All of the scenarios in the garrison healthcare suit should be considered from the perspective of a healthcare professional working in a military garrison healthcare centre with responsibility for the clinical care of patients and management of the healthcare centre. The primary supporting reference for this suit is the World Medical Association International Code of Medical Ethics (WMA Code) at: https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/ . You should also consider your national professional ethical codes and relevant military law or guidance

Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: You have been invited out for a date by one of the personnel in your unit whom you are attracted to. You have recently prescribed contraception to this person. What do you do?
• List the Issues that arise from the scenario.
• Identify Critical Information required and Assumptions to be made:

This scenario covers the ethics and law regarding personal relationships with patients. This is particularly sensitive in the military environment as your patients are also your work colleagues and maybe your friends.

Step 2 – ANALYSE

Patient: your patient has the right to expect that their healthcare professionals will not use any therapeutic ‘power’ to form a personal relationship with them.

Clinical: all healthcare staff have a duty not to have personal, emotional relationships with their patients – e.g. WMA Para 27 - The physician must maintain appropriate professional boundaries. The physician must never engage in abusive, exploitative, or other inappropriate relationships or behaviour with a patient and must not engage in a sexual relationship with a current patient.

Legal: There may be national law regarding personal relationships with vulnerable people, including patients.

Societal/Military: There may also be military law or guidance regarding personal relationships between military personnel, especially if there is a rank difference, a clinical relationship, an executive relationship, or within military training schools.

Step 3 – FUSE

• Summarise conclusions
• Insert citations to key reference sources for your analysis
• Determine the exact Decision(s) to be made

You cannot embark on a personal, emotional relationship with one of your patients. You have already had an intimate conversation with this person through your clinical assessment and prescription of contraception.  

Step 4 – DECIDE

• What is your Decision?
• Why (can you justify it)?
• Residual uncertainly, need for review?

You will need to decide if you wish to start a non-platonic relationship with this person. If so, you will need to ensure that you will not be contravening any ethical or legal guidance from both a healthcare professional and military professional perspective. In the first instance, you should explain to the individual that you cannot accept the invitation to go on a date until you have explicitly made arrangements for them to stop being your patient, and have ensured that any subsequent contact between you meets legal, ethical and military policy guidance.

Contributors – Brigadier (Rtd) Charles Beardmore MBBS MRCGP MFOM MA MSc MBA LLM. Charlie is a qualified General Practitioner with 32 years of military service that culminated in the role of Head of Defence Primary Healthcare in the UK. He is studying for a PhD on the topics of military healthcare ethics. Brigadier Phil Carter MBChB MRCGP MPH MA. Phil is a qualified General Practitioner with 28 years of military service, He recently served as Commander of Defence Primary Healthcare in the UK and Chief Medical of a multinational operational headquarters in the Middle East.