Ethics in the Field: The Experiences of Canadian Military Healthcare Professionals

Military healthcare professionals often feel under great pressure during international missions. When the armed forces of several nations with their own codes and procedures work together and rely on a common medical infrastructure, the likelihood of ethical dilemmas increases. To gain a better understanding of the causes of ethical tensions in the context of military medical services, the authors B. Williams-Jones, S. de Laat, M. Hunt, C. Rochon, A. Okhowat, L. Schwartz and J. Horning interviewed a total of fifty medical professionals in the Canadian armed forces about their involvement in international missions, such as armed conflicts, natural disaster-assistance, or peace missions. Broadly, they assigned the causes of ethical challenges to four main categories: resource scarcity; historical, cultural and social structures; policies and agendas; and professional roles.

During international deployments, military, humanitarian and developmental missions often coexist. The authors write that this is why there is frequently an overlap and a collision of roles, which military healthcare professionals (physicians, nurses, medical technicians and allied health professionals) have to deal with. Military healthcare professionals may be asked to undertake the work of healers, soldiers, and development workers simultaneously or in succession. This can lead to complex ethical challenges that go far beyond familiar case examples in medical ethics.

When they compared “real” ethical problems faced by medical personnel against the literature in bioethics and especially military medical ethics, the team of authors found considerable divergence. Dual loyalty, for instance – a topic which has received much attention to date – is apparently no cause for concern. Instead, complex challenges arise from issues which play a key role specifically in humanitarian missions. These include dealing with resource scarcity, the impossibility of providing continuous care, and the inevitable realization that health care provision in one’s home country differs from that in international missions.

Interestingly, the authors observe that though the precepts of medical ethics may apply in military conflict situations, there are nevertheless different weightings owing to divergent influences and the various actors’ perceptions. Triage and just resource allocation, standards of treatment and care, informed consent, patient autonomy, and the protection of human rights are all aspects which have varying degrees of significance. These issues become even more pronounced in armed conflicts, where military medical personnel have to take the interests of both patients and soldiers into account. Increasing pressure is noticeable, as it is not unusual for military medical personnel to be required to take part in medical aid programs to gain the local population’s trust. They also frequently feel forced to certify soldiers as fit for combat when this might be debated; to violate patient privacy for military ends; or to treat soldiers, combatants, or civilians against their will. 

The study confirms the authors’ initial hypothesis. Military healthcare professionals can benefit greatly from context and job-specific ethics training since they work in very different environments and conflicts. Consequently, the team of authors argues that comprehensive ethics training is urgently needed due to these diverse challenges.