All of the scenarios in the Role 4 suit should be considered from the perspective of a health professional working in a military hospital receiving casualties from military operations with responsibility for the clinical care of patients and management of the facility. The primary supporting reference for this suit is the World Medical Association International Code of Medical Ethics (WMA Code) at: https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/ supported by the WMA Declaration of Lisbon on the Rights of the Patient at: https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/#:~:text=Every%20person%20is%20entitled%20without,with%20his%2Fher%20best%20interests. You should also consider your national professional ethical codes and relevant military law or guidance.

Step 1 – IDENTIFY THE PROBLEM(S)

Briefly state the Scenario: The wife of the Commanding Officer of a number of patients in your hospital wants to visit them. What do you need to check before you might allow this?

• List the Issues that arise from the scenario.
• Identify Critical Information required and Assumptions to be made:

This scenario covers the ethics and law regarding respect, autonomy, and confidentiality regarding patient choice over visitors. This is similar to Role 4 - ACE, but the motivations for this visit might be different.

Step 2 – ANALYSE

Patient: Patients have the right to dignity, privacy, and confidentiality. WMA Code Para 13 - In providing medical care, the physician must respect the dignity, autonomy, and rights of the patient.  AND WMA Code Para 22 - The physician must respect the patient’s privacy and confidentiality. The patient must retain their inviolable right to refuse to be visited.

Clinical: Clinical staff must ensure that patient care is not disrupted by such a visit.

Legal: the Commanding Officer’s wife does not have any automatic, legal authority to visit military patients.

Societal/Military: in some armed forces the wife of a Commanding Officer assumes some duties to oversee the welfare arrangements for military families.

Step 3 – FUSE

• Summarise conclusions
• Insert citations to key reference sources for your analysis
• Determine the exact Decision(s) to be made

The patient’s autonomy must be respected, including their right to refuse to be visited. However, it might be appropriate for a Commanding Officer’s wife to visit military personnel in hospital in order to provide welfare support and assistance to their partners and families.

Step 4 – DECIDE

• What is your Decision?
• Why (can you justify it)?
• Residual uncertainly, need for review?

The reasons for the visit by the Commanding Officer’s wife must be explicitly understood by all patients on her visit programme. Patients must retain the right to refuse to be visited. This should comply with any procedures for visits to military patients by non-family members.

Contributor – Group Captain (Rtd) Teresa Griffiths CBE ARRC. Military Chief Nurse, Royal Centre for Defence Medicine (2010 - 2013) and Commanding Officer Defence Medical Rehabilitation Centre Headley Court/Stanford Hall (2016-2018).