Doctors working in the armed forces owe the same moral obligations to their patients, whether comrades, enemy combatants or civilians, and are subject to the same ethical standards as civilian doctors. The extremity of the circumstances in which military doctors operate can make it difficult at times to understand how best to fulfil these obligations.
Unlike the majority of civilian doctors, military doctors can also be subject to significant competing or dual loyalties. Ethical obligations to individual patients may come into conflict with the demands of military necessity or with perceived obligations to the operational unit.
For example, a doctor’s duty of confidentiality will potentially come into tension with his or her obligation to keep commanders informed of an individual patient’s fitness for active service.
Of course these simultaneous duties do not inevitably create a conflict, and neither are they unique to military medicine. Occupational health physicians and prison doctors have similar dual obligations, which must be carefully managed.
Useful parallels can be drawn between the extreme demands of combat and some medical emergencies in civilian life, for example providing impromptu treatment at the site of a major disaster. In these circumstances, professional ethics require that robust priorities are set and that attention is given to the most serious urgent need.
Military doctors may, in certain contexts, be required to fulfil their duty of care to the injured by, for example, securing the immediate area from further attack, or preventing a struck vessel from sinking, rather than attending directly to the medical needs of the injured. Only when it is safe to do so, will doctors turn their attention to delivering treatment.
In a small number of high profile cases involving serious abuse by non-medical military personnel, medical staff may have had difficulty understanding and/or fulfilling their key ethical obligations to the individuals in their care.
In 2011, the report of the public inquiry into the death of Iraqi civilian Baha Mousa, in British military custody in 2003, found that military guidance on ethical duties to avoid involvement in interrogation or on practical procedures for the medical treatment of detainees, including medical examination and the identification and reporting of abuse, was not provided to regimental medical officers at that time. Such cases highlight the importance of supporting military doctors in understanding and fulfilling their ethical obligations.
In the BMA’s view, a sound grasp of basic ethical principles can bring clarity to doctors’ decision-making when under pressure. In this tool kit we outline these key principles and give advice on how they can be interpreted in practice. Although this tool kit is designed primarily to support doctors, it will also provide useful guidance to other health professionals, and those with health-related or management roles, in the armed forces.
Using this guidance
This tool kit is not intended to be a comprehensive guide to ethical questions arising for military doctors. It signposts the kinds of ethical factors doctors need to take into consideration when making decisions.
We have also included more detailed guidance, including from the Ministry of Defence, and further sources of information and support. When facing specific ethical dilemmas, doctors are strongly recommended to refer to this more comprehensive guidance, or to seek further advice from the BMA, GMC or their personal medical legal defence organisation.
For advice on legal issues, doctors should refer to an appropriate local Ministry of Defence legal adviser. When on operations, doctors should refer to the medical chain of command for ethics advice.
Start using the tool kit