伦理挑战。
本文提出了在分析 2010 年海地地震人道救援中的脆弱性和公平性研究中确定的四个伦理问题。
使用解释性描述方法，跨学科研究团队分析了对参与救援的 24 名海地和外籍卫生工作者和决策者进行的 24 次半结构化深入访谈。
通过分析确定的伦理问题是：(1) 在广泛脆弱性和需求增加的情况下，应如何分配有限的资源？(2) 在什么情况下，为维持外籍救灾人员而花费（大量）资源在伦理上会出现问题？(3) 如何平衡快速和反应性干预与更慎重和协调的方法？(4) 在干预措施以满足急性需求可能导致长期脆弱性的情况下，哪些权衡是合理的？
这些问题是在可用资源与广泛和增加的需求之间存在巨大差距的情况下提出的。这种差距在大规模危机中可能是不可避免的，可能是当地和国际救援人员感到伦理困扰的根源。对与危机应对相关的伦理问题的分析可以促进关于如何设计和实施救济工作以最大程度地减少伦理困扰并改善对当地人民的援助的讨论。
