Military Medical Ethics

12,1

MB

828

stron

5668

ID

Department of Defense

2004

rok

Volume 1

Contents

Front Matter

Contributors

Foreword by The Surgeon General

Preface

Section I: Medical Ethics

1. The Moral Foundations of the Patient-Physician Relationship: The Essence of Medical Ethics

Edmund D. Pelligrino

The patient-physician relationship has evolved throughout the centuries, remaining the central basis

for medical care during eras of paternalism, autonomy, and managed care.

2. Theories of Medical Ethics: The Philosophical Structure

David C. Thomasma

Medical ethics applies philosophical theories to clinical problems. There are competing theories, each

with strengths and weaknesses, that can be used to analyze ethical issues.

3. Clinical Ethics: The Art of Medicine

John Collins Harvey

Clinical ethics is the practical application of ethical theory at the bedside. Ethics consultants and

educators help clinicians grapple with ethical dilemmas in the patient-physician relationship. Seminal

cases are discussed in an attachment to the chapter.

4. The Science Behind the Art: Empirical Research on Medical Ethics

Daniel P. Sulmasy

Research into the application of medical ethics uses rigorous methods of inquiry to examine the

current status of thinking in the field. It describes, rather than applies, the use of ethical analysis in

actual situations, including those unique to the military.

Section II: Military Ethics

5. The Profession of Arms and the Officer Corps

Anthony E. Hartle

The professional ethic for the American military has strong roots in history and provides a rich

tradition and basis for right action in the pluralistic culture in society today.

6. Honor, Combat Ethics, and Military Culture

Faris R. Kirkland

Honor, one of the core values in military service, should be reciprocal between superiors and

subordinates. Ethical leadership is an essential responsibility of those entrusted to command

soldiers in combat.

7. The Military and Its Relationship to the Society It Serves

Nicholas G. Fotion

There are several models describing the relationship between the military and the society it serves

that reflect the tension between a closed military culture and one more similar to, or even identical

to, the civilian culture.

8. Just War Doctrine and the International Law of War

William V. O'Brien and Anthony C. Arend

Decisions to resort to war and how to conduct a war have been analyzed using moral theory.

International laws of war and international conventions attempt to codify moral and legal restraints

on these decisions.

9. The Soldier and Autonomy

Sandra L. Visser

The Military mission requires significant individual sacrifices from the soldier, including some of his

autonomy. Appropriately balancing individual liberty with the needs of the military requires rigorous

ethical analysis and justification.

Section III: The Synthesis of Medicine and the Military

10. Physician-Soldier: A Moral Profession

William Madden and Brian S. Carter

The profession of medicine may appear to have opposite goals from the profession of arms, in that

one involves healing and the other killing. In reality, however, the professions and their goals are

remarkably similar and morally can be combined.

11. Physician-Soldier: A Moral Dilemma?

Victor W. Sidel and Barry Levy

In contradistinction to the previous chapter, these authors contend that conflicts arising between the

ethos of both professions make it morally impossible for physicians to serve in the military.

Response to the chapter by Edmund G. Howe, MD, JD and Dominic R. Rascona, MD

12. Mixed Agency in Military Medicine: Ethical Roles in Conflict

Edmund G. Howe

Mixed agency involves the conflict between duties to the individual patient and those to the

military. Ethical analysis can be applied to resolving this conflict and, by so doing, emotional

distress to the physician can be minimized.

Back Matter

Abbreviations and Acronyms

Index

Volume 2

Contents

Front Matter

Contributors

Foreword by The Surgeon General

Preface

Section IV: Medical Ethics in the Military

13. Medical Ethics on the Battlefield: The Crucible of Military Medical Ethics

Thomas E. Beam, MD

The battlefield is perhaps the most difficult of all environments in which to practice medicine.

Pressures from the threat of enemy attack as well as unique issues, such as returning

soldier/patients to duty, triage or even euthanasia on the battlefield, and physician participation in

interrogation of prisoners of war, require agonizing choices.

14. Nazi Medical Ethics: Ordinary Doctors?

Robert N. Proctor, PhD

Medicine under the Nazi regime flourished and physicians participated, not as pawns but as

pioneers, in the horrors of genocide and unethical experimentation. The reasons for this are varied

and have many factors, but do not lessen the terror of physicians killing and torturing patients.

15. Nazi Hypothermia Research: Should the Data Be Used?

Robert S. Pozos, PhD

One of the better known examples of unethical research under the Nazi regime is that of the

hypothermia experiments on prisoners. A recurring question remains as to whether or not the data

represent good science and if so, whether or not to use these data.

16. Japanese Biomedical Experimentation During the World War II Era

Sheldon H. Harris, PhD

The Japanese experiments in China during World War II are perhaps less well known that those of

the Nazi physicians, but equal them in scope and in harm to their victims. However, there was no

Japanese equivalent to the Nuremberg physician's trial. This raises obvious questions with very

interesting implications.

17. The Cold War and Beyond: Covert and Deceptive American Medical Experimentation

Susan E. Lederer, PhD

Examination of the history of experimentation in America before, during, and after World War II

provides an opportunity to review unethical research in a democratic society so that one can learn

and possibly prevent their ever occurring again.

18. Medical Ethics in Military Biomedical Research

Michael E. Frisina, MA

The very concept of biomedical research in the military raises ethical questions. However, it is

possible to obtain good data while adhering to principals of research ethics.

19. The Human Volunteer in Military Biomedical Research

Paul J. Amoroso, MD and Lynn L. Wenger, MSBA

Human subject research within the military raises unique issues, including concerns for coercion,

adequacy of informed consent, and use of epidemiologic data obtained for different purposes.

There are more stringent regulations in place within the military than in the civilian sector to

safeguard against potential violations of human subject research ethics.

20. Nursing Ethics and the Military

Janet R. Southby, RN, DNSc

Ethics in nursing has a rich history, one which the military has helped developed. Ethics as viewed

by nurses is complementary to that of physicians.

21. Religious and Cultural Considerations in Military Healthcare

David M. DeDonato, MDiv, MA, BCC and Rick D. Mathis, JD, MDiv, MA

Religion and cultural practices are extremely important to medicine in the military due to frequent

opportunities for interaction with other cultures. the study of views of wellness and illness can

assist health care professionals address conflicts arising from religious and cultural differences.

22. Societal Influences and the Ethics of Military Healthcare

Jay Stanley, PhD

In a civilian controlled military, societal influences are a major factor in military medicine and its

ethics.

23. Military Medicine in War: The Geneva Conventions Today

Lewis C. Vollmar, Jr., MD, MBA, MA (Law)

The Geneva Conventions, as they pertain to medical personnel and their patients, provide specific

reciprocal privileges and obligations. They exist to attempt to ensure safety and an appropriate

level of care for those sick, wounded, or captured.

24. Military Medicine in Humanitarian Missions

Joan T. Zajtchuk, MD, Spec in HSA

Examining the history of military medicine in humanitarian missions provides an understanding of

its changing role. Lessons learned from past efforts can help develop effective programs in the

future.

25. Military Humanitarian Assistance, The Pitfalls and Promise of Good Intentions

Elspeth Cameron Ritchie, MD and Robert L. Mott, MD, MPH

Peacetime engagement projects and conflict-related contingency operations require different

methods of planning and execution. Mistakes made in past missions highlight some of the problems

associated with well-intentioned efforts. There are also unique stresses experienced by healthcare

professionals working in these environments.

26. A Look Toward the Future

Thomas E. Beam, MD and Edmund G. Howe, MD, JD

Technological advances currently being considered provide an opportunity to develop a method for

ethical analysis of those in the future. Compensatory justice may require earlier introduction of