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Military Medical Ethics: Issues Regarding Dual Loyalties - Workshop Summary
Addressing the need for training in medical ethics can involve a range of approaches. At the Uniformed Services University of the Health Sciences, medical ethics is an essential element of the core curriculum and encompasses varied teaching methods, including inviting speakers to discuss their experiences, case study discussions, and field practice exercises. Continuing education of health professionals offers ongoing opportunities to learn from interdisciplinary perspectives. Training outside the classroom in a real-world situation, such as aboard a naval hospital ship on a humanitarian mission, offers teachable moments for addressing ethical dilemmas. Innovative approaches for enhancing ethics training are being tried in various contexts. For example, at Northwestern University, training in ethical issues in palliative medicine includes interdisciplinary hospital rounds, interactions with patients in nonclinical settings, and instruction focused on real patients and their life experiences—sometimes presented through videotaped interviews.
Organizational values and behavior strongly influence adherence to ethical principles. In the military, the commander sets the tone, as does his or her counterpart in civilian senior management. A just organization exhibits ethical awareness, judgment, and motivation and implements ethical standards. A step that organizations can take to strengthen their ethical infrastructure is to establish an ombudsperson’s office to investigate individual complaints and report findings in the aggregate, without personal identifiers. Ensuring that organizations act ethically requires involving staff at many levels, along with organizational feedback, deliberation, organized advocacy, and appropriate checks and balances, some of which may be external to the organization.
Within the military services, primary responsibility to the patient should prevail in nearly all circumstances. This workshop focused on situations in which ethical conflicts arise because of dual loyalties. Workshop participants emphasized several points:
Dual loyalty situations can occur in military medicine, although in most routine aspects of health care, military medicine is similar to civilian medicine.
Models used in occupational medicine, sports medicine, and prison medicine, among others, can be informative in considering ways to address ethical issues in military medicine.
Some important differences exist between international declarations and DoD health policies regarding hunger strikes. The two views cannot easily be reconciled in the abstract, but, in many