You suspect the host-nation base guards are refusing some people acces · Medical

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6 You suspect the host-nation base guards are refusing some people access to healthcare because they are from the 'wrong' area or tribe. What do you do?

Specific Topic(s):

• This scenario is about ensuring non-discriminatory access to healthcare and probity as a professional standard. It links to 2 Clubs and Jack Clubs.

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. No distinction is made between patients, except in respect of decisions based upon clinical need and available resources.

11. Safe access by health-care personnel to patients, health-care facilities and equipment shall not be unduly impeded, nor shall patients’ access to health-care facilities and health-care personnel be unduly impeded.

Geneva Conventions:

Non-discrimination is covered across the Geneva Conventions and associated Protocols https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/vwTreaties1949.xsp :

First Geneva Convention, Article 12;

Second Geneva Convention, Article 12;

Third Geneva Convention, Article 16;

Fourth Geneva Convention, Article 13;

Additional Protocol I, Article 75(1);

Additional Protocol II, Article 4(1);

Customary IHL:

Rule 88. Adverse distinction in the application of international humanitarian law based on race, colour, sex, language, religion or belief, political or other opinion, national or social origin, wealth, birth or other status, or on any other similar criteria is prohibited. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_rul_rule88

Ethical principles:

WMA INTERNATIONAL CODE OF MEDICAL ETHICS - https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

A PHYSICIAN SHALL not allow his/her judgment to be influenced by personal profit or unfair discrimination.

WMA STATEMENT ON ARMED CONFLICTS - https://www.wma.net/policies-post/wma-statement-on-armed-conflicts/

11. The WMA recognizes that the impact of armed conflict will be most significant upon women and vulnerable populations, including children, the young, the elderly and the poorest members of society. Physicians should seek to ensure that allocation of medical care resources does not have a discriminatory impact.

Discussion:

Review of the question: this question highlights that discrimination in access to medical care can occur throughout the pathway of care and may be controlled by behaviours of actors that are not immediately obvious to medical leadership.

Interpretation of the principles/policy from the references: all of the references emphasise the legal and ethical duties to provide medical care solely on the basis of clinical priority and without discrimination.

Framework for answering the scenario/question:

• What are the risks associated with this behaviour? To individual patients, to the reputation of the medical unit and the force?

• What is the evidence for this allegation? [how might this be detected]

• How might the allegation be proven?

• How should any investigation into the allegation be undertaken and who should do it?

• Who needs to know about the investigation? – chain of command, police, professional regulatory bodies, etc.

• What are the potential outcomes of the investigation?

• What might be the consequences of sacking members of the guard force?

Further discussion points

• How is this different from the application of ‘medical rules of eligibility’?

• How does this affect the role of military medical services in support of state control of borders from migration?

• What are the risks of discrimination associated with accepting referrals from the local civilian/military medical system into an international medical facility under ‘medical rules of eligibility’ for ‘consent building’? How might this be monitored?

Author: Professor Martin Bricknell