Centre for Military Ethics

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Medical Deck

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In a mass casualty situation, is it ethical for a military medical unit to keep beds empty for new military casualties?
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The local culture or national legal framework has only weak protections against domestic violence or gender-based violence. How do you respond to a badly injured female who reveals that her husband attacked her?
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A rape victim asks to be given a ‘morning-after pill’ which your clinic has available. However, it is illegal in the country where you are operating. What do you do?
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Under what circumstances would it be appropriate to use local donors to provide blood for patients in a military medical facility?
Could you ever rely on blood or donors that have not been pre-screened?
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When facing staff shortages, under what conditions may you use local volunteers without any medical training?
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How do you balance time taken for patient care with record keeping? What is the minimum information you should record?
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The command asks you in a routine situation to act in a capacity that your professional body would not recognise you as having the correct qualifications or training to perform.
What should you do?
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Clinical governance is not equal across organisations, how might you respond to an allegation that care in another nation’s medical facility is not clinically acceptable?
Would it/should it affect where you allocate cases?
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What should a health care professional do if faced with an order from a commanding officer requiring them to violate the principles of medical ethics?
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A talented and irreplaceable staff member is accepting bribes in order to prioritise patients.
How might this be addressed?
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A badly injured enemy combatant claims that his injuries were caused after he had been captured.
How do you respond?
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Your local military commander asks for off duty medical personnel to contribute to guarding the perimeter of the military compound.
How do you respond?
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Special forces capture a combatant whom they believe has vital information about a future terrorist attack. The combatant refuses a life-saving treatment stating that he would “rather die than live as a prisoner and traitor”.
What can/should you do?
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Non-state Armed Groups may recruit under-18s into their forces.
What are the duties of medical personnel towards 'children' as combatants?
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In order for you to get access to the wounded and sick, you have to share information with the host-nation authorities and/or the UN about the identities of the patients in your care.
Do you share the information?
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How do you decide the first person to treat or allocate single resources between two casualties with the same triage score?
Who do you care for first and which criteria matters from a medical ethics perspective?
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How do you manage consent when there are profound communication barriers?
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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?
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You have evidence a government is committing atrocities against its own citizens. Should health care personnel allow media access to the patients in order to publicize the alleged crimes?
What else could a health care professional do?
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There is a shortage of beds and you have a stable but ventilated patient who can be moved to a local hospital but you know there are no nurses on night shifts. This could mean a death sentence.
What do you do?
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The divorced parents of a very badly injured soldier in your base hospital refuse to be present together but each insists that only they can speak on behalf of their son.
His brain injuries are such that he is not competent to consent to medical treatment. How do you resolve this?
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Should you allocate People with Disabilities extra support during an emergency evacuation if that means expecting apparently able-bodied people to manage by themselves?
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The husband of a badly wounded female refuses to permit your male medics to treat her.
What do you do?
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A distraught local national father refuses to allow the transfer of his badly injured daughter to another allied medical unit where more appropriate care can be provided.
What do you do?
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If you were faced with limited resources, how would you balance palliative care priorities with pain relief for incoming trauma patients?
Who gets the painkillers?
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With modern medicine it is possible to save the lives of people with devastating injuries that will profoundly change their lives forever.
Are there limits to how far treatment should be taken? Who decides?
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Faced with an outbreak of a highly infectious disease, you have insufficient PPE for every patient-facing clinician, though you have adequate supplies of equipment used for normal infection control.
To whom do you allocate the higher level of protection? Do you require everyone else to continue working with the lower level equipment?
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Can military medical staff be ordered to deliver care if doing so involves severe risk of injury or death to themselves?
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You are deployed to a conflict where the enemy are deliberately and consistently violating the rules of war. You have been tasked to send an ambulance on a very dangerous mission to collect enemy casualties.
Should your own personnel be put in harms’ way to save the life of someone who would not reciprocate?
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You are struggling to justify your country’s involvement in a war you believe to be unwinnable.
How do you cope?
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Your team has been working under intense conditions for days; you are all sleep-deprived and are making errors that put patients at risk. There is no back-fill support available.
As team leader, what is your duty of care to protect your team and yourself?
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Pre-deployment you had concerns about a colleague struggling with his mental health after multiple tours of duty. His performance is erratic. One day he seems fine the next he is making preventable errors.
His surgical skills are desperately needed. What can you do?
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Inevitably, the delivery of health care in conflict means not everything goes the way you would like or plan, even when you have done everything right.
How do you manage a sense of failure e.g. a patient death or a missed diagnosis?
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You are in a convoy that drives past the aftermath of a roadside bomb. Several local nationals are in need of emergency care.
The commander orders you not to stop because the road is dangerous and there is a risk of being attacked. Is the commander right?
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May off label and not yet approved medications be used on military personnel if it could save their lives?
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Is it acceptable to allow firearms into a medical facility?
If so, who may carry them?
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A local patrol commander tells the attached medical personnel to remove their Red Cross arm bands because this disrupts camouflage.
Is this acceptable?
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The commander of a logistic convoy wishes to put food and water into the ambulance of the convoy.
Should this be permitted?
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When faced with an infectious disease outbreak, should military medical personnel be willing to accept greater risks than civilian medical workers?
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Effective team communications has been shown to lead to better staff outcomes, including reduced stress and improved job satisfaction.
What are the basics of good team communication and how can you incorporate them?
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What cultural barriers can there be to effective team communication?
What can you do about them?
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Do you consider that health care personnel in your own team/facility have a good working relationship and treat each other with respect?
What could be improved in this area?
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Breakdown in team communication has been identified as a leading factor in adverse patient events and a major cause of inadequate healthcare delivery.
What examples of breakdown in communications have you experienced?
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The traditional 'no-fault culture' of medicine does not apply in a crisis situation.
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What do you understand by the term 'self-care'?
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What do you need to know about the roles and responsibilities of your fellow practitioners on multi-disciplinary teams in order to feel confident and capable of providing effective care?
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During a visit to a coalition partner medical facility, you overhear a conversation in which a health care professional admits to using placebos in place of pain medication which had run dangerously low.
They claim the placebo worked and patients reported pain relief. If your team ran out of pain medication would you be willing to offer your patients a placebo?
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During a mass casualty incident that stretched your team, two patients died from potentially survivable injuries.
How might you address this with the team afterwards?
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You are asked to take a surgical team from another nation into your facility to increase surgical capacity, but they don’t speak your language.
What do you do?
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The allied headquarters have asked for patient identifiable information to be posted to an information system so that they can see the details of all patients in the medical system in the theatre.
Do you agree?
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A coalition nation has shared evidence of an experimental treatment improving patient outcomes from trauma.
Is it ethical to adopt it in your facility?
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Regular triage protocols cannot cope with an unfolding mass casualty situation.
How do you build consent across your care team for the decisions that must be made?
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The Four Principles of Medical Ethics
Beneficence, Justice, Autonomy and Non-malificence
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Core Principles from the Geneva Conventions