Being a healthcare professional has been said to be one of the most rewarding and fulfilling roles as you save the lives of others. Being in the military has a different twist to the picture. As military personnel, you lay your life on the frontline to fight for your people, and as medical personnel, you are there to save every life you can, often under extreme and challenging conditions.
Military healthcare professionals, including doctors, nurses, or biomedical scientists, must adapt to the tenets of a military environment. They may operate in various work settings, ranging from well-equipped military hospitals, remote relief areas with limited resources, and field hospitals in conflict zones or war fronts. Medical ethics is governed based on certifications of qualifications and competence done by relevant professional bodies, such as the General Medical Council for Medical Doctors and the Health Professional Council for Biomedical Scientists. The Geneva Conventions and other international humanitarian laws mainly govern military healthcare professionals. This is the basis of the term “Dual Loyalty” associated with Military medical healthcare professionals because they are in between two principles in practice, which may become conflicting as they must uphold national security supporting the military objectives and the responsibility to cater to patients and treat every patient 5 .
Military healthcare professionals are usually specially trained by their medical body and Army officers to be resilient, empathic, and physically fit to provide care under such diverse and sometimes harsh conditions. They must also have a strong ethical compass to guide them in their duties as a military healthcare professional; you can get deployed anywhere, on the battlefield, on naval bases, or even in remote areas, which is why one of the critical skills is adaptability 3 . Requirements for joining the army include a basic physical fitness assessment, an age requirement of 17 to 35 years, basic military training and a bachelor's degree in your field; for example, for a Biomedical scientist, you would require a degree in Biomedical science and be registered with relevant bodies.
This rigorous training prepares them for the psychological and physical challenges of treating both civilians and soldiers. Some of the training includes emergency medical procedures, trauma care, and the use of other medical technologies. Also, military healthcare professionals must be adaptable to different cultures, traditions, customs, beliefs, and medical needs of the population they are deployed to serve; this is part of military training and is designed to maintain the integrity and core elements of medical military professionals 2 .
Medical personnel must follow a different set of rules and ethics. This is very different from being a civilian healthcare professional because of the different circumstances and modes of operations in the military.
The ethics of doctors and healthcare professionals are summed in the dictum, “First do no harm, so they do their best to save every sick and injured person that comes their way. In military ethics, the soldier is loyal only to his country and must fight the war to protect national security. The role combines both the military physician and the healthcare professional. The military physician is expected to be both a patriotic soldier and a human physician. A military physician is expected to bridge these professions and blend into one. Military medical personnel are faced with diverse challenges, especially on the field 1 .
Their roles as military healthcare professionals may be termed complicated as they may face different challenges. For example, confidentiality cannot be breached; they must keep every patient's information confidential. These healthcare professionals find themselves in a dilemma whether to keep the information of a soldier struggling with alcohol dependency from the military commanders 7 .
Also, in a war situation, the healthcare professional may face challenges making difficult decisions urgently, deciding who receives treatment on the severity of injuries and survival likelihood. This may be a heartbreaking decision to make for the healthcare professional and others 4 .
The Geneva Convention states, "Each belligerent must treat his fallen adversaries as he would the wounded of his own army. It means that medical healthcare professionals must treat all injured and sick soldiers regardless of whether they are the enemy or not. This would mean two things: upholding the mission of winning the war and keeping the Hippocratic oath 6 . Assaults and injuries are a standard part of the war, so medical aid must be provided solely for medical needs regardless of sex, race, nationality, religion or political opinions. The wounded and sick must not be left without medical assistance, and treatment should be based on urgency. It is also important to note that following the Geneva Conventions, Military medical healthcare professionals are to be regarded as non-combatants and are forbidden to engage in war, so they have a special status, and they are not to be captured and they are immune from attacks 8 .
Being a military healthcare professional is beyond duty; it is more of a calling because you are responsible for many lives, including your own. You can decide who gets urgent attention and who can wait with limited resources. These tough choices are part of what moulds the military healthcare professional 1 .
It is, however, very rewarding to serve and to be able to help save the lives of others. If eligible and fit to be a military healthcare professional, you will undergo several training sessions to prepare for your roles and guide you in your ethical duties and responsibilities. Aside from the generic training that would need to be undertaken by every personnel in the military, some other institutions have developed training, such as the ICMM Centre of Reference for Education on International Humanitarian Law and Ethics, the U.S. DoD Medical Ethics Centre (DMEC), and the King’s College London Centre for Military Ethics (KCME). These trainings and workshops are usually done annually on Military Medical ethics and are solely to support military healthcare professionals to make legal and ethical decisions in the military context 5 .
Navigating the ethical challenges of a military healthcare professional requires a solid ethical and moral compass. Military healthcare professionals are primarily responsible for their patients and must ensure they give their best care to their patients, whether civilians or soldiers. They are also responsible for the resources allocated to them, whether limited or abundant, ensuring the most crucial needs are met. They must find the balance between their military obligations and medical duty. It is, however, the most rewarding position, and their commitment and resilience help to save lives and uphold the core values of both the medical and military professions.
References
1 Bricknell, M., & Story, R. (2022). An Overview to Military Medical Ethics. Journal of Military and Veterans' Health , 30 . https://jmvh.org/article/an-overview-to-military-medical-ethics/
2 Brintz, C. E., Miller, S., Olmsted, K. R., Bartoszek, M., Cartwright, J., Kizakevich, P. N., Butler, M., Asefnia, N., Buben, A., & Gaylord, S. A. (2020). Adapting Mindfulness Training for Military Service Members With Chronic Pain. Mil Med , 185 (3-4), 385-393. https://doi.org/10.1093/milmed/usz312
3 Finnegan, A., Finnegan, S., McKenna, H., McGhee, S., Ricketts, L., McCourt, K., Warren, J., & Thomas, M. (2016). Characteristics and values of a British military nurse. International implications of War Zone qualitative research. Nurse Education Today , 36 , 86-95. https://doi.org/https://doi.org/10.1016/j.nedt.2015.07.030
4 Hines, L. A., Gribble, R., Wessely, S., Dandeker, C., & Fear, N. T. (2014). Are the Armed Forces Understood and Supported by the Public? A View from the United Kingdom. Armed Forces & Society , 41 (4), 688-713. https://doi.org/10.1177/0095327X14559975
5 Lin, C.-Y., Bricknell, M. C. M., Brockie, A. F., & Kelly, J. C. (2022). Military Healthcare Ethics: Making It Relevant to the Whole Military Care Team. Military Medicine , 188 (1-2), 21-24. https://doi.org/10.1093/milmed/usac321
6 Meyer, H. S., Bader-Larsen, K. S., Artino, A., & Varpio, L. (2021). Ethical Bearing Is About Our Conduct: Ethics as an Essential Component of Military Interprofessional Healthcare Teams. Military Medicine , 186 (Supplement_3), 23-28. https://doi.org/10.1093/milmed/usab197
7 Noroozi, M., Zahedi, L., Bathaei, F. S., & Salari, P. (2018). Challenges of Confidentiality in Clinical Settings: Compilation of an Ethical Guideline. Iran J Public Health , 47 (6), 875-883.
8 Vaidya, R., & Bobdey, S. (2021). Medical ethics during armed conflicts: Dilemmas of a physician soldier. Med J Armed Forces India , 77 (4), 377-381. https://doi.org/10.1016/j.mjafi.2021.08.013