Conflict of Roles and Duties – Why Military Doctors are Doctors

“I will willingly refrain from doing any injury or wrong from falsehood.” The Hippocratic Oath from the 4th century B.C. – found today in the modern garb of medical ethical principles – guides many doctors in their actions: respect for the patient’s autonomy, doing no harm, doing good, and justice. They commit themselves by this oath just like a soldier taking a military oath of allegiance. International law acknowledges this: In an armed conflict, military doctors are not permitted either to harm other people themselves, or be harmed by others. Daniel Messelken sees a potential role conflict in the union of doctor and soldier: While one is healing and caring, the other is fighting and harming. Thus, from a medical ethical and international law perspective, he develops his argument that greater weight should be given to the medical role.

Doctors follow medical ethics, which focuses on the individual patient’s well-being, whereas soldiers are guided by military ethics with its collective point of view. This dual role produces conflicts – whether real or only perceived – e.g. in respect of triage criteria or patient selection. From the doctor, this role requires conscious decisions, and from the military and political environment the will to recognize military doctors as physicians. The provisions of international law require a clear division of roles, stipulating that military doctors are to comply with not only medical but expressly also medical ethical standards.

According to Messelken, the declaration by the World Medical Association (WMA) that medical ethics in times of armed conflicts is identical to medical ethics in peacetime, is not uncontroversial. But it rightly prevents military doctors being regarded as soldiers with special skills, and clearly emphasizes their healing task and their neutral medical duty.