Military Medicine Archives - Protection of Conscience Project Library

Dual Loyalty/Military Medicine

Cecil B. Wilson

Extract
Military medicine is described as the ethical issue of dual loyalty, and how it relates to those health care personnel who are both officers in the military and are medical officers such as doctors and nurses. . . Notably, I wear two hats − one to my country as an officer and one to my patients as their doctor. This clinical role may bring conflict between professional duties to a patient and obligations − expressed or implied, real or perceived, to the interest of a third party such as an employer, an insurer or the state − that can violate patient’s rights. Dual loyalty, in this case, is simultaneous for obligations expressed or implied to a patient and a third party such as the military.

Wilson CB. Dual Loyalty/Military Medicine. World Med J 2022 Nov;70(3): 4-7.

Military Medical Ethics – Physician First, Last, Always

George J Annas

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
The chair of the President’s Council on Bioethics, Edmund Pellegrino, has insisted that medical ethics are and must be the same for civilian and military physicians, “except in the most extreme contingencies.” There is no special medical ethics for active-duty military physicians any more than there is for Veterans Affairs physicians, National Guard physicians, public health physicians, prison physicians, or managed care physicians. The only question is whether there are “extreme contingencies” that justify physicians’ suspension of their medical–ethical obligations.

Annas GJ. Military Medical Ethics – Physician First, Last, Always. N Engl J Med. 2008;1087-1090.

(Correspondence) Military medicine and human rights

Andre N Sofair, Peter G Lurie

Extract
The Hippocratic Oath states: “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing.” It is our responsibility to make these words a reality.

Sofair AN, Lurie PG. (Correspondence) Military medicine and human rights. The Lancet. 2004 Nov 20;364(1851.

(Correspondence) Military medicine and human rights

Kevin C Kiley

Extract
Remember the many thousands who have served and are serving honorably, caring for American soldiers and Iraqis, and not the few who might have greatly disappointed us with their lack of proper ethical judgment.

Kiley KC. (Correspondence) Military medicine and human rights. The Lancet. 2004 Nov 20;364(9448):1851-1852.

The position of the Chilean Medical Association with respect to torture as an instrument of political repression

Gunther Seelman

Extract
We reaffirm . . . our most categorical rejection of torture. Likewise, we reiterate our resolute support of the diverse initiatives aimed at investigating the participation of doctors in these unacceptable and condemnable practices, and the sanctioning of these activities within the medical profession and scientific organisations. . . There exists irrefutable proof that, during the 16 years of dictatorship, doctors and other members of the health care professions caused brutal suffering to their peers. Doctors involved in acts of torture are, for the most part, members of the armed forces. The conduct of these professionals is the result of the displacement of their medical vocation by the doctrine of ‘national security’, which conceives of the masses and their social and political organisations as the ‘internal enemy’.

Seelman G. The position of the Chilean Medical Association with respect to torture as an instrument of political repression. J Med Ethics. 1991 Dec; 17(Supplement):33-34.

Torture and the participation of doctors

Ugur Cilasun

(Notes that no doctors in private practice were known to have been involved in torture in Turkey. Those involved were working part-time or full-time for the government, or in the military.)
Extract
. . . Government pressure, on full or part-time employees, emerges in various forms. Doctors who refuse to participate in the act of torture can be accused of not obeying the orders of their immediate superiors and can be either dismissed from government service, or relocated to other posts with highly unfavourable working/living conditions. Material considerations, fear of being removed from family, and the obvious threat of coming under suspicion of ‘secretly collaborating with public enemies’, etc, exerts such emotional pressure that doctors are forced to participate, directly or indirectly, in the act of torture.

Cilasun U. Torture and the participation of doctors. J Med Ethics. 1991 Dec;17(1):S21-S22.