Medical Ethics on the Battlefield

1
Medical Ethics on the Battlefield

• Michael S. Oshiki, MD, FAAFP
• LTC, MC, FS, USA
• 15 March 2008

2
Battlefield Medical Ethics

• Historical Perspective
• Contemporary Challenges on the 21st Century
  Battlefield
• War on Terror
• Counter-Insurgency
• Others
• Literature Review
• Case Studies

3
Historical Perspective

• Conflicts between the different roles of military
  medical providers as clinician and military
  officer are not new.
• Three sets of players that the provider must
  consider
• Combatants (declared on otherwise)
• Non-Combatants
• The State
• 1949 Geneva Conventions outline the role of
  military medical personnel as non-combatants.
• Role of military medicine in counter-insurgency
  operations has been evolving over time.

4
Historical Perspective (cont)

• Some clear-cut violations of established
  principles on the conduct of military medical
  personnel
• Nazi medical experiments (ex. Dr. Mengele)
• Japanese medical experiments (ex. Unit 731)
• Some more defensible examples of issues that have
  generated debate
• Use of pyridostigmine in Desert Shield/Storm
• Use of stimulant medications in aviators

5
The 21st Century BattlefieldThe War on Terror

• Post 9/11 circumstances of the global war on
  terror present new challenges for military
  medical personnel.
• Questions involving the role of military medicine
  in detainee care loom large.
• Guantanamo
• Abu Ghraib
• Triage and treatment at level I, II and III MTFs
  in a combat zone for different casualty
  populations (Medical Rules of Eligibility).

6
The 21st Century Battlefield Counter-Insurgency
Operations

• The evolving role of military medicine in
  counter-insurgency operations generates many
  questions?
• What is the role for humanitarian medical
  assistance?
• How much does healthcare factor as a weapon in
  the counter-insurgency fight?
• How much does the standard of care apply to
  different patient populations?
• How much does HIPAA apply to different
  populations?

7
The 21st Century BattlefieldOther Challenges

• 21st century technology raises potential issues
  as well
• The rapidly evolving role of information
  technology raises new concerns over the
  confidentiality of service members medical care.
• What is the optimal role for new and better
  pharmacologic agents and vaccines?
• To protect the service member against potential
  threats (e.g. PB, malaria chemoprophylaxis,
  vaccines)
• To enhance service member performance (e.g.
  stimulants, sleep aids)

8
Literature Review

• Geneva Conventions
• Military Regulations
• General Medical Literature
• Military Medical Literature
• Legal and Ethical Literature
• Popular Media

9
Case Studies

• Detainee Care
• Medical Rules of Eligibility
• Humanitarian Aid and Medical Civil-Military
  Operations
• Service Member Confidentiality
• Questions of Medication