All of the scenarios in the Role 4 suit should be considered from the perspective of a health professional working in a military hospital receiving casualties from military operations with responsibility for the clinical care of patients and management of the facility. 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/ supported by the WMA Declaration of Lisbon on the Rights of the Patient at: https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/#:~:text=Every%20person%20is%20entitled%20without,with%20his%2Fher%20best%20interests. 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: A military charity requests that publicity material is handed to relatives of patients. It contains photographs of patients that could only have been taken in your hospital, and you have no knowledge that they were taken. 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 confidentiality, privacy, and the use of patient imagery.

Step 2 – ANALYSE

Patient: all patients are entitled to confidentiality, include protection of their identity and imagery. WMA Declaration of Lisbon – Para 8 8. Right to confidentiality and Para 10 Right to dignity.

Clinical: the taking of images within a clinical setting is likely to be subject to strict rules about consent and storage of data.

Legal: there may be copyright issues relating the obtaining and use of images from your hospital.

Societal/Military: there may be military issues associated with images of military personnel and units (military hospital) being in the public domain.

Step 3 – FUSE

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

Your primary duty is to ensure that your patients’ dignity and confidentiality is respected. You should also consider the implications of supporting fund-raising for a particular charity.

Step 4 – DECIDE

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

You might initiate an investigation to establish how the images on the publicity material was obtained and the procedures for obtaining consent. If this is all satisfactory, you might consider how the hospital supports fund raising for all military charities in order to determine whether any particular charity should receive special support. This might include supporting the creation and provision of publicity material.   

Contributor – Group Captain (Rtd) Teresa Griffiths CBE ARRC. Military Chief Nurse, Royal Centre for Defence Medicine (2010 - 2013) and Commanding Officer Defence Medical Rehabilitation Centre Headley Court/Stanford Hall (2016-2018).