BMA offers combat-ready ethics advice
26 November 2012
Military doctors can access guidance on ethical issues they are likely to encounter while on active service following today’s launch of a pocket-sized handbook.
The BMA tool kit covers issues such as dual loyalties, consent and capacity, confidentiality, treating detainees and identifying and reporting unethical practices and abuse.
It was produced by the BMA medical ethics committee and BMA armed forces committee and aims to be a handy guide to assist the ethical decision-making of armed forces doctors in combat situations.
Ethical Decision-making for Doctors in the Armed Forces: the Tool Kit highlights how military doctors have the same ethical obligations to patients as civilian doctors. Conflict and high-pressure situations can sometimes make this difficult but the tool kit helps doctors to handle these challenging circumstances.
BMA director of professional activities Vivienne Nathanson said: ‘It is essential that doctors understand how to apply the fundamental ethical principles that exist in healthcare in a military setting.’
Hard to handle
BMA armed forces committee chair Brendan McKeating added: ‘The BMA has produced this tool kit so that doctors working in the armed forces have easy access to context-specific guidance on how to handle difficult ethical issues. We want to support them in very challenging circumstances.’
The tool kit publication follows a report of the public inquiry last year into the death of Iraqi civilian Baha Mousa in British custody. The inquiry, at which the BMA gave evidence, found there was an absence of military guidance on ethical issues facing regimental medical officers at the time of Mr Mousa’s death in 2003.
Core principles in the guide include:
- Medical care should be delivered according to clinical need, impartially and without discrimination
- Doctors should not be involved in, or cooperate with torture or cruel, inhuman and degrading treatment or punishment, which is illegal in all circumstances
- Doctors should report violations of ethics and applicable laws, or practices that interfere with their ability to meet their ethical duties, to the appropriate chain of command
- Doctors must be able to justify any departure from accepted ethical principles or guidelines
The tool kit also provides examples of scenarios that may present ethical dilemmas. For example, the section about managing dual loyalties describes how the British field hospital in Afghanistan treats casualties solely on the basis of clinical need.
However, it says doctors could feel morally or loyally obliged to prioritise the treatment of friends and colleagues over civilians and the enemy. This could lead them to make objectively unethical decisions. It is therefore important that doctors recognise such feelings in order to be able to set them aside.