ACORNS - POLICY - FIVE

All of the scenarios in the policy suit should be considered from the perspective of a health professional in a staff appointment as the lead officer for medical policy within a Ministry of Defence (rank equivalent of OF4/Commander/Lieutenant Colonel/Wing Commander).

Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: In addition to your staff role, you are also senior clinician. A friend asks for your support in an investigation of a clinical incident. On reviewing the documents, you believe that your friend was negligent. Do you agree to support them?
• 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 professional and personal loyalties.

Step 2 – ANALYSE

Patient: whilst you are not directly involved in this case, you are obliged to be honest and transparent in your assessment of the clinical implications of this case on any patients involved.

Clinical: you also have duty to express your opinion on the clinical management of this case. This is an additional professional duty because of your role in health policy.

Legal: you also need to consider how you complied with the patient’s consent and confidentiality in your reading of the clinical notes.  

Societal/Military: it is also important that your friend is properly supported during the investigative process, unfortunately it is extremely likely that clinicians will make mistakes during their professional career – however good they might be.

Step 3 – FUSE

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

This scenario is a dual loyalty question between your loyalty towards your friend, your professional loyalties in regard to maintaining clinical standards, and the additional conflict of duties as the lead for medical policy within the Ministry of Defence. Serial 37 of the WMA International Code of Medical Ethics states: ‘The physician should avoid acting in such a way as to weaken public trust in the medical profession. To maintain that trust, individual physicians must hold themselves and fellow physicians to the highest standards of professional conduct and be prepared to report behaviour that conflicts with the principles of this Code to the appropriate authorities’ https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/ .  

Step 4 – DECIDE

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

Your professional duties override your personal loyalties towards your friend. You should examine your conflicts in your duties to your friend and your duty to report your assessment of the case. You also have a duty to ensure that your friend is appropriately supported and this extends to your role on behalf of your friend’s employer to support them. If you are to support your friend, you would be wise to report your support to the investigatory authorities in light of your role in medical policy.  

Contributor – Air Vice Marshal (Rtd) Alastair Reid CB FFOM, Surgeon General UK Defence Medical Services 2019-2021.