Abstract
While physicians are generally understood as owing moral obligation to the health and well being of their individual patients, military health professionals can face ethical tensions between responsibilities to individual patients and responsibilities to the military mission. The conflicting obligations of the two roles held by the physician-soldier are often referred to as the problem of dual loyalties and have long been a topic of debate. This paper seeks to enrich the dualloyalties debate by examining the embedded case study of medical civilian assistance programs. These programs represent the use of medicine within the military for strategic goals. Thus, a physician is expected to meet his obligation to his role as a soldier while also practicing medicine. These programs involve obligations inherent in both roles of the physician-soldier and thusly they serve as excellent exemplars for the problem of dual loyalties at an institutional level. This paper focuses on Medical Readiness Training Exercises (MEDRETEs). These programs are short-term, generally taking place in low-income nations in order to accomplish strategic goals including training opportunities for military medical professionals that are not possible on the home front. This form of temporary program raises ethical concerns regarding the exploitation of vulnerable populations and the value of what is termed “parachute medicine”. The short-term nature of these interventions makes long-term treatment and follow-up impossible, begging the question as to whether this peak and trough approach to foreign civilian aid is of any use. Physicians are generally understood as having obligations towards the well being of the patient, which these programs do not necessarily prioritize. Rather, the programmatic intent is military, with political and strategic aims of furthering international relations, increasing US military global presence and providing austere and tropical training opportunities for military healthcare providers. This can be morally problematic for the physician-soldier.
Highlights
Military physicians are simultaneously members of two professions
This paper focuses on Medical Readiness Training Exercises (MEDRETEs)
Identifying as both soldiers and physicians can occasionally create moral dilemmas that are unique to military medicine. This complicated moral experience has been called the “problem of dual-loyalties” or sometimes “mixed agency”, and has been understood as a fundamental issue in military medical ethics. These military medical professionals have historically found themselves confronted with situations where military protocol, orders or strategy require them to act or behave in a way that is contrary to norms of civilian medical ethics, occasionally valuing the mission over the individual patient
Summary
Military physicians are simultaneously members of two professions. Identifying as both soldiers and physicians can occasionally create moral dilemmas that are unique to military medicine. Zajtchuk held the belief that humanitarian and civic assistance activities or HCAs had “the potential of becoming the greatest promoter of developing positive US policy in Central America” [14] He believed that these programs would be a good way for him to occupy the time of his staff, improving troop morale and preventing boredom [14]. In Vietnam, the main focus had been psychological warfare; in Honduras the MEDCAP was a training mission with the specific purpose of enhancing a military medical professional’s ability to practice medicine in austere conditions [16] As it no longer prioritized the same goals as the MEDCAP, this reorientation led to a change in name. MEDRETEs provided many training opportunities that the military saw as advantageous for military readiness and mission success
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