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 senior nurse complains to you that there have been too many visits from senior military officers to your hospital which is disrupting patient care. 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 publicity visits to healthcare settings and the protection of patients’ dignity, identity, and imagery.

Step 2 – ANALYSE

Patient: patients and their families are entitled to compassion and confidentiality while they receive medical care. They may receive psychological benefit from meeting senior visitors and may value the attention. However, they retain the inviolable right to refuse to be visited.

Clinical: clinical staff must protect the patient and their families from unwelcome intrusion into their personal lives – WMA Code Para 13 - In providing medical care, the physician must respect the dignity, autonomy, and rights of the patient. They must also ensure that visits do not interfere with routine clinical care. WMA Code Para 24 - The physician must refrain from intrusive or otherwise inappropriate advertising and marketing – including wider marketing of the armed forces or senior personnel.

Legal: there may be legal restrictions on the use of images or other media regarding patients and care settings.

Societal/Military: there may be benefits from visits by senior military visitors to the organisation as well as the patients; there are also risks, especially if the visit doesn’t meet the expectations of the visitor.

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 receive the medical care that they need and that it is not disrupted by non-clinical activities. However, senior military visitors have a right to understand the care that their personnel are receiving and that the wounded and sick are properly looked after, including welfare and administrative support.

Step 4 – DECIDE

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

The control and management of senior visits is a significant task for the headquarters of the military hospital. Many patients and their families may gain significant benefit from these experiences, but there are risks that the visit is for the benefit of the visitor or that sensitive personal information is put on public display without consent. You may wish to design a standard programme for visitors, agree the arrangements for photography (including consent), agree the review of publicity material prior to release, and agree that disruption to clinical care is minimised. You might want to agree a procedure for booking visits with the senior staff so that the number and frequency is controlled.     

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).