Specific Topic(s):

Protection of vulnerable patients

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ – Health-care personnel act in the best interest of their patients and whenever possible with their explicit consent. If, in performing their professional duties, they have conflicting loyalties, their primary obligation, in terms of their ethical principles, is to their patients.

Geneva Conventions: Rule 134. The specific protection, health and assistance needs of women affected by armed conflict must be respected.

https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_cha_chapter39_rule134

UN Peacekeeping Operations – protection of civilians - ‘duty to protect’:

https://peacekeeping.un.org/en/protecting-civilians

UN Peacekeeping Operations – women, peace and security: https://peacekeeping.un.org/en/promoting-women-peace-and-security

Discussion:

Review of the question: this covers both the duty of healthcare professionals to safeguard patients and also duties to protect civilians (which might be the background to admission) and reduce gender-based violence.

Interpretation of the principles/policy from the references: healthcare professionals have a duty to safeguard the health of their patients, especially more vulnerable groups such as children, women and the elderly. Specific duties might also arise from the mandate for the military operation (e.g. UN peacekeeping operations) and also from professional duties mandated by national healthcare regulating organisations (e.g. General Medical Council).

Framework for answering the scenario/question:

• What are the obligations for the healthcare team to safeguard the health of the patient?

• What options might exist to protect the safety of the patient?

• What if she does not consent to your safeguarding plans?

• What if you safeguarding plans are not compliant with the law or practice in the host country?

Further issues for consideration:

• Is this argument different for children, the elderly, LBGTQ patients?

• There can also be challenges at the other end of the spectrum. For example, some jurisdictions require mandatory reporting of any domestic violence incidents. What would you do if a victim of domestic violence begs you not to call the police and says she will not stay and receive badly needed aid if you do?