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Public Health Ethics Advance Access originally published online on March 3, 2009
Public Health Ethics 2009 2(1):89-99; doi:10.1093/phe/phn042
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© The Author 2009. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org

Allocating Resources in Humanitarian Medicine

Samia A. Hurst*

Institute for Biomedical Ethics, Geneva University Medical School, Geneva, Switzerland

Nathalie Mezger

Médecins sans Frontières, Switzerland

Alex Mauron

Geneva University Medical School, Switzerland

* Corresponding author: Institute for Biomedical Ethics, CMU/1 rue Michel Servet, 1211 Geneva 4, Switzerland. Tel.: +4122-3793479; Fax. +4122-3793472; Email: samia.hurst{at}unige.ch.


  Abstract

Fair resource allocation in humanitarian medicine is gaining in importance and complexity, but remains insufficiently explored. It raises specific issues regarding non-ideal fairness, global solidarity, legitimacy in non-governmental institutions and conflicts of interest. All would benefit from further exploration. We propose that some headway could be made by adapting existing frameworks of procedural fairness for use in humanitarian organizations. Despite the difficulties in applying it to humanitarian medicine, it is possible to partly adapt Daniels and Sabin's ‘Accountability for reasonableness’ to this context. This would require: (1) inclusion of internally explicit decisions and rationales; (2) publicity to donors, local staff, community leaders and governments, as well as frank answers to any beneficiary—or potential beneficiary—who asked for clarification of decisions and their rationale; (3) a consistent reasoning strategy to weigh conflicting views of equity in specific situations; (4) advocacy within the organization as a mechanism for revision and appeals; and (5) internal regulation according to publicly accessible mechanisms. Organizations could generate a common corpus of allocation decisions from which to draw in future similar cases. Importantly, the complexity of these challenges should encourage, rather than hinder, broader discussion on ethical aspects of resource allocation in humanitarian medicine.


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