Len Rubenstein, the director of the Conflict and Health pillar of the Center for Public Health and Human Rights, and Court Robinson, an affiliated faculty member, have recently developed and published a handbook titled “Ethical Decision-Making in Humanitarian Health in Situations of Extreme Violence” in collaboration with the Johns Hopkins University Berman Institute of Bioethics, the Syrian American Medical Society (SAMS) and the International Rescue Committee (IRC).While the basis of Rubenstein’s project was on the Syrian context of violence and political turbulence, the guidelines that the handbook provides was written in such a way that it can be used in a multitude of situations that involve challenging, soul wrenching medical ethics under extreme duress.
When a hospital is destroyed as a result of targeted terrorism, should healthcare providers move to a different location and risk denying healthcare access to the original population they served, or should they rebuild the infrastructure and risk another targeted attack? When healthcare providers are forced under duress to prioritize wounded combatants over wounded, ordinary citizens, how should they proceed? These are all extremely difficult situations with no easy solution, yet these are decisions that almost always require immediate action from healthcare providers placed in violent contexts.
Further, in the midst of targeted terrorism and constant political strife, healthcare providers are not given the liberty to ponder the ethical and moral dilemmas surrounding each and every one of their actions. When the whistles of bombs and bullet ricochets are all around them, can we reasonably demand level-headed philosophical reasoning from them in the heat of extreme stress? The handbook recognizes this and emphasizes prior planning and preparation for such situations. The handbook is meant as a preparation guide in anticipation of an event rather than a handbook to consult during the violent context itself.
The full contents of the handbook can be read here.The handbook provides the rationale for the need of ethical guidelines, results from the collaborative research project’s inquiry into the most often cited ethical dilemmas, the recommendations for tackling those ethical dilemmas, and guidelines for implementing such recommendations. Further, the handbook consists of many plausible scenarios meant to serve as a workshop activity — these activities are meant to reflect real-life situations so that participants in the workshop can better plan for a situation that can arise.
Contemporary political strife has created many ethical and moral challenges as targeted terrorism continue to aim to instill fear in civilian populations to further an organization’s own ends. Len Rubenstein’s handbook is a timely guideline that provides another layer of much needed preparation for healthcare providers in such settings so that they not only continue to provide their services to the best of their abilities but also alleviate the psychological and emotional trauma that may manifest because of the actions the healthcare providers had to take in the midst of an impossible situation.