Abstract
It is clear that in the eyes of a growing number of humanitarian fieldworkers and decision-makers, palliative care is something humanitarian organizations should strive to provide as they address the needs of populations affected by crises. What remains less clear are the moral justifications underlying the push to do so. This chapter dives beneath surface prescriptions of what “ought to be” the place of palliative care within humanitarian response. It presents and analyses a series of evocative statements made by 24 humanitarian healthcare actors (policy makers and healthcare professionals) about why, on what bases, and with what caveats, care for the dying deserves more attention within humanitarian healthcare response. Embedded in these statements are sometimes explicit, sometimes implicit ideas about what it means be a human and a humanitarian, and what humans need and deserve. Clarifying the experiences, practical considerations, understandings of care and responsibility, and (potentially culturally-specific) norms and values underlying these feelings renders these available for more thorough reflection, discussion, and debate.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Amir, T., R. Yantzi, S. de Laat, C. Bernard, L. Elit, C. Schuster-Wallace, L. Redwood-Campbell, M. Hunt, and L. Schwartz. 2020 ‘Dying alone is hard anywhere in the world’: Palliative care in natural disaster response. Hamilton: Humanitarian Health Ethics. https://humethnet.files.wordpress.com/2020/06/natural_disaster_cr_17june_2020_final_compressed-1.pdf. Accessed 15 Apr 2021.
Barclay, L. 2018. Dignitarian medical ethics. Journal of Medical Ethics 44 (1): 62–67. https://doi.org/10.1136/medethics-2017-104467.
Benatar, S.R., A.S. Daar, and P.A. Singer. 2003. Global health ethics: The rationale for mutual caring. Ethics & International Affairs 79: 107–138. https://doi.org/10.1111/1468-2346.00298.
Chung, R., and M.R. Hunt. 2012. Justice and health inequalities in humanitarian crises: Structured health vulnerabilities and natural disasters. In Health inequalities and global justice, ed. P.T. Lenard and C. Straehle, 197–212. Edinburgh: Edinburgh University Press.
Cook, D., and G. Rocker. 2014. Dying with dignity in the intensive care unit. The New England Journal of Medicine 370 (26): 2506–2514. https://doi.org/10.1056/NEJMra1208795.
de Laat, S., and T. Amir. 2020. Provide what they need until the last minute: A case report for humanitarian practioners and policy makers. Humanitarian Health Ethics: Hamilton (Canada). https://humethnet.files.wordpress.com/2021/01/rwanda-case-report.pdf. Accessed 15 Apr 2021.
Durocher, E., R. Chung, C. Rochon, and M. Hunt. 2016. Understanding and addressing vulnerability following the 2010 Haiti earthquake: Applying a feminist lens to examine perspectives of Haitian and expatriate health care providers and decision-makers. Journal of Human Rights Practice 8 (2): 219–238. https://doi.org/10.1093/jhuman/huw007.
ENHA (Ethics Narratives in Humanitarian Aid). 2012. Co-investigators: Schwartz, L., Adelson, N., Elit, L., Redwood-Campbell, L., Sinding, C.. “Ethics in conditions of disaster and deprivation: learning from health workers’ narratives.” CIHR Operating Grant. (2009–2012). CIHR#173548.
Gillis, C. 2014, October. The Interview: An MSF doctor on the battle against Ebola, Dr. Tim Jagatic on his Ebola patients, working in a haz-mat suit when it’s 40° C, and the agony of knowing the right help is out there. MacLean’s Magazine. 24 October. Retrieved from http://www.macleans.ca/news/world/theinterview-an-msf-doctor-on-the-battle-against-ebola/
Hunt, M.R. 2009a. Moral experience of Canadian healthcare professionals in humanitarian work. Prehospital and Disaster Medicine. 24 (6): 518–524.
———. 2009b. Cholera and nothing more. Public Health Ethics 3 (1): 55–59.
Hunt, M.R., C. Sinding, and L. Schwartz. 2012. Tragic choices in humanitarian health work. The Journal of Clinical Ethics 23 (4): 338–344.
Hunt, M., A. Chénier, K. Bezanson, E. Nouvet, C. Bernard, S. de Laat, G. Krishnaraj, and L. Schwartz. 2018. Moral experiences of humanitarian health professionals caring for patients who are dying or likely to die in a humanitarian crisis. Journal of International Humanitarian Action 3 (12). https://doi.org/10.1186/s41018-018-0040-9.
Hunt, M., E. Nouvet, A. Chenier, G. Krishnaraj, C. Bernard, K. Bezanson, S. de Laat, and L. Schwartz. 2020. Addressing obstacles for the inclusion of palliative care in humanitarian health projects: A qualitative study of humanitarian health professionals’ and policy makers’ perceptions. Conflict and Health 14: 70. https://doi.org/10.1186/s13031-020-00314-9.
Knaul, F.M, P.E. Farmer, E.L. Krakauer, L. De Lima, A. Bhadelia, X.J. Kwete, H. Arreola-Ornelas, O. Gómez-Dantés, N.M. Rodriguez, G.A.O. Alleyne, S. R. Connor, D.J. Hunter, D. Lohman, L. Radbruch, M. del Rocío Sáenz Madrigal, R. Atun, K.M. Foley, J. Frenk, D.T. Jamison, M.R. Rajagopal. on behalf of the Lancet Commission on Palliative Care and Pain Relief Study Group. 2017. Alleviating the access abyss in palliative care and pain relief – An imperative of universal health coverage. The Lancet Commission Report. October 12. https://doi.org/10.1016/S0140-6736(17)32513-8.
Macklin, R. 2003. Dignity is a useless concept: It means no more than respect for persons or their autonomy. British Medical Journal 327 (7429): 1419–1420.
Mol, A. 2008. The logic of care. New York: Routledge.
Nouvet, E., and T. Jakamovic. 2016. Moral sentiments in ‘Aidland’: Special section introduction. Critique of Anthropology 36 (3): 223–227. https://doi.org/10.1177/0308275X16646838.
Nouvet, E., M. Sivaram, K. Bezanson, G. Krishnaraj, M. Hunt, S. de Laat, S. Sanger, L. Banfield, F. Escobio, and L. Schwartz. 2018a. Palliative care in humanitarian crises: A review of the literature. Journal of International Humanitarian Action 3: 5. https://doi.org/10.1186/s41018-018-0033-8.
Nouvet, E., E. Chan, and L.J. Schwartz. 2018b. Looking good but doing harm? Perceptions of short-term medical missions in Nicaragua. Global Public Health 13 (4): 456–472. https://doi.org/10.1080/17441692.2016.1220610.
Nouvet, E., K. Bezanson, M. Hunt, S. Kouyate, L. Schwartz, F. Binta Diallo, S. de Laat, O. Bah-Sow, A. Mdou Diallo, and P. Diallo. 2021. Dying in honour: Experiences of patient care during the 2013–2016 Ebola outbreak in Guinea. Journal of International Humanitarian Action 6 (10): 1. https://doi.org/10.1186/s41018-021-00099-3.
Park, S.-J., and G. Akello. 2017. The oughtness of care: Fear, stress, and caregiving during the 2000–2001 Ebola outbreak in Gulu, Uganda. Social Science & Medicine 194: 60–66.
Pictet, J. 1979. The fundamental principles of the red cross: Commentary. https://www.icrc.org/eng/resources/documents/misc/fundamental-principles-commentary-010179.htm. Accessed 1 Dec 2017.
Piotukh, V. 2015. Biopolitics, governmentality, and humanitarianism. Caring for the population in Afghanistan and Belarus. London/New York: Routledge.
Powell, R.A., L. Schwartz, E. Nouvet, J. Marston, M. Petrova, L. Radbruch, and B. Sutton. 2017. Palliative care in humanitarian crises: Always something to offer. Lancet 389: 1498–1499. https://doi.org/10.1016/S0140-6736(17)30978-9.
Proulx, K., and C. Jacelon. 2004. Dying with dignity: The good patient versus the good death. American Journal of Hospice & Palliative Medicine 21 (2): 116–120. https://doi.org/10.1177/104990910402100209.
Schwartz, L., C. Sinding, M. Hunt, L. Elit, L. Redwood-Campbell, A. Adelson, L. Luther, J. Ranford, and S. de Laat. 2010. Ethics in humanitarian aid work: Learning from the narratives of humanitarian health workers. AJOB Primary Research 1 (3): 45–54. https://doi.org/10.1080/21507716.2010.505898.
Schwartz, L., M. Hunt, S. de Laat, and L. Redwood-Campbell. 2013. Ethics and emergency disaster response. Normative approaches and training needs for humanitarian health care providers. In Disaster bioethics: Normative issues when nothing is normal, ed. Dónal O'Mathúna, 33–48. Dordrecht: Springer.
Sinding, C., L. Schwartz, M. Hunt, L. Redwood-Campbell, L. Elit, and J. Ranford. 2010. ‘Playing god because you have to’: Health professionals’ narratives of rationing care in humanitarian and development work. Public Health Ethics 3 (2): 147–156.
Singer, P. 1979. Practical ethics. Cambridge: Cambridge University Press.
Smith, J., and T. Aloudat. 2017. Palliative care in humanitarian medicine. Palliative Medicine 31: 99–101. https://doi.org/10.1177/0269216316686258.
SPHERE PROJECT. 2018. The sphere handbook: Humanitarian charter and minimum standards in humanitarian response. 4th ed. Switzerland: Geneva. www.spherestandards.org/handbook. Accessed 15 Apr 2021.
WHO. 2015. Palliative care fact sheet N°402. http://www.who.int/mediacentre/factsheets/fs402/en/. Accessed 21 Aug 2015.
Zarrabi, A.J., R. Huo, and D.E. Meier. 2015. High-value palliative care for cancer patients. American Medical Association Journal of Ethics 17: 1064–1072. https://doi.org/10.1001/journalofethics.2015.17.11.pfor3-1511.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Nouvet, E. et al. (2022). Unpacking the “Oughtness” of Palliative Care in Humanitarian Crises: Moral Logics and What Is at Stake?. In: Messelken, D., Winkler, D. (eds) Health Care in Contexts of Risk, Uncertainty, and Hybridity. Military and Humanitarian Health Ethics. Springer, Cham. https://doi.org/10.1007/978-3-030-80443-5_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-80443-5_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-80442-8
Online ISBN: 978-3-030-80443-5
eBook Packages: Religion and PhilosophyPhilosophy and Religion (R0)