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BT 15.000 718.042 Td /F2 21.0 Tf  [(Challenging Operations: An Ethical Framework to Assist )] TJ ET
BT 15.000 693.094 Td /F2 21.0 Tf  [(Humanitarian Aid Workers in their Decision-making Processes)] TJ ET
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BT 79.721 675.088 Td /F3 9.8 Tf  [(Discussion)] TJ ET
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BT 108.599 663.247 Td /F1 9.8 Tf  [(Nikola Biller-Andorno)] TJ ET
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BT 26.250 651.342 Td /F1 9.8 Tf  [(Clarinval C, Biller-Andorno N. Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their )] TJ ET
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BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(Introduction: This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(framework for systematically and effectively addressing such issues.)] TJ ET
BT 26.250 547.167 Td /F1 9.8 Tf  [(Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the )] TJ ET
BT 26.250 535.262 Td /F1 9.8 Tf  [(course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the )] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or )] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship.)] TJ ET
BT 26.250 492.048 Td /F1 9.8 Tf  [(Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of )] TJ ET
BT 26.250 480.143 Td /F1 9.8 Tf  [(humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist )] TJ ET
BT 26.250 468.238 Td /F1 9.8 Tf  [(humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide )] TJ ET
BT 26.250 456.333 Td /F1 9.8 Tf  [(humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also )] TJ ET
BT 26.250 444.429 Td /F1 9.8 Tf  [(includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making )] TJ ET
BT 26.250 432.524 Td /F1 9.8 Tf  [(process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to )] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(implement the framework effectively.)] TJ ET
BT 26.250 401.214 Td /F1 9.8 Tf  [(Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the )] TJ ET
BT 26.250 389.310 Td /F1 9.8 Tf  [(decision-making challenges encountered in relief operations in the humanitarian aid context.)] TJ ET
BT 26.250 352.707 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 332.753 Td /F1 9.8 Tf  [(This work was supported by the K�the-Zingg Schwichtenberg-Fonds \(KZS 01/12, )] TJ ET
BT 26.250 320.848 Td /F1 9.8 Tf  [(https://www.samw.ch/de/Portraet/Kommissionen/KZS.html\). The funders had no role in study design, data collection and )] TJ ET
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BT 26.250 279.841 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 259.887 Td /F1 9.8 Tf  [(In the field of humanitarian action, making ethically justified decisions is challenging. In disaster affected contexts the needs )] TJ ET
BT 26.250 247.982 Td /F1 9.8 Tf  [(faced by populations oftentimes outweigh personal and material resources)] TJ ET
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BT 351.883 247.982 Td /F1 9.8 Tf  [(. AT the same time, well-intentioned humanitarian )] TJ ET
BT 26.250 236.077 Td /F1 9.8 Tf  [(actors focus on meeting those needs. While addressing those needs, these actors promote values such as independence, )] TJ ET
BT 26.250 224.172 Td /F1 9.8 Tf  [(impartiality, saving lives, prevention and preparedness, providing aid, promoting health and well-being)] TJ ET
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BT 470.004 228.061 Td /F1 8.7 Tf  [(�)] TJ ET
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BT 491.688 224.172 Td /F1 9.8 Tf  [(.)] TJ ET
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BT 26.250 192.863 Td /F1 9.8 Tf  [(For example, in contexts where a value such as saving lives conflicts with personal security, aid workers may choose to refrain )] TJ ET
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BT 500.319 180.958 Td /F1 9.8 Tf  [( emphasizes that )] TJ ET
BT 26.250 169.053 Td /F1 9.8 Tf  [(�humanitarian principles are often misrepresented as primary sources of legitimacy.� Doing �the right thing� requires more than )] TJ ET
BT 26.250 157.149 Td /F1 9.8 Tf  [(good intentions; it also asks for careful consideration and an explicit, systematic approach. In this paper, we propose a )] TJ ET
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BT 26.250 651.342 Td /F1 9.8 Tf  [(Clarinval C, Biller-Andorno N. Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(Decision-making Processes. PLOS Currents Disasters. 2014 Jun 23 . Edition 1. doi: )] TJ ET
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BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(Introduction: This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(framework for systematically and effectively addressing such issues.)] TJ ET
BT 26.250 547.167 Td /F1 9.8 Tf  [(Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the )] TJ ET
BT 26.250 535.262 Td /F1 9.8 Tf  [(course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the )] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or )] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship.)] TJ ET
BT 26.250 492.048 Td /F1 9.8 Tf  [(Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of )] TJ ET
BT 26.250 480.143 Td /F1 9.8 Tf  [(humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist )] TJ ET
BT 26.250 468.238 Td /F1 9.8 Tf  [(humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide )] TJ ET
BT 26.250 456.333 Td /F1 9.8 Tf  [(humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also )] TJ ET
BT 26.250 444.429 Td /F1 9.8 Tf  [(includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making )] TJ ET
BT 26.250 432.524 Td /F1 9.8 Tf  [(process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to )] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(implement the framework effectively.)] TJ ET
BT 26.250 401.214 Td /F1 9.8 Tf  [(Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the )] TJ ET
BT 26.250 389.310 Td /F1 9.8 Tf  [(decision-making challenges encountered in relief operations in the humanitarian aid context.)] TJ ET
BT 26.250 352.707 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 332.753 Td /F1 9.8 Tf  [(This work was supported by the K�the-Zingg Schwichtenberg-Fonds \(KZS 01/12, )] TJ ET
BT 26.250 320.848 Td /F1 9.8 Tf  [(https://www.samw.ch/de/Portraet/Kommissionen/KZS.html\). The funders had no role in study design, data collection and )] TJ ET
BT 26.250 308.943 Td /F1 9.8 Tf  [(analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist.)] TJ ET
BT 26.250 279.841 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 259.887 Td /F1 9.8 Tf  [(In the field of humanitarian action, making ethically justified decisions is challenging. In disaster affected contexts the needs )] TJ ET
BT 26.250 247.982 Td /F1 9.8 Tf  [(faced by populations oftentimes outweigh personal and material resources)] TJ ET
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BT 347.064 249.489 Td /F4 8.7 Tf  [(1)] TJ ET
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BT 351.883 247.982 Td /F1 9.8 Tf  [(. AT the same time, well-intentioned humanitarian )] TJ ET
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BT 465.185 225.680 Td /F4 8.7 Tf  [(2)] TJ ET
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BT 470.004 228.061 Td /F1 8.7 Tf  [(�)] TJ ET
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BT 482.051 225.680 Td /F4 8.7 Tf  [(26)] TJ ET
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BT 491.688 224.172 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 204.768 Td /F1 9.8 Tf  [(In many cases, these values cannot simply be implemented, but need to be specified and possibly weighed against each other. )] TJ ET
BT 26.250 192.863 Td /F1 9.8 Tf  [(For example, in contexts where a value such as saving lives conflicts with personal security, aid workers may choose to refrain )] TJ ET
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BT 422.892 180.958 Td /F1 9.8 Tf  [( . Further, Calain)] TJ ET
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BT 500.319 180.958 Td /F1 9.8 Tf  [( emphasizes that )] TJ ET
BT 26.250 169.053 Td /F1 9.8 Tf  [(�humanitarian principles are often misrepresented as primary sources of legitimacy.� Doing �the right thing� requires more than )] TJ ET
BT 26.250 157.149 Td /F1 9.8 Tf  [(good intentions; it also asks for careful consideration and an explicit, systematic approach. In this paper, we propose a )] TJ ET
BT 26.250 145.244 Td /F1 9.8 Tf  [(framework of principles, procedural steps, and organizational resources to ensure that the decision-making process is )] TJ ET
BT 26.250 133.339 Td /F1 9.8 Tf  [(consistent and fair, and that humanitarian actors can work through these issues in a well-argued and efficient manner.)] TJ ET
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BT 15.000 693.094 Td /F2 21.0 Tf  [(Humanitarian Aid Workers in their Decision-making Processes)] TJ ET
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BT 15.000 675.088 Td /F3 9.8 Tf  [(June 23, 2014)] TJ ET
BT 74.846 675.088 Td /F3 9.8 Tf  [(�)] TJ ET
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BT 79.721 675.088 Td /F3 9.8 Tf  [(Discussion)] TJ ET
BT 26.250 663.247 Td /F1 9.8 Tf  [(Caroline Clarinval)] TJ ET
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BT 103.177 663.247 Td /F1 9.8 Tf  [(, )] TJ ET
0.267 0.267 0.267 rg
BT 108.599 663.247 Td /F1 9.8 Tf  [(Nikola Biller-Andorno)] TJ ET
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BT 26.250 651.342 Td /F1 9.8 Tf  [(Clarinval C, Biller-Andorno N. Challenging Operations: An Ethical Framework to Assist Humanitarian Aid Workers in their )] TJ ET
BT 26.250 639.438 Td /F1 9.8 Tf  [(Decision-making Processes. PLOS Currents Disasters. 2014 Jun 23 . Edition 1. doi: )] TJ ET
BT 26.250 627.533 Td /F1 9.8 Tf  [(10.1371/currents.dis.96bec99f13800a8059bb5b5a82028bbf.)] TJ ET
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BT 26.250 598.430 Td /F4 12.0 Tf  [(Abstract)] TJ ET
BT 26.250 578.476 Td /F1 9.8 Tf  [(Introduction: This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a )] TJ ET
BT 26.250 566.571 Td /F1 9.8 Tf  [(framework for systematically and effectively addressing such issues.)] TJ ET
BT 26.250 547.167 Td /F1 9.8 Tf  [(Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the )] TJ ET
BT 26.250 535.262 Td /F1 9.8 Tf  [(course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the )] TJ ET
BT 26.250 523.357 Td /F1 9.8 Tf  [(headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or )] TJ ET
BT 26.250 511.452 Td /F1 9.8 Tf  [(regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship.)] TJ ET
BT 26.250 492.048 Td /F1 9.8 Tf  [(Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of )] TJ ET
BT 26.250 480.143 Td /F1 9.8 Tf  [(humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist )] TJ ET
BT 26.250 468.238 Td /F1 9.8 Tf  [(humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide )] TJ ET
BT 26.250 456.333 Td /F1 9.8 Tf  [(humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also )] TJ ET
BT 26.250 444.429 Td /F1 9.8 Tf  [(includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making )] TJ ET
BT 26.250 432.524 Td /F1 9.8 Tf  [(process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to )] TJ ET
BT 26.250 420.619 Td /F1 9.8 Tf  [(implement the framework effectively.)] TJ ET
BT 26.250 401.214 Td /F1 9.8 Tf  [(Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the )] TJ ET
BT 26.250 389.310 Td /F1 9.8 Tf  [(decision-making challenges encountered in relief operations in the humanitarian aid context.)] TJ ET
BT 26.250 352.707 Td /F4 12.0 Tf  [(Funding Statement)] TJ ET
BT 26.250 332.753 Td /F1 9.8 Tf  [(This work was supported by the K�the-Zingg Schwichtenberg-Fonds \(KZS 01/12, )] TJ ET
BT 26.250 320.848 Td /F1 9.8 Tf  [(https://www.samw.ch/de/Portraet/Kommissionen/KZS.html\). The funders had no role in study design, data collection and )] TJ ET
BT 26.250 308.943 Td /F1 9.8 Tf  [(analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist.)] TJ ET
BT 26.250 279.841 Td /F4 12.0 Tf  [(Introduction)] TJ ET
BT 26.250 259.887 Td /F1 9.8 Tf  [(In the field of humanitarian action, making ethically justified decisions is challenging. In disaster affected contexts the needs )] TJ ET
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BT 465.185 225.680 Td /F4 8.7 Tf  [(2)] TJ ET
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BT 470.004 228.061 Td /F1 8.7 Tf  [(�)] TJ ET
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BT 474.823 225.680 Td /F4 8.7 Tf  [(4)] TJ ET
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BT 479.641 228.061 Td /F1 8.7 Tf  [(,)] TJ ET
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BT 422.892 180.958 Td /F1 9.8 Tf  [( . Further, Calain)] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Dilemmas arise frequently \(but not exclusively\) in the context of resource allocation, particularly since humanitarian aid is a )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(limited resource, with programmatic decisions being based on unmet needs)] TJ ET
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BT 351.920 757.079 Td /F4 8.7 Tf  [(7)] TJ ET
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BT 356.738 755.571 Td /F1 9.8 Tf  [(. Distribution occurs according to parameters such )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(as the role of other actors, prioritization across contexts of available resources, and the cost and benefits to an organization of )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(specific interventions. Moreover, the organization�s mandate, responsibility, expertise, capacity, impact, and foreign and )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(domestic policy are involved )] TJ ET
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BT 150.875 721.364 Td /F4 8.7 Tf  [(7)] TJ ET
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BT 155.693 723.745 Td /F1 8.7 Tf  [(,)] TJ ET
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BT 158.103 721.364 Td /F4 8.7 Tf  [(8)] TJ ET
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BT 162.921 719.857 Td /F1 9.8 Tf  [(. The multitude of potentially conflicting factors � some of ethical or strategic relevance � )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(demonstrates the necessity of a framework for working through the process of clarifying, specifying, and weighing these factors )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(in an accountable way.)] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(In usual practice, the humanitarian discourse neither disentangles conflicting values nor identifies and clearly names ethical )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(issues. Rather, ethical problems tend to be reduced to matters of geopolitics or management. For example, assisting )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(populations in contexts with limited access must consider the critical trade-off between the principles of beneficence and justice. )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(Due to the lack of security on the ground, agencies are unable to confirm whether all of the goods reach the population )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(successfully. As long as this process of ethical decision-making is neglected, operational decisions might be made in a )] TJ ET
BT 26.250 617.119 Td /F1 9.8 Tf  [(discriminatory way, potentially skewing assessments and affecting programmatic outcomes.)] TJ ET
BT 26.250 597.714 Td /F1 9.8 Tf  [(One reason for this situation may be that managers in charge of humanitarian operations are unlikely to be trained in ethics. )] TJ ET
BT 26.250 585.810 Td /F1 9.8 Tf  [(Hence, ethical issues remain unidentified and therefore unaddressed. Fink and Redaelli)] TJ ET
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BT 403.965 587.317 Td /F4 8.7 Tf  [(9)] TJ ET
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BT 408.784 585.810 Td /F1 9.8 Tf  [(argue that donor governments are )] TJ ET
BT 26.250 573.905 Td /F1 9.8 Tf  [(biased in funding aid operations that are geographically closer, politically compatible and in oil exporting countries. Results of )] TJ ET
BT 26.250 562.000 Td /F1 9.8 Tf  [(their study further show that political factors are as important as the prevailing needs.)] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(Overall, the resource allocation processes seem to lack structure and transparency, hindering a comprehensive evaluation of )] TJ ET
BT 26.250 530.691 Td /F1 9.8 Tf  [(the impact of aid. Therefore, decision-making processes of aid agencies are stifled and run the risk of adding further damage to )] TJ ET
BT 26.250 518.786 Td /F1 9.8 Tf  [(their beneficiaries.)] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(This paper aims to meet this challenge which hinders the effectiveness of humanitarian efforts. First, we use three cases )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(situated at macro-, meso- and micro-levels to illustrate different ethical conflicts that may arise in the context of humanitarian )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(aid. Second, we propose a novel ethical framework suggesting a set of normative values that might be considered by )] TJ ET
BT 26.250 463.667 Td /F1 9.8 Tf  [(humanitarian aid workers during their decision-making process. This set of values draws parallels to certain public health ethics )] TJ ET
BT 26.250 451.762 Td /F1 9.8 Tf  [(frameworks, since humanitarian aid workers often focus on assisting large populations. Third, to address those processes, we )] TJ ET
BT 26.250 439.857 Td /F1 9.8 Tf  [(propose a ten-step approach that is based on clinical ethics models. As such, tools that have already proven useful for )] TJ ET
BT 26.250 427.953 Td /F1 9.8 Tf  [(addressing dilemmas in the clinical setting are applied to a humanitarian aid context for the first time. Finally, we propose certain )] TJ ET
BT 26.250 416.048 Td /F1 9.8 Tf  [(organizational measures that aim to support humanitarian aid organizations in their effort of implementing the framework and )] TJ ET
BT 26.250 404.143 Td /F1 9.8 Tf  [(securing well-argued and fair decision-making in their daily work.)] TJ ET
BT 26.250 367.541 Td /F4 12.0 Tf  [(Cases)] TJ ET
BT 26.250 347.586 Td /F1 9.8 Tf  [(The following cases)] TJ ET
BT 111.865 351.475 Td /F1 8.7 Tf  [([1])] TJ ET
BT 121.502 347.586 Td /F1 9.8 Tf  [( have been chosen to illustrate the ethical dimension of many decisions in humanitarian aid. They reflect )] TJ ET
BT 26.250 335.682 Td /F1 9.8 Tf  [(instances that have occurred in practice, and are likely to describe situations that are familiar in some form or other by those )] TJ ET
BT 26.250 323.777 Td /F1 9.8 Tf  [(active in the field.)] TJ ET
BT 26.250 304.372 Td /F4 9.8 Tf  [(1.1. Macro-level \(headquarters\): Repeated budget allocation � a matter of fair process)] TJ ET
BT 26.250 284.967 Td /F1 9.8 Tf  [(For most humanitarian organizations, the management of operational budgets rely on suggested interventions from the field and )] TJ ET
BT 26.250 273.063 Td /F1 9.8 Tf  [(the amount of financial resources sourced by fundraisers. Humanitarian aid has restricted capacities, which usually leads to a )] TJ ET
BT 26.250 261.158 Td /F1 9.8 Tf  [(prioritization of populations in acute crisis. In these situations, emergency appeals can be launched to raise additional funds. )] TJ ET
BT 26.250 249.253 Td /F1 9.8 Tf  [(However, the allocation of aid to more chronic contexts in the state of deterioration, stabilization, or imminent recovery also )] TJ ET
BT 26.250 237.348 Td /F1 9.8 Tf  [(needs scrutiny, because the respective populations might be over- or underserved. The budget of these more long-term )] TJ ET
BT 26.250 225.444 Td /F1 9.8 Tf  [(operations is usually annually reviewed and adjusted.)] TJ ET
BT 26.250 206.039 Td /F5 9.8 Tf  [(Case: Organization X holds a budget committee meeting at headquarters. The available budget is clearly insufficient to cover all )] TJ ET
BT 26.250 194.134 Td /F5 9.8 Tf  [(the proposed interventions; in fact, it is ten percent smaller than last year. Apart from a few new interventions, most of programs )] TJ ET
BT 26.250 182.229 Td /F5 9.8 Tf  [(have run for several years. Some programs were implemented very successfully, but as those working in the field argue, they )] TJ ET
BT 26.250 170.325 Td /F5 9.8 Tf  [(must receive continued funding in order to secure sustainable improvement. Another program has had poor outcomes but is )] TJ ET
BT 26.250 158.420 Td /F5 9.8 Tf  [(situated in an area of particular strategic importance for the organization, generating a great level of interest among the media )] TJ ET
BT 26.250 146.515 Td /F5 9.8 Tf  [(and public. Another has done poorly, but is working under difficult circumstances and provides crucial support to a severely )] TJ ET
BT 26.250 134.610 Td /F5 9.8 Tf  [(deprived population. How should the committee allocate the budget? Should they reduce the funding of all projects evenly? )] TJ ET
BT 26.250 122.706 Td /F5 9.8 Tf  [(Should some projects be treated preferentially, while others are downsized or discontinued? If so, what criteria should be used )] TJ ET
BT 26.250 110.801 Td /F5 9.8 Tf  [(in making the decisions: urgency, need, population size, location, success of the intervention, political considerations, or still )] TJ ET
BT 26.250 98.896 Td /F5 9.8 Tf  [(other factors?)] TJ ET
BT 26.250 79.491 Td /F1 9.8 Tf  [(As illustrated in this case, repeated budget cuts in practice are likely to be carried out at central headquarter level. If decisions )] TJ ET
BT 26.250 67.587 Td /F1 9.8 Tf  [(are made in a top-down fashion behind closed doors, the expert staff in the concerned countries are unlikely to participate in the )] TJ ET
BT 26.250 55.682 Td /F1 9.8 Tf  [(decision-making process, leading to a lack of transparency and accountability. Populations affected by disasters are subjected )] TJ ET
BT 26.250 43.777 Td /F1 9.8 Tf  [(to arbitrary budget allocations and may or may not benefit from external aid, depending on who voices their concerns most )] TJ ET
Q
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BT 26.250 767.476 Td /F1 9.8 Tf  [(Dilemmas arise frequently \(but not exclusively\) in the context of resource allocation, particularly since humanitarian aid is a )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(limited resource, with programmatic decisions being based on unmet needs)] TJ ET
0.267 0.267 0.267 rg
BT 351.920 757.079 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 356.738 755.571 Td /F1 9.8 Tf  [(. Distribution occurs according to parameters such )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(as the role of other actors, prioritization across contexts of available resources, and the cost and benefits to an organization of )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(specific interventions. Moreover, the organization�s mandate, responsibility, expertise, capacity, impact, and foreign and )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(domestic policy are involved )] TJ ET
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BT 150.875 721.364 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 155.693 723.745 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 158.103 721.364 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 162.921 719.857 Td /F1 9.8 Tf  [(. The multitude of potentially conflicting factors � some of ethical or strategic relevance � )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(demonstrates the necessity of a framework for working through the process of clarifying, specifying, and weighing these factors )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(in an accountable way.)] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(In usual practice, the humanitarian discourse neither disentangles conflicting values nor identifies and clearly names ethical )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(issues. Rather, ethical problems tend to be reduced to matters of geopolitics or management. For example, assisting )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(populations in contexts with limited access must consider the critical trade-off between the principles of beneficence and justice. )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(Due to the lack of security on the ground, agencies are unable to confirm whether all of the goods reach the population )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(successfully. As long as this process of ethical decision-making is neglected, operational decisions might be made in a )] TJ ET
BT 26.250 617.119 Td /F1 9.8 Tf  [(discriminatory way, potentially skewing assessments and affecting programmatic outcomes.)] TJ ET
BT 26.250 597.714 Td /F1 9.8 Tf  [(One reason for this situation may be that managers in charge of humanitarian operations are unlikely to be trained in ethics. )] TJ ET
BT 26.250 585.810 Td /F1 9.8 Tf  [(Hence, ethical issues remain unidentified and therefore unaddressed. Fink and Redaelli)] TJ ET
0.267 0.267 0.267 rg
BT 403.965 587.317 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 408.784 585.810 Td /F1 9.8 Tf  [(argue that donor governments are )] TJ ET
BT 26.250 573.905 Td /F1 9.8 Tf  [(biased in funding aid operations that are geographically closer, politically compatible and in oil exporting countries. Results of )] TJ ET
BT 26.250 562.000 Td /F1 9.8 Tf  [(their study further show that political factors are as important as the prevailing needs.)] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(Overall, the resource allocation processes seem to lack structure and transparency, hindering a comprehensive evaluation of )] TJ ET
BT 26.250 530.691 Td /F1 9.8 Tf  [(the impact of aid. Therefore, decision-making processes of aid agencies are stifled and run the risk of adding further damage to )] TJ ET
BT 26.250 518.786 Td /F1 9.8 Tf  [(their beneficiaries.)] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(This paper aims to meet this challenge which hinders the effectiveness of humanitarian efforts. First, we use three cases )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(situated at macro-, meso- and micro-levels to illustrate different ethical conflicts that may arise in the context of humanitarian )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(aid. Second, we propose a novel ethical framework suggesting a set of normative values that might be considered by )] TJ ET
BT 26.250 463.667 Td /F1 9.8 Tf  [(humanitarian aid workers during their decision-making process. This set of values draws parallels to certain public health ethics )] TJ ET
BT 26.250 451.762 Td /F1 9.8 Tf  [(frameworks, since humanitarian aid workers often focus on assisting large populations. Third, to address those processes, we )] TJ ET
BT 26.250 439.857 Td /F1 9.8 Tf  [(propose a ten-step approach that is based on clinical ethics models. As such, tools that have already proven useful for )] TJ ET
BT 26.250 427.953 Td /F1 9.8 Tf  [(addressing dilemmas in the clinical setting are applied to a humanitarian aid context for the first time. Finally, we propose certain )] TJ ET
BT 26.250 416.048 Td /F1 9.8 Tf  [(organizational measures that aim to support humanitarian aid organizations in their effort of implementing the framework and )] TJ ET
BT 26.250 404.143 Td /F1 9.8 Tf  [(securing well-argued and fair decision-making in their daily work.)] TJ ET
BT 26.250 367.541 Td /F4 12.0 Tf  [(Cases)] TJ ET
BT 26.250 347.586 Td /F1 9.8 Tf  [(The following cases)] TJ ET
BT 111.865 351.475 Td /F1 8.7 Tf  [([1])] TJ ET
BT 121.502 347.586 Td /F1 9.8 Tf  [( have been chosen to illustrate the ethical dimension of many decisions in humanitarian aid. They reflect )] TJ ET
BT 26.250 335.682 Td /F1 9.8 Tf  [(instances that have occurred in practice, and are likely to describe situations that are familiar in some form or other by those )] TJ ET
BT 26.250 323.777 Td /F1 9.8 Tf  [(active in the field.)] TJ ET
BT 26.250 304.372 Td /F4 9.8 Tf  [(1.1. Macro-level \(headquarters\): Repeated budget allocation � a matter of fair process)] TJ ET
BT 26.250 284.967 Td /F1 9.8 Tf  [(For most humanitarian organizations, the management of operational budgets rely on suggested interventions from the field and )] TJ ET
BT 26.250 273.063 Td /F1 9.8 Tf  [(the amount of financial resources sourced by fundraisers. Humanitarian aid has restricted capacities, which usually leads to a )] TJ ET
BT 26.250 261.158 Td /F1 9.8 Tf  [(prioritization of populations in acute crisis. In these situations, emergency appeals can be launched to raise additional funds. )] TJ ET
BT 26.250 249.253 Td /F1 9.8 Tf  [(However, the allocation of aid to more chronic contexts in the state of deterioration, stabilization, or imminent recovery also )] TJ ET
BT 26.250 237.348 Td /F1 9.8 Tf  [(needs scrutiny, because the respective populations might be over- or underserved. The budget of these more long-term )] TJ ET
BT 26.250 225.444 Td /F1 9.8 Tf  [(operations is usually annually reviewed and adjusted.)] TJ ET
BT 26.250 206.039 Td /F5 9.8 Tf  [(Case: Organization X holds a budget committee meeting at headquarters. The available budget is clearly insufficient to cover all )] TJ ET
BT 26.250 194.134 Td /F5 9.8 Tf  [(the proposed interventions; in fact, it is ten percent smaller than last year. Apart from a few new interventions, most of programs )] TJ ET
BT 26.250 182.229 Td /F5 9.8 Tf  [(have run for several years. Some programs were implemented very successfully, but as those working in the field argue, they )] TJ ET
BT 26.250 170.325 Td /F5 9.8 Tf  [(must receive continued funding in order to secure sustainable improvement. Another program has had poor outcomes but is )] TJ ET
BT 26.250 158.420 Td /F5 9.8 Tf  [(situated in an area of particular strategic importance for the organization, generating a great level of interest among the media )] TJ ET
BT 26.250 146.515 Td /F5 9.8 Tf  [(and public. Another has done poorly, but is working under difficult circumstances and provides crucial support to a severely )] TJ ET
BT 26.250 134.610 Td /F5 9.8 Tf  [(deprived population. How should the committee allocate the budget? Should they reduce the funding of all projects evenly? )] TJ ET
BT 26.250 122.706 Td /F5 9.8 Tf  [(Should some projects be treated preferentially, while others are downsized or discontinued? If so, what criteria should be used )] TJ ET
BT 26.250 110.801 Td /F5 9.8 Tf  [(in making the decisions: urgency, need, population size, location, success of the intervention, political considerations, or still )] TJ ET
BT 26.250 98.896 Td /F5 9.8 Tf  [(other factors?)] TJ ET
BT 26.250 79.491 Td /F1 9.8 Tf  [(As illustrated in this case, repeated budget cuts in practice are likely to be carried out at central headquarter level. If decisions )] TJ ET
BT 26.250 67.587 Td /F1 9.8 Tf  [(are made in a top-down fashion behind closed doors, the expert staff in the concerned countries are unlikely to participate in the )] TJ ET
BT 26.250 55.682 Td /F1 9.8 Tf  [(decision-making process, leading to a lack of transparency and accountability. Populations affected by disasters are subjected )] TJ ET
BT 26.250 43.777 Td /F1 9.8 Tf  [(to arbitrary budget allocations and may or may not benefit from external aid, depending on who voices their concerns most )] TJ ET
Q
q
15.000 29.491 577.500 747.509 re W n
0.271 0.267 0.267 rg
BT 26.250 767.476 Td /F1 9.8 Tf  [(Dilemmas arise frequently \(but not exclusively\) in the context of resource allocation, particularly since humanitarian aid is a )] TJ ET
BT 26.250 755.571 Td /F1 9.8 Tf  [(limited resource, with programmatic decisions being based on unmet needs)] TJ ET
0.267 0.267 0.267 rg
BT 351.920 757.079 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 356.738 755.571 Td /F1 9.8 Tf  [(. Distribution occurs according to parameters such )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(as the role of other actors, prioritization across contexts of available resources, and the cost and benefits to an organization of )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(specific interventions. Moreover, the organization�s mandate, responsibility, expertise, capacity, impact, and foreign and )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(domestic policy are involved )] TJ ET
0.267 0.267 0.267 rg
BT 150.875 721.364 Td /F4 8.7 Tf  [(7)] TJ ET
0.271 0.267 0.267 rg
BT 155.693 723.745 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 158.103 721.364 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 162.921 719.857 Td /F1 9.8 Tf  [(. The multitude of potentially conflicting factors � some of ethical or strategic relevance � )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(demonstrates the necessity of a framework for working through the process of clarifying, specifying, and weighing these factors )] TJ ET
BT 26.250 696.048 Td /F1 9.8 Tf  [(in an accountable way.)] TJ ET
BT 26.250 676.643 Td /F1 9.8 Tf  [(In usual practice, the humanitarian discourse neither disentangles conflicting values nor identifies and clearly names ethical )] TJ ET
BT 26.250 664.738 Td /F1 9.8 Tf  [(issues. Rather, ethical problems tend to be reduced to matters of geopolitics or management. For example, assisting )] TJ ET
BT 26.250 652.833 Td /F1 9.8 Tf  [(populations in contexts with limited access must consider the critical trade-off between the principles of beneficence and justice. )] TJ ET
BT 26.250 640.929 Td /F1 9.8 Tf  [(Due to the lack of security on the ground, agencies are unable to confirm whether all of the goods reach the population )] TJ ET
BT 26.250 629.024 Td /F1 9.8 Tf  [(successfully. As long as this process of ethical decision-making is neglected, operational decisions might be made in a )] TJ ET
BT 26.250 617.119 Td /F1 9.8 Tf  [(discriminatory way, potentially skewing assessments and affecting programmatic outcomes.)] TJ ET
BT 26.250 597.714 Td /F1 9.8 Tf  [(One reason for this situation may be that managers in charge of humanitarian operations are unlikely to be trained in ethics. )] TJ ET
BT 26.250 585.810 Td /F1 9.8 Tf  [(Hence, ethical issues remain unidentified and therefore unaddressed. Fink and Redaelli)] TJ ET
0.267 0.267 0.267 rg
BT 403.965 587.317 Td /F4 8.7 Tf  [(9)] TJ ET
0.271 0.267 0.267 rg
BT 408.784 585.810 Td /F1 9.8 Tf  [(argue that donor governments are )] TJ ET
BT 26.250 573.905 Td /F1 9.8 Tf  [(biased in funding aid operations that are geographically closer, politically compatible and in oil exporting countries. Results of )] TJ ET
BT 26.250 562.000 Td /F1 9.8 Tf  [(their study further show that political factors are as important as the prevailing needs.)] TJ ET
BT 26.250 542.595 Td /F1 9.8 Tf  [(Overall, the resource allocation processes seem to lack structure and transparency, hindering a comprehensive evaluation of )] TJ ET
BT 26.250 530.691 Td /F1 9.8 Tf  [(the impact of aid. Therefore, decision-making processes of aid agencies are stifled and run the risk of adding further damage to )] TJ ET
BT 26.250 518.786 Td /F1 9.8 Tf  [(their beneficiaries.)] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(This paper aims to meet this challenge which hinders the effectiveness of humanitarian efforts. First, we use three cases )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(situated at macro-, meso- and micro-levels to illustrate different ethical conflicts that may arise in the context of humanitarian )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(aid. Second, we propose a novel ethical framework suggesting a set of normative values that might be considered by )] TJ ET
BT 26.250 463.667 Td /F1 9.8 Tf  [(humanitarian aid workers during their decision-making process. This set of values draws parallels to certain public health ethics )] TJ ET
BT 26.250 451.762 Td /F1 9.8 Tf  [(frameworks, since humanitarian aid workers often focus on assisting large populations. Third, to address those processes, we )] TJ ET
BT 26.250 439.857 Td /F1 9.8 Tf  [(propose a ten-step approach that is based on clinical ethics models. As such, tools that have already proven useful for )] TJ ET
BT 26.250 427.953 Td /F1 9.8 Tf  [(addressing dilemmas in the clinical setting are applied to a humanitarian aid context for the first time. Finally, we propose certain )] TJ ET
BT 26.250 416.048 Td /F1 9.8 Tf  [(organizational measures that aim to support humanitarian aid organizations in their effort of implementing the framework and )] TJ ET
BT 26.250 404.143 Td /F1 9.8 Tf  [(securing well-argued and fair decision-making in their daily work.)] TJ ET
BT 26.250 367.541 Td /F4 12.0 Tf  [(Cases)] TJ ET
BT 26.250 347.586 Td /F1 9.8 Tf  [(The following cases)] TJ ET
BT 111.865 351.475 Td /F1 8.7 Tf  [([1])] TJ ET
BT 121.502 347.586 Td /F1 9.8 Tf  [( have been chosen to illustrate the ethical dimension of many decisions in humanitarian aid. They reflect )] TJ ET
BT 26.250 335.682 Td /F1 9.8 Tf  [(instances that have occurred in practice, and are likely to describe situations that are familiar in some form or other by those )] TJ ET
BT 26.250 323.777 Td /F1 9.8 Tf  [(active in the field.)] TJ ET
BT 26.250 304.372 Td /F4 9.8 Tf  [(1.1. Macro-level \(headquarters\): Repeated budget allocation � a matter of fair process)] TJ ET
BT 26.250 284.967 Td /F1 9.8 Tf  [(For most humanitarian organizations, the management of operational budgets rely on suggested interventions from the field and )] TJ ET
BT 26.250 273.063 Td /F1 9.8 Tf  [(the amount of financial resources sourced by fundraisers. Humanitarian aid has restricted capacities, which usually leads to a )] TJ ET
BT 26.250 261.158 Td /F1 9.8 Tf  [(prioritization of populations in acute crisis. In these situations, emergency appeals can be launched to raise additional funds. )] TJ ET
BT 26.250 249.253 Td /F1 9.8 Tf  [(However, the allocation of aid to more chronic contexts in the state of deterioration, stabilization, or imminent recovery also )] TJ ET
BT 26.250 237.348 Td /F1 9.8 Tf  [(needs scrutiny, because the respective populations might be over- or underserved. The budget of these more long-term )] TJ ET
BT 26.250 225.444 Td /F1 9.8 Tf  [(operations is usually annually reviewed and adjusted.)] TJ ET
BT 26.250 206.039 Td /F5 9.8 Tf  [(Case: Organization X holds a budget committee meeting at headquarters. The available budget is clearly insufficient to cover all )] TJ ET
BT 26.250 194.134 Td /F5 9.8 Tf  [(the proposed interventions; in fact, it is ten percent smaller than last year. Apart from a few new interventions, most of programs )] TJ ET
BT 26.250 182.229 Td /F5 9.8 Tf  [(have run for several years. Some programs were implemented very successfully, but as those working in the field argue, they )] TJ ET
BT 26.250 170.325 Td /F5 9.8 Tf  [(must receive continued funding in order to secure sustainable improvement. Another program has had poor outcomes but is )] TJ ET
BT 26.250 158.420 Td /F5 9.8 Tf  [(situated in an area of particular strategic importance for the organization, generating a great level of interest among the media )] TJ ET
BT 26.250 146.515 Td /F5 9.8 Tf  [(and public. Another has done poorly, but is working under difficult circumstances and provides crucial support to a severely )] TJ ET
BT 26.250 134.610 Td /F5 9.8 Tf  [(deprived population. How should the committee allocate the budget? Should they reduce the funding of all projects evenly? )] TJ ET
BT 26.250 122.706 Td /F5 9.8 Tf  [(Should some projects be treated preferentially, while others are downsized or discontinued? If so, what criteria should be used )] TJ ET
BT 26.250 110.801 Td /F5 9.8 Tf  [(in making the decisions: urgency, need, population size, location, success of the intervention, political considerations, or still )] TJ ET
BT 26.250 98.896 Td /F5 9.8 Tf  [(other factors?)] TJ ET
BT 26.250 79.491 Td /F1 9.8 Tf  [(As illustrated in this case, repeated budget cuts in practice are likely to be carried out at central headquarter level. If decisions )] TJ ET
BT 26.250 67.587 Td /F1 9.8 Tf  [(are made in a top-down fashion behind closed doors, the expert staff in the concerned countries are unlikely to participate in the )] TJ ET
BT 26.250 55.682 Td /F1 9.8 Tf  [(decision-making process, leading to a lack of transparency and accountability. Populations affected by disasters are subjected )] TJ ET
BT 26.250 43.777 Td /F1 9.8 Tf  [(to arbitrary budget allocations and may or may not benefit from external aid, depending on who voices their concerns most )] TJ ET
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BT 26.250 124.143 Td /F1 9.8 Tf  [(dilemmas arise. Programs should also be regularly monitored and evaluated in order to avoid causing unnecessary and )] TJ ET
BT 26.250 112.239 Td /F1 9.8 Tf  [(unjustified harm.)] TJ ET
BT 26.250 92.834 Td /F1 9.8 Tf  [(These three cases illustrate that humanitarian contexts are riddled with ethical issues on every level and they vary in complexity. )] TJ ET
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BT 275.962 743.667 Td /F1 9.8 Tf  [(.)] TJ ET
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BT 397.415 704.857 Td /F1 9.8 Tf  [(. Given this mix of underlying motivations, )] TJ ET
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BT 26.250 681.048 Td /F1 9.8 Tf  [(food rations are allocated to certain populations over a short period of one or two months. During this period, it is unlikely that )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(the nutritional status of the targeted populations will improve significantly, because effective food aid requires a prolonged )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(intervention, supported by surveillance. This has increasing relevance in areas where the populations are food insecure. )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(However, food aid is also provided in areas where populations are not necessarily food insecure. Therefore, food assistance )] TJ ET
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BT 26.250 621.524 Td /F1 9.8 Tf  [(certain local groups like leaders, political factions, or rebels.)] TJ ET
BT 26.250 602.119 Td /F5 9.8 Tf  [(Case: In a war-stricken area, a humanitarian aid organization carries out a one-off food distribution that is unlikely to significantly )] TJ ET
BT 26.250 590.214 Td /F5 9.8 Tf  [(improve the nutritional status of a given population. The primary aim is to establish contact with local leaders in order to improve )] TJ ET
BT 26.250 578.310 Td /F5 9.8 Tf  [(the organization�s acceptability. The staff deployed to this highly volatile context remain unaware of the underlying operational )] TJ ET
BT 26.250 566.405 Td /F5 9.8 Tf  [(reasons and believe that the distributions would serve the purpose of improving the nutritional status of a food-insecure )] TJ ET
BT 26.250 554.500 Td /F5 9.8 Tf  [(population. When fighting begins between rebel groups near the distribution site, aid workers decide to abandon the distribution. )] TJ ET
BT 26.250 542.595 Td /F5 9.8 Tf  [(They request a discussion with program leaders about the mission�s purpose. When learning the real goal of the intervention, )] TJ ET
BT 26.250 530.691 Td /F5 9.8 Tf  [(they feel deceived and abused, and some state they would not have taken the risks just for �the glory of the organization.�)] TJ ET
BT 26.250 511.286 Td /F1 9.8 Tf  [(A justification for this intervention could have been that in the context of armed conflict, involving all parties in the conflict is )] TJ ET
BT 26.250 499.381 Td /F1 9.8 Tf  [(acknowledged as paramount to promoting acceptability of the humanitarian organization and its staff, which will in turn )] TJ ET
BT 26.250 487.476 Td /F1 9.8 Tf  [(contribute to their safety and security. Since this was not communicated from the outset, the staff on the ground rightly felt that )] TJ ET
BT 26.250 475.572 Td /F1 9.8 Tf  [(they had been used for a purpose that they were not informed about and had not consented to. As a result, they lost trust in )] TJ ET
BT 26.250 463.667 Td /F1 9.8 Tf  [(their organization and the self-serving agenda which would merely enhance the organization�s reputation or ensure that the area )] TJ ET
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BT 222.863 365.334 Td /F1 9.8 Tf  [(. The expatriate physician�s role is to ensure that the conditions for knowledge )] TJ ET
BT 26.250 353.429 Td /F1 9.8 Tf  [(transfer are optimal and that the treatment benefits the patient.)] TJ ET
BT 26.250 334.024 Td /F5 9.8 Tf  [(Case: A humanitarian organization wishes to remain present in a specific context and opts for a capacity-building program for )] TJ ET
BT 26.250 322.119 Td /F5 9.8 Tf  [(surgeons. An expatriate physician is tasked to train his local counterparts. During one surgical procedure, it is agreed that the )] TJ ET
BT 26.250 310.215 Td /F5 9.8 Tf  [(physician will teach the local surgeons how to set an external fixator to treat a complex fracture. However, the local physicians )] TJ ET
BT 26.250 298.310 Td /F5 9.8 Tf  [(do not follow the instructions of the physician in charge, which results in harm to the patient, eventually leading to the )] TJ ET
BT 26.250 286.405 Td /F5 9.8 Tf  [(amputation of a limb. From the expatriate surgeon�s view, the reasons for this are mainly linked to unresolved matters of power )] TJ ET
BT 26.250 274.500 Td /F5 9.8 Tf  [(and status, rendered more complex through the intercultural setting. Subsequent post-operative care is exclusively provided by )] TJ ET
BT 26.250 262.596 Td /F5 9.8 Tf  [(the local surgeons, as the expatriate surgeon lacks access to the facilities on a regular basis. No follow-up of the patient is )] TJ ET
BT 26.250 250.691 Td /F5 9.8 Tf  [(possible by the physician who should act as trainer. The incident is reported to the organization�s managers, who agree that no )] TJ ET
BT 26.250 238.786 Td /F5 9.8 Tf  [(further steps are needed to address the situation, accepting the harm as a kind of �collateral damage� for an otherwise useful )] TJ ET
BT 26.250 226.881 Td /F5 9.8 Tf  [(program.)] TJ ET
BT 26.250 207.477 Td /F1 9.8 Tf  [(For the organization, the emphasis was on ensuring a continued presence in the country, accepting a certain degree of harm. )] TJ ET
BT 26.250 195.572 Td /F1 9.8 Tf  [(However, it cannot simply be assumed that high-risk actions potentially resulting in significant harm to patients are justified for )] TJ ET
BT 26.250 183.667 Td /F1 9.8 Tf  [(the sake of remaining present in certain contexts, at least if this means pursuing a political rather than a purely humanitarian )] TJ ET
BT 26.250 171.762 Td /F1 9.8 Tf  [(goal. Programs that deploy highly qualified staff such as surgeons and have the goal of implementing projects bearing high risks )] TJ ET
BT 26.250 159.858 Td /F1 9.8 Tf  [(to the affected population need to be thoroughly evaluated in regard to potential harms and benefits, as well as their distribution. )] TJ ET
BT 26.250 147.953 Td /F1 9.8 Tf  [(At present, the decision-making structures do not explicitly insist on carrying out an in-depth review of the benefits or risks that )] TJ ET
BT 26.250 136.048 Td /F1 9.8 Tf  [(certain operations have on the beneficiaries. Ethical aspects should be identified before deploying teams or at least as )] TJ ET
BT 26.250 124.143 Td /F1 9.8 Tf  [(dilemmas arise. Programs should also be regularly monitored and evaluated in order to avoid causing unnecessary and )] TJ ET
BT 26.250 112.239 Td /F1 9.8 Tf  [(unjustified harm.)] TJ ET
BT 26.250 92.834 Td /F1 9.8 Tf  [(These three cases illustrate that humanitarian contexts are riddled with ethical issues on every level and they vary in complexity. )] TJ ET
BT 26.250 80.929 Td /F1 9.8 Tf  [(Providing a simple, straightforward answer to these issues is difficult and often impossible. First, there appears to be a gap in )] TJ ET
BT 26.250 69.024 Td /F1 9.8 Tf  [(the literature regarding the identification of possible ethical issues and their distinction from geopolitical or strategic questions. )] TJ ET
BT 26.250 57.120 Td /F1 9.8 Tf  [(Second, there may be genuine conflicts of principles or values that cannot be solved by decreeing a single �solution� but need to )] TJ ET
BT 26.250 45.215 Td /F1 9.8 Tf  [(be resolved by identifying and critically examining arguments in light of input from various perspectives and the relevant )] TJ ET
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BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 26.250 671.350 Td /F4 12.0 Tf  [(Ethical framework)] TJ ET
BT 26.250 651.396 Td /F1 9.8 Tf  [(Generally, the decision-making processes involved in allocating and delivering limited humanitarian resources strive to improve )] TJ ET
BT 26.250 639.491 Td /F1 9.8 Tf  [(people�s well-being. However, decision-making processes and the degree to which ethical issues are identified and addressed )] TJ ET
BT 26.250 627.586 Td /F1 9.8 Tf  [(differ across organizations. No structured reference framework currently exists that can assist aid workers in identifying potential )] TJ ET
BT 26.250 615.681 Td /F1 9.8 Tf  [(ethical issues and support them in their decision-making process.)] TJ ET
BT 26.250 596.277 Td /F1 9.8 Tf  [(In this section, we propose such a framework, drawing on resources that have been developed in the fields of public health and )] TJ ET
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BT 26.250 573.974 Td /F4 8.7 Tf  [(12)] TJ ET
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BT 35.887 572.467 Td /F1 9.8 Tf  [(. Such dilemmas may arise in the humanitarian context, since programs aim to assist populations in a way that might affect )] TJ ET
BT 26.250 560.562 Td /F1 9.8 Tf  [(individual rights. On the other hand, we refer to processes that have proven useful in the clinical context, with clinical ethics )] TJ ET
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BT 426.185 550.165 Td /F4 8.7 Tf  [(13)] TJ ET
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BT 435.823 548.658 Td /F1 9.8 Tf  [(. Likewise, humanitarian aid )] TJ ET
BT 26.250 536.753 Td /F1 9.8 Tf  [(workers care for individuals and populations affected by disasters and may therefore be confronted with similar issues.)] TJ ET
BT 26.250 517.348 Td /F1 9.8 Tf  [(Distilling relevant experiences and insights from both public health ethics and clinical ethics and adjusting them to the context of )] TJ ET
BT 26.250 505.443 Td /F1 9.8 Tf  [(humanitarian aid may allow the young field of ethics of humanitarian action to advance in an efficient way, while benefitting from )] TJ ET
BT 26.250 493.539 Td /F1 9.8 Tf  [(achievements in neighboring fields.)] TJ ET
BT 26.250 474.134 Td /F4 9.8 Tf  [(2.1. Public health ethics frameworks)] TJ ET
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BT 327.564 456.236 Td /F4 8.7 Tf  [(14)] TJ ET
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BT 337.201 454.729 Td /F1 9.8 Tf  [(. They highlight values such as promoting respect for )] TJ ET
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BT 26.250 430.920 Td /F1 9.8 Tf  [(Similarly, one could argue that the distribution of humanitarian relief relies on similar values, insofar as they focus on large )] TJ ET
BT 26.250 419.015 Td /F1 9.8 Tf  [(populations. For example, the allocation of food assistance programs may target several camps, each hosting hundreds of )] TJ ET
BT 26.250 407.110 Td /F1 9.8 Tf  [(thousands of internally displaced persons or refugees. As such, drawing parallels to current public health ethics frameworks is )] TJ ET
BT 26.250 395.205 Td /F1 9.8 Tf  [(reasonable when responding to the needs caused by disasters.)] TJ ET
BT 26.250 375.801 Td /F1 9.8 Tf  [(A challenge in addressing ethical issues in public health is that much policy-making remains in silos, which hinders the joint )] TJ ET
BT 26.250 363.896 Td /F1 9.8 Tf  [(effort at forming cross-sectoral public policy)] TJ ET
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BT 213.723 365.403 Td /F4 8.7 Tf  [(15)] TJ ET
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BT 223.360 363.896 Td /F1 9.8 Tf  [(. A similar case is seen in humanitarian action. Programs appear to be )] TJ ET
BT 26.250 351.991 Td /F1 9.8 Tf  [(distinguished by disciplines such as civil engineering, medicine, agronomy, or law. They might also be differentiated into )] TJ ET
BT 26.250 340.086 Td /F1 9.8 Tf  [(departments such as water and habitat interventions, health interventions, or food and non-food interventions. Changing this )] TJ ET
BT 26.250 328.182 Td /F1 9.8 Tf  [(would require altering the structure of aid organizations. Meanwhile, the dilemma that arises concerns �the rights and freedoms )] TJ ET
BT 26.250 316.277 Td /F1 9.8 Tf  [(of individuals, and the needs and good of the community�)] TJ ET
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BT 273.383 317.784 Td /F4 8.7 Tf  [(12)] TJ ET
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BT 283.021 316.277 Td /F1 9.8 Tf  [(, which cannot remain unaddressed in the field of humanitarian )] TJ ET
BT 26.250 304.372 Td /F1 9.8 Tf  [(action and requires the development of certain skills and tools.)] TJ ET
BT 26.250 284.967 Td /F4 9.8 Tf  [(2.2. Clinical ethics frameworks)] TJ ET
BT 26.250 265.563 Td /F1 9.8 Tf  [(In referring to clinical ethics frameworks in the context of humanitarian action, we acknowledge that humanitarian action evolves )] TJ ET
BT 26.250 253.658 Td /F1 9.8 Tf  [(in a complex environment involving multiple relationships. Some of these are hierarchical, and some are fraught with cross-)] TJ ET
BT 26.250 241.753 Td /F1 9.8 Tf  [(cultural issues. Deciding the correct course of action can be a formidable challenge under such circumstances. Yet, decisions )] TJ ET
BT 26.250 229.848 Td /F1 9.8 Tf  [(must be made in clinical settings according to professional norms)] TJ ET
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BT 307.479 231.356 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 317.116 229.848 Td /F1 9.8 Tf  [( and in humanitarian action, these decisions sometimes )] TJ ET
BT 26.250 217.944 Td /F1 9.8 Tf  [(need to be made quickly and with consideration of their potentially very serious impact. Although clinical practice is mainly )] TJ ET
BT 26.250 206.039 Td /F1 9.8 Tf  [(concerned with individuals while the focus of humanitarian aid is on populations, both perspectives converge in the need to )] TJ ET
BT 26.250 194.134 Td /F1 9.8 Tf  [(respond to challenging situations in an efficient and clearly-argued manner. Having a defined procedural process can improve )] TJ ET
BT 26.250 182.229 Td /F1 9.8 Tf  [(the transparency, accountability, and quality of decisions.)] TJ ET
BT 26.250 162.825 Td /F1 9.8 Tf  [(In the context of clinical settings, complex decisions, including the allocation of limited resources, have to be made frequently. )] TJ ET
BT 26.250 150.920 Td /F1 9.8 Tf  [(Clinical ethicists have developed various tools that assist decision-makers in this difficult task. Key features of some of these )] TJ ET
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BT 26.250 743.667 Td /F1 9.8 Tf  [(standardized steps tailored to the humanitarian context that are currently unavailable. In absence of set criteria on how to weigh )] TJ ET
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BT 26.250 671.350 Td /F4 12.0 Tf  [(Ethical framework)] TJ ET
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BT 26.250 615.681 Td /F1 9.8 Tf  [(ethical issues and support them in their decision-making process.)] TJ ET
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BT 26.250 517.348 Td /F1 9.8 Tf  [(Distilling relevant experiences and insights from both public health ethics and clinical ethics and adjusting them to the context of )] TJ ET
BT 26.250 505.443 Td /F1 9.8 Tf  [(humanitarian aid may allow the young field of ethics of humanitarian action to advance in an efficient way, while benefitting from )] TJ ET
BT 26.250 493.539 Td /F1 9.8 Tf  [(achievements in neighboring fields.)] TJ ET
BT 26.250 474.134 Td /F4 9.8 Tf  [(2.1. Public health ethics frameworks)] TJ ET
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BT 337.201 454.729 Td /F1 9.8 Tf  [(. They highlight values such as promoting respect for )] TJ ET
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BT 26.250 407.110 Td /F1 9.8 Tf  [(thousands of internally displaced persons or refugees. As such, drawing parallels to current public health ethics frameworks is )] TJ ET
BT 26.250 395.205 Td /F1 9.8 Tf  [(reasonable when responding to the needs caused by disasters.)] TJ ET
BT 26.250 375.801 Td /F1 9.8 Tf  [(A challenge in addressing ethical issues in public health is that much policy-making remains in silos, which hinders the joint )] TJ ET
BT 26.250 363.896 Td /F1 9.8 Tf  [(effort at forming cross-sectoral public policy)] TJ ET
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BT 213.723 365.403 Td /F4 8.7 Tf  [(15)] TJ ET
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BT 223.360 363.896 Td /F1 9.8 Tf  [(. A similar case is seen in humanitarian action. Programs appear to be )] TJ ET
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BT 26.250 340.086 Td /F1 9.8 Tf  [(departments such as water and habitat interventions, health interventions, or food and non-food interventions. Changing this )] TJ ET
BT 26.250 328.182 Td /F1 9.8 Tf  [(would require altering the structure of aid organizations. Meanwhile, the dilemma that arises concerns �the rights and freedoms )] TJ ET
BT 26.250 316.277 Td /F1 9.8 Tf  [(of individuals, and the needs and good of the community�)] TJ ET
0.267 0.267 0.267 rg
BT 273.383 317.784 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 283.021 316.277 Td /F1 9.8 Tf  [(, which cannot remain unaddressed in the field of humanitarian )] TJ ET
BT 26.250 304.372 Td /F1 9.8 Tf  [(action and requires the development of certain skills and tools.)] TJ ET
BT 26.250 284.967 Td /F4 9.8 Tf  [(2.2. Clinical ethics frameworks)] TJ ET
BT 26.250 265.563 Td /F1 9.8 Tf  [(In referring to clinical ethics frameworks in the context of humanitarian action, we acknowledge that humanitarian action evolves )] TJ ET
BT 26.250 253.658 Td /F1 9.8 Tf  [(in a complex environment involving multiple relationships. Some of these are hierarchical, and some are fraught with cross-)] TJ ET
BT 26.250 241.753 Td /F1 9.8 Tf  [(cultural issues. Deciding the correct course of action can be a formidable challenge under such circumstances. Yet, decisions )] TJ ET
BT 26.250 229.848 Td /F1 9.8 Tf  [(must be made in clinical settings according to professional norms)] TJ ET
0.267 0.267 0.267 rg
BT 307.479 231.356 Td /F4 8.7 Tf  [(13)] TJ ET
0.271 0.267 0.267 rg
BT 317.116 229.848 Td /F1 9.8 Tf  [( and in humanitarian action, these decisions sometimes )] TJ ET
BT 26.250 217.944 Td /F1 9.8 Tf  [(need to be made quickly and with consideration of their potentially very serious impact. Although clinical practice is mainly )] TJ ET
BT 26.250 206.039 Td /F1 9.8 Tf  [(concerned with individuals while the focus of humanitarian aid is on populations, both perspectives converge in the need to )] TJ ET
BT 26.250 194.134 Td /F1 9.8 Tf  [(respond to challenging situations in an efficient and clearly-argued manner. Having a defined procedural process can improve )] TJ ET
BT 26.250 182.229 Td /F1 9.8 Tf  [(the transparency, accountability, and quality of decisions.)] TJ ET
BT 26.250 162.825 Td /F1 9.8 Tf  [(In the context of clinical settings, complex decisions, including the allocation of limited resources, have to be made frequently. )] TJ ET
BT 26.250 150.920 Td /F1 9.8 Tf  [(Clinical ethicists have developed various tools that assist decision-makers in this difficult task. Key features of some of these )] TJ ET
BT 26.250 139.015 Td /F1 9.8 Tf  [(tools)] TJ ET
BT 46.842 142.903 Td /F1 8.7 Tf  [([3])] TJ ET
BT 56.479 139.015 Td /F1 9.8 Tf  [( are:)] TJ ET
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BT 26.250 755.571 Td /F1 9.8 Tf  [(as beneficence and non-maleficence, or equality and needs. This process would benefit from an ethical framework and )] TJ ET
BT 26.250 743.667 Td /F1 9.8 Tf  [(standardized steps tailored to the humanitarian context that are currently unavailable. In absence of set criteria on how to weigh )] TJ ET
BT 26.250 731.762 Td /F1 9.8 Tf  [(the principles, we suggest pointing towards Beauchamp and Childresses�)] TJ ET
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BT 341.633 733.269 Td /F4 8.7 Tf  [(22)] TJ ET
0.271 0.267 0.267 rg
BT 351.271 731.762 Td /F1 9.8 Tf  [( process and conditions of weighing and balancing )] TJ ET
BT 26.250 719.857 Td /F1 9.8 Tf  [(principles highlighting that �balancing is the process of finding reasons to support beliefs about which moral norms should )] TJ ET
BT 26.250 707.952 Td /F1 9.8 Tf  [(prevail.�)] TJ ET
BT 59.839 711.841 Td /F1 8.7 Tf  [([2])] TJ ET
BT 26.250 671.350 Td /F4 12.0 Tf  [(Ethical framework)] TJ ET
BT 26.250 651.396 Td /F1 9.8 Tf  [(Generally, the decision-making processes involved in allocating and delivering limited humanitarian resources strive to improve )] TJ ET
BT 26.250 639.491 Td /F1 9.8 Tf  [(people�s well-being. However, decision-making processes and the degree to which ethical issues are identified and addressed )] TJ ET
BT 26.250 627.586 Td /F1 9.8 Tf  [(differ across organizations. No structured reference framework currently exists that can assist aid workers in identifying potential )] TJ ET
BT 26.250 615.681 Td /F1 9.8 Tf  [(ethical issues and support them in their decision-making process.)] TJ ET
BT 26.250 596.277 Td /F1 9.8 Tf  [(In this section, we propose such a framework, drawing on resources that have been developed in the fields of public health and )] TJ ET
BT 26.250 584.372 Td /F1 9.8 Tf  [(clinical ethics. In public health ethics, the focus is on eventual dilemmas arising between individual rights and community benefit)] TJ ET
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BT 26.250 573.974 Td /F4 8.7 Tf  [(12)] TJ ET
0.271 0.267 0.267 rg
BT 35.887 572.467 Td /F1 9.8 Tf  [(. Such dilemmas may arise in the humanitarian context, since programs aim to assist populations in a way that might affect )] TJ ET
BT 26.250 560.562 Td /F1 9.8 Tf  [(individual rights. On the other hand, we refer to processes that have proven useful in the clinical context, with clinical ethics )] TJ ET
BT 26.250 548.658 Td /F1 9.8 Tf  [(offering guidance on the management and resolution of moral conflicts arising in-patient care)] TJ ET
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BT 426.185 550.165 Td /F4 8.7 Tf  [(13)] TJ ET
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BT 435.823 548.658 Td /F1 9.8 Tf  [(. Likewise, humanitarian aid )] TJ ET
BT 26.250 536.753 Td /F1 9.8 Tf  [(workers care for individuals and populations affected by disasters and may therefore be confronted with similar issues.)] TJ ET
BT 26.250 517.348 Td /F1 9.8 Tf  [(Distilling relevant experiences and insights from both public health ethics and clinical ethics and adjusting them to the context of )] TJ ET
BT 26.250 505.443 Td /F1 9.8 Tf  [(humanitarian aid may allow the young field of ethics of humanitarian action to advance in an efficient way, while benefitting from )] TJ ET
BT 26.250 493.539 Td /F1 9.8 Tf  [(achievements in neighboring fields.)] TJ ET
BT 26.250 474.134 Td /F4 9.8 Tf  [(2.1. Public health ethics frameworks)] TJ ET
BT 26.250 454.729 Td /F1 9.8 Tf  [(In public health, a number of ethical frameworks have been proposed )] TJ ET
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BT 327.564 456.236 Td /F4 8.7 Tf  [(14)] TJ ET
0.271 0.267 0.267 rg
BT 337.201 454.729 Td /F1 9.8 Tf  [(. They highlight values such as promoting respect for )] TJ ET
BT 26.250 442.824 Td /F1 9.8 Tf  [(people while protecting public health, producing maximal benefits while minimizing harm, cost-effectiveness, and social justice. )] TJ ET
BT 26.250 430.920 Td /F1 9.8 Tf  [(Similarly, one could argue that the distribution of humanitarian relief relies on similar values, insofar as they focus on large )] TJ ET
BT 26.250 419.015 Td /F1 9.8 Tf  [(populations. For example, the allocation of food assistance programs may target several camps, each hosting hundreds of )] TJ ET
BT 26.250 407.110 Td /F1 9.8 Tf  [(thousands of internally displaced persons or refugees. As such, drawing parallels to current public health ethics frameworks is )] TJ ET
BT 26.250 395.205 Td /F1 9.8 Tf  [(reasonable when responding to the needs caused by disasters.)] TJ ET
BT 26.250 375.801 Td /F1 9.8 Tf  [(A challenge in addressing ethical issues in public health is that much policy-making remains in silos, which hinders the joint )] TJ ET
BT 26.250 363.896 Td /F1 9.8 Tf  [(effort at forming cross-sectoral public policy)] TJ ET
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BT 213.723 365.403 Td /F4 8.7 Tf  [(15)] TJ ET
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BT 223.360 363.896 Td /F1 9.8 Tf  [(. A similar case is seen in humanitarian action. Programs appear to be )] TJ ET
BT 26.250 351.991 Td /F1 9.8 Tf  [(distinguished by disciplines such as civil engineering, medicine, agronomy, or law. They might also be differentiated into )] TJ ET
BT 26.250 340.086 Td /F1 9.8 Tf  [(departments such as water and habitat interventions, health interventions, or food and non-food interventions. Changing this )] TJ ET
BT 26.250 328.182 Td /F1 9.8 Tf  [(would require altering the structure of aid organizations. Meanwhile, the dilemma that arises concerns �the rights and freedoms )] TJ ET
BT 26.250 316.277 Td /F1 9.8 Tf  [(of individuals, and the needs and good of the community�)] TJ ET
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BT 273.383 317.784 Td /F4 8.7 Tf  [(12)] TJ ET
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BT 283.021 316.277 Td /F1 9.8 Tf  [(, which cannot remain unaddressed in the field of humanitarian )] TJ ET
BT 26.250 304.372 Td /F1 9.8 Tf  [(action and requires the development of certain skills and tools.)] TJ ET
BT 26.250 284.967 Td /F4 9.8 Tf  [(2.2. Clinical ethics frameworks)] TJ ET
BT 26.250 265.563 Td /F1 9.8 Tf  [(In referring to clinical ethics frameworks in the context of humanitarian action, we acknowledge that humanitarian action evolves )] TJ ET
BT 26.250 253.658 Td /F1 9.8 Tf  [(in a complex environment involving multiple relationships. Some of these are hierarchical, and some are fraught with cross-)] TJ ET
BT 26.250 241.753 Td /F1 9.8 Tf  [(cultural issues. Deciding the correct course of action can be a formidable challenge under such circumstances. Yet, decisions )] TJ ET
BT 26.250 229.848 Td /F1 9.8 Tf  [(must be made in clinical settings according to professional norms)] TJ ET
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BT 307.479 231.356 Td /F4 8.7 Tf  [(13)] TJ ET
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BT 317.116 229.848 Td /F1 9.8 Tf  [( and in humanitarian action, these decisions sometimes )] TJ ET
BT 26.250 217.944 Td /F1 9.8 Tf  [(need to be made quickly and with consideration of their potentially very serious impact. Although clinical practice is mainly )] TJ ET
BT 26.250 206.039 Td /F1 9.8 Tf  [(concerned with individuals while the focus of humanitarian aid is on populations, both perspectives converge in the need to )] TJ ET
BT 26.250 194.134 Td /F1 9.8 Tf  [(respond to challenging situations in an efficient and clearly-argued manner. Having a defined procedural process can improve )] TJ ET
BT 26.250 182.229 Td /F1 9.8 Tf  [(the transparency, accountability, and quality of decisions.)] TJ ET
BT 26.250 162.825 Td /F1 9.8 Tf  [(In the context of clinical settings, complex decisions, including the allocation of limited resources, have to be made frequently. )] TJ ET
BT 26.250 150.920 Td /F1 9.8 Tf  [(Clinical ethicists have developed various tools that assist decision-makers in this difficult task. Key features of some of these )] TJ ET
BT 26.250 139.015 Td /F1 9.8 Tf  [(tools)] TJ ET
BT 46.842 142.903 Td /F1 8.7 Tf  [([3])] TJ ET
BT 56.479 139.015 Td /F1 9.8 Tf  [( are:)] TJ ET
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BT 291.710 19.825 Td /F1 11.0 Tf  [(4)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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BT 32.206 767.494 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 45.750 767.476 Td /F1 9.8 Tf  [(Situation analysis involving all concerned actors)] TJ ET
BT 32.206 751.839 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 45.750 751.821 Td /F1 9.8 Tf  [(Description of the key values at stake and their potential conflict)] TJ ET
BT 32.206 736.184 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 45.750 736.167 Td /F1 9.8 Tf  [(Critical examination of the arguments at stake)] TJ ET
BT 32.206 720.530 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 45.750 720.512 Td /F1 9.8 Tf  [(Description of options and their potential and forecasted consequences on each actor)] TJ ET
BT 32.206 704.875 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 45.750 704.857 Td /F1 9.8 Tf  [(Weighing of options)] TJ ET
BT 32.206 689.220 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 45.750 689.202 Td /F1 9.8 Tf  [(Agreeing on the way forward)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(In a suitably adapted form, similarly structured multi-step approaches might also support the decision-making processes in )] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(humanitarian programs. In addition, clinical ethics has developed models for fostering expertise in clinical institutions without )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(moral responsibility being delegated to an �ethics expert� \(see �Institutional requirements� below\).)] TJ ET
BT 26.250 622.833 Td /F4 9.8 Tf  [(2.3. Identifying ethical issues and making decisions in humanitarian aid)] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(Our suggested ethical framework is an attempt to engage the humanitarian community in the discourse of identifying ethical )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(issues in the context of humanitarian action and to provide tools to strengthen the decision-making process of humanitarian aid )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(workers. The framework draws from previously developed concepts that have proven useful in public health and clinical ethics. )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(This framework has three main aims.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(First, it intends to emphazise that humanitarian action is based on )] TJ ET
BT 312.383 548.310 Td /F5 9.8 Tf  [(sets of values )] TJ ET
BT 374.705 548.310 Td /F1 9.8 Tf  [(referred to explicitly or implicitly by )] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(humanitarian actors, organizations and donors)] TJ ET
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BT 226.759 537.912 Td /F4 8.7 Tf  [(25)] TJ ET
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BT 236.396 536.405 Td /F1 9.8 Tf  [( . Stakeholders or agencies may embrace different sets of values)] TJ ET
0.267 0.267 0.267 rg
BT 516.562 537.912 Td /F4 8.7 Tf  [(16)] TJ ET
0.271 0.267 0.267 rg
BT 526.200 536.405 Td /F1 9.8 Tf  [(. Certain )] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(values represent the substantive views of the organization such as impartiality, independence or religious beliefs. Others values )] TJ ET
BT 26.250 512.595 Td /F1 9.8 Tf  [(mirror procedural values such as accountability, transparency and needs-based approaches. However, some authors challenge )] TJ ET
BT 26.250 500.691 Td /F1 9.8 Tf  [(the applicability of values such as neutrality or impartiality)] TJ ET
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BT 273.880 502.198 Td /F4 8.7 Tf  [(16)] TJ ET
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BT 283.518 504.579 Td /F1 8.7 Tf  [(,)] TJ ET
0.267 0.267 0.267 rg
BT 285.927 502.198 Td /F4 8.7 Tf  [(17)] TJ ET
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BT 295.565 500.691 Td /F1 9.8 Tf  [(, while other values are considered as �tools� to carry out the )] TJ ET
BT 26.250 488.786 Td /F1 9.8 Tf  [(operations. Terry)] TJ ET
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BT 99.941 490.293 Td /F4 8.7 Tf  [(18)] TJ ET
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BT 109.578 488.786 Td /F1 9.8 Tf  [( refers to the contested principle of neutrality, stating that in the Afghan context, �neutrality was still an )] TJ ET
BT 26.250 476.881 Td /F1 9.8 Tf  [(appropriate means to gain access to people in need.� On the other hand, values such as solidarity, defending human rights, or )] TJ ET
BT 26.250 464.976 Td /F1 9.8 Tf  [(accountability are much less contested. However, as soon as values conflict with each other, humanitarian aid workers are likely )] TJ ET
BT 26.250 453.072 Td /F1 9.8 Tf  [(to face a dilemma. Therefore, the proposed framework aims to raise awareness that certain issues faced by humanitarian aid )] TJ ET
BT 26.250 441.167 Td /F1 9.8 Tf  [(workers are ethical issues, as opposed to geopolitical or managerial questions, and humanitarian actors are therefore likely to )] TJ ET
BT 26.250 429.262 Td /F1 9.8 Tf  [(face dilemmas that might lead to moral distress. This is particularly applicable to professionals who should adhere to particular )] TJ ET
BT 26.250 417.357 Td /F1 9.8 Tf  [(codes of ethics, such as physicians. It also suggests that certain values can be attributed to the different levels of decision-)] TJ ET
BT 26.250 405.453 Td /F1 9.8 Tf  [(making, namely at the macro-, meso-, and micro-level \(Table 1\).)] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(Second, a )] TJ ET
BT 72.865 386.048 Td /F5 9.8 Tf  [(procedural process)] TJ ET
BT 155.769 386.048 Td /F1 9.8 Tf  [( is proposed providing a ten-step approach \(Table 2\) is proposed to ensure that ethical )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(considerations are factored into the decision-making process and addressed in an adequate manner. This model provides a )] TJ ET
BT 26.250 362.238 Td /F1 9.8 Tf  [(structure and promotes transparency of the decision-making process, which allows for a comprehensive monitoring and )] TJ ET
BT 26.250 350.334 Td /F1 9.8 Tf  [(evaluation of humanitarian programs. Third, the framework formulates )] TJ ET
BT 330.236 350.334 Td /F5 9.8 Tf  [(institutional requirements)] TJ ET
BT 438.607 350.334 Td /F1 9.8 Tf  [(, drawing parallels to a tool that )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(has proven useful in the clinical setting. Overall, the proposed framework has been based on the experiences of several )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(humanitarian fieldworkers and was tested and deemed useful by humanitarian aid workers and donor agencies. This approach )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(was designed so that it can evolve further and be adjusted to specific needs in the field.)] TJ ET
BT 26.250 295.215 Td /F4 9.8 Tf  [(Part One: Defining a set of values guiding humanitarian action)] TJ ET
BT 26.250 275.810 Td /F1 9.8 Tf  [(The values listed in Table 1 have been drawn from an empirical study by one of the authors that analyzed the value statements )] TJ ET
BT 26.250 263.905 Td /F1 9.8 Tf  [(of 46 international organizations active in the humanitarian context)] TJ ET
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BT 322.030 263.905 Td /F1 9.8 Tf  [(. The ten most frequently mentioned values by the )] TJ ET
BT 26.250 252.000 Td /F1 9.8 Tf  [(humanitarian organizations were: health, independence, poverty reduction, accountability, humanity, sustainability, )] TJ ET
BT 26.250 240.096 Td /F1 9.8 Tf  [(transparency, relief, dignity, and empowerment.)] TJ ET
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BT 32.206 767.494 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 45.750 767.476 Td /F1 9.8 Tf  [(Situation analysis involving all concerned actors)] TJ ET
BT 32.206 751.839 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 45.750 751.821 Td /F1 9.8 Tf  [(Description of the key values at stake and their potential conflict)] TJ ET
BT 32.206 736.184 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 45.750 736.167 Td /F1 9.8 Tf  [(Critical examination of the arguments at stake)] TJ ET
BT 32.206 720.530 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 45.750 720.512 Td /F1 9.8 Tf  [(Description of options and their potential and forecasted consequences on each actor)] TJ ET
BT 32.206 704.875 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 45.750 704.857 Td /F1 9.8 Tf  [(Weighing of options)] TJ ET
BT 32.206 689.220 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 45.750 689.202 Td /F1 9.8 Tf  [(Agreeing on the way forward)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(In a suitably adapted form, similarly structured multi-step approaches might also support the decision-making processes in )] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(humanitarian programs. In addition, clinical ethics has developed models for fostering expertise in clinical institutions without )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(moral responsibility being delegated to an �ethics expert� \(see �Institutional requirements� below\).)] TJ ET
BT 26.250 622.833 Td /F4 9.8 Tf  [(2.3. Identifying ethical issues and making decisions in humanitarian aid)] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(Our suggested ethical framework is an attempt to engage the humanitarian community in the discourse of identifying ethical )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(issues in the context of humanitarian action and to provide tools to strengthen the decision-making process of humanitarian aid )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(workers. The framework draws from previously developed concepts that have proven useful in public health and clinical ethics. )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(This framework has three main aims.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(First, it intends to emphazise that humanitarian action is based on )] TJ ET
BT 312.383 548.310 Td /F5 9.8 Tf  [(sets of values )] TJ ET
BT 374.705 548.310 Td /F1 9.8 Tf  [(referred to explicitly or implicitly by )] TJ ET
BT 26.250 536.405 Td /F1 9.8 Tf  [(humanitarian actors, organizations and donors)] TJ ET
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BT 226.759 537.912 Td /F4 8.7 Tf  [(25)] TJ ET
0.271 0.267 0.267 rg
BT 236.396 536.405 Td /F1 9.8 Tf  [( . Stakeholders or agencies may embrace different sets of values)] TJ ET
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BT 516.562 537.912 Td /F4 8.7 Tf  [(16)] TJ ET
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BT 526.200 536.405 Td /F1 9.8 Tf  [(. Certain )] TJ ET
BT 26.250 524.500 Td /F1 9.8 Tf  [(values represent the substantive views of the organization such as impartiality, independence or religious beliefs. Others values )] TJ ET
BT 26.250 512.595 Td /F1 9.8 Tf  [(mirror procedural values such as accountability, transparency and needs-based approaches. However, some authors challenge )] TJ ET
BT 26.250 500.691 Td /F1 9.8 Tf  [(the applicability of values such as neutrality or impartiality)] TJ ET
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BT 273.880 502.198 Td /F4 8.7 Tf  [(16)] TJ ET
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BT 26.250 464.976 Td /F1 9.8 Tf  [(accountability are much less contested. However, as soon as values conflict with each other, humanitarian aid workers are likely )] TJ ET
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BT 26.250 405.453 Td /F1 9.8 Tf  [(making, namely at the macro-, meso-, and micro-level \(Table 1\).)] TJ ET
BT 26.250 386.048 Td /F1 9.8 Tf  [(Second, a )] TJ ET
BT 72.865 386.048 Td /F5 9.8 Tf  [(procedural process)] TJ ET
BT 155.769 386.048 Td /F1 9.8 Tf  [( is proposed providing a ten-step approach \(Table 2\) is proposed to ensure that ethical )] TJ ET
BT 26.250 374.143 Td /F1 9.8 Tf  [(considerations are factored into the decision-making process and addressed in an adequate manner. This model provides a )] TJ ET
BT 26.250 362.238 Td /F1 9.8 Tf  [(structure and promotes transparency of the decision-making process, which allows for a comprehensive monitoring and )] TJ ET
BT 26.250 350.334 Td /F1 9.8 Tf  [(evaluation of humanitarian programs. Third, the framework formulates )] TJ ET
BT 330.236 350.334 Td /F5 9.8 Tf  [(institutional requirements)] TJ ET
BT 438.607 350.334 Td /F1 9.8 Tf  [(, drawing parallels to a tool that )] TJ ET
BT 26.250 338.429 Td /F1 9.8 Tf  [(has proven useful in the clinical setting. Overall, the proposed framework has been based on the experiences of several )] TJ ET
BT 26.250 326.524 Td /F1 9.8 Tf  [(humanitarian fieldworkers and was tested and deemed useful by humanitarian aid workers and donor agencies. This approach )] TJ ET
BT 26.250 314.619 Td /F1 9.8 Tf  [(was designed so that it can evolve further and be adjusted to specific needs in the field.)] TJ ET
BT 26.250 295.215 Td /F4 9.8 Tf  [(Part One: Defining a set of values guiding humanitarian action)] TJ ET
BT 26.250 275.810 Td /F1 9.8 Tf  [(The values listed in Table 1 have been drawn from an empirical study by one of the authors that analyzed the value statements )] TJ ET
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BT 45.750 689.202 Td /F1 9.8 Tf  [(Agreeing on the way forward)] TJ ET
BT 26.250 666.048 Td /F1 9.8 Tf  [(In a suitably adapted form, similarly structured multi-step approaches might also support the decision-making processes in )] TJ ET
BT 26.250 654.143 Td /F1 9.8 Tf  [(humanitarian programs. In addition, clinical ethics has developed models for fostering expertise in clinical institutions without )] TJ ET
BT 26.250 642.238 Td /F1 9.8 Tf  [(moral responsibility being delegated to an �ethics expert� \(see �Institutional requirements� below\).)] TJ ET
BT 26.250 622.833 Td /F4 9.8 Tf  [(2.3. Identifying ethical issues and making decisions in humanitarian aid)] TJ ET
BT 26.250 603.429 Td /F1 9.8 Tf  [(Our suggested ethical framework is an attempt to engage the humanitarian community in the discourse of identifying ethical )] TJ ET
BT 26.250 591.524 Td /F1 9.8 Tf  [(issues in the context of humanitarian action and to provide tools to strengthen the decision-making process of humanitarian aid )] TJ ET
BT 26.250 579.619 Td /F1 9.8 Tf  [(workers. The framework draws from previously developed concepts that have proven useful in public health and clinical ethics. )] TJ ET
BT 26.250 567.714 Td /F1 9.8 Tf  [(This framework has three main aims.)] TJ ET
BT 26.250 548.310 Td /F1 9.8 Tf  [(First, it intends to emphazise that humanitarian action is based on )] TJ ET
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BT 267.124 639.626 Td /F1 9.8 Tf  [(Efficiency)] TJ ET
BT 26.250 459.075 Td /F1 9.8 Tf  [(These values)] TJ ET
BT 84.233 462.964 Td /F1 8.7 Tf  [([4])] TJ ET
BT 93.871 459.075 Td /F1 9.8 Tf  [( represent only a selection that can serve as a starting point for individual organizations developing their own )] TJ ET
BT 26.250 447.171 Td /F1 9.8 Tf  [(value matrix. These organizations will find that some values are specific to levels relevant to their decision-making structure, )] TJ ET
BT 26.250 435.266 Td /F1 9.8 Tf  [(while others cut across different issues. For instance, aid workers at the micro-level might not be expected to worry about the )] TJ ET
BT 26.250 423.361 Td /F1 9.8 Tf  [(sustainability of organizations, which may be of more concern to headquarters. However, the aid workers might be expected to )] TJ ET
BT 26.250 411.456 Td /F1 9.8 Tf  [(deliver aid in a non-discriminatory way. Some of the values in an organization�s value matrix will be more substantive, while )] TJ ET
BT 26.250 399.552 Td /F1 9.8 Tf  [(others are more procedural. Although the classification of some values can be contested, the point is to revisit two central )] TJ ET
BT 26.250 387.647 Td /F1 9.8 Tf  [(questions organizations should ask themselves: a\) What are the moral values we try to realize with our work, and b\) How do we )] TJ ET
BT 26.250 375.742 Td /F1 9.8 Tf  [(want to obtain these goals?)] TJ ET
BT 26.250 356.337 Td /F4 9.8 Tf  [(Part Two: A ten-step approach to ethical decision-making in humanitarian aid)] TJ ET
BT 26.250 336.933 Td /F1 9.8 Tf  [(Based on the assumption that decision-makers are aware of the need to a\) identify ethical issues in the humanitarian context as )] TJ ET
BT 26.250 325.028 Td /F1 9.8 Tf  [(such, and that b\) the organization embraces values, norms, or principles that can serve to justify a response, we suggest a ten-)] TJ ET
BT 26.250 313.123 Td /F1 9.8 Tf  [(step approach that supports aid workers at macro-, meso- and micro-levels alike in their difficult task of making ethically sound )] TJ ET
BT 26.250 301.218 Td /F1 9.8 Tf  [(decisions. This approach is based on tools that are well-established and effective in clinical settings.)] TJ ET
BT 26.250 281.814 Td /F1 9.8 Tf  [(However, before initiating the first step, the following preconditions should be met. First, a platform to discuss needs should be )] TJ ET
BT 26.250 269.909 Td /F1 9.8 Tf  [(made available where opinions can be shared openly. This might entail a round-table discussion similar to ethical consultations )] TJ ET
BT 26.250 258.004 Td /F1 9.8 Tf  [(in a clinical setting. These discussions would ideally evolve into regular meetings of an established group of ethics committees. )] TJ ET
BT 26.250 246.099 Td /F1 9.8 Tf  [(Second, all participants acknowledge that various interests may affect the decision-making process, such as those of )] TJ ET
BT 26.250 234.195 Td /F1 9.8 Tf  [(organizations themselves, the donor community, local or regional governments, and others. It is, however, paramount that the )] TJ ET
BT 26.250 222.290 Td /F1 9.8 Tf  [(interests of the beneficiary are at the center of the debate during the discussion. Finally, an ethicist should oversee the )] TJ ET
BT 26.250 210.385 Td /F1 9.8 Tf  [(discussion, ensuring that all participants have equal opportunity to express their viewpoints. Based on the success of this )] TJ ET
BT 26.250 198.480 Td /F1 9.8 Tf  [(approach for dealing with ethical dilemmas in clinical settings, we believe that a formally trained ethicist would be a valuable )] TJ ET
BT 26.250 186.576 Td /F1 9.8 Tf  [(asset to humanitarian organizations. Ethicists have a unique ability to identify critical ethical issues and act as an intermediary )] TJ ET
BT 26.250 174.671 Td /F1 9.8 Tf  [(between multiple parties in order to resolve them fairly. Hiring such a professional would not require significant financial )] TJ ET
BT 26.250 162.766 Td /F1 9.8 Tf  [(investment from an organization and might also provide aid workers, managers, or physicians with some degree of formal ethics )] TJ ET
BT 26.250 150.861 Td /F1 9.8 Tf  [(training.)] TJ ET
Q
q
15.000 119.744 577.500 657.256 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 1: Set of values commonly shared among humanitarian aid organizations)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 513.599 555.000 242.165 re f
0.965 0.965 0.965 rg
27.000 742.734 120.202 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 120.577 0.750 re f
26.625 742.359 0.750 13.030 re f
0.965 0.965 0.965 rg
147.202 742.734 238.330 12.280 re f
0.267 0.267 0.267 rg
147.202 754.639 115.047 0.750 re f
262.249 754.639 123.282 0.750 re f
0.271 0.267 0.267 rg
BT 151.702 745.490 Td /F4 9.8 Tf  [(Specific values)] TJ ET
0.965 0.965 0.965 rg
385.531 742.734 194.969 12.280 re f
0.267 0.267 0.267 rg
385.531 754.639 101.033 0.750 re f
486.564 754.639 94.311 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 390.031 745.490 Td /F4 9.8 Tf  [(Cross-cutting values)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 120.952 0.750 re f
26.625 726.478 0.750 16.631 re f
146.827 742.359 115.797 0.750 re f
146.827 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 152.077 732.504 Td /F1 9.8 Tf  [(Substantive)] TJ ET
0.267 0.267 0.267 rg
261.874 742.359 124.032 0.750 re f
261.874 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 267.124 732.504 Td /F1 9.8 Tf  [(Procedural)] TJ ET
0.267 0.267 0.267 rg
385.156 742.359 101.783 0.750 re f
385.156 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 390.406 732.504 Td /F1 9.8 Tf  [(Substantive)] TJ ET
0.267 0.267 0.267 rg
486.189 742.359 94.686 0.750 re f
486.189 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 491.439 732.504 Td /F1 9.8 Tf  [(Procedural)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 120.952 0.750 re f
26.625 687.637 0.750 39.591 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(Macro and meso level)] TJ ET
BT 31.875 708.991 Td /F1 9.8 Tf  [(\(Headquarter and )] TJ ET
BT 31.875 701.360 Td /F1 9.8 Tf  [(regional level\))] TJ ET
0.267 0.267 0.267 rg
146.827 726.478 115.797 0.750 re f
146.827 687.637 0.750 39.591 re f
0.271 0.267 0.267 rg
BT 152.077 716.623 Td /F1 9.8 Tf  [(Poverty reduction )] TJ ET
BT 152.077 708.991 Td /F1 9.8 Tf  [(Sustainability)] TJ ET
0.267 0.267 0.267 rg
261.874 726.478 124.032 0.750 re f
261.874 687.637 0.750 39.591 re f
0.271 0.267 0.267 rg
BT 267.124 716.623 Td /F1 9.8 Tf  [(Inclusiveness)] TJ ET
BT 267.124 708.991 Td /F1 9.8 Tf  [(Accountability)] TJ ET
BT 267.124 701.360 Td /F1 9.8 Tf  [(Reasonableness)] TJ ET
BT 267.124 693.729 Td /F1 9.8 Tf  [(Critical analysis)] TJ ET
0.267 0.267 0.267 rg
385.156 726.478 101.783 0.750 re f
385.156 513.974 101.783 0.750 re f
385.156 688.012 0.750 39.216 re f
385.156 513.974 0.750 174.038 re f
0.271 0.267 0.267 rg
BT 390.406 716.623 Td /F1 9.8 Tf  [(Duty to provide care)] TJ ET
BT 390.406 708.991 Td /F1 9.8 Tf  [(Vulnerability)] TJ ET
BT 390.406 701.360 Td /F1 9.8 Tf  [(Justice)] TJ ET
BT 390.406 693.729 Td /F1 9.8 Tf  [(Solidarity)] TJ ET
BT 390.406 686.098 Td /F1 9.8 Tf  [(Equity)] TJ ET
BT 390.406 678.466 Td /F1 9.8 Tf  [(Beneficence)] TJ ET
BT 390.406 670.835 Td /F1 9.8 Tf  [(Non-maleficence)] TJ ET
BT 390.406 663.204 Td /F1 9.8 Tf  [(Cost-effectiveness)] TJ ET
BT 390.406 655.573 Td /F1 9.8 Tf  [(Stewardship)] TJ ET
0.267 0.267 0.267 rg
486.189 726.478 94.686 0.750 re f
486.189 513.974 94.686 0.750 re f
486.189 688.012 0.750 39.216 re f
580.125 688.012 0.750 39.216 re f
486.189 513.974 0.750 174.038 re f
580.125 513.974 0.750 174.038 re f
0.271 0.267 0.267 rg
BT 491.439 716.623 Td /F1 9.8 Tf  [(Transparency)] TJ ET
BT 491.439 708.991 Td /F1 9.8 Tf  [(Scrutiny)] TJ ET
0.267 0.267 0.267 rg
26.625 687.637 120.952 0.750 re f
26.625 513.974 120.952 0.750 re f
26.625 513.974 0.750 174.413 re f
0.271 0.267 0.267 rg
BT 31.875 677.782 Td /F1 9.8 Tf  [(Micro level)] TJ ET
BT 31.875 670.151 Td /F1 9.8 Tf  [(\(Local level\))] TJ ET
0.267 0.267 0.267 rg
146.827 687.637 115.797 0.750 re f
146.827 513.974 115.797 0.750 re f
146.827 513.974 0.750 174.413 re f
0.271 0.267 0.267 rg
BT 152.077 677.782 Td /F1 9.8 Tf  [(Focus on the worst off)] TJ ET
BT 152.077 670.151 Td /F1 9.8 Tf  [(Self-determination)] TJ ET
BT 152.077 662.520 Td /F1 9.8 Tf  [(Security)] TJ ET
BT 152.077 654.888 Td /F1 9.8 Tf  [(Autonomy)] TJ ET
BT 152.077 647.257 Td /F1 9.8 Tf  [(Beneficiary-)] TJ ET
BT 152.077 639.626 Td /F1 9.8 Tf  [(centeredness)] TJ ET
BT 152.077 631.995 Td /F1 9.8 Tf  [(Non-discrimination)] TJ ET
BT 152.077 624.363 Td /F1 9.8 Tf  [(Empowerment)] TJ ET
0.267 0.267 0.267 rg
261.874 687.637 124.032 0.750 re f
261.874 513.974 124.032 0.750 re f
261.874 513.974 0.750 174.413 re f
0.271 0.267 0.267 rg
BT 267.124 677.782 Td /F1 9.8 Tf  [(Responsiveness)] TJ ET
BT 267.124 670.151 Td /F1 9.8 Tf  [(Engagement)] TJ ET
BT 267.124 662.520 Td /F1 9.8 Tf  [(Timeliness)] TJ ET
BT 267.124 654.888 Td /F1 9.8 Tf  [(Protecting confidentiality)] TJ ET
BT 267.124 647.257 Td /F1 9.8 Tf  [(Effectiveness)] TJ ET
BT 267.124 639.626 Td /F1 9.8 Tf  [(Efficiency)] TJ ET
BT 26.250 459.075 Td /F1 9.8 Tf  [(These values)] TJ ET
BT 84.233 462.964 Td /F1 8.7 Tf  [([4])] TJ ET
BT 93.871 459.075 Td /F1 9.8 Tf  [( represent only a selection that can serve as a starting point for individual organizations developing their own )] TJ ET
BT 26.250 447.171 Td /F1 9.8 Tf  [(value matrix. These organizations will find that some values are specific to levels relevant to their decision-making structure, )] TJ ET
BT 26.250 435.266 Td /F1 9.8 Tf  [(while others cut across different issues. For instance, aid workers at the micro-level might not be expected to worry about the )] TJ ET
BT 26.250 423.361 Td /F1 9.8 Tf  [(sustainability of organizations, which may be of more concern to headquarters. However, the aid workers might be expected to )] TJ ET
BT 26.250 411.456 Td /F1 9.8 Tf  [(deliver aid in a non-discriminatory way. Some of the values in an organization�s value matrix will be more substantive, while )] TJ ET
BT 26.250 399.552 Td /F1 9.8 Tf  [(others are more procedural. Although the classification of some values can be contested, the point is to revisit two central )] TJ ET
BT 26.250 387.647 Td /F1 9.8 Tf  [(questions organizations should ask themselves: a\) What are the moral values we try to realize with our work, and b\) How do we )] TJ ET
BT 26.250 375.742 Td /F1 9.8 Tf  [(want to obtain these goals?)] TJ ET
BT 26.250 356.337 Td /F4 9.8 Tf  [(Part Two: A ten-step approach to ethical decision-making in humanitarian aid)] TJ ET
BT 26.250 336.933 Td /F1 9.8 Tf  [(Based on the assumption that decision-makers are aware of the need to a\) identify ethical issues in the humanitarian context as )] TJ ET
BT 26.250 325.028 Td /F1 9.8 Tf  [(such, and that b\) the organization embraces values, norms, or principles that can serve to justify a response, we suggest a ten-)] TJ ET
BT 26.250 313.123 Td /F1 9.8 Tf  [(step approach that supports aid workers at macro-, meso- and micro-levels alike in their difficult task of making ethically sound )] TJ ET
BT 26.250 301.218 Td /F1 9.8 Tf  [(decisions. This approach is based on tools that are well-established and effective in clinical settings.)] TJ ET
BT 26.250 281.814 Td /F1 9.8 Tf  [(However, before initiating the first step, the following preconditions should be met. First, a platform to discuss needs should be )] TJ ET
BT 26.250 269.909 Td /F1 9.8 Tf  [(made available where opinions can be shared openly. This might entail a round-table discussion similar to ethical consultations )] TJ ET
BT 26.250 258.004 Td /F1 9.8 Tf  [(in a clinical setting. These discussions would ideally evolve into regular meetings of an established group of ethics committees. )] TJ ET
BT 26.250 246.099 Td /F1 9.8 Tf  [(Second, all participants acknowledge that various interests may affect the decision-making process, such as those of )] TJ ET
BT 26.250 234.195 Td /F1 9.8 Tf  [(organizations themselves, the donor community, local or regional governments, and others. It is, however, paramount that the )] TJ ET
BT 26.250 222.290 Td /F1 9.8 Tf  [(interests of the beneficiary are at the center of the debate during the discussion. Finally, an ethicist should oversee the )] TJ ET
BT 26.250 210.385 Td /F1 9.8 Tf  [(discussion, ensuring that all participants have equal opportunity to express their viewpoints. Based on the success of this )] TJ ET
BT 26.250 198.480 Td /F1 9.8 Tf  [(approach for dealing with ethical dilemmas in clinical settings, we believe that a formally trained ethicist would be a valuable )] TJ ET
BT 26.250 186.576 Td /F1 9.8 Tf  [(asset to humanitarian organizations. Ethicists have a unique ability to identify critical ethical issues and act as an intermediary )] TJ ET
BT 26.250 174.671 Td /F1 9.8 Tf  [(between multiple parties in order to resolve them fairly. Hiring such a professional would not require significant financial )] TJ ET
BT 26.250 162.766 Td /F1 9.8 Tf  [(investment from an organization and might also provide aid workers, managers, or physicians with some degree of formal ethics )] TJ ET
BT 26.250 150.861 Td /F1 9.8 Tf  [(training.)] TJ ET
Q
q
15.000 119.744 577.500 657.256 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 1: Set of values commonly shared among humanitarian aid organizations)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 513.599 555.000 242.165 re f
0.965 0.965 0.965 rg
27.000 742.734 120.202 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 120.577 0.750 re f
26.625 742.359 0.750 13.030 re f
0.965 0.965 0.965 rg
147.202 742.734 238.330 12.280 re f
0.267 0.267 0.267 rg
147.202 754.639 115.047 0.750 re f
262.249 754.639 123.282 0.750 re f
0.271 0.267 0.267 rg
BT 151.702 745.490 Td /F4 9.8 Tf  [(Specific values)] TJ ET
0.965 0.965 0.965 rg
385.531 742.734 194.969 12.280 re f
0.267 0.267 0.267 rg
385.531 754.639 101.033 0.750 re f
486.564 754.639 94.311 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 390.031 745.490 Td /F4 9.8 Tf  [(Cross-cutting values)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 120.952 0.750 re f
26.625 726.478 0.750 16.631 re f
146.827 742.359 115.797 0.750 re f
146.827 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 152.077 732.504 Td /F1 9.8 Tf  [(Substantive)] TJ ET
0.267 0.267 0.267 rg
261.874 742.359 124.032 0.750 re f
261.874 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 267.124 732.504 Td /F1 9.8 Tf  [(Procedural)] TJ ET
0.267 0.267 0.267 rg
385.156 742.359 101.783 0.750 re f
385.156 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 390.406 732.504 Td /F1 9.8 Tf  [(Substantive)] TJ ET
0.267 0.267 0.267 rg
486.189 742.359 94.686 0.750 re f
486.189 726.478 0.750 16.631 re f
580.125 726.478 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 491.439 732.504 Td /F1 9.8 Tf  [(Procedural)] TJ ET
0.267 0.267 0.267 rg
26.625 726.478 120.952 0.750 re f
26.625 687.637 0.750 39.591 re f
0.271 0.267 0.267 rg
BT 31.875 716.623 Td /F1 9.8 Tf  [(Macro and meso level)] TJ ET
BT 31.875 708.991 Td /F1 9.8 Tf  [(\(Headquarter and )] TJ ET
BT 31.875 701.360 Td /F1 9.8 Tf  [(regional level\))] TJ ET
0.267 0.267 0.267 rg
146.827 726.478 115.797 0.750 re f
146.827 687.637 0.750 39.591 re f
0.271 0.267 0.267 rg
BT 152.077 716.623 Td /F1 9.8 Tf  [(Poverty reduction )] TJ ET
BT 152.077 708.991 Td /F1 9.8 Tf  [(Sustainability)] TJ ET
0.267 0.267 0.267 rg
261.874 726.478 124.032 0.750 re f
261.874 687.637 0.750 39.591 re f
0.271 0.267 0.267 rg
BT 267.124 716.623 Td /F1 9.8 Tf  [(Inclusiveness)] TJ ET
BT 267.124 708.991 Td /F1 9.8 Tf  [(Accountability)] TJ ET
BT 267.124 701.360 Td /F1 9.8 Tf  [(Reasonableness)] TJ ET
BT 267.124 693.729 Td /F1 9.8 Tf  [(Critical analysis)] TJ ET
0.267 0.267 0.267 rg
385.156 726.478 101.783 0.750 re f
385.156 513.974 101.783 0.750 re f
385.156 688.012 0.750 39.216 re f
385.156 513.974 0.750 174.038 re f
0.271 0.267 0.267 rg
BT 390.406 716.623 Td /F1 9.8 Tf  [(Duty to provide care)] TJ ET
BT 390.406 708.991 Td /F1 9.8 Tf  [(Vulnerability)] TJ ET
BT 390.406 701.360 Td /F1 9.8 Tf  [(Justice)] TJ ET
BT 390.406 693.729 Td /F1 9.8 Tf  [(Solidarity)] TJ ET
BT 390.406 686.098 Td /F1 9.8 Tf  [(Equity)] TJ ET
BT 390.406 678.466 Td /F1 9.8 Tf  [(Beneficence)] TJ ET
BT 390.406 670.835 Td /F1 9.8 Tf  [(Non-maleficence)] TJ ET
BT 390.406 663.204 Td /F1 9.8 Tf  [(Cost-effectiveness)] TJ ET
BT 390.406 655.573 Td /F1 9.8 Tf  [(Stewardship)] TJ ET
0.267 0.267 0.267 rg
486.189 726.478 94.686 0.750 re f
486.189 513.974 94.686 0.750 re f
486.189 688.012 0.750 39.216 re f
580.125 688.012 0.750 39.216 re f
486.189 513.974 0.750 174.038 re f
580.125 513.974 0.750 174.038 re f
0.271 0.267 0.267 rg
BT 491.439 716.623 Td /F1 9.8 Tf  [(Transparency)] TJ ET
BT 491.439 708.991 Td /F1 9.8 Tf  [(Scrutiny)] TJ ET
0.267 0.267 0.267 rg
26.625 687.637 120.952 0.750 re f
26.625 513.974 120.952 0.750 re f
26.625 513.974 0.750 174.413 re f
0.271 0.267 0.267 rg
BT 31.875 677.782 Td /F1 9.8 Tf  [(Micro level)] TJ ET
BT 31.875 670.151 Td /F1 9.8 Tf  [(\(Local level\))] TJ ET
0.267 0.267 0.267 rg
146.827 687.637 115.797 0.750 re f
146.827 513.974 115.797 0.750 re f
146.827 513.974 0.750 174.413 re f
0.271 0.267 0.267 rg
BT 152.077 677.782 Td /F1 9.8 Tf  [(Focus on the worst off)] TJ ET
BT 152.077 670.151 Td /F1 9.8 Tf  [(Self-determination)] TJ ET
BT 152.077 662.520 Td /F1 9.8 Tf  [(Security)] TJ ET
BT 152.077 654.888 Td /F1 9.8 Tf  [(Autonomy)] TJ ET
BT 152.077 647.257 Td /F1 9.8 Tf  [(Beneficiary-)] TJ ET
BT 152.077 639.626 Td /F1 9.8 Tf  [(centeredness)] TJ ET
BT 152.077 631.995 Td /F1 9.8 Tf  [(Non-discrimination)] TJ ET
BT 152.077 624.363 Td /F1 9.8 Tf  [(Empowerment)] TJ ET
0.267 0.267 0.267 rg
261.874 687.637 124.032 0.750 re f
261.874 513.974 124.032 0.750 re f
261.874 513.974 0.750 174.413 re f
0.271 0.267 0.267 rg
BT 267.124 677.782 Td /F1 9.8 Tf  [(Responsiveness)] TJ ET
BT 267.124 670.151 Td /F1 9.8 Tf  [(Engagement)] TJ ET
BT 267.124 662.520 Td /F1 9.8 Tf  [(Timeliness)] TJ ET
BT 267.124 654.888 Td /F1 9.8 Tf  [(Protecting confidentiality)] TJ ET
BT 267.124 647.257 Td /F1 9.8 Tf  [(Effectiveness)] TJ ET
BT 267.124 639.626 Td /F1 9.8 Tf  [(Efficiency)] TJ ET
BT 26.250 459.075 Td /F1 9.8 Tf  [(These values)] TJ ET
BT 84.233 462.964 Td /F1 8.7 Tf  [([4])] TJ ET
BT 93.871 459.075 Td /F1 9.8 Tf  [( represent only a selection that can serve as a starting point for individual organizations developing their own )] TJ ET
BT 26.250 447.171 Td /F1 9.8 Tf  [(value matrix. These organizations will find that some values are specific to levels relevant to their decision-making structure, )] TJ ET
BT 26.250 435.266 Td /F1 9.8 Tf  [(while others cut across different issues. For instance, aid workers at the micro-level might not be expected to worry about the )] TJ ET
BT 26.250 423.361 Td /F1 9.8 Tf  [(sustainability of organizations, which may be of more concern to headquarters. However, the aid workers might be expected to )] TJ ET
BT 26.250 411.456 Td /F1 9.8 Tf  [(deliver aid in a non-discriminatory way. Some of the values in an organization�s value matrix will be more substantive, while )] TJ ET
BT 26.250 399.552 Td /F1 9.8 Tf  [(others are more procedural. Although the classification of some values can be contested, the point is to revisit two central )] TJ ET
BT 26.250 387.647 Td /F1 9.8 Tf  [(questions organizations should ask themselves: a\) What are the moral values we try to realize with our work, and b\) How do we )] TJ ET
BT 26.250 375.742 Td /F1 9.8 Tf  [(want to obtain these goals?)] TJ ET
BT 26.250 356.337 Td /F4 9.8 Tf  [(Part Two: A ten-step approach to ethical decision-making in humanitarian aid)] TJ ET
BT 26.250 336.933 Td /F1 9.8 Tf  [(Based on the assumption that decision-makers are aware of the need to a\) identify ethical issues in the humanitarian context as )] TJ ET
BT 26.250 325.028 Td /F1 9.8 Tf  [(such, and that b\) the organization embraces values, norms, or principles that can serve to justify a response, we suggest a ten-)] TJ ET
BT 26.250 313.123 Td /F1 9.8 Tf  [(step approach that supports aid workers at macro-, meso- and micro-levels alike in their difficult task of making ethically sound )] TJ ET
BT 26.250 301.218 Td /F1 9.8 Tf  [(decisions. This approach is based on tools that are well-established and effective in clinical settings.)] TJ ET
BT 26.250 281.814 Td /F1 9.8 Tf  [(However, before initiating the first step, the following preconditions should be met. First, a platform to discuss needs should be )] TJ ET
BT 26.250 269.909 Td /F1 9.8 Tf  [(made available where opinions can be shared openly. This might entail a round-table discussion similar to ethical consultations )] TJ ET
BT 26.250 258.004 Td /F1 9.8 Tf  [(in a clinical setting. These discussions would ideally evolve into regular meetings of an established group of ethics committees. )] TJ ET
BT 26.250 246.099 Td /F1 9.8 Tf  [(Second, all participants acknowledge that various interests may affect the decision-making process, such as those of )] TJ ET
BT 26.250 234.195 Td /F1 9.8 Tf  [(organizations themselves, the donor community, local or regional governments, and others. It is, however, paramount that the )] TJ ET
BT 26.250 222.290 Td /F1 9.8 Tf  [(interests of the beneficiary are at the center of the debate during the discussion. Finally, an ethicist should oversee the )] TJ ET
BT 26.250 210.385 Td /F1 9.8 Tf  [(discussion, ensuring that all participants have equal opportunity to express their viewpoints. Based on the success of this )] TJ ET
BT 26.250 198.480 Td /F1 9.8 Tf  [(approach for dealing with ethical dilemmas in clinical settings, we believe that a formally trained ethicist would be a valuable )] TJ ET
BT 26.250 186.576 Td /F1 9.8 Tf  [(asset to humanitarian organizations. Ethicists have a unique ability to identify critical ethical issues and act as an intermediary )] TJ ET
BT 26.250 174.671 Td /F1 9.8 Tf  [(between multiple parties in order to resolve them fairly. Hiring such a professional would not require significant financial )] TJ ET
BT 26.250 162.766 Td /F1 9.8 Tf  [(investment from an organization and might also provide aid workers, managers, or physicians with some degree of formal ethics )] TJ ET
BT 26.250 150.861 Td /F1 9.8 Tf  [(training.)] TJ ET
Q
q
0.000 0.000 0.000 rg
BT 291.710 19.825 Td /F1 11.0 Tf  [(6)] TJ ET
BT 25.000 19.825 Td /F1 11.0 Tf  [(PLOS Currents Disasters)] TJ ET

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q
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q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 2: A ten-step approach to ethical decision-making in humanitarian aid)] TJ ET
Q
1.000 1.000 1.000 rg
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0.965 0.965 0.965 rg
27.000 742.734 32.329 12.280 re f
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26.625 754.639 32.704 0.750 re f
26.625 742.359 0.750 13.030 re f
0.965 0.965 0.965 rg
59.329 742.734 179.041 12.280 re f
0.267 0.267 0.267 rg
59.329 754.639 179.041 0.750 re f
0.271 0.267 0.267 rg
BT 63.829 745.490 Td /F4 9.8 Tf  [(Activity)] TJ ET
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238.370 742.734 342.130 12.280 re f
0.267 0.267 0.267 rg
238.370 754.639 342.505 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 242.870 745.490 Td /F4 9.8 Tf  [(Description of the activity)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 33.079 0.750 re f
26.625 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
58.954 742.359 179.791 0.750 re f
58.954 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 64.204 732.504 Td /F1 9.8 Tf  [(Gathering evidence)] TJ ET
0.267 0.267 0.267 rg
237.995 742.359 342.880 0.750 re f
237.995 653.943 0.750 89.166 re f
580.125 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 243.245 732.504 Td /F1 9.8 Tf  [(Situation analysis involving all concerned actors)] TJ ET
BT 243.245 724.873 Td /F1 9.8 Tf  [(Define who is part of the decision-making process and justify the )] TJ ET
BT 243.245 717.241 Td /F1 9.8 Tf  [(inclusion/exclusion of stakeholders)] TJ ET
BT 243.245 709.610 Td /F1 9.8 Tf  [(Decide who is in charge of the process \(in absence of an ethicist\))] TJ ET
0.267 0.267 0.267 rg
26.625 653.943 33.079 0.750 re f
26.625 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 644.088 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
58.954 653.943 179.791 0.750 re f
58.954 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 64.204 644.088 Td /F1 9.8 Tf  [(Specifying values, norms)] TJ ET
BT 64.204 636.457 Td /F1 9.8 Tf  [(or principles)] TJ ET
0.267 0.267 0.267 rg
237.995 653.943 342.880 0.750 re f
237.995 607.537 0.750 47.156 re f
580.125 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 243.245 644.088 Td /F1 9.8 Tf  [(Description of the key values at stake)] TJ ET
BT 243.245 636.457 Td /F1 9.8 Tf  [(� Individual values and interests)] TJ ET
BT 243.245 628.825 Td /F1 9.8 Tf  [(� Institutional values and interests)] TJ ET
BT 243.245 621.194 Td /F1 9.8 Tf  [(� Legal norms)] TJ ET
BT 243.245 613.563 Td /F1 9.8 Tf  [(� Social norms)] TJ ET
0.267 0.267 0.267 rg
26.625 607.537 33.079 0.750 re f
26.625 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 597.682 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
58.954 607.537 179.791 0.750 re f
58.954 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 597.682 Td /F1 9.8 Tf  [(Critical examination of arguments)] TJ ET
0.267 0.267 0.267 rg
237.995 607.537 342.880 0.750 re f
237.995 584.024 0.750 24.262 re f
580.125 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 597.682 Td /F1 9.8 Tf  [(Critical examination of the legal, factual and ethical issues)] TJ ET
BT 243.245 590.050 Td /F1 9.8 Tf  [(Identify the ethical conflict precisely)] TJ ET
0.267 0.267 0.267 rg
26.625 584.024 33.079 0.750 re f
26.625 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 574.169 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
58.954 584.024 179.791 0.750 re f
58.954 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 574.169 Td /F1 9.8 Tf  [(Defining options)] TJ ET
0.267 0.267 0.267 rg
237.995 584.024 342.880 0.750 re f
237.995 560.512 0.750 24.262 re f
580.125 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 574.169 Td /F1 9.8 Tf  [(Describe options and their potential and forecasted )] TJ ET
BT 243.245 566.538 Td /F1 9.8 Tf  [(consequences on each actor)] TJ ET
0.267 0.267 0.267 rg
26.625 560.512 33.079 0.750 re f
26.625 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 550.657 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
58.954 560.512 179.791 0.750 re f
58.954 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 550.657 Td /F1 9.8 Tf  [(Weighing)] TJ ET
0.267 0.267 0.267 rg
237.995 560.512 342.880 0.750 re f
237.995 536.999 0.750 24.262 re f
580.125 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 550.657 Td /F1 9.8 Tf  [(Weighing of options in the light of the identified arguments )] TJ ET
BT 243.245 543.025 Td /F1 9.8 Tf  [(and available evidence)] TJ ET
0.267 0.267 0.267 rg
26.625 536.999 33.079 0.750 re f
26.625 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 527.144 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
58.954 536.999 179.791 0.750 re f
58.954 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 64.204 527.144 Td /F1 9.8 Tf  [(Elaborating decisions)] TJ ET
0.267 0.267 0.267 rg
237.995 536.999 342.880 0.750 re f
237.995 521.118 0.750 16.631 re f
580.125 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 243.245 527.144 Td /F1 9.8 Tf  [(Deciding on the most appropriate option)] TJ ET
0.267 0.267 0.267 rg
26.625 521.118 33.079 0.750 re f
26.625 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 31.875 511.263 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
58.954 521.118 179.791 0.750 re f
58.954 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 64.204 511.263 Td /F1 9.8 Tf  [(Providing justification)] TJ ET
0.267 0.267 0.267 rg
237.995 521.118 342.880 0.750 re f
237.995 489.974 0.750 31.894 re f
580.125 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 243.245 511.263 Td /F1 9.8 Tf  [(Justifying the choice of the option)] TJ ET
BT 243.245 503.632 Td /F1 9.8 Tf  [(Ensure transparency of the choice including reasons and justifications)] TJ ET
BT 243.245 496.000 Td /F1 9.8 Tf  [(Define limits of the decisions)] TJ ET
0.267 0.267 0.267 rg
26.625 489.974 33.079 0.750 re f
26.625 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 480.119 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
58.954 489.974 179.791 0.750 re f
58.954 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 480.119 Td /F1 9.8 Tf  [(Implementation)] TJ ET
0.267 0.267 0.267 rg
237.995 489.974 342.880 0.750 re f
237.995 466.462 0.750 24.262 re f
580.125 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 480.119 Td /F1 9.8 Tf  [(Define measures to improve successful implementation)] TJ ET
BT 243.245 472.488 Td /F1 9.8 Tf  [(Define indicators to monitor progress)] TJ ET
0.267 0.267 0.267 rg
26.625 466.462 33.079 0.750 re f
26.625 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 456.607 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
58.954 466.462 179.791 0.750 re f
58.954 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 64.204 456.607 Td /F1 9.8 Tf  [(Monitoring and )] TJ ET
BT 64.204 448.975 Td /F1 9.8 Tf  [(evaluation)] TJ ET
0.267 0.267 0.267 rg
237.995 466.462 342.880 0.750 re f
237.995 420.055 0.750 47.156 re f
580.125 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 243.245 456.607 Td /F1 9.8 Tf  [(Monitoring of indicators assessing the decision�s impact)] TJ ET
BT 243.245 448.975 Td /F1 9.8 Tf  [(Providing evidence of the decision�s impact on all concerned \(internal/ )] TJ ET
BT 243.245 441.344 Td /F1 9.8 Tf  [(external stakeholders\))] TJ ET
BT 243.245 433.713 Td /F1 9.8 Tf  [(Generating evidence of benefits and harms)] TJ ET
BT 243.245 426.082 Td /F1 9.8 Tf  [(Final evaluation of the decision-making process)] TJ ET
0.267 0.267 0.267 rg
26.625 420.055 33.079 0.750 re f
26.625 404.174 33.079 0.750 re f
26.625 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 410.200 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
58.954 420.055 179.791 0.750 re f
58.954 404.174 179.791 0.750 re f
58.954 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 64.204 410.200 Td /F1 9.8 Tf  [(Recommendations)] TJ ET
0.267 0.267 0.267 rg
237.995 420.055 342.880 0.750 re f
237.995 404.174 342.880 0.750 re f
237.995 404.174 0.750 16.631 re f
580.125 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 243.245 410.200 Td /F1 9.8 Tf  [(Recommendations for future actions)] TJ ET
BT 26.250 349.275 Td /F1 9.8 Tf  [(This proposed approach embodies the core of the ethical framework by providing a structure to the decision-making process by )] TJ ET
BT 26.250 337.371 Td /F1 9.8 Tf  [(humanitarian actors. It improves its transparency, which is paramount to promoting justice. This ten-step approach is applicable )] TJ ET
BT 26.250 325.466 Td /F1 9.8 Tf  [(at a macro-, meso- and micro-level.)] TJ ET
BT 26.250 306.061 Td /F4 9.8 Tf  [(Means of verification)] TJ ET
BT 26.250 286.656 Td /F1 9.8 Tf  [(To test whether the )] TJ ET
BT 112.421 286.656 Td /F1 9.8 Tf  [(decision was correct, the following means of verification are considered helpful: a\) decisions are based on )] TJ ET
BT 26.250 274.752 Td /F1 9.8 Tf  [(available evidence)] TJ ET
0.267 0.267 0.267 rg
BT 106.454 276.259 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 116.091 274.752 Td /F1 9.8 Tf  [(, b\) decision-makers would agree with the defined option if they were in the beneficiaries� situation and c\) )] TJ ET
BT 26.250 262.847 Td /F1 9.8 Tf  [(decisions are relevant and allow for revision and appeals)] TJ ET
0.267 0.267 0.267 rg
BT 271.190 264.354 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 280.827 262.847 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 243.442 Td /F1 9.8 Tf  [(A well-documented and transparent decision-making process is essential to permitting review and questioning whether or not )] TJ ET
BT 26.250 231.537 Td /F1 9.8 Tf  [(the decision was appropriate. As such, organizations can monitor and evaluate the operational implementation of the program )] TJ ET
BT 26.250 219.633 Td /F1 9.8 Tf  [(and retrospectively assess the portrayed options and whether another decision would have been a better one. These factors )] TJ ET
BT 26.250 207.728 Td /F1 9.8 Tf  [(thereby contribute to the continuous improvement of decision-making processes within the organization.)] TJ ET
BT 26.250 188.323 Td /F4 9.8 Tf  [(Part Three: Institutional requirements for high ethical standards in humanitarian aid organizations)] TJ ET
BT 26.250 168.918 Td /F1 9.8 Tf  [(Guiding humanitarian aid workers in their difficult task to make decisions and allocate resources)] TJ ET
0.267 0.267 0.267 rg
BT 438.616 170.426 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 448.254 168.918 Td /F1 9.8 Tf  [(, requires skilled )] TJ ET
BT 26.250 157.014 Td /F1 9.8 Tf  [(professionals especially in challenging contexts. In many situations, staff will likely find it difficult to a\) identify issues as being )] TJ ET
BT 26.250 145.109 Td /F1 9.8 Tf  [(ethical ones, b\) shape decision-making processes in a way that complies with the set of procedural values embraced by an )] TJ ET
BT 26.250 133.204 Td /F1 9.8 Tf  [(organization, and c\) help formulate core arguments and analyze them in light of relevant empirical information.)] TJ ET
BT 26.250 113.799 Td /F1 9.8 Tf  [(In clinical ethics, the hub and spokes model)] TJ ET
0.267 0.267 0.267 rg
BT 214.298 115.307 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 219.117 113.799 Td /F1 9.8 Tf  [( has proven to be quite useful. A trained ethicist acts as the �hub,� representing the )] TJ ET
BT 26.250 101.895 Td /F1 9.8 Tf  [(organization�s central resource for ethical issues. The ethicist may help define an organization�s value matrix, develop the )] TJ ET
BT 26.250 89.990 Td /F1 9.8 Tf  [(structures and processes required for the ten-step approach to ethical decision-making, and run an ethics consultation service. )] TJ ET
BT 26.250 78.085 Td /F1 9.8 Tf  [(The ethicist will also actively involve interested colleagues in ethics activities, offer continuous educational opportunities, and )] TJ ET
BT 26.250 66.180 Td /F1 9.8 Tf  [(create the focal point or �spokes� for ethical issues at various levels and in the different departments of the organization. In this )] TJ ET
BT 26.250 54.276 Td /F1 9.8 Tf  [(way, ethical expertise is disseminated but not diluted.)] TJ ET
Q
q
15.000 44.395 577.500 732.605 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 2: A ten-step approach to ethical decision-making in humanitarian aid)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 403.799 555.000 351.965 re f
0.965 0.965 0.965 rg
27.000 742.734 32.329 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 32.704 0.750 re f
26.625 742.359 0.750 13.030 re f
0.965 0.965 0.965 rg
59.329 742.734 179.041 12.280 re f
0.267 0.267 0.267 rg
59.329 754.639 179.041 0.750 re f
0.271 0.267 0.267 rg
BT 63.829 745.490 Td /F4 9.8 Tf  [(Activity)] TJ ET
0.965 0.965 0.965 rg
238.370 742.734 342.130 12.280 re f
0.267 0.267 0.267 rg
238.370 754.639 342.505 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 242.870 745.490 Td /F4 9.8 Tf  [(Description of the activity)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 33.079 0.750 re f
26.625 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
58.954 742.359 179.791 0.750 re f
58.954 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 64.204 732.504 Td /F1 9.8 Tf  [(Gathering evidence)] TJ ET
0.267 0.267 0.267 rg
237.995 742.359 342.880 0.750 re f
237.995 653.943 0.750 89.166 re f
580.125 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 243.245 732.504 Td /F1 9.8 Tf  [(Situation analysis involving all concerned actors)] TJ ET
BT 243.245 724.873 Td /F1 9.8 Tf  [(Define who is part of the decision-making process and justify the )] TJ ET
BT 243.245 717.241 Td /F1 9.8 Tf  [(inclusion/exclusion of stakeholders)] TJ ET
BT 243.245 709.610 Td /F1 9.8 Tf  [(Decide who is in charge of the process \(in absence of an ethicist\))] TJ ET
0.267 0.267 0.267 rg
26.625 653.943 33.079 0.750 re f
26.625 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 644.088 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
58.954 653.943 179.791 0.750 re f
58.954 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 64.204 644.088 Td /F1 9.8 Tf  [(Specifying values, norms)] TJ ET
BT 64.204 636.457 Td /F1 9.8 Tf  [(or principles)] TJ ET
0.267 0.267 0.267 rg
237.995 653.943 342.880 0.750 re f
237.995 607.537 0.750 47.156 re f
580.125 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 243.245 644.088 Td /F1 9.8 Tf  [(Description of the key values at stake)] TJ ET
BT 243.245 636.457 Td /F1 9.8 Tf  [(� Individual values and interests)] TJ ET
BT 243.245 628.825 Td /F1 9.8 Tf  [(� Institutional values and interests)] TJ ET
BT 243.245 621.194 Td /F1 9.8 Tf  [(� Legal norms)] TJ ET
BT 243.245 613.563 Td /F1 9.8 Tf  [(� Social norms)] TJ ET
0.267 0.267 0.267 rg
26.625 607.537 33.079 0.750 re f
26.625 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 597.682 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
58.954 607.537 179.791 0.750 re f
58.954 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 597.682 Td /F1 9.8 Tf  [(Critical examination of arguments)] TJ ET
0.267 0.267 0.267 rg
237.995 607.537 342.880 0.750 re f
237.995 584.024 0.750 24.262 re f
580.125 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 597.682 Td /F1 9.8 Tf  [(Critical examination of the legal, factual and ethical issues)] TJ ET
BT 243.245 590.050 Td /F1 9.8 Tf  [(Identify the ethical conflict precisely)] TJ ET
0.267 0.267 0.267 rg
26.625 584.024 33.079 0.750 re f
26.625 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 574.169 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
58.954 584.024 179.791 0.750 re f
58.954 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 574.169 Td /F1 9.8 Tf  [(Defining options)] TJ ET
0.267 0.267 0.267 rg
237.995 584.024 342.880 0.750 re f
237.995 560.512 0.750 24.262 re f
580.125 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 574.169 Td /F1 9.8 Tf  [(Describe options and their potential and forecasted )] TJ ET
BT 243.245 566.538 Td /F1 9.8 Tf  [(consequences on each actor)] TJ ET
0.267 0.267 0.267 rg
26.625 560.512 33.079 0.750 re f
26.625 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 550.657 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
58.954 560.512 179.791 0.750 re f
58.954 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 550.657 Td /F1 9.8 Tf  [(Weighing)] TJ ET
0.267 0.267 0.267 rg
237.995 560.512 342.880 0.750 re f
237.995 536.999 0.750 24.262 re f
580.125 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 550.657 Td /F1 9.8 Tf  [(Weighing of options in the light of the identified arguments )] TJ ET
BT 243.245 543.025 Td /F1 9.8 Tf  [(and available evidence)] TJ ET
0.267 0.267 0.267 rg
26.625 536.999 33.079 0.750 re f
26.625 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 527.144 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
58.954 536.999 179.791 0.750 re f
58.954 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 64.204 527.144 Td /F1 9.8 Tf  [(Elaborating decisions)] TJ ET
0.267 0.267 0.267 rg
237.995 536.999 342.880 0.750 re f
237.995 521.118 0.750 16.631 re f
580.125 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 243.245 527.144 Td /F1 9.8 Tf  [(Deciding on the most appropriate option)] TJ ET
0.267 0.267 0.267 rg
26.625 521.118 33.079 0.750 re f
26.625 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 31.875 511.263 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
58.954 521.118 179.791 0.750 re f
58.954 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 64.204 511.263 Td /F1 9.8 Tf  [(Providing justification)] TJ ET
0.267 0.267 0.267 rg
237.995 521.118 342.880 0.750 re f
237.995 489.974 0.750 31.894 re f
580.125 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 243.245 511.263 Td /F1 9.8 Tf  [(Justifying the choice of the option)] TJ ET
BT 243.245 503.632 Td /F1 9.8 Tf  [(Ensure transparency of the choice including reasons and justifications)] TJ ET
BT 243.245 496.000 Td /F1 9.8 Tf  [(Define limits of the decisions)] TJ ET
0.267 0.267 0.267 rg
26.625 489.974 33.079 0.750 re f
26.625 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 480.119 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
58.954 489.974 179.791 0.750 re f
58.954 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 480.119 Td /F1 9.8 Tf  [(Implementation)] TJ ET
0.267 0.267 0.267 rg
237.995 489.974 342.880 0.750 re f
237.995 466.462 0.750 24.262 re f
580.125 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 480.119 Td /F1 9.8 Tf  [(Define measures to improve successful implementation)] TJ ET
BT 243.245 472.488 Td /F1 9.8 Tf  [(Define indicators to monitor progress)] TJ ET
0.267 0.267 0.267 rg
26.625 466.462 33.079 0.750 re f
26.625 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 456.607 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
58.954 466.462 179.791 0.750 re f
58.954 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 64.204 456.607 Td /F1 9.8 Tf  [(Monitoring and )] TJ ET
BT 64.204 448.975 Td /F1 9.8 Tf  [(evaluation)] TJ ET
0.267 0.267 0.267 rg
237.995 466.462 342.880 0.750 re f
237.995 420.055 0.750 47.156 re f
580.125 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 243.245 456.607 Td /F1 9.8 Tf  [(Monitoring of indicators assessing the decision�s impact)] TJ ET
BT 243.245 448.975 Td /F1 9.8 Tf  [(Providing evidence of the decision�s impact on all concerned \(internal/ )] TJ ET
BT 243.245 441.344 Td /F1 9.8 Tf  [(external stakeholders\))] TJ ET
BT 243.245 433.713 Td /F1 9.8 Tf  [(Generating evidence of benefits and harms)] TJ ET
BT 243.245 426.082 Td /F1 9.8 Tf  [(Final evaluation of the decision-making process)] TJ ET
0.267 0.267 0.267 rg
26.625 420.055 33.079 0.750 re f
26.625 404.174 33.079 0.750 re f
26.625 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 410.200 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
58.954 420.055 179.791 0.750 re f
58.954 404.174 179.791 0.750 re f
58.954 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 64.204 410.200 Td /F1 9.8 Tf  [(Recommendations)] TJ ET
0.267 0.267 0.267 rg
237.995 420.055 342.880 0.750 re f
237.995 404.174 342.880 0.750 re f
237.995 404.174 0.750 16.631 re f
580.125 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 243.245 410.200 Td /F1 9.8 Tf  [(Recommendations for future actions)] TJ ET
BT 26.250 349.275 Td /F1 9.8 Tf  [(This proposed approach embodies the core of the ethical framework by providing a structure to the decision-making process by )] TJ ET
BT 26.250 337.371 Td /F1 9.8 Tf  [(humanitarian actors. It improves its transparency, which is paramount to promoting justice. This ten-step approach is applicable )] TJ ET
BT 26.250 325.466 Td /F1 9.8 Tf  [(at a macro-, meso- and micro-level.)] TJ ET
BT 26.250 306.061 Td /F4 9.8 Tf  [(Means of verification)] TJ ET
BT 26.250 286.656 Td /F1 9.8 Tf  [(To test whether the )] TJ ET
BT 112.421 286.656 Td /F1 9.8 Tf  [(decision was correct, the following means of verification are considered helpful: a\) decisions are based on )] TJ ET
BT 26.250 274.752 Td /F1 9.8 Tf  [(available evidence)] TJ ET
0.267 0.267 0.267 rg
BT 106.454 276.259 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 116.091 274.752 Td /F1 9.8 Tf  [(, b\) decision-makers would agree with the defined option if they were in the beneficiaries� situation and c\) )] TJ ET
BT 26.250 262.847 Td /F1 9.8 Tf  [(decisions are relevant and allow for revision and appeals)] TJ ET
0.267 0.267 0.267 rg
BT 271.190 264.354 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 280.827 262.847 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 243.442 Td /F1 9.8 Tf  [(A well-documented and transparent decision-making process is essential to permitting review and questioning whether or not )] TJ ET
BT 26.250 231.537 Td /F1 9.8 Tf  [(the decision was appropriate. As such, organizations can monitor and evaluate the operational implementation of the program )] TJ ET
BT 26.250 219.633 Td /F1 9.8 Tf  [(and retrospectively assess the portrayed options and whether another decision would have been a better one. These factors )] TJ ET
BT 26.250 207.728 Td /F1 9.8 Tf  [(thereby contribute to the continuous improvement of decision-making processes within the organization.)] TJ ET
BT 26.250 188.323 Td /F4 9.8 Tf  [(Part Three: Institutional requirements for high ethical standards in humanitarian aid organizations)] TJ ET
BT 26.250 168.918 Td /F1 9.8 Tf  [(Guiding humanitarian aid workers in their difficult task to make decisions and allocate resources)] TJ ET
0.267 0.267 0.267 rg
BT 438.616 170.426 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 448.254 168.918 Td /F1 9.8 Tf  [(, requires skilled )] TJ ET
BT 26.250 157.014 Td /F1 9.8 Tf  [(professionals especially in challenging contexts. In many situations, staff will likely find it difficult to a\) identify issues as being )] TJ ET
BT 26.250 145.109 Td /F1 9.8 Tf  [(ethical ones, b\) shape decision-making processes in a way that complies with the set of procedural values embraced by an )] TJ ET
BT 26.250 133.204 Td /F1 9.8 Tf  [(organization, and c\) help formulate core arguments and analyze them in light of relevant empirical information.)] TJ ET
BT 26.250 113.799 Td /F1 9.8 Tf  [(In clinical ethics, the hub and spokes model)] TJ ET
0.267 0.267 0.267 rg
BT 214.298 115.307 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 219.117 113.799 Td /F1 9.8 Tf  [( has proven to be quite useful. A trained ethicist acts as the �hub,� representing the )] TJ ET
BT 26.250 101.895 Td /F1 9.8 Tf  [(organization�s central resource for ethical issues. The ethicist may help define an organization�s value matrix, develop the )] TJ ET
BT 26.250 89.990 Td /F1 9.8 Tf  [(structures and processes required for the ten-step approach to ethical decision-making, and run an ethics consultation service. )] TJ ET
BT 26.250 78.085 Td /F1 9.8 Tf  [(The ethicist will also actively involve interested colleagues in ethics activities, offer continuous educational opportunities, and )] TJ ET
BT 26.250 66.180 Td /F1 9.8 Tf  [(create the focal point or �spokes� for ethical issues at various levels and in the different departments of the organization. In this )] TJ ET
BT 26.250 54.276 Td /F1 9.8 Tf  [(way, ethical expertise is disseminated but not diluted.)] TJ ET
Q
q
15.000 44.395 577.500 732.605 re W n
q
26.250 763.264 555.000 13.736 re W n
0.271 0.267 0.267 rg
BT 26.250 766.011 Td /F1 9.8 Tf  [(Table 2: A ten-step approach to ethical decision-making in humanitarian aid)] TJ ET
Q
1.000 1.000 1.000 rg
26.250 403.799 555.000 351.965 re f
0.965 0.965 0.965 rg
27.000 742.734 32.329 12.280 re f
0.267 0.267 0.267 rg
26.625 754.639 32.704 0.750 re f
26.625 742.359 0.750 13.030 re f
0.965 0.965 0.965 rg
59.329 742.734 179.041 12.280 re f
0.267 0.267 0.267 rg
59.329 754.639 179.041 0.750 re f
0.271 0.267 0.267 rg
BT 63.829 745.490 Td /F4 9.8 Tf  [(Activity)] TJ ET
0.965 0.965 0.965 rg
238.370 742.734 342.130 12.280 re f
0.267 0.267 0.267 rg
238.370 754.639 342.505 0.750 re f
580.125 742.359 0.750 13.030 re f
0.271 0.267 0.267 rg
BT 242.870 745.490 Td /F4 9.8 Tf  [(Description of the activity)] TJ ET
0.267 0.267 0.267 rg
26.625 742.359 33.079 0.750 re f
26.625 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 31.875 732.504 Td /F1 9.8 Tf  [(1)] TJ ET
0.267 0.267 0.267 rg
58.954 742.359 179.791 0.750 re f
58.954 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 64.204 732.504 Td /F1 9.8 Tf  [(Gathering evidence)] TJ ET
0.267 0.267 0.267 rg
237.995 742.359 342.880 0.750 re f
237.995 653.943 0.750 89.166 re f
580.125 653.943 0.750 89.166 re f
0.271 0.267 0.267 rg
BT 243.245 732.504 Td /F1 9.8 Tf  [(Situation analysis involving all concerned actors)] TJ ET
BT 243.245 724.873 Td /F1 9.8 Tf  [(Define who is part of the decision-making process and justify the )] TJ ET
BT 243.245 717.241 Td /F1 9.8 Tf  [(inclusion/exclusion of stakeholders)] TJ ET
BT 243.245 709.610 Td /F1 9.8 Tf  [(Decide who is in charge of the process \(in absence of an ethicist\))] TJ ET
0.267 0.267 0.267 rg
26.625 653.943 33.079 0.750 re f
26.625 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 644.088 Td /F1 9.8 Tf  [(2)] TJ ET
0.267 0.267 0.267 rg
58.954 653.943 179.791 0.750 re f
58.954 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 64.204 644.088 Td /F1 9.8 Tf  [(Specifying values, norms)] TJ ET
BT 64.204 636.457 Td /F1 9.8 Tf  [(or principles)] TJ ET
0.267 0.267 0.267 rg
237.995 653.943 342.880 0.750 re f
237.995 607.537 0.750 47.156 re f
580.125 607.537 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 243.245 644.088 Td /F1 9.8 Tf  [(Description of the key values at stake)] TJ ET
BT 243.245 636.457 Td /F1 9.8 Tf  [(� Individual values and interests)] TJ ET
BT 243.245 628.825 Td /F1 9.8 Tf  [(� Institutional values and interests)] TJ ET
BT 243.245 621.194 Td /F1 9.8 Tf  [(� Legal norms)] TJ ET
BT 243.245 613.563 Td /F1 9.8 Tf  [(� Social norms)] TJ ET
0.267 0.267 0.267 rg
26.625 607.537 33.079 0.750 re f
26.625 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 597.682 Td /F1 9.8 Tf  [(3)] TJ ET
0.267 0.267 0.267 rg
58.954 607.537 179.791 0.750 re f
58.954 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 597.682 Td /F1 9.8 Tf  [(Critical examination of arguments)] TJ ET
0.267 0.267 0.267 rg
237.995 607.537 342.880 0.750 re f
237.995 584.024 0.750 24.262 re f
580.125 584.024 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 597.682 Td /F1 9.8 Tf  [(Critical examination of the legal, factual and ethical issues)] TJ ET
BT 243.245 590.050 Td /F1 9.8 Tf  [(Identify the ethical conflict precisely)] TJ ET
0.267 0.267 0.267 rg
26.625 584.024 33.079 0.750 re f
26.625 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 574.169 Td /F1 9.8 Tf  [(4)] TJ ET
0.267 0.267 0.267 rg
58.954 584.024 179.791 0.750 re f
58.954 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 574.169 Td /F1 9.8 Tf  [(Defining options)] TJ ET
0.267 0.267 0.267 rg
237.995 584.024 342.880 0.750 re f
237.995 560.512 0.750 24.262 re f
580.125 560.512 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 574.169 Td /F1 9.8 Tf  [(Describe options and their potential and forecasted )] TJ ET
BT 243.245 566.538 Td /F1 9.8 Tf  [(consequences on each actor)] TJ ET
0.267 0.267 0.267 rg
26.625 560.512 33.079 0.750 re f
26.625 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 550.657 Td /F1 9.8 Tf  [(5)] TJ ET
0.267 0.267 0.267 rg
58.954 560.512 179.791 0.750 re f
58.954 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 550.657 Td /F1 9.8 Tf  [(Weighing)] TJ ET
0.267 0.267 0.267 rg
237.995 560.512 342.880 0.750 re f
237.995 536.999 0.750 24.262 re f
580.125 536.999 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 550.657 Td /F1 9.8 Tf  [(Weighing of options in the light of the identified arguments )] TJ ET
BT 243.245 543.025 Td /F1 9.8 Tf  [(and available evidence)] TJ ET
0.267 0.267 0.267 rg
26.625 536.999 33.079 0.750 re f
26.625 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 527.144 Td /F1 9.8 Tf  [(6)] TJ ET
0.267 0.267 0.267 rg
58.954 536.999 179.791 0.750 re f
58.954 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 64.204 527.144 Td /F1 9.8 Tf  [(Elaborating decisions)] TJ ET
0.267 0.267 0.267 rg
237.995 536.999 342.880 0.750 re f
237.995 521.118 0.750 16.631 re f
580.125 521.118 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 243.245 527.144 Td /F1 9.8 Tf  [(Deciding on the most appropriate option)] TJ ET
0.267 0.267 0.267 rg
26.625 521.118 33.079 0.750 re f
26.625 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 31.875 511.263 Td /F1 9.8 Tf  [(7)] TJ ET
0.267 0.267 0.267 rg
58.954 521.118 179.791 0.750 re f
58.954 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 64.204 511.263 Td /F1 9.8 Tf  [(Providing justification)] TJ ET
0.267 0.267 0.267 rg
237.995 521.118 342.880 0.750 re f
237.995 489.974 0.750 31.894 re f
580.125 489.974 0.750 31.894 re f
0.271 0.267 0.267 rg
BT 243.245 511.263 Td /F1 9.8 Tf  [(Justifying the choice of the option)] TJ ET
BT 243.245 503.632 Td /F1 9.8 Tf  [(Ensure transparency of the choice including reasons and justifications)] TJ ET
BT 243.245 496.000 Td /F1 9.8 Tf  [(Define limits of the decisions)] TJ ET
0.267 0.267 0.267 rg
26.625 489.974 33.079 0.750 re f
26.625 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 31.875 480.119 Td /F1 9.8 Tf  [(8)] TJ ET
0.267 0.267 0.267 rg
58.954 489.974 179.791 0.750 re f
58.954 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 64.204 480.119 Td /F1 9.8 Tf  [(Implementation)] TJ ET
0.267 0.267 0.267 rg
237.995 489.974 342.880 0.750 re f
237.995 466.462 0.750 24.262 re f
580.125 466.462 0.750 24.262 re f
0.271 0.267 0.267 rg
BT 243.245 480.119 Td /F1 9.8 Tf  [(Define measures to improve successful implementation)] TJ ET
BT 243.245 472.488 Td /F1 9.8 Tf  [(Define indicators to monitor progress)] TJ ET
0.267 0.267 0.267 rg
26.625 466.462 33.079 0.750 re f
26.625 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 31.875 456.607 Td /F1 9.8 Tf  [(9)] TJ ET
0.267 0.267 0.267 rg
58.954 466.462 179.791 0.750 re f
58.954 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 64.204 456.607 Td /F1 9.8 Tf  [(Monitoring and )] TJ ET
BT 64.204 448.975 Td /F1 9.8 Tf  [(evaluation)] TJ ET
0.267 0.267 0.267 rg
237.995 466.462 342.880 0.750 re f
237.995 420.055 0.750 47.156 re f
580.125 420.055 0.750 47.156 re f
0.271 0.267 0.267 rg
BT 243.245 456.607 Td /F1 9.8 Tf  [(Monitoring of indicators assessing the decision�s impact)] TJ ET
BT 243.245 448.975 Td /F1 9.8 Tf  [(Providing evidence of the decision�s impact on all concerned \(internal/ )] TJ ET
BT 243.245 441.344 Td /F1 9.8 Tf  [(external stakeholders\))] TJ ET
BT 243.245 433.713 Td /F1 9.8 Tf  [(Generating evidence of benefits and harms)] TJ ET
BT 243.245 426.082 Td /F1 9.8 Tf  [(Final evaluation of the decision-making process)] TJ ET
0.267 0.267 0.267 rg
26.625 420.055 33.079 0.750 re f
26.625 404.174 33.079 0.750 re f
26.625 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 31.875 410.200 Td /F1 9.8 Tf  [(10)] TJ ET
0.267 0.267 0.267 rg
58.954 420.055 179.791 0.750 re f
58.954 404.174 179.791 0.750 re f
58.954 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 64.204 410.200 Td /F1 9.8 Tf  [(Recommendations)] TJ ET
0.267 0.267 0.267 rg
237.995 420.055 342.880 0.750 re f
237.995 404.174 342.880 0.750 re f
237.995 404.174 0.750 16.631 re f
580.125 404.174 0.750 16.631 re f
0.271 0.267 0.267 rg
BT 243.245 410.200 Td /F1 9.8 Tf  [(Recommendations for future actions)] TJ ET
BT 26.250 349.275 Td /F1 9.8 Tf  [(This proposed approach embodies the core of the ethical framework by providing a structure to the decision-making process by )] TJ ET
BT 26.250 337.371 Td /F1 9.8 Tf  [(humanitarian actors. It improves its transparency, which is paramount to promoting justice. This ten-step approach is applicable )] TJ ET
BT 26.250 325.466 Td /F1 9.8 Tf  [(at a macro-, meso- and micro-level.)] TJ ET
BT 26.250 306.061 Td /F4 9.8 Tf  [(Means of verification)] TJ ET
BT 26.250 286.656 Td /F1 9.8 Tf  [(To test whether the )] TJ ET
BT 112.421 286.656 Td /F1 9.8 Tf  [(decision was correct, the following means of verification are considered helpful: a\) decisions are based on )] TJ ET
BT 26.250 274.752 Td /F1 9.8 Tf  [(available evidence)] TJ ET
0.267 0.267 0.267 rg
BT 106.454 276.259 Td /F4 8.7 Tf  [(19)] TJ ET
0.271 0.267 0.267 rg
BT 116.091 274.752 Td /F1 9.8 Tf  [(, b\) decision-makers would agree with the defined option if they were in the beneficiaries� situation and c\) )] TJ ET
BT 26.250 262.847 Td /F1 9.8 Tf  [(decisions are relevant and allow for revision and appeals)] TJ ET
0.267 0.267 0.267 rg
BT 271.190 264.354 Td /F4 8.7 Tf  [(20)] TJ ET
0.271 0.267 0.267 rg
BT 280.827 262.847 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 243.442 Td /F1 9.8 Tf  [(A well-documented and transparent decision-making process is essential to permitting review and questioning whether or not )] TJ ET
BT 26.250 231.537 Td /F1 9.8 Tf  [(the decision was appropriate. As such, organizations can monitor and evaluate the operational implementation of the program )] TJ ET
BT 26.250 219.633 Td /F1 9.8 Tf  [(and retrospectively assess the portrayed options and whether another decision would have been a better one. These factors )] TJ ET
BT 26.250 207.728 Td /F1 9.8 Tf  [(thereby contribute to the continuous improvement of decision-making processes within the organization.)] TJ ET
BT 26.250 188.323 Td /F4 9.8 Tf  [(Part Three: Institutional requirements for high ethical standards in humanitarian aid organizations)] TJ ET
BT 26.250 168.918 Td /F1 9.8 Tf  [(Guiding humanitarian aid workers in their difficult task to make decisions and allocate resources)] TJ ET
0.267 0.267 0.267 rg
BT 438.616 170.426 Td /F4 8.7 Tf  [(21)] TJ ET
0.271 0.267 0.267 rg
BT 448.254 168.918 Td /F1 9.8 Tf  [(, requires skilled )] TJ ET
BT 26.250 157.014 Td /F1 9.8 Tf  [(professionals especially in challenging contexts. In many situations, staff will likely find it difficult to a\) identify issues as being )] TJ ET
BT 26.250 145.109 Td /F1 9.8 Tf  [(ethical ones, b\) shape decision-making processes in a way that complies with the set of procedural values embraced by an )] TJ ET
BT 26.250 133.204 Td /F1 9.8 Tf  [(organization, and c\) help formulate core arguments and analyze them in light of relevant empirical information.)] TJ ET
BT 26.250 113.799 Td /F1 9.8 Tf  [(In clinical ethics, the hub and spokes model)] TJ ET
0.267 0.267 0.267 rg
BT 214.298 115.307 Td /F4 8.7 Tf  [(8)] TJ ET
0.271 0.267 0.267 rg
BT 219.117 113.799 Td /F1 9.8 Tf  [( has proven to be quite useful. A trained ethicist acts as the �hub,� representing the )] TJ ET
BT 26.250 101.895 Td /F1 9.8 Tf  [(organization�s central resource for ethical issues. The ethicist may help define an organization�s value matrix, develop the )] TJ ET
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BT 26.250 499.821 Td /F1 9.8 Tf  [(As with clinical practice, humanitarian contexts are often highly challenging and ideally require a fully trained ethicist to assist )] TJ ET
BT 26.250 487.917 Td /F1 9.8 Tf  [(and act as a mediator who guides the decision-making process. The experienced ethicists train all ethics resource leaders to )] TJ ET
BT 26.250 476.012 Td /F1 9.8 Tf  [(ensure that skilled humanitarian aid workers are available and able to act as ethicists at all levels. Depending on the level at )] TJ ET
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BT 26.250 440.298 Td /F1 9.8 Tf  [(stated in the ethical framework proposed here or agrees to a set of core principles for future reference and to shape the )] TJ ET
BT 26.250 428.393 Td /F1 9.8 Tf  [(decision-making process.)] TJ ET
BT 26.250 391.790 Td /F4 12.0 Tf  [(Remaining challenges)] TJ ET
BT 26.250 371.836 Td /F1 9.8 Tf  [(Looking across humanitarian organizations show that a wide range of values continues to prevail, and reaching a consensus on )] TJ ET
BT 26.250 359.931 Td /F1 9.8 Tf  [(a set of core values or principles is a challenging task. Yet, humanitarian action is embedded in substantive and procedural )] TJ ET
BT 26.250 348.027 Td /F1 9.8 Tf  [(values of ethical relevance. At present, however, identifying conflicting values is not part of many organizations� decision-making )] TJ ET
BT 26.250 336.122 Td /F1 9.8 Tf  [(culture, which is predominantly marked by a geopolitical discourse. Therefore, a platform is required to allow for such debates.)] TJ ET
BT 26.250 316.717 Td /F1 9.8 Tf  [(Beginning with the framework described in this paper, each organization must elaborate their own approach to ethical decision-)] TJ ET
BT 26.250 304.812 Td /F1 9.8 Tf  [(making, attuned to their value set and the ethics resources available at their institution. Importantly, regardless of the detail in )] TJ ET
BT 26.250 292.908 Td /F1 9.8 Tf  [(the structures and processes, they must be conceived as a learning system that begins imperfectly but aims at continuous )] TJ ET
BT 26.250 281.003 Td /F1 9.8 Tf  [(improvement. In addition to tailoring the overall approach to the specific needs and features of individual humanitarian aid )] TJ ET
BT 26.250 269.098 Td /F1 9.8 Tf  [(organizations, a further challenge will be creating opportunities for exchange between organizations. It will be important for )] TJ ET
BT 26.250 257.193 Td /F1 9.8 Tf  [(organizations to benefit mutually from experiences and explore potential for common standards that might emerge.)] TJ ET
BT 26.250 237.789 Td /F1 9.8 Tf  [(Another anticipated obstacle involves the issue of resources required for establishing or upscaling an ethics structure in )] TJ ET
BT 26.250 225.884 Td /F1 9.8 Tf  [(humanitarian aid organizations. With regard to this concern, it is important to consider that to pursue a greater goal, material )] TJ ET
BT 26.250 213.979 Td /F1 9.8 Tf  [(and human resources are at risk of being misused or instrumentalized. The aim of the ethical framework is to raise such )] TJ ET
BT 26.250 202.074 Td /F1 9.8 Tf  [(concerns and demand specific justifications in such cases. Solid, ethical decision-making processes can help save resources by )] TJ ET
BT 26.250 190.170 Td /F1 9.8 Tf  [(adding a level of scrutiny that may help avoid bad or wasteful choices. The meso-level case described above provides a useful )] TJ ET
BT 26.250 178.265 Td /F1 9.8 Tf  [(example in which this approach would have been beneficial. The organization�s primary goal in distributing food aid was not to )] TJ ET
BT 26.250 166.360 Td /F1 9.8 Tf  [(improve the local population�s nutritional status, but, instead it was to increase access to local leaders. Therefore, ethicists play )] TJ ET
BT 26.250 154.455 Td /F1 9.8 Tf  [(an important role in guiding organizations through the decision-making process. It is left up to each organization to find the )] TJ ET
BT 26.250 142.551 Td /F1 9.8 Tf  [(mechanism that best suits their decision-making process. Applying the hub and spokes model does not require extensive )] TJ ET
BT 26.250 130.646 Td /F1 9.8 Tf  [(additional human resources, but will require staff with a specific profile who already have the necessary competencies.)] TJ ET
BT 26.250 94.043 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 26.250 74.089 Td /F1 9.8 Tf  [(In this paper, we emphasize that ethical issues are inherent in humanitarian action. We highlight sp,e possible ethical dilemmas )] TJ ET
BT 26.250 62.184 Td /F1 9.8 Tf  [(and decisions faced by humanitarian workers and show that their participation in the decision-making process was often lacking. )] TJ ET
BT 26.250 50.280 Td /F1 9.8 Tf  [(The proposed ethical framework strives to a\) stress certain values that guide humanitarian action, b\) recommend a ten-step )] TJ ET
BT 26.250 38.375 Td /F1 9.8 Tf  [(approach that strengthens humanitarian aid workers� capacity to identify and address ethical issues when making decisions, )] TJ ET
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BT 26.250 499.821 Td /F1 9.8 Tf  [(As with clinical practice, humanitarian contexts are often highly challenging and ideally require a fully trained ethicist to assist )] TJ ET
BT 26.250 487.917 Td /F1 9.8 Tf  [(and act as a mediator who guides the decision-making process. The experienced ethicists train all ethics resource leaders to )] TJ ET
BT 26.250 476.012 Td /F1 9.8 Tf  [(ensure that skilled humanitarian aid workers are available and able to act as ethicists at all levels. Depending on the level at )] TJ ET
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BT 26.250 452.202 Td /F1 9.8 Tf  [(including key stakeholders as participants. Subsequently, the committee either decides to proceed according to the principles )] TJ ET
BT 26.250 440.298 Td /F1 9.8 Tf  [(stated in the ethical framework proposed here or agrees to a set of core principles for future reference and to shape the )] TJ ET
BT 26.250 428.393 Td /F1 9.8 Tf  [(decision-making process.)] TJ ET
BT 26.250 391.790 Td /F4 12.0 Tf  [(Remaining challenges)] TJ ET
BT 26.250 371.836 Td /F1 9.8 Tf  [(Looking across humanitarian organizations show that a wide range of values continues to prevail, and reaching a consensus on )] TJ ET
BT 26.250 359.931 Td /F1 9.8 Tf  [(a set of core values or principles is a challenging task. Yet, humanitarian action is embedded in substantive and procedural )] TJ ET
BT 26.250 348.027 Td /F1 9.8 Tf  [(values of ethical relevance. At present, however, identifying conflicting values is not part of many organizations� decision-making )] TJ ET
BT 26.250 336.122 Td /F1 9.8 Tf  [(culture, which is predominantly marked by a geopolitical discourse. Therefore, a platform is required to allow for such debates.)] TJ ET
BT 26.250 316.717 Td /F1 9.8 Tf  [(Beginning with the framework described in this paper, each organization must elaborate their own approach to ethical decision-)] TJ ET
BT 26.250 304.812 Td /F1 9.8 Tf  [(making, attuned to their value set and the ethics resources available at their institution. Importantly, regardless of the detail in )] TJ ET
BT 26.250 292.908 Td /F1 9.8 Tf  [(the structures and processes, they must be conceived as a learning system that begins imperfectly but aims at continuous )] TJ ET
BT 26.250 281.003 Td /F1 9.8 Tf  [(improvement. In addition to tailoring the overall approach to the specific needs and features of individual humanitarian aid )] TJ ET
BT 26.250 269.098 Td /F1 9.8 Tf  [(organizations, a further challenge will be creating opportunities for exchange between organizations. It will be important for )] TJ ET
BT 26.250 257.193 Td /F1 9.8 Tf  [(organizations to benefit mutually from experiences and explore potential for common standards that might emerge.)] TJ ET
BT 26.250 237.789 Td /F1 9.8 Tf  [(Another anticipated obstacle involves the issue of resources required for establishing or upscaling an ethics structure in )] TJ ET
BT 26.250 225.884 Td /F1 9.8 Tf  [(humanitarian aid organizations. With regard to this concern, it is important to consider that to pursue a greater goal, material )] TJ ET
BT 26.250 213.979 Td /F1 9.8 Tf  [(and human resources are at risk of being misused or instrumentalized. The aim of the ethical framework is to raise such )] TJ ET
BT 26.250 202.074 Td /F1 9.8 Tf  [(concerns and demand specific justifications in such cases. Solid, ethical decision-making processes can help save resources by )] TJ ET
BT 26.250 190.170 Td /F1 9.8 Tf  [(adding a level of scrutiny that may help avoid bad or wasteful choices. The meso-level case described above provides a useful )] TJ ET
BT 26.250 178.265 Td /F1 9.8 Tf  [(example in which this approach would have been beneficial. The organization�s primary goal in distributing food aid was not to )] TJ ET
BT 26.250 166.360 Td /F1 9.8 Tf  [(improve the local population�s nutritional status, but, instead it was to increase access to local leaders. Therefore, ethicists play )] TJ ET
BT 26.250 154.455 Td /F1 9.8 Tf  [(an important role in guiding organizations through the decision-making process. It is left up to each organization to find the )] TJ ET
BT 26.250 142.551 Td /F1 9.8 Tf  [(mechanism that best suits their decision-making process. Applying the hub and spokes model does not require extensive )] TJ ET
BT 26.250 130.646 Td /F1 9.8 Tf  [(additional human resources, but will require staff with a specific profile who already have the necessary competencies.)] TJ ET
BT 26.250 94.043 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 26.250 74.089 Td /F1 9.8 Tf  [(In this paper, we emphasize that ethical issues are inherent in humanitarian action. We highlight sp,e possible ethical dilemmas )] TJ ET
BT 26.250 62.184 Td /F1 9.8 Tf  [(and decisions faced by humanitarian workers and show that their participation in the decision-making process was often lacking. )] TJ ET
BT 26.250 50.280 Td /F1 9.8 Tf  [(The proposed ethical framework strives to a\) stress certain values that guide humanitarian action, b\) recommend a ten-step )] TJ ET
BT 26.250 38.375 Td /F1 9.8 Tf  [(approach that strengthens humanitarian aid workers� capacity to identify and address ethical issues when making decisions, )] TJ ET
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BT 26.250 499.821 Td /F1 9.8 Tf  [(As with clinical practice, humanitarian contexts are often highly challenging and ideally require a fully trained ethicist to assist )] TJ ET
BT 26.250 487.917 Td /F1 9.8 Tf  [(and act as a mediator who guides the decision-making process. The experienced ethicists train all ethics resource leaders to )] TJ ET
BT 26.250 476.012 Td /F1 9.8 Tf  [(ensure that skilled humanitarian aid workers are available and able to act as ethicists at all levels. Depending on the level at )] TJ ET
BT 26.250 464.107 Td /F1 9.8 Tf  [(which ethical consultation is needed, either the experienced ethicists or the ethics resource leader constitute a committee )] TJ ET
BT 26.250 452.202 Td /F1 9.8 Tf  [(including key stakeholders as participants. Subsequently, the committee either decides to proceed according to the principles )] TJ ET
BT 26.250 440.298 Td /F1 9.8 Tf  [(stated in the ethical framework proposed here or agrees to a set of core principles for future reference and to shape the )] TJ ET
BT 26.250 428.393 Td /F1 9.8 Tf  [(decision-making process.)] TJ ET
BT 26.250 391.790 Td /F4 12.0 Tf  [(Remaining challenges)] TJ ET
BT 26.250 371.836 Td /F1 9.8 Tf  [(Looking across humanitarian organizations show that a wide range of values continues to prevail, and reaching a consensus on )] TJ ET
BT 26.250 359.931 Td /F1 9.8 Tf  [(a set of core values or principles is a challenging task. Yet, humanitarian action is embedded in substantive and procedural )] TJ ET
BT 26.250 348.027 Td /F1 9.8 Tf  [(values of ethical relevance. At present, however, identifying conflicting values is not part of many organizations� decision-making )] TJ ET
BT 26.250 336.122 Td /F1 9.8 Tf  [(culture, which is predominantly marked by a geopolitical discourse. Therefore, a platform is required to allow for such debates.)] TJ ET
BT 26.250 316.717 Td /F1 9.8 Tf  [(Beginning with the framework described in this paper, each organization must elaborate their own approach to ethical decision-)] TJ ET
BT 26.250 304.812 Td /F1 9.8 Tf  [(making, attuned to their value set and the ethics resources available at their institution. Importantly, regardless of the detail in )] TJ ET
BT 26.250 292.908 Td /F1 9.8 Tf  [(the structures and processes, they must be conceived as a learning system that begins imperfectly but aims at continuous )] TJ ET
BT 26.250 281.003 Td /F1 9.8 Tf  [(improvement. In addition to tailoring the overall approach to the specific needs and features of individual humanitarian aid )] TJ ET
BT 26.250 269.098 Td /F1 9.8 Tf  [(organizations, a further challenge will be creating opportunities for exchange between organizations. It will be important for )] TJ ET
BT 26.250 257.193 Td /F1 9.8 Tf  [(organizations to benefit mutually from experiences and explore potential for common standards that might emerge.)] TJ ET
BT 26.250 237.789 Td /F1 9.8 Tf  [(Another anticipated obstacle involves the issue of resources required for establishing or upscaling an ethics structure in )] TJ ET
BT 26.250 225.884 Td /F1 9.8 Tf  [(humanitarian aid organizations. With regard to this concern, it is important to consider that to pursue a greater goal, material )] TJ ET
BT 26.250 213.979 Td /F1 9.8 Tf  [(and human resources are at risk of being misused or instrumentalized. The aim of the ethical framework is to raise such )] TJ ET
BT 26.250 202.074 Td /F1 9.8 Tf  [(concerns and demand specific justifications in such cases. Solid, ethical decision-making processes can help save resources by )] TJ ET
BT 26.250 190.170 Td /F1 9.8 Tf  [(adding a level of scrutiny that may help avoid bad or wasteful choices. The meso-level case described above provides a useful )] TJ ET
BT 26.250 178.265 Td /F1 9.8 Tf  [(example in which this approach would have been beneficial. The organization�s primary goal in distributing food aid was not to )] TJ ET
BT 26.250 166.360 Td /F1 9.8 Tf  [(improve the local population�s nutritional status, but, instead it was to increase access to local leaders. Therefore, ethicists play )] TJ ET
BT 26.250 154.455 Td /F1 9.8 Tf  [(an important role in guiding organizations through the decision-making process. It is left up to each organization to find the )] TJ ET
BT 26.250 142.551 Td /F1 9.8 Tf  [(mechanism that best suits their decision-making process. Applying the hub and spokes model does not require extensive )] TJ ET
BT 26.250 130.646 Td /F1 9.8 Tf  [(additional human resources, but will require staff with a specific profile who already have the necessary competencies.)] TJ ET
BT 26.250 94.043 Td /F4 12.0 Tf  [(Conclusion)] TJ ET
BT 26.250 74.089 Td /F1 9.8 Tf  [(In this paper, we emphasize that ethical issues are inherent in humanitarian action. We highlight sp,e possible ethical dilemmas )] TJ ET
BT 26.250 62.184 Td /F1 9.8 Tf  [(and decisions faced by humanitarian workers and show that their participation in the decision-making process was often lacking. )] TJ ET
BT 26.250 50.280 Td /F1 9.8 Tf  [(The proposed ethical framework strives to a\) stress certain values that guide humanitarian action, b\) recommend a ten-step )] TJ ET
BT 26.250 38.375 Td /F1 9.8 Tf  [(approach that strengthens humanitarian aid workers� capacity to identify and address ethical issues when making decisions, )] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(and c\) suggest a model \(�hub and spokes�\) that helps define the organizational resources needed to implement the framework.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(The ethical framework aims to support humanitarian aid workers and other stakeholders in their decision-making process, which )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(will ultimately improve the processes of project cycle management. This is especially relevant because humanitarian action )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(remains a challenging field involving multiple actors that adhere to different sets of principles in often highly complex and volatile )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(environments. The proposed tools also foster exchange through mediated discussions involving all stakeholders, which in turn )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(promotes coherence in decisions and outcomes.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(If humanitarian organizations had adopted such an approach in the sample cases presented in this paper, the outcome would )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(have been significantly different. For example, repeated budget allocations would not occur without involving the program )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(managers in the field, who are directly concerned with such decisions. Material resources would not be used to meet covert )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(goals and staff members would be educated so that they can provide informed consent prior to their deployment. Moreover, )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(measures would be taken to mitigate the harm of any operational program on the beneficiaries.)] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(Because humanitarian action frequently evolves in highly volatile contexts, promoting ethical considerations within and across )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(actors and organizations is essential to avoid exacerbating the challenges faced by victims of disasters.)] TJ ET
BT 26.250 565.517 Td /F4 12.0 Tf  [(Footnotes)] TJ ET
BT 26.250 545.562 Td /F1 9.8 Tf  [([1] The macro-, meso- and micro-levels chosen in this context represent the three main levels of decision-making within a )] TJ ET
BT 26.250 533.658 Td /F1 9.8 Tf  [(humanitarian organization, partially excluding a social ecological)] TJ ET
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BT 303.150 535.165 Td /F4 8.7 Tf  [(27)] TJ ET
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BT 312.787 533.658 Td /F1 9.8 Tf  [(.)] TJ ET
BT 26.250 514.253 Td /F1 9.8 Tf  [([2] Beauchamp and Childress \(2009: 23\) propose six conditions that �must be met to justify infringing one prima facie norm to )] TJ ET
BT 26.250 502.348 Td /F1 9.8 Tf  [(adhere to another. According to the authors 1\) good reasons can be offered to act on the overriding norm rather than on the )] TJ ET
BT 26.250 490.443 Td /F1 9.8 Tf  [(infringed norm. 2\) The moral objective justifying the infringement has a realistic prospect of achievement. 3\) No morally )] TJ ET
BT 26.250 478.539 Td /F1 9.8 Tf  [(preferable alternative actions are available. 4\) The lowest level of infringement, commensurate with achieving the primary goal )] TJ ET
BT 26.250 466.634 Td /F1 9.8 Tf  [(of the action, has been selected. 5\) Any negative effects of the infringement have been minimized. 6\) All affected parties have )] TJ ET
BT 26.250 454.729 Td /F1 9.8 Tf  [(been treated impartially.)] TJ ET
BT 26.250 435.324 Td /F1 9.8 Tf  [([3]These tools are described in Fletcher�s Introduction to Clinical Ethics )] TJ ET
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BT 335.120 436.832 Td /F4 8.7 Tf  [(13)] TJ ET
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BT 344.758 435.324 Td /F1 9.8 Tf  [(, Beauchamp and Childress, Principles of Biomedical )] TJ ET
BT 26.250 423.420 Td /F1 9.8 Tf  [(Ethics)] TJ ET
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BT 52.799 424.927 Td /F4 8.7 Tf  [(22)] TJ ET
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BT 62.437 423.420 Td /F1 9.8 Tf  [(, Singer)] TJ ET
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BT 96.035 424.927 Td /F4 8.7 Tf  [(23)] TJ ET
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BT 105.672 423.420 Td /F1 9.8 Tf  [(, Bioethics at the bedside: a clinicians guide, Wall)] TJ ET
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BT 318.642 424.927 Td /F4 8.7 Tf  [(24)] TJ ET
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BT 328.279 423.420 Td /F1 9.8 Tf  [(, Ethics for International Medicine: A Practical Guide for )] TJ ET
BT 26.250 411.515 Td /F1 9.8 Tf  [(Aid Workers in Developing Countries.)] TJ ET
BT 26.250 392.110 Td /F1 9.8 Tf  [([4] For the purposes of this paper, we do not distinguish between values, norms and principles. The values in the table could )] TJ ET
BT 26.250 380.205 Td /F1 9.8 Tf  [(also be phrased as principles or norms.)] TJ ET
BT 26.250 343.603 Td /F4 12.0 Tf  [(Acknowledgements)] TJ ET
BT 26.250 323.649 Td /F1 9.8 Tf  [(We wish to thank Paul Bouvier, Philippe Calain, Martin Herrmann, Shazia Islamshah and Raissa Magnin for their insightful and )] TJ ET
BT 26.250 311.744 Td /F1 9.8 Tf  [(valuable comments.)] TJ ET
BT 26.250 282.641 Td /F4 12.0 Tf  [(References)] TJ ET
BT 26.250 255.187 Td /F1 9.8 Tf  [(1.)] TJ ET
BT 38.132 255.187 Td /F1 9.8 Tf  [(Hunt MR. Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work. Disasters. 2011 )] TJ ET
BT 26.250 243.282 Td /F1 9.8 Tf  [(Jul;35\(3\):606-22. PubMed PMID:21410748.)] TJ ET
BT 26.250 223.878 Td /F1 9.8 Tf  [(2.)] TJ ET
BT 38.132 223.878 Td /F1 9.8 Tf  [(International Committee of the Red Cross. The Fundamental Principles of the Red Cross. 1979. )] TJ ET
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BT 26.250 215.392 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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BT 26.250 196.842 Td /F1 9.8 Tf  [(3.)] TJ ET
BT 38.132 196.842 Td /F1 9.8 Tf  [(MSF. History & Principles. 2014.)] TJ ET
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BT 26.250 188.356 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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BT 26.250 169.806 Td /F1 9.8 Tf  [(4.)] TJ ET
BT 38.132 169.806 Td /F1 9.8 Tf  [(ECHO. Humanitarian Aid and Civil Protection. 2014.)] TJ ET
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BT 26.250 161.320 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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BT 26.250 142.770 Td /F1 9.8 Tf  [(5.)] TJ ET
BT 38.132 142.770 Td /F1 9.8 Tf  [(Hammond L., Vaughan-Lee H. Humanitarian space in Somalia: a scarce commodity. 2012: 1-15.)] TJ ET
BT 26.250 123.365 Td /F1 9.8 Tf  [(6.)] TJ ET
BT 38.132 123.365 Td /F1 9.8 Tf  [(Calain P. In Search of the 'New Informal Legitimacy' of M�decins Sans Fronti�res. Public Health Ethics. 2012 Apr;5\(1\):56-66. )] TJ ET
BT 26.250 111.460 Td /F1 9.8 Tf  [(PubMed PMID:22442647.)] TJ ET
BT 26.250 92.055 Td /F1 9.8 Tf  [(7.)] TJ ET
BT 38.132 92.055 Td /F1 9.8 Tf  [(Darcy J., Hofmann C. According to need? Needs assessments and decision-making in the humanitarian sector.2003: 47-52.)] TJ ET
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BT 26.250 83.569 Td /F1 7.5 Tf  [(REFERENCE LINK)] TJ ET
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BT 26.250 65.019 Td /F1 9.8 Tf  [(8.)] TJ ET
BT 38.132 65.019 Td /F1 9.8 Tf  [(MacRae S, Chidwick P, Berry S, Secker B, H�bert P, Shaul RZ, Faith K, Singer PA. Clinical bioethics integration, )] TJ ET
BT 26.250 53.115 Td /F1 9.8 Tf  [(sustainability, and accountability: the Hub and Spokes Strategy. J Med Ethics. 2005 May;31\(5\):256-61. PubMed )] TJ ET
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BT 26.250 767.476 Td /F1 9.8 Tf  [(and c\) suggest a model \(�hub and spokes�\) that helps define the organizational resources needed to implement the framework.)] TJ ET
BT 26.250 748.071 Td /F1 9.8 Tf  [(The ethical framework aims to support humanitarian aid workers and other stakeholders in their decision-making process, which )] TJ ET
BT 26.250 736.167 Td /F1 9.8 Tf  [(will ultimately improve the processes of project cycle management. This is especially relevant because humanitarian action )] TJ ET
BT 26.250 724.262 Td /F1 9.8 Tf  [(remains a challenging field involving multiple actors that adhere to different sets of principles in often highly complex and volatile )] TJ ET
BT 26.250 712.357 Td /F1 9.8 Tf  [(environments. The proposed tools also foster exchange through mediated discussions involving all stakeholders, which in turn )] TJ ET
BT 26.250 700.452 Td /F1 9.8 Tf  [(promotes coherence in decisions and outcomes.)] TJ ET
BT 26.250 681.048 Td /F1 9.8 Tf  [(If humanitarian organizations had adopted such an approach in the sample cases presented in this paper, the outcome would )] TJ ET
BT 26.250 669.143 Td /F1 9.8 Tf  [(have been significantly different. For example, repeated budget allocations would not occur without involving the program )] TJ ET
BT 26.250 657.238 Td /F1 9.8 Tf  [(managers in the field, who are directly concerned with such decisions. Material resources would not be used to meet covert )] TJ ET
BT 26.250 645.333 Td /F1 9.8 Tf  [(goals and staff members would be educated so that they can provide informed consent prior to their deployment. Moreover, )] TJ ET
BT 26.250 633.429 Td /F1 9.8 Tf  [(measures would be taken to mitigate the harm of any operational program on the beneficiaries.)] TJ ET
BT 26.250 614.024 Td /F1 9.8 Tf  [(Because humanitarian action frequently evolves in highly volatile contexts, promoting ethical considerations within and across )] TJ ET
BT 26.250 602.119 Td /F1 9.8 Tf  [(actors and organizations is essential to avoid exacerbating the challenges faced by victims of disasters.)] TJ ET
BT 26.250 565.517 Td /F4 12.0 Tf  [(Footnotes)] TJ ET
BT 26.250 545.562 Td /F1 9.8 Tf  [([1] The macro-, meso- and micro-levels chosen in this context represent the three main levels of decision-making within a )] TJ ET
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BT 312.787 533.658 Td /F1 9.8 Tf  [(.)] TJ ET
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BT 26.250 490.443 Td /F1 9.8 Tf  [(infringed norm. 2\) The moral objective justifying the infringement has a realistic prospect of achievement. 3\) No morally )] TJ ET
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BT 43.553 455.559 Td /F1 9.8 Tf  [(Daniels N., Sabin J., Setting limits fairly: Learning to Share Resources for Health. Oxford University Press. 2008: 45.)] TJ ET
BT 26.250 436.155 Td /F1 9.8 Tf  [(21.)] TJ ET
BT 43.553 436.155 Td /F1 9.8 Tf  [(de Waal A. The humanitarians' tragedy: escapable and inescapable cruelties. Disasters. 2010 Apr;34 Suppl 2:S130-7. )] TJ ET
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BT 26.250 404.845 Td /F1 9.8 Tf  [(22.)] TJ ET
BT 43.553 404.845 Td /F1 9.8 Tf  [(Beauchamp T., Childress J., Principles of Biomedical Ethics. Oxford University Press. 2009.)] TJ ET
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BT 43.553 385.440 Td /F1 9.8 Tf  [(Singer P., Bioethics for clinicians. 1999.)] TJ ET
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BT 43.553 366.036 Td /F1 9.8 Tf  [(Wall A., Ethics for International Medicine: A Practical Guide for Aid Workers in Developing Countries. 2012: 5-19.)] TJ ET
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BT 43.553 346.631 Td /F1 9.8 Tf  [(Clarinval, C. Humanitarian Values: a neglected debate. Proceedings of the 3rd ICMM Workshop on Military Medical Ethics. )] TJ ET
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BT 26.250 518.178 Td /F1 9.8 Tf  [(18.)] TJ ET
BT 43.553 518.178 Td /F1 9.8 Tf  [(Terry F. The International Committee of the Red Cross in Afghanistan: reasserting the neutrality of humanitarian action. )] TJ ET
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BT 26.250 486.869 Td /F1 9.8 Tf  [(19.)] TJ ET
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BT 43.553 436.155 Td /F1 9.8 Tf  [(de Waal A. The humanitarians' tragedy: escapable and inescapable cruelties. Disasters. 2010 Apr;34 Suppl 2:S130-7. )] TJ ET
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BT 43.553 404.845 Td /F1 9.8 Tf  [(Beauchamp T., Childress J., Principles of Biomedical Ethics. Oxford University Press. 2009.)] TJ ET
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BT 43.553 385.440 Td /F1 9.8 Tf  [(Singer P., Bioethics for clinicians. 1999.)] TJ ET
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BT 43.553 366.036 Td /F1 9.8 Tf  [(Wall A., Ethics for International Medicine: A Practical Guide for Aid Workers in Developing Countries. 2012: 5-19.)] TJ ET
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BT 43.553 315.321 Td /F1 9.8 Tf  [(World Health Organization. Health and well-being - a common purpose, a shared responsibility. Health 2020 Leadership for )] TJ ET
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