Table 2

Ethical principles that should guide palliative care and symptom control in humanitarian contexts, as per WHO 2018 guide

Ethical principleWHO guidance
Respect for persons
  • All patients’ dignity and human rights must be respected .

  • Health professionals should provide patients with all health-related information, respect their decision-making and provide appropriate recommendations.

  • Patient’s health-related information should remain confidential.

Non-maleficence
  • Health professionals should only pursue interventions that provide more good than harm.

  • All patients should have access to palliative care to minimise suffering . Expectant patients should only receive palliation.

  • Never discriminate on the basis of ethnicity, religion, gender, age or political affiliation.

  • Avoid complicity with torture (political ethics?)

Beneficence
  • Work to provide the patient with the most good by meeting their physical, psychological, social and/or spiritual needs.

  • Anticipate and prevent future suffering.

  • Protect from violence and coercion (political ethics?)

  • Show great judiciousness when the good of the patient or family may be in conflict with the public good (eg, infectious diseases).

Justice
  • Similar patients should be treated similarly regardless of ethnicity, religion, gender, age or political affiliation.

  • Vulnerable patients may require more intensive services.

  • Health providers and aid workers may require increased health services due to added risks and burdens (principle of reciprocity).

  • Patient’s autonomy should never be restricted unless for the greater good.

Solidarity
  • A community, including the global community, should stand together to face common threats and overcome pathogenic inequalities. (political ethics?)

Non-abandonment
  • Medical care should be provided to all needy patients.

  • Expectant patients must be provided with palliative care.

Double effect
  • An action intended to bring about a good outcome (alleviation of pain) is permissible despite the possibility of a harmful outcome (hastening death). The reason for undertaking such high-risk action must be grave (misuses of science?).

  • Statements in bold and italics refer to those that show an implicit concern for the health of populations and groups.

  • Statements in bold refer to those that are fully consistent with a perspective concerned with groups and populations.