We can’t escape ethical dilemmas
Everything is politics, they say. The same can be said of ethics, especially when considering the definition of an ethical issue as ‘a problem or a situation that requires a person or organisation to choose between alternatives that must be evaluated as right (ethical) or wrong (unethical)’.[1] Sounds fairly easy, just choosing between right and wrong. However, the reality on the ground often doesn’t allow for fast-track or easy choices. In the era of globalisation, applying moral values to health issues may have become even more...
We can’t escape ethical dilemmas
Everything is politics, they say. The same can be said of ethics, especially when considering the definition of an ethical issue as ‘a problem or a situation that requires a person or organisation to choose between alternatives that must be evaluated as right (ethical) or wrong (unethical)’.[1] Sounds fairly easy, just choosing between right and wrong. However, the reality on the ground often doesn’t allow for fast-track or easy choices. In the era of globalisation, applying moral values to health issues may have become even more complex. On the other hand, is it really necessary to single out the ‘global’ dimensions of a health issue when dealing with ethical dilemmas? Maybe not. This edition of MTb corresponds with the thematic focus of the NVTG annual symposium which focuses on ethical dilemmas in global health (November 9, the Rode Hoed in Amsterdam). Dr Ann Phoya, one of the keynote speakers of this conference, will illustrate how Malawi – the country with one of the severest shortages of health workers – has managed to scale up HIV services and improve maternal health through a targeted Human Resources for Health Strategy. Two articles in this edition deal with her work in Malawi and the wider context of agenda setting in favor of applying ethical considerations to a joint plan to address the human resources for health crisis worldwide.[2] Our ‘Letter from the Tropics’ this time takes us to the emergency ward of a health facility located near the Amazon border between Ecuador and Peru. A Western trained medical doctor is confronted with the implications of having sworn the Hippocratic Oath ‘that he will do everything in his ability and judgement to save a person’s life’. Clearly, in his daily practice the hard-fought right of informed consent is being brought to the test. Ethical dilemmas galore: in humanitarian aid, in the fight against HIV/AIDS, in conducting global health research and balancing research agendas, in participating as a medical doctor in the EU asylum procedure, and as a local public health practitioner in a postwar context along the Myanmar-Thailand border. This MTb presents several such dilemmas in global health. The hard part, as one of the authors in this edition concludes, is that many ethical problems are simply not easy to answer. The list of situations in which ethical dilemmas arise is long. The truth of the matter is: ‘We can’t escape them. When confronted, our responsibility is to reason our way through them, identify the best options (or the least bad ones), and to act according to our best judgment’.[3] ETHICAL DILEMMAS ARE NOT EASY QUESTIONS, AND THEY SHOULD NEVER BE SOLVED BY EASY ANSWERS How to reach such judgment? Practical guidelines may be helpful in dissecting ethical issues and in justifying one action over the other, as the WHO outlines in its Ethical Guidelines. Other – more direct – ways are training courses in ethics, like the one for health practitioners in Thailand. Trying to ask the right questions and engage different stakeholders is always a good starting point. We are looking forward to your engagement in the discussions during our annual symposium: (Human) Resources, Research and Rights: Ethical dilemmas in Global Health.
Esther Jurgens, NVTG policy advisor and consultant global health