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Challenges to ethical obligations and humanitarian principles in conflict settings: a systematic review

机译：冲突环境中对道德义务和人道主义原则的挑战：系统回顾

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Abstract BackgroundHumanitarian health care organizations and health workers working in contexts of armed or violent conflict experience challenges in fulfilling ethical obligations and humanitarian principles. To better understand the types of challenges experienced in these contexts, we conducted a systematic literature review.MethodsA broad search strategy was developed for English language publications available in PubMed, Ovid/EMBASE, and Scopus. The search relied upon three key concept blocks: conflict settings, humanitarian or relief organizations, and non-clinical or non-military ethics. To be included, publications had to (1) refer implicitly or explicitly to ethics and/or humanitarian principle(s), (2) relate to non-military relief work in active conflict or conflict-affected settings, (3) relate to organizational mission and/or delivery of services, and (4) relate to events after 1900. Records were qualitatively analyzed using an emergent thematic analysis approach that mapped challenges onto recognized ethical obligations and humanitarian principles.ResultsA total of 66 out of a possible 2077 retrieved records met inclusion criteria. The most frequently noted ethical challenges for organizations working in conflict settings were (1) providing the highest attainable quality of care, (2) protecting workers, and (3) minimizing unintended harms. The humanitarian principle most frequently noted as challenging to uphold was neutrality (the duty that humanitarian actors must not take sides in a conflict). Ethical challenges and humanitarian principles were commonly co-coded. For example, the challenge of providing the highest attainable quality of care frequently intersected with the humanitarian principle of humanity.ConclusionsBy categorizing the types of ethical challenges experienced by humanitarian care organizations, this review can help organizations anticipate issues that might arise in conflict settings. The identified relationships between ethical challenges and humanitarian principles suggests that frameworks and guidance for ethical decision-making, if adapted for conflict settings, could support organizational capacity to fulfill ethical and humanitarian commitments.
机译：摘要背景在武装冲突或暴力冲突中工作的人道主义卫生保健组织和卫生工作者在履行道德义务和人道主义原则方面面临挑战。为了更好地理解在这些情况下遇到的挑战的类型，我们进行了系统的文献综述。方法为PubMed，Ovid / EMBASE和Scopus中的英语出版物开发了广泛的搜索策略。搜寻依赖于三个关键概念块：冲突背景，人道主义或救济组织以及非临床或非军事伦理。要纳入这些出版物，出版物必须（1）隐式或显式地提及道德和/或人道主义原则，（2）与活跃冲突或受冲突影响地区的非军事救济工作有关，（3）与组织有关（4）与1900年以后的事件有关。使用新兴的主题分析方法对记录进行定性分析，将挑战映射到公认的道德义务和人道主义原则上。结果在可能的2077个检索到的记录中，共有66个符合纳入标准。对于在冲突环境中工作的组织，最经常注意到的道德挑战是：（1）提供可达到的最高护理质量;（2）保护工人;（3）将意外伤害降至最低。最常被指出坚持的挑战的人道主义原则是中立（人道主义行为者不得在冲突中表示支持的责任）。道德挑战和人道主义原则通常是共同编码的。例如，提供最高可实现的护理质量的挑战经常与人道人道主义原则相交。结论通过对人道主义护理组织所遇到的道德挑战的类型进行分类，本综述可以帮助组织预测冲突环境中可能出现的问题。确定的道德挑战与人道主义原则之间的关系表明，如果将道德决策的框架和指南适应冲突环境，则可以支持组织履行道德和人道主义承诺的能力。

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