ACORNS - POLICY - JACK

All of the scenarios in the policy suit should be considered from the perspective of a health professional in a staff appointment as the lead officer for medical policy within a Ministry of Defence (rank equivalent of OF4/Commander/Lieutenant Colonel/Wing Commander).

Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: You are asked to write a rebuttal for an adverse news report on the provision of mental health services to veterans. You know that your request for more funding for this service was rejected. Is it ethical to write a media release?
• 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 health policy decisions that are impacted by the availability of resources (money, people, infrastructure etc). The topic of mental ill-health to armed forces personnel and veterans has been politically contentious in many countries. Within Ministries of Defence, there is often a Public Affairs branch that organises the public communications of all military activities including the response to adverse media stories. They may seek technical advice on topics prior to publication. You will need to consider how this task balances your technical knowledge on a topic with the truth of any internal issues regarding the policy and allocation of resources to care for veterans – including whether is the responsibility of the Ministry of Defence or other organisation (e.g. Ministry of Health).

Step 2 – ANALYSE

Patient: your first duty to do no harm to patients through policy, but also to provide ‘beneficence’ if there is an appropriate healthcare intervention. Do you have knowledge of the health needs of this patient group and what is your institution’s responsibility towards them?  

Clinical: you should consider what is known about the topic and the current clinical arrangements for these patients. You might also consider an international comparison with other militaries.

Legal: You should consider who has the legal duty to meet the health needs of veterans alongside any ethical/societal duties towards veterans. You might consider your duties as an advocate for patients and in balancing competing demands for health services across society -  WMA International Code of Medical Ethics https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

Societal/Military: you might consider the technical and political history to why it is the subject of this adverse news report. You should also consider the reasons why your request for funding was rejected.

Step 3 – FUSE

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

This scenario covers a politically sensitive subject. You might consider whether you are the best qualified person to provide answers to the request for information, and also who else might be contributing to the response. Above all else, you must not lie.

Step 4 – DECIDE

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

You should provide a factually correct answer that covers your area of responsibility. You might need to include information or advice from senior clinical experts. You might wish to highlight the opportunities for more investment, but it is highly likely that senior leaders in the Ministry of Defence will not wish to put negative issues of funding or resource choices into the public domain. If you have a strongly held view that this was the wrong choice, you might consider requesting the leave your appointment or resigning.    

Contributor – Air Vice Marshal (Rtd) Alastair Reid CB FFOM, Surgeon General UK Defence Medical Services 2019-2021.