Specific Topic(s):

Ethics of clinical practice beyond specific competencies

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ – In armed conflict or other emergencies, health-care personnel are required to render immediate attention and requisite care to the best of their ability.

Geneva Conventions: not applicable

Discussion:

Review of the question: it is not possible to be a specialist on every domain of military medical practice. Indeed there may be limits to the total number of personnel who can be deployed and this might result in an extension of practice for members of the team compared to normal civilian practice in health facilities in the parent country. Examples could include treating new-borns or very young children without being a paediatrician; or performing an emergency Caesarean without having done it before, or a secondary care physician being asked to act as a GP for a period of planned leave. This covers similar issues to 6 Clubs.

Interpretation of the principles/policy from the references:

Medical personnel are expected to provide healthcare to their patients to the best of their ability, which also places obligations on their employing organisation to provide training and experience for their role. Most national professional bodies will have statements regarding the duty to practice within the limits of personal competence (knowledge, training, experience – see further reading). This is also likely to provide leeway for an emergency situation – so called ‘Good Samaritan’ acts in which there is a duty to utilise professional knowledge beyond that of a member of the general public.

Framework for answering the scenario/question:

• What is the specific role/task that is required to be undertaken?

• Could this be assigned to someone with better competence to fill the role?

• Is it possible to receive addition training/experience before taking on the role?

• Does the employer/chain of command accept liability for any adverse outcome arising from your lack specific qualifications for this role?

Further issues for consideration:

• How might these considerations be adjusted for arranging healthcare for non-military beneficiaries populations such as children, pregnant mothers and the elderly.

• How might these considerations be adjusted for small medical teams supporting high risk forces – e.g. mobile surgical teams in support of Special Forces operations? – see further reading

Good Medical Practice. Domain 1 Knowledge, Skills and Performance. Apply knowledge and experience to practice. UK General Medical Council. At: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-1---knowledge-skills-and-performance#paragraph-7 accessed 29 May 2020.

T Woolley, J A Round, M Ingram, Global lessons: developing military trauma care and lessons for civilian practice, BJA: British Journal of Anaesthesia, Volume 119, Issue suppl_1, December 2017, Pages i135–i142, https://doi.org/10.1093/bja/aex382

Dana A, Mohammadimehr M. A Study on Capabilities Required In Military Medicine to Develop Modular Training Courses: A Qualitative Study. J Adv Med Educ Prof. 2017;5(3):134‐147.

Eibner, Christine. Maintaining Military Medical Skills During Peacetime: Outlining and Assessing a New Approach. 1st ed., RAND Corporation, 2008. JSTOR, www.jstor.org/stable/10.7249/mg638osd. Accessed 29 May 2020.