Specific Topic(s): ‘the ultimate sacrifice’ versus duty of care by employers. – this links to the discussion in 2H

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ – Health-care personnel, as well as health-care facilities and medical transports, whether military or civilian, must be respected by all. They are protected while performing their duties and the safest possible working environment shall be provided to them.

Geneva Conventions:

Rule 25. Medical personnel exclusively assigned to medical duties must be respected and protected in all circumstances. They lose their protection if they commit, outside their humanitarian function, acts harmful to the enemy. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule25

Rule 28. Medical units exclusively assigned to medical purposes must be respected and protected in all circumstances. They lose their protection if they are being used, outside their humanitarian function, to commit acts harmful to the enemy. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule28

Discussion:

Review of the question: this question examines the additional obligations of military healthcare workers to accept a higher level of personal risk in compliance with military law compared to civilian healthcare workers and whether this applies if the threat is the same. Consider in the context of the international response to Ebola in West Africa in 2014 and the Coronavirus in 2020.

Interpretation of the principles/policy from the references:

• Medical personnel and facilities should be protected from conflict – independent of whether they are military or civilian.

• A humanitarian crisis from an infectious disease may occur in a conflict situation or may cause a breakdown of security.

• Once military medical personnel have volunteered for service in the Armed Forces, they are subject to military law and can be ordered to be exposed to risk.

• Civilians volunteer for their employment (including in crisis) and can withdraw their consent to work.

Framework for answering the scenario/question:

• What is the risk to healthcare workers - from the infectious disease, from the operational environment (i.e. security and other threats)?

• Is the use of military medical resources an appropriate response?

• Are all measures in place to control the risks to military medical personnel? Security, transmission of infection etc

• Are the standards the same as for civilians? Are any differences justified?

• Are military personnel to be ordered, or to volunteer for their mission? Can they refuse? Are there any factors that might be ground to refuse/be excluded? (disproportionate level of personal risk (e.g. pre-existing disease, pregnant), disproportionate level of impact (other members of the same family already exposed/affected)?

• Is the additional level of risk compensated? – better baseline pay, additional pay to the risk, reduction in other duties, suitable injury/death in service benefits, non-financial benefits (e.g. US GI Bill for service personnel).

Further issues for consideration:

• What if a military healthcare worker has a conscientious objection to the mission? – see card 5 Hearts

• What if the risk management system (including personal protective equipment) is less good that the civilian standard?

• What if other military forces have decided not to expose their military medical personnel to the same levels of risk?

BAER, D. (2011). The ultimate sacrifice and the ethics of humanitarian intervention. Review of International Studies, 37(1), 301-326. Retrieved June 11, 2020, from www.jstor.org/stable/23024595

Draper, H., Jenkins, S. Ethical challenges experienced by UK military medical personnel deployed to Sierra Leone (operation GRITROCK) during the 2014–2015 Ebola outbreak: a qualitative study. BMC Med Ethics 18, 77 (2017). https://doi.org/10.1186/s12910-017-0234-5

Jordan D. Lane, MSC USA, Sarah S. McNair, MSC USA, Sending Soldiers to Fight Ebola, Military Medicine, Volume 180, Issue 6, June 2015, Pages 607–608, https://doi.org/10.7205/MILMED-D-14-00679

Bricknell M, Hodgetts T, Beaton K, et al. Operation GRITROCK: the Defence Medical Services’ story and emerging lessons from supporting the UK response to the Ebola crisis. BMJ Military Health 2016;162:169-175. http://dx.doi.org/10.1136/jramc-2015-000512 (full access requires a subscription)