The burden of choice: a qualitative study of healthcare professionals’ reactions to ethical challenges in humanitarian crises

Healthcare professionals are a vital aspect of public health delivery in humanitarian crises. Both overt and subtle complexities in the decision making process during periods of instability may involve moral and ethical considerations. Few studies have examined the lived experiences of healthcare professionals encountering ethical challenges in the field. The aims of this qualitative study were to explore how healthcare professionals perceive complex ethical choices and to understand the impact these challenges had on them both personally and professionally. The data was analyzed using manifest and latent qualitative content analysis. Four themes emerged from the data analysis: ethics as a sense of right or wrong, adversely bearing the burden of choice, held hostage by institutional constraints, and the difficulty of preparing for ethical challenges. The overarching theme struggling to make the right choice established that ethical challenges created difficulties for healthcare professionals both in negative psychological outcomes and the perception of reduced patient care. Awareness of these ethical challenges can help organizations to fully support healthcare professionals in the field to reduce personal struggles and provide optimal care delivery.