One of the ways in which transnational medical agencies (TMAs) such as Medicins Sans Frontieres aim to increase the access of the global poor to health services is by supplying medical aid to people who need it in developing countries. The moral imperative supporting such work is clear enough, but a variety of factors can make such work difficult. One of those factors is the wrongdoing of other agents and agencies. For as a result of such wrongdoing, the attempt to (...) supply medical aid can sometimes lead to significant negative effects. What should TMAs do in such situations? On one view, TMAs should take account of any negative effects arising from the wrongdoing of others in just the same way in which they take account of negative effects arising more directly from their own actions, or from natural forces. To many people, this view seems wrong. In this paper, I articulate and discuss several different reasons why one might think this. In doing so, I hope to contribute to a debate about the more general question of how TMAs should respond to the wrongdoing of others. (shrink)

Thomas Pogge and Andrew Kuper suggest that we should promote an ‘institutional’ solution to global poverty. They advocate the institutional solution because they think that non-governmental organizations (NGOs) can never be the primary agents of justice in the long run. They provide several standard criticisms of NGO aid in support of this claim. However, there is a more serious problem for institutional solutions: how to generate enough goodwill among rich nation-states that they would be willing to commit themselves to supranational (...) institutional reforms. In the current international political climate, the implementation of such institutional reforms introduces several intractable problems, including difficulties of global coordination and enforcement. I defend the solution of NGO aid from the criticisms presented by Pogge and Kuper, and propose how it might be reformed. My main suggestion is that all practising NGOs should be required to be ‘accountable for reasonableness’ in the sense that Norman Daniels and James Sabin have outlined. (shrink)

Journal of Social Philosophy, EarlyView.

This paper analyses the commodification of post-tsunami aid in Sri Lanka, a process that ‘contaminated’ the ‘purity’ of good intentions with the politics of patronage and international aid. It argues that gifts are not just material transfers of ‘aid’, but also embodiments of cultural symbolism, social power, and political affiliations. The tsunami gift re-enforced and reconfigured exchange relationships among different patrons and clients in Sri Lankan communities, perpetuating the political economy that has driven social conflict and discontent in the post-independence (...) years. Beyond dominant rationales of ethnic or political party patronage, the paper finds that gifts by disingenuous patrons not only became patrimonial, but that the patrimonial rationale emerged as much from above as from below—a dynamic that became nearly inescapable and self-reinforcing. Through three case studies, we explore the intricate chain of relations, obligations, and expectations pertinent in the co-evolving, but often contradictory, gift rationales that permeate the practices, performances, and discourses of tsunami aid. (shrink)

Humanitarian emergencies and natural disasters can overwhelm the capacity of local and national agencies to respond to the needs of affected populations. In such cases, international relief organizations are frequently involved in the provision of emergency assistance. Health care professionals play a key role in these interventions. This practice environment is significantly different from the context of health care delivery in the home countries of expatriate health care professionals. Clinicians who travel from a developed nation to a resource-poor setting where (...) a humanitarian crisis has occurred experience a shift of professional, social, cultural and regulatory environments. In this dissertation I examine the ethics of health care practice in humanitarian work. I evaluate the literature of global bioethics, global health ethics and the ethics of humanitarian assistance, and consider the contributions of various ethics frameworks and normative approaches. I also develop a set of questions to guide health care professionals as they address ethically complex issues arising in clinical practice during humanitarian crises. In the empirical component of this research program I use Interpretive Description methodology to examine the moral experience of health care professionals in humanitarian relief work, and clinician experiences of resources and constraints for addressing ethical issues in humanitarian settings. Building upon the inductively derived findings, I argue for strategies and approaches that humanitarian organizations, project teams, and health care professionals can adopt to respond to the ethics of this field of practice. I also provide a critical review of Interpretive Description methodology. The research presented in this dissertation makes an important contribution to the ethical analysis of health care practice in humanitarian work. (shrink)

This article aims to demonstrate how the impact of humanitarian crises on health outcomes is related to social justice issues, even when these crises are brought upon by natural disasters. Pre-existing inequalities between individuals and social groups within a community affect in important and complex ways the health disparities which result from natural disasters. Drawing on the thought-provoking work of Paul Farmer, my main hypothesis is that socio-political factors prior to natural disasters determine ‘structured health risks’ that humanitarian crises will (...) necessarily exacerbate. To adequately respond to these structured health risks, medical humanitarianism cannot abide by an apolitical approach which mainly focuses on emergency relief. A more comprehensive analysis of the socio-political aspects of the health impact of humanitarian crises indicates that a more comprehensive approach to medical humanitarianism is necessary. This has three implications. First, a coherent account of medical humanitarianism needs to assess the international dimension of structural injustice that leads to structured health disparities. Second, this comprehensive approach to medical humanitarianism supports the ‘denaturalization of natural disasters’ argument. Third, medical humanitarianism should be organized around a broader and more complex approach of overlapping sequences which bridge emergency relief, reconstruction and development through a better aligned, orchestrated and coherent international effort. (shrink)

The International Committee of the Red Cross (ICRC) offers a dilemma for international political theory. ICRC's success as a humanitarian actor in international conflict is credited to its neutral stance. However, ICRC neutrality is vulnerable to serious challenges regarding its supposed avoidance of the political. ICRC neutrality is commonly dismissed as either illusory or impossible. The problem is not grounded in the principle of neutrality itself, though, but rather in the lack of critical engagement with what it means to be (...) neutral on a humanitarian register. ICRC misreads the demands of neutrality in such ways as to permit both partiality and irresponsibility to its mission. Drawing from Roland Barthes' address of the neutral, I argue that international humanitarianism is possible as a neutral movement but that this neutrality can only be such through vigorous and fundamentally political movement responsible to the goals of human well-being and dignity as questions. (shrink)