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: A consultant has refused to deploy for a military mission. You suspect this is because of their private practice. You receive a report that they have just been medically downgraded below the deployment standard. Can he/she be ordered to deploy?
• 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 the obligation to serve on military operations for military medical personnel and the potential for personal/economic conflicts of interest. This would be an extremely sensitive topic that should only be handled at the most senior level with maintenance of strict confidentiality. However, it is worth considering the topic in order to highlight the key issues to be considered.

Step 2 – ANALYSE

Patient: there is an institutional duty to military patients to ensure that they are provided with healthcare on operations. A doctor working in private practice has personal duties to patients under their care, including arrangements for cover if their military duties prevent them meeting their obligations.  

Clinical: military health professionals have a duty to be competent to undertake their duties for military operations, including undertaking training for this role.

Legal: All military personnel have a duty to comply with a legal military order including being prepared to deploy on military operations. This can be disruptive to personal and family circumstances. All doctors have a responsibility to be honest about their health -  WMA International Code of Medical Ethics https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/

Societal/Military: in addition to the legal obligation to follow a military order, there is the potential for significant loss of reputation if this individual has ‘played the system’ and arranged to be downgraded to avoid a deployment. Conversely, they could have grounds for complaint if their medical condition is genuine and they feel that their honestly is being challenged.

Step 3 – FUSE

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

This scenario covers a reputationally sensitive subject. You might consider whether you have sufficient seniority and status to investigate this situation. However the scenario is valid for discussing the ethics of potential conflicts of interest.

Step 4 – DECIDE

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

It is reasonable for an employer to review the occupational assessment of an individual’s medical fitness. This should describe the limitations and opportunities of their medical condition on their work. You might also review the timeline of events, including the date of notice for deployment and the date of occupational assessment. Depending on your initial assessment, you might consider if there are grounds for further review. You could: ask for a second opinion on their medical fitness, ordering them to cover for the duties of another person nominated for the deployment, ensuring that their actual activities are restricted to those defined in their medical assessment (including whether they undertake private practice), withdraw their permission to undertake private practice etc, etc – or even find that they do have a medical condition that restricts their duties and express your sympathy and support!    

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