Ethics Armed forces doctor

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5. Competence

Key messages

  • The wellbeing of patients must be the doctor’s overriding concern.
  • Where doctors are required to undertake a procedure that exceeds their competence and could put patients at risk, they should request supervision from a senior or more experienced colleague.
  • If the doctor believes that intervening will present a significantly greater risk of harm than waiting for a suitable colleague to become available, he or she should decline.
  • Where there is otherwise no prospect of a patient receiving medical intervention, generally doctors should act if that would be likely to increase a patient’s chances of survival or a significantly improved outcome.

 

Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must… recognise and work within the limits of your competence.  

The duties of a doctor registered with the General Medical Council

Is it unethical for doctors to act outside of their competence?

Disregarding the General Medical Council’s requirement that doctors work within the limits of their competence could leave doctors open to fitness to practise proceedings or legal action. However, the increasing specialisation of medical practice means that military doctors may routinely be required to provide care for patients across a broader range of competencies than would be required of a practitioner in ordinary civilian practice.

For example, it would be impractical to deploy individuals from all surgical specialties to all field hospitals. Consequently military surgeons are routinely required to treat injuries outside the limits of competence that would normally apply to their specialty in civilian practice.

Military doctors may therefore find themselves in a position where they are required, or feel under pressure, to undertake procedures that they would not normally attempt outside of the military context. Doctors may also witness others being placed under similar pressures. It can be difficult to decline such requests, or to expose such practices, but the wellbeing of patients must be the overriding concern.

 

What should doctors do if they are called upon to exceed their competence?

Where doctors are requested to undertake a procedure that they believe exceeds their competence and could harm patients, they should, where possible, request supervision from a senior or more experienced colleague to ensure that any risks to patients are minimised. If the request for supervision is declined, or there is no suitable colleague available, and the doctor believes that intervening will present a significantly greater risk of harm than waiting for a suitable colleague to become available, he or she should decline.

These circumstances can be difficult, and it may be necessary to report any such situation that remains unresolved via the medical chain of command. Doctors themselves have a duty to mitigate such difficulties as far as practical by seeking appropriate training and experience. In addition, the chain of command should ensure that this can and does occur.

 

Is it ever acceptable for doctors to exceed their competence?

Generally, if no other suitably qualified colleague is available, doctors should act if that would be likely to increase a patient’s chances of survival or a significantly improved outcome. In certain circumstances, including combat and other emergency situations, doctors may be stretched to the very limit of their competence.

Circumstances may arise where there is a stark choice between intervention from a doctor who is inexperienced in a particular procedure and a patient receiving no intervention at all. Consideration should be given to whether it would result in a better overall outcome for the patient if that doctor were to intervene, despite a lack of experience, than if there was no intervention. Decisions should be made on the basis of each individual case.

 

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Ethical decision making for doctors in the armed forces tool kit (PDF)