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The Rationale of Needs-Based Objectivity

Because social and political distinctions are morally superficial when compared to life itself, the doctrine of humanitarian impartiality dictates that the only thing that can legitimately distinguish the necessity of attending to one person over another in humanitarian action is their relative need. In other words, the measure of prioritizing between different people’s lives is based only on who is more likely to lose their life. Objective levels of suffering, not subjective ties of attachment and identity, determine the proper criterion for the prioritization of humanitarian acts. Humanitarian response is prioritized in proportion to people’s need, not their identities.

This needs-based objectivity is a morally reasonable way to apply the value of humanity in situations where it is impossible to help everybody in need equally because of limited resources. It introduces a sense of fairness that respects people’s essential equality but acts reasonably to be as humanitarian as possible when not everyone can be helped. In extreme situations when food or medical services are overwhelmed by need, the medical objectivity of triage is used to narrow down humanitarian focus even more. Triage is not based on the criterion of need but survival. A person is judged on how likely it is they can recover. Importantly, this kind of survival-based objectivity seems to make painful but genuine moral sense to those involved—carers and patients alike. In his important ethical ethnography of Medians Sans Frontieres (MSF), Peter Redfield recounts the experience of James Orbinski and his MSF colleagues who provided humanitarian health care during the Rwandan genocide, in which hundreds of thousands of people were murdered by machetes. With so many terribly wounded people arriving at their clinic, the MSF team triaged people by writing a 1, 2 or 3 on tapes stuck onto their foreheads. As Orbinsky recalled: "1 meant treat now, 2 meant treat within twenty-four hours and 3 meant irretrievable. The 3s were moved to the small hill by the roadside opposite the emergency room and left to die in as much comfort as could be mustered for them.” The MSF team found this process extremely upsetting, but Orbinsky remembered the words of a terribly disfigured woman in the 3 queue who, seeing his distress, whispered to him to take courage and attend to the others.47

This episode reflects an extreme and very intimate problem of impartiality, but humanitarian agencies have to make much more strategic decisions about impartiality as well. They have to look at whole national populations and decide in which locality it is best to work, and with which groups (men, women, young or old) and which range of needs. Agencies also have to look between countries to see, for example, if it is more reasonable and feasible for them to work in Syria or the Central African Republic (CAR). Whether impartiality decisions are intimate choices made in clinics or strategic choices made at headquarters, the reasonable objectivity of these decisions requires evidence. What is the precise nature of a person’s wounds? How do levels of hunger compare across a country? What differential impact could we have on human lives between Syria and CAR? Needs-based impartiality depends on evidence about needs. This makes evidence a very important part of ethical practice.

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