Action, Evidence, and Empathy When It Feels Like “There Is No More To Give”: Moral Experiences of Healthcare Workers and Researchers in Humanitarian and Public Health Crises

Abstract

When responding to public health crises such as the COVID-19 pandemic or caring for children with palliative care needs in complex humanitarian crises, healthcare workers may feel powerless or uncertain as to how they should act in response to the overwhelming needs of patients and communities. This dissertation aims to better understand the moral experiences of health and health research personnel during humanitarian and public health crises, taking seriously their moral experiences as windows into the ethical dimensions of these contexts, and to explore how understanding their moral experiences may be useful in improving care and ethical practice.

Firstly, an interview-based interpretive description study examines the moral experiences of health and health research personnel who worked at the intersection of research and clinical care during the first wave of the COVID-19 pandemic. Secondly, a focused ethnographic study conducted at an Médecins Sans Frontières pediatric hospital in Cox’s Bazar, Bangladesh explores health care workers moral experiences related to palliative and end of life care in a humanitarian crisis context. A narrative exploration of the ethnographic findings is presented using composite stories focused on the value and challenges to empathy in humanitarian action. Finally, a reflexive analysis explores my moral experience of the research process including implications of my identity as a practicing nurse, multiple roles in the research context, and relationships with research participants.

While the two studies were conducted in very different crisis contexts, the overall dissertation demonstrates the importance of evidence-based practice as a reference point that shapes the moral experience of health care workers in crisis contexts. The dissertation contributes to understanding the implications of healthcare workers moral compulsion to act on behalf of their patients, and the value of broader understandings of action in crisis contexts where the evidence-base is often inadequate.