{"id":47643,"date":"2020-05-28T14:15:16","date_gmt":"2020-05-28T13:15:16","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47643"},"modified":"2020-05-28T17:39:40","modified_gmt":"2020-05-28T16:39:40","slug":"covid-19-in-humanitarian-settings-addressing-ethics-to-reduce-moral-distress","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/28\/covid-19-in-humanitarian-settings-addressing-ethics-to-reduce-moral-distress\/","title":{"rendered":"Covid-19 in humanitarian settings: addressing ethics to reduce moral distress"},"content":{"rendered":"

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. As humanitarian organisations mobilise to build covid-19 treatment centres, and scale up community-based approaches to case management, we need to consider the resilience of the humanitarian workforce. Our internal evaluations of the Save the Children Ebola response in West Africa highlighted the need for better support for frontline staff who invariably find themselves grappling with the demanding ethical dilemmas inherent to large-scale outbreak responses in humanitarian settings. Given the high likelihood of moral distress, the question is how to prepare our staff for what is to come.<\/span><\/p>\n

Moral challenge<\/span><\/i><\/p>\n

This outbreak will likely prove especially troubling given the breadth and severity of the needs in contexts defined by power imbalances, complex political contexts, extreme shortages of basic health goods, and a lack of external controls over the work of humanitarian actors. Areas of ethical tension will almost certainly include the allocation of scarce resources, discontinuing care or closing to new admissions (both for covid-19 cases and those with other morbidities), “complicity” in coercive measures, care for staff amidst (PPE) supply shortages, and prioritisation vis-\u00e0-vis pre-existing crisis needs. Complicating factors may include the differences between the ethical orientations of different professional groups, such as between clinical ethics and humanitarian health or public health ethics, or an unfamiliarity with the weight or value that principles hold within a given context and culture.\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

How should humanitarian organisations respond?<\/span><\/i><\/p>\n

Ethically informed best practice sets out clear goals, but does little to alleviate moral distress when these goals are unattainable or in conflict. Humanitarian responses to covid-19 will confront fieldworkers with situations where all principled options lead to harm; this is unavoidable. The way forward lies in establishing a culture that avoids divisive arguments over right and wrong, and instead considers how the various options bring both benefits and harms. This realisation places a premium upon procedural ethics: the process by which decisions are made.\u00a0<\/span><\/p>\n

Organisational support is therefore an obligatory aspect of an organisation\u2019s duty of care. In addition to supporting ethically coherent decision-making processes, organisations must also:<\/span><\/p>\n