MSF Field Research
Issue Date: Jul-2016
A Médecins Sans Frontières ethics framework for humanitarian innovation
Sheather, Julian; Jobanputra, Kiran; Schopper, Doris; Pringle, John; Venis, Sarah; Wong, Sidney; Vincent-Smith, Robin
Abstract:
A framework to be used to guide work that does not lie within the purview of formal research ethics oversight
URI: http://hdl.handle.net/10144/615490

Full text [framework only]

This framework is intended to be used to guide work that does not directly involve human participants and does not lie within the purview of formal research ethics oversight.

.1. Clearly identify the problem you are seeking to address, and what benefit you expect the innovation to have. This step may seem obvious, so what is its ethical significance? When identifying the problem, there should be consideration of up-stream solutions that may address the problem in a holistic and sustainable way. For instance, rather than focusing on technocratic fixes, what are the socio-political determinants of the problem and the wider possibilities for solutions? Who has stakes in finding a solution and who may have interests in perpetuating the problem? Is the problem a moving target? Collaboration and cross-fertilization with other disciplines should be considered in order to help to see the problem from various perspectives. In short, do not underestimate the importance of fully identifying the problem.

.2. Ensure that the innovation shows respect for human dignity. While this is a broad concept, it has practical implications. The focus of concern is respect for human beings, reminding us that the simplest or most direct solutions may not be ethically appropriate. Innovators must show due respect for the multiple and overlapping interests of those affected by the innovation. It extends beyond a concern for physical wellbeing to include psychological and cultural integrity. It also incorporates a concern for individual privacy and a respect for the confidentiality of individual, family, and community-based data.

.3. Clarify how you will involve the end user from the start of the process. Innovation should be driven by the requirements of the user. The innovation cycle should be participatory, using methods to involve relevant individuals and communities. Innovators must be sensitive to power dynamics between and within cultures and power imbalances between aid workers and beneficiaries.

.4. Identify and weigh harms and benefits. When considering innovations, a critical first step is the identification, as far as is reasonably possible, of potential harms along with the anticipated benefits. The next step involves weighing these harms and benefits.
.a. Where reasonably foreseeable harms outweigh the likely benefits, implementation will not be ethical. Potential harms include, but are not limited to, physical and psychological harms to individuals. There is also need to consider potential harm to communities.
.b. Where innovation involves a favourable balance of benefits and harms, all reasonable steps must be taken to minimise (mitigate) the harms as far as possible. Unnecessary harms must be eliminated. Where harms are unavoidable, those affected should be informed of the nature and severity of the risks involved.
.c. Conflicted partnerships or conflicts of interest may result in reputational harm to the organisation. If these are identified then oversight by an existing Ethics Review Board is recommended.

.5. Describe the distribution of harms and benefits, and ensure that the risk of harm is not borne by those who do not stand to benefit. Innovators need to give careful consideration to the distribution of benefits and harms associated with their projects. Do the risks or benefits fall unequally across groups? If so, is it appropriate to proceed, and how can these inequalities of distribution be addressed or mitigated? Equally, it is important that the innovation takes into account vulnerable groups; it may be ethically warranted to give particular attention to those who have particular needs. Just as we tend to give more health care to the unwell, so particular attention may need to be given to those who are vulnerable or who may not be able to protect their own interests. This is expressed in the humanitarian principle of impartiality. In addition, consider whether anyone is ‘wronged’ by the innovation. A ‘wrong’ is an infringement that is distinct from harm. For example, selecting one group for an innovation project over another may wrong the other group (as opposed to harming them).

.6. Plan (and carry out) an evaluation that delivers the information needed for subsequent decisions to implement or scale-up the innovation; and then ensure that the beneficiaries have access to the innovation. Innovation requires an acceptance of the risk of failure – not all innovation projects will achieve their desired outcome. But in all cases, we can learn and apply these lessons in the future. Given the time, energy, and resources that these projects require, rigorous evaluation and sharing of lessons is itself a moral obligation. Therefore, consideration should be given to dissemination of findings, since it may be important to avoid further exposure to potential harm by sharing findings, whether these are positive or negative. Likewise there should be a willingness and strategy for wider implementation of the innovation if found to be successful, and a commitment to ensure beneficiaries – at least in the communities where it was tested and ideally in similar communities affected by humanitarian crises – have access to the innovation subsequently.