Can military medical staff be ordered to deliver care if doing so invo · Medical

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3 Can military medical staff be ordered to deliver care if doing so involves severe risk of injury or death to themselves?

Specific Topic(s):

• This question discusses the balance of benefits to a patient from receiving healthcare versus the risks to their personal health and safety?

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ –

3. The primary task of health-care personnel is to preserve human physical and mental health and to alleviate suffering. They shall provide the necessary care with humanity, while respecting the dignity of the person concerned, with no discrimination of any kind, whether in times of peace or of armed conflict or other emergencies.

7. 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

Customary IHL:

Not applicable

Ethical principles:

WMA INTERNATIONAL CODE OF MEDICAL ETHICS – https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

A PHYSICIAN SHALL give emergency care as a humanitarian duty unless he/she is assured that others are willing and able to give such care.

Discussion:

Review of the question: the balance of risk to a healthcare provider versus the benefit to the patient from having access to healthcare is at the heart of the role of military medical personnel. There is a general risk from being present in an area of military operations, and therefore exposed to indirect conflict (e.g. artillery fire, rockets, CBRN attack). There may be a specific risk associated with extracting a casualty during ‘care under fire’ or with treating a casualty with a highly contagious infectious disease or an embedded military munition.

Interpretation of the principles/policy from the references: All healthcare workers are ethically required to render healthcare in an emergency, a so called ‘good Samaritan’ act. But there is no ethical obligation for a healthcare worker to expose themselves to harm as a result of their work. Civilian employers have a legal obligation to reduce the risks of harm from work to their employees as far as reasonably practical. By definition, serving in military uniform means that a military healthcare worker can be given a legal order to expose themselves to personal danger. However, the chain of command (the legal authority to issue the order) has to be sure that the benefits of mission success exceed the risks of harm to individuals. Medical personnel may volunteer to place themselves at risk of harm or death in order to provide ‘humanitarian’ medical care. Indeed, military medical personnel often receive awards for gallantry for doing just this.

Framework for answering the scenario/question:

• Consider the implications of volunteering for service as a member of the armed forces: being put at risk, taking life, ordered to be employed where required etc.

• Consider the types of legal order that might put you at risk: deploying to a military theatre, travelling in targeted military vehicles, undertaking foot patrols, treating infectious disease patients etc.

• Consider what types of order might be unlawful: being exposed to military risk without the recognised mitigations (e.g. failure to provide body armour, helmet, CBRN suit, gas mask etc.), being exposed to medical risk without the recognised mitigations (e.g. inadequate personal protective equipment, not being immunized, not providing the recognised treatments etc.).

• Consider the differences between managing risk to the health and safety of a humanitarian volunteer versus a military healthcare worker.

Further discussion points:

• How might the military duty to accept being exposed to risk of harm be codified and taught? Consider national and international examples (e.g. US soldiers’ Creed, UK Values and Standards of the Army, Australian Army Values and Contract). Are these different between armies, navies and air forces…and medics?

• Can military medical personnel be ordered to serve with higher risk military units? (e.g. airborne forces, commando forces, special forces).

• Can military medical personnel be ordered to use their skills in higher risk medical tasks? (e.g. can a pre-hospital care trained doctor be assigned to a forward medical evacuation helicopter against their will?)

• When might the leader of a medical unit refuse an order to expose their personnel to risk?

• What obligations do military healthcare workers have towards their patients if the enemy overruns their facility, and there is a risk of being taken prisoner or killed? ...this is a subtly different question for which there are obligations under the Geneva Convention.

Author: Professor Martin Bricknell