Explore the vast range of titles available.

Project closure is a core feature of humanitarian action. However, how decisions to end projects are made, and how closure is planned and implemented, has implications for upholding ethical commitments, and can have positive or negative consequences for affected communities, local stakeholders, and humanitarian organizations and their staff. To better understand the ethical dimensions of closing humanitarian projects, we undertook an investigation of national and international humanitarian workers’ experiences. Guided by interpretive description methodology, we conducted an exploratory qualitative study with two rounds of semi-structured interviews. Four national and five international staff of non-governmental organizations with experience of humanitarian health project closure took part. The participants had diverse professional roles and disciplinary backgrounds. All participants took part in the first round of interviews which focused on experiences and perceptions of ethics and project closure. Analysis of these interviews contributed to the development of a draft “ethics guidance note.” Five of the participants took part in the second round of interviews which focused on receiving feedback on the draft guidance note. We used constant comparative techniques and a recursive approach to data collection and analysis. In this article, we draw on both rounds of interviews to present findings related to how participants understood and experienced ethical responsibilities, challenges, and opportunities for humanitarian project closure. We identified six recurrent ethical concerns highlighted by interviewees regarding closure of humanitarian projects: respectfully engaging with partners and stakeholders, planning responsively, communicating transparently, demonstrating care for local communities and staff during project closure, anticipating and acting to minimize harms, and attending to sustainability and project legacy. We present these ethical concerns according to the temporal horizon of humanitarian action, that is, arising across five phases of a project’s timeline: design, implementation, deciding whether to close, implementing closure, and post-closure. This exploratory study contributes to discussions concerning the ethics of project closure by illuminating how they are experienced and understood from the perspectives of national and international humanitarian workers. The interview findings contributed to the development of an ethics guidance note that aims to support project closures that minimize harms and uphold values, while being mindful of the limits of ethical ideals in non-ideal circumstances.

The number of people requiring humanitarian assistance has risen steadily in recent years and was estimated to be 201.5 million people in 2017 (ALNAP 2018). The need for assistance is expected to continue rising due to prolonged conflicts, mass population displacement, and increased frequency of natural disasters and climate-related crises (OCHA 2018). However, funding for humanitarian action has not kept pace with need, and this shortfall continues to grow (ALNAP 2018). These factors contribute to the reality that humanitarian organizations routinely face difficult decisions of where and when to open and close projects. Since humanitarian projects are intended to be temporary interventions responding to the needs of populations affected by crises, project closure is an inescapable component of humanitarian aid. How closure is planned and implemented is a crucial feature of the success of the overall intervention (Gerstenhaber 2014), yet making and enacting decisions to close projects involves complex ethical considerations and reasoning (Hunt and Miao 2018; Lee and Ozerdem 2015; World Food Programme 2004). Humanitarian projects are closed or transitioned for a variety of reasons, including when program objectives have been met, when the emergency phase has been declared over, and when there is increased insecurity or a lack of funding (Akbarzada and Mackey 2018; Alonso and Brugha 2006; ICRC 2009; Maxwell 1999; Solidarités International 2016; Trócaire 2016). Projects can phase down (reducing services gradually but maintaining a small presence), phase out (tapering services before closing), phase over or hand over (transfer to a local partner), or be abruptly closed (sudden withdrawal without handing over to a local partner) (Gardner et al. 2005; Lee and Ozerdem 2015). Many humanitarian emergency projects are transitioned to recovery or longer-term development projects. Closure decisions are also subject to a range of internal and external influences and features related to how humanitarian organizations make decisions more broadly, including diversity in the types and mandates of organizations, the relationships and competition that exists within the aid sector, funding models and organizations’ relative dependency on external funding, and institutional structures and cultures that have developed within different organizations (Heyse 2016).

Following disasters, persons with disabilities (PWD) are especially vulnerable to harm, yet they have commonly been excluded from disaster planning, and their needs have been poorly addressed during disaster relief. Following the 2010 Haiti earthquake, thousands of individuals experienced acute injuries. Many more individuals with preexisting disabilities experienced heightened vulnerability related to considerations including safety, access to services, and meeting basic needs. The objective of this research was to better understand the perceptions of responders and decision-makers regarding disability and efforts to address the needs of PWD following the 2010 earthquake. We conducted a qualitative study using interpretive description methodology and semistructured interviews with 14 Haitian and 10 international participants who were involved in the earthquake response. Participants identified PWD as being among the most vulnerable individuals following the earthquake. Though some forms of disability received considerable attention in aid efforts, the needs of other PWD did not. Several factors were identified as challenges for efforts to address the needs of PWD including lack of coordination and information sharing, the involvement of multiple aid sectors, perceptions that this should be the responsibility of specialized organizations, and the need to prioritize limited resources. Participants also reported shifts in local social views related to disability following the earthquake. Addressing the needs of PWD following a disaster is a crucial population health challenge and raises questions related to equity and responsibility for non-governmental organizations, governments, and local communities.

In this article, I want to show that the securitization of health issues in the name of national interests led to the militarization of health care in the context of the war against terrorism. However, the connection between health and security also gave way to the emergence of the notion of human security, thus, converging with the human right to health approach and the cosmopolitan discourse on global health. These two perspectives on the relation between health and security lead to conflicting imperatives in the current state of counter-terrorism operations. I argue that when the securitization of health concerns in the name of national security conflicts with the provision of health care in the name of universal human rights, the higher moral end must trump the prudential one. Moreover, it is a duty to promote the human right to health when liberal democracies in foreign policies directly violate this moral ideal in the name of national security.

Background The governments and citizens of the developed nations are increasingly called upon to contribute financially to health initiatives outside their borders. Although international development assistance for health has grown rapidly over the last two decades, austerity measures related to the 2008 and 2011 global financial crises may impact negatively on aid expenditures. The competition between national priorities and foreign aid commitments raises important ethical questions for donor nations. This paper aims to foster individual reflection and public debate on donor responsibilities for global health. Methods We undertook a critical review of contemporary accounts of justice. We selected theories that: (i) articulate important and widely held moral intuitions; (ii) have had extensive impact on debates about global justice; (iii) represent diverse approaches to moral reasoning; and (iv) present distinct stances on the normative importance of national borders. Due to space limitations we limit the discussion to four frameworks. Results Consequentialist, relational, human rights, and social contract approaches were considered. Responsibilities to provide international assistance were seen as significant by all four theories and place limits on the scope of acceptable national autonomy. Among the range of potential aid foci, interventions for health enjoyed consistent prominence. The four theories concur that there are important ethical responsibilities to support initiatives to improve the health of the worst off worldwide, but offer different rationales for intervention and suggest different implicit limits on responsibilities. Conclusions Despite significant theoretical disagreements, four influential accounts of justice offer important reasons to support many current initiatives to promote global health. Ethical argumentation can complement pragmatic reasons to support global health interventions and provide an important foundation to strengthen collective action.

The adoption of Projet de loi 83 (PL83) in 2021 aimed to grant previously uninsured migrant children in Quebec access to provincial public health insurance. Three years later, health professionals continue to encounter children who should be eligible for provincial insurance through PL83 but remain uninsured and who face various structural barriers that contribute to this limited access (language, administrative navigation, and access to information). This commentary, based on the conceptual framework of the ethics of care, considers autonomy as the ability to make one’s own choices with support from others. Contrary to a conception of autonomy as self-sufficiency, the ethics of care encourages the design of policies and implementation measures capable of helping vulnerable individuals overcome barriers. In the case of access to healthcare for migrant children, we suggest presumptive eligibility and raising awareness among all key stakeholders who interact with parents, from admission and administrative staff to physicians.

Breast cancer screening policies are developing into personalized approaches that use individual risk factor information, sometimes including genetic data, to create tailored breast cancer screening plans. The aim of personalized approaches is to optimize the balance of benefits and harms of breast cancer screening. Ethical implementation of personalized breast cancer screening (PBCS) policies requires consideration of not only benefits and harms, but also, potential effects on existing breast cancer inequities. In Canada, one important inequity is that South Asian people have more late-stage breast cancer diagnoses, and therefore a greater burden of breast cancer morbidity, compared to non-South Asian people. If PBCS policies are to play a role in ameliorating this inequity, they need to be responsive to the needs, values, and lived experiences of South Asian communities. This includes responsiveness to what South Asian communities self-determine as benefits, harms, and ethical issues of PBCS; lived experiences of breast cancer and health care; and social contexts in which PBCS plays out. Research about PBCS ethical issues in Canada has concentrated on informed consent, equity of screening access, and genetic discrimination from the perspectives of the public, policymakers, and primary care providers. However, these ethical issues are unlikely to fully map on to the needs of equity-denied groups, whose voices and values are underrepresented in the literature about PBCS ethics. This epistemic injustice hinders the implementation of PBCS policies in ways that contribute to equity in breast cancer prevention for South Asian people. Pluralistic ethical frameworks and social values about breast cancer screening and the use of genetic information in health care have been articulated worldwide. Yet little is known about what South Asian people in Canada, a large and diverse constellation of communities with a disproportionate burden of breast cancer morbidity, self-determine and experience as potential ethical issues regarding PBCS. This knowledge can inform efforts to reduce the burden of breast cancer for South Asian patients, families, and communities. This understanding may also widen the scope of bioethical issues in Canada and enrich existing theories and frameworks for addressing health equity for culturally diverse groups in Canada.

BackgroundSituations 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.PurposeThis 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.MethodsUsing 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.ResultsEthical 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?DiscussionThe 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.

Dans la section « Méthodologie » de son article « Regretting Motherhood : A Sociopolitical Analysis » (2015), la sociologue Orna Donath révèle son non-désir d’enfant pour situer sa positionalité en tant que chercheure (conformément à certaines épistémologies féministes critiques qui remettent en cause la soi-disant neutralité axiologique du chercheur sans nécessairement nier l’aspiration à l’objectivité, bien comprise, en sciences humaines et sociales). La plénitude ne désigne pas ici une conception hédoniste du bonheur mais plutôt la certitude permanente d’une raison d’être qui donne un sens à tous les projets et comble tous les moments d’une joie fondamentale. Il faudrait un sociologue ou un démographe pour analyser ces chiffres de manière experte afin d’expliquer pour quelles raisons, en dépit du fait que les femmes ont tendance à enfanter de plus en plus tard pendant la trentaine, le plus haut pourcentage de femmes âgées de 40 à 44 ans (et dont les enfants seraient encore mineurs) vivant sans enfant se situe à 31,81 % en Belgique et 28,22 % en Allemagne. Sans être en mesure d’examiner cette dernière hypothèse, elle est soulevée ici en vue d’illustrer une particularité importante de la recherche menée par Orna Donath. Les attentes sociales relativement à la féminité exemplaire culminent vers la maternité, peut-être davantage encore dans la société israélienne où, comme l’indique Donath, l’accès et le financement public des technologies de reproduction sont les plus élevés à l’échelle internationale. Dans les milieux féministes activistes et universitaires, le désir de ne pas vouloir d’enfant ne doit pas soulever de vives controverses dans la mesure où cette préférence relève de la liberté individuelle et du droit des femmes d’exercer leur autonomie. Espace de conflit entre des approches féministes divergentes où les unes reprochent aux autres de reconduire des conceptions de l’allaitement et de l’attachement parental qui constituent des formes de servitude volontaire (Badinter, 2010), où les dernières reprochent aux premières de ne pas comprendre que la revendication du droit de vivre pleinement la maternité (par l’allaitement public, par exemple) dans l’organisation du travail et dans l’espace politique constitue une lutte inachevée (Slaughter, 2012). Le « problème des nounous », tel qu’il est décrit par Tronto (2002), recadre également la maternité au coeur des injustices structurelles causant préjudice aux femmes privilégiées, pénalisées par la maternité sur le plan professionnel, et qui délèguent donc — certains parleront d’une forme d’exploitation — le labeur des soins à des femmes plus désavantagées qui doivent (ou choisissent de) s’expatrier afin de gagner un salaire suffisant à l’étranger pour subvenir aux besoins de leurs propres enfants dont elles sont séparées. Les déclinaisons plus sombres et complexes de l’amour maternel font l’objet de grandes créations artistiques qui nous aident à mieux distinguer les contours entre la détresse maternelle et le regret de la maternité. Dans un article publié dans le Washington Post le 30 juillet 2014, en pleine guerre de Gaza, Wejdan Abu Shammala, mère de quatre enfants, décrit ses propres dilemmes tragiques lorsqu’elle se livrait à une délibération surréaliste pour déterminer quel enfant devait dormir dans quelle pièce de la maison pour tenter de minimiser le nombre de décès en cas de bombardement nocturne. En effet, il serait important de poursuivre des recherches pour mieux comprendre comment le facteur des discriminations sociales peut jouer un rôle particulier dans l’expérience du regret de la maternité. Mais dans tous ces cas de figure, on peut regretter d’avoir mis au monde des enfants affligés de souffrance, mais ce n’est pas l’espèce particulière de regret dont parle l’étude de Donath. Toutefois, le regret ne mène pas nécessairement à un désamour même s’il confirme une absence de désir dans la relation parentale entre mère contrainte et enfant non souhaité. Donath navigue avec beaucoup de délicatesse pour tenter de rendre