Specific Topic(s):

• This is a scenario (similar to 2 Hearts, 3 Hearts and 4 Hearts) in which decision-making involves a balance between personal risks and potential benefits to the sick or injured. In this case, the decision is NOT to provide help.

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:

Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), 8 June 1977. https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Treaty.xsp?documentId=AA0C5BCBAB5C4A85C12563CD002D6D09&action=openDocument

Art 7 Protection and care:

1. All the wounded, sick and shipwrecked, whether or not they have taken part in the armed conflict, shall be respected and protected.

2. In all circumstances they shall be treated humanely and shall receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. There shall be no distinction among them founded on any grounds other than medical ones.

Customary IHL:

Rule 110. The wounded, sick and shipwrecked must receive, to the fullest extent practicable and with the least possible delay, the medical care and attention required by their condition. No distinction may be made among them founded on any grounds other than medical ones. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule110

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. This question poses two issues: the risk to life is associated with a very specific medical task posed by stopping to help and the possible benefits to the civilian casualties.

Interpretation of the principles/policy from the references: Institutionally, the armed forces are required to provide the same level of medical care for injured civilians as for their own personnel on the basis of non-discrimination. Medical personnel are obliged to provide emergency medical care as a humanitarian duty. However, they are not required to risk their life meet these obligations.

Framework for answering the scenario/question:

• Consider the obligations of the parties. Although there might be a threat from further enemy activity (further bombs, an ambush), there is an obligation to consider providing medical care for injured civilians unless there is a clear and present risk by doing so.

• There should be no discrimination on the provision of emergency healthcare except for clinical need.

• Consider the level of risk. Is there an actual threat or a potential threat? What is the level of protection/security for your convoy? Are there any other agencies already responding to the incident (e.g. civilian police, ambulance or local assistance)? What is the ‘mood’ of the crowd, and are they likely to be a threat?

• What type of medical response can you provide? – first aid, or more complete pre-hospital care?

• Do existing Standing Operational Procedures (SOPs) cover these circumstances? – specific ‘medical rules of eligibility’, banning a response, calling for external assistance etc.?

• Are you able to persuade the convoy commander to change his/her mind?

Further discussion points:

• If you decided to stop, what should be your immediate action drills?

• How might you evacuate the civilian casualties, to where?

Author: Professor Martin Bricknell