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Fanning Z. "Socialization for Scarcity" in Emergency Management: Rethinking Assumptions of Resource Scarcity in Humanitarian Crises. Ann Glob Health 2023; 89:24. [PMID: 36969098 PMCID: PMC10038112 DOI: 10.5334/aogh.3960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/26/2023] [Indexed: 03/26/2023] Open
Abstract
Background Physician-anthropologist Paul Farmer theorizes a process of "socialization for scarcity" (SfS), which assumes permanent and unchangeable resource scarcity for the world's poor. International health and poverty decisions that are based off of this premise are therefore used to justify inadequate care for vulnerable populations. Objectives The theory of SfS has predominantly been applied to the context of global health and development. This paper aims to apply SfS to the field of emergency management, asking, "How does SfS function in the context of humanitarian crises, and what implications does this have for emergency management?" Methods This paper reviewed Farmer's own descriptions of SfS as well as articles by colleagues and other scholars who elaborated on his theory, analyzing their contributions to issues relevant in emergency management. Findings This review finds that SfS is both applicable to and amplified within emergency management because of the uncertain, competitive, and urgent nature of humanitarian crises. The paper then describes potential approaches to combating SfS in emergency contexts. Conclusions SfS is the result of deficient effort toward discovering approaches to managing emergencies that do not presume scarcity. The assumption of permanent resource scarcity, especially in low- and middle-income countries (LMICs), is a matter of inequity and injustice and stands opposed to imperative systemic change. Emergency managers must work to eradicate dangerous presumptions that leave already suffering individuals even further from the dignified, appropriate and adequate care they require and deserve.
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Affiliation(s)
- Zoe Fanning
- London School of Economics and Political Science, London, UK
- Mayo Clinic Alix School of Medicine, Rochester, MN, US
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Asgary R, Lawrence K. Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers. BMJ Open 2020; 10:e039463. [PMID: 32938603 PMCID: PMC7497554 DOI: 10.1136/bmjopen-2020-039463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Data regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited. METHODS We conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations. RESULTS 61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks. CONCLUSIONS Ethical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.
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Affiliation(s)
- Ramin Asgary
- Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
- Medicine, Weill Cornell Medical College, New York, New York, USA
- Medical Department, Medecins Sans Frontieres/Doctors Without Borders, Paris, France
| | - Katharine Lawrence
- Population Health, New York University School of Medicine, New York, New York, USA
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Barsky E, Sayeed S. Parental manual ventilation in resource-limited settings: an ethical controversy. JOURNAL OF MEDICAL ETHICS 2020; 46:459-464. [PMID: 32376715 DOI: 10.1136/medethics-2019-105992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
Lower respiratory tract infections are a leading cause of paediatric morbidity and mortality worldwide. Children in low-income countries are disproportionately affected. This is in large part due to limitations in healthcare resources and medical technologies. Mechanical ventilation can be a life-saving therapy for many children with acute respiratory failure. The scarcity of functioning ventilators in low-income countries results in countless preventable deaths. Some hospitals have attempted to adapt to this scarcity by using hand-bag ventilation, as either a bridge to a mechanical ventilator, or until clinical improvement occurs rendering mechanical ventilation no longer necessary. In instances of hand-bag ventilation, an endotracheal tube is first placed. Family members are then asked to play the role of a ventilator, manually compressing a bag repeatedly to inflate the child's lungs. This approach is fraught with numerous ethical challenges. A careful examination of the data and a nuanced approach to the ethical considerations are imperative. Ethical arguments in support of and in opposition to allowing parental hand-bag ventilation are explored, including the best interests of the child, the child's right to an open future, beneficence and parental protection, legitimising substandard care, and finally, contextual concerns. An algorithmic, potentially ethically permissible approach to parental participation in manual ventilation is proposed.
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Affiliation(s)
- Emily Barsky
- Division of Pulmonary Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sadath Sayeed
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Persad G. Considering Quality of Life while Repudiating Disability Injustice: A Pathways Approach to Setting Priorities. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2019; 47:294-303. [PMID: 31298101 DOI: 10.1177/1073110519857285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article proposes a novel strategy, one that draws on insights from antidiscrimination law, for addressing a persistent challenge in medical ethics and the philosophy of disability: whether health systems can consider quality of life without unjustly discriminating against individuals with disabilities. It argues that rather than uniformly considering or ignoring quality of life, health systems should take a more nuanced approach. Under the article's proposal, health systems should treat cases where (1) quality of life suffers because of disability-focused exclusion or injustice differently from cases where (2) lower quality of life results from laws of nature, resource scarcity, or appropriate tradeoffs. Decisionmakers should ignore quality-of-life losses that result from injustice or exclusion when ignoring them would improve the prospects of individuals with disabilities; in contrast, they should consider quality-of-life losses that are unavoidable or stem from resource scarcity or permissible tradeoffs. On this proposal, while health systems should not amplify existing injustice against individuals with disabilities, they are not required to altogether ignore the potential effects of disability on quality of life.
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Affiliation(s)
- Govind Persad
- Govind Persad, J.D., Ph.D., is an Assistant Professor at the University of Denver Sturm College of Law. He holds a J.D. and Ph.D. from Stanford University (Stanford, CA) and was recently selected as a 2018-2021 Greenwall Faculty Scholar in Bioethics. His research interests include priority-setting and other ethical issues in health care financing
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Persad GC, Emanuel EJ. The Case for Resource Sensitivity: Why It Is Ethical to Provide Cheaper, Less Effective Treatments in Global Health. Hastings Cent Rep 2018; 47:17-24. [PMID: 28940341 DOI: 10.1002/hast.764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
When Dr. Hortense screens her patients in Chicago for cervical dysplasia and cancer, she conducts a pelvic exam, takes a sample of cervical cells, and sends them for Pap cytology and human papilloma virus DNA co-testing. But when she conducts cervical cancer screening in Botswana, she employs a much simpler diagnostic strategy. She applies acetic acid to highlight precancerous lesions and visually inspects the cervix-a technique known as the VIA (visual inspection with acetic acid) method. She treats suspicious lesions with cryotherapy. There are multiple reasons that Dr. Hortense uses VIA in developing countries. It requires no specialized laboratory facilities or highly trained personnel. With immediate results, there is no delay in diagnosis and treatment, ensuring that patients are not lost to follow-up. Most importantly, VIA is considerably cheaper than Pap and HPV co-testing. This difference in care between Chicago and Botswana presents an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.
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Smith J, Aloudat T. Dilemmas in access to medicines: a humanitarian perspective. Lancet 2017; 389:1007-1008. [PMID: 28290989 DOI: 10.1016/s0140-6736(17)30660-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/13/2016] [Indexed: 11/18/2022]
Affiliation(s)
- James Smith
- Médecins sans Frontières, 78 Rue de Lausanne, Geneva 1211, Switzerland.
| | - Tammam Aloudat
- Médecins sans Frontières, 78 Rue de Lausanne, Geneva 1211, Switzerland
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Emanuel EJ, Persad G. Dilemmas in access to medicines: a humanitarian perspective - Authors' reply. Lancet 2017; 389:1008-1009. [PMID: 28290990 DOI: 10.1016/s0140-6736(17)30659-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022]
Affiliation(s)
- Ezekiel J Emanuel
- Department of Medical Ethics and Health Policy, Department of Health Care Management, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Govind Persad
- Department of Health Policy and Management and Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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Eckenwiler L. Care worker migration, global health equity, and ethical place-making. WOMENS STUDIES INTERNATIONAL FORUM 2014. [DOI: 10.1016/j.wsif.2014.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lencucha R. Cosmopolitanism and foreign policy for health: ethics for and beyond the state. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:29. [PMID: 23829176 PMCID: PMC3717113 DOI: 10.1186/1472-698x-13-29] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 07/04/2013] [Indexed: 11/29/2022]
Abstract
Background Foreign policy holds great potential to improve the health of a global citizenship. Our contemporary political order is, in part, characterized by sovereign states acting either in opposition or cooperation with other sovereign states. This order is also characterized by transnational efforts to address transnational issues such as those featured so prominently in the area of global health, such as the spread of infectious disease, health worker migration and the movement of health-harming products. These two features of the current order understandably create tension for truly global initiatives. Discussion National security has become the dominant ethical frame underlying the health-based foreign policy of many states, despite the transnational nature of many contemporary health challenges. This ethical approach engages global health as a means to achieving national security objectives. Implicit in this ethical frame is the version of humanity that dichotomizes between “us” and “them”. What has been left out of this discourse, for the most part, is the role that foreign policy can play in extending the responsibility of states to protect and promote health of the other, for the sake of the other. Summary The principal purpose of this paper is to review arguments for a cosmopolitan ethics of health-based foreign policy. I will argue that health-based foreign policy that is motivated by security interests is lacking both morally and practically to further global health goals. In other words, a cosmopolitan ethic is not only intrinsically superior as a moral ideal, but also has potential to contribute to utilitarian ends. This paper draws on the cosmopolitanism literature to build robust support for foreign policies that contribute to sustainable systems of global health governance.
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Affiliation(s)
- Raphael Lencucha
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Hosmer House, 3630 Promenade Sir William Osler, Montréal, QC H3G 1Y5, Canada.
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Hunt MR, Sinding C, Schwartz L. Tragic Choices in Humanitarian Health Work. THE JOURNAL OF CLINICAL ETHICS 2012. [DOI: 10.1086/jce201223407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Chung R. A Theoretical Framework for a Comprehensive Approach to Medical Humanitarianism. Public Health Ethics 2012. [DOI: 10.1093/phe/phs001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Swanson RC, Bongiovanni A, Bradley E, Murugan V, Sundewall J, Betigeri A, Nyonator F, Cattaneo A, Harless B, Ostrovsky A, Labonté R. Toward a consensus on guiding principles for health systems strengthening. PLoS Med 2010; 7:e1000385. [PMID: 21203584 PMCID: PMC3006350 DOI: 10.1371/journal.pmed.1000385] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Based upon a review of the literature, Robert Chad Swanson and colleagues present a set of guiding principles for health systems strengthening.
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Affiliation(s)
- Robert C Swanson
- Department of Health Sciences, Brigham Young University, Provo, Utah, United States of America.
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Pinto AD. Denaturalizing "natural" disasters: Haiti's earthquake and the humanitarian impulse. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2010; 4:e193-6. [PMID: 21687340 PMCID: PMC3090106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 09/07/2010] [Accepted: 09/08/2010] [Indexed: 11/16/2022]
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Sinding C, Schwartz L, Hunt M, Redwood-Campbell L, Elit L, Ranford J. 'Playing God Because you Have to': Health Professionals' Narratives of Rationing Care in Humanitarian and Development Work. Public Health Ethics 2010. [DOI: 10.1093/phe/phq015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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