Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: You are the SNCO in charge of a small medical unit. A female soldier does not want to attend the facility as she is worried she will face disciplinary action for getting sunburnt? What should you do for her to receive the right care and treatment?
• 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 autonomy of the patient to make their own decisions about their care, and the right to confidentiality balanced against the right of an employer to know the medical fitness of their employees.

Step 2 – ANALYSE

Patient: The principle of autonomy, non-maleficence and beneficence applies. The patient has the final right to autonomy; however, it is important that they fully understand the consequences (health and wider employment) of not acquiring medical treatment when they know they ought to.  There may be wider personal circumstances that need to be explored in order to understand the soldier’s reluctance to be taken off duty.

Clinical: While there may be understandable reasons for the soldier’s reluctance to attend a medical facility for treatment, it is important to explain the reasons why this is necessary. There may be health implications of the soldier getting sunburnt if left untreated.

Legal: The International Council of Nurses Code of Ethics is at: https://www.icn.ch/sites/default/files/2023-04/ICN_Code-of-Ethics_EN_Web_0_0.pdf . A patient’s decision must be free of manipulation, coercion and deceit. We must ensure that we do not force a patient into making a decision and that we must be truthful with the information that we present to them.  Therefore, this may require the SNCO to reassure the female soldier that whilst it is the patient’s right to choose or refuse treatments, and to hold in confidence personal information regarding a patient’s condition the priority is to ensure their health and well-being and that they are fit for duty.  This in turn will ensure operational effectiveness. The international code says that nurses should practice in a non-discriminatory way and whilst the condition has been unintentionally self-inflicted, it is extremely unlikely that any soldier will seek medical attention if they are going to face disciplinary action or have a genuine fear of this.

Societal/Military: In order for the female soldier to receive the right and proper treatment reassurance will need to be given to them that they will not face any disciplinary action.   Complexities will arise if the condition prevents the soldier from doing their duty. This will be more of a challenging situation for the SNCO and how they communicate to the chain of command the reason for the soldier’s temporarily absence from duty.

Step 3 – FUSE

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

This scenario balances patient autonomy, clinical care, and military duty. There might also be a discussion about the dual loyalty of clinical professionalism and military obligations.

Step 4 – DECIDE

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

Although a minor condition that is easily treatable, this is likely to be a complex personal issue for both the SNCO and the patient with consequences of not being able to perform a duty during an operational tour. It may be reasonable to withhold notification of the soldier’s inability to go about her daily duties to her chain of command for a short period.

References and Further Reading

International Council of Nurses (Revised 2021), The ICN Code of Ethics for Nurses at Code. Available at ICN_Code-of-Ethics_EN_Web_0_0.pdf; accessed 25 August 2023

Nursing Midwifery Council: Future nurse: Standards of proficiency for registered nurses. Available at future-nurse-proficiencies.pdf (nmc.org.uk); accessed 25 August 2023

Nursing Midwifery Council. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates - The Nursing and Midwifery Council (nmc.org.uk) accessed 24 August 2023

Nursing and Midwifery Board of Australia. Available at https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx; accessed 24 August 2023

Contributor - Lt Col Janet Kelly VR RGN RM DIpHSM MA (HRM) LLB (Hons) PGHCE PhD. Senior Lecturer in Midwifery, Healthcare Law & Ethics; University of Hull. Chair for the Nursing Midwifery Council's Fitness to Practise Conduct and Competence Committees (2013 to 2021). She has served as a commissioned officer in Queen Alexandra's Royal Army Nursing Corps both as a regular and reservist for over 30 years and is now at the rank of Lieutenant Colonel.