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Ethics-ch-10, Med, Military Medical Ethics Volume 1
[ Pobierz całość w formacie PDF ]Physician-Soldier: A Moral Profession
MILITARY MEDICAL ETHICS
V
OLUME
I
S
ECTION
III: T
HE
S
YNTHESIS
OF
M
EDICINE
AND
THE
M
ILITARY
Section Editor:
E
DMUND
G. H
OWE
, MD, JD
Director, Programs in Ethics, Uniformed Services University of the Health Sciences
Chair, Committee of Department of Defense Ethics Consultants to the Surgeons General
Robert Benney
Flashlight Surgery
Saipan
Doctors performing brain surgery by flashlight during a blackout necessitated by a Japanese air raid. The austerity of
the surroundings is evident in the lack of medical equipment and supplies.
Art: Courtesy of Army Art Collection, US Army Center of Military History, Washington, DC.
267
Military Medical Ethics, Volume 1
268
Physician-Soldier: A Moral Profession
Chapter 10
PHYSICIAN-SOLDIER: A MORAL
PROFESSION
WILLIAM MADDEN, MD
*
;
AND
BRIAN S. CARTER, MD, FAAP
†
INTRODUCTION
OVERVIEW: THE PROFESSIONS AND SOCIETY
THE PROFESSION OF MEDICINE
Ethics in Medicine
The Roles of the Physician
The Goals of Medicine in the Presence of Disease and Death
THE PROFESSION OF ARMS
Ethics in the Military
The Roles of the Military Professional
The Goals of the Military Professional and the Impact of Violence and
Destruction
PROFESSIONAL SIMILARITIES BETWEEN MEDICINE AND THE MILITARY
THE PHYSICIAN-SOLDIER: PROVIDING MEDICAL CARE AND
CONSERVING LIVES
Understanding the Principle of Conservation
The Evolution of Conservation as Metaphor
Beyond the Metaphor of Conservation
CONCLUSION
*
Colonel (Retired), Medical Corps, United States Army; formerly, Commander, Medical Element, Joint Task Force Bravo, Soto Cano Air Force
Base, Comayagua, Honduras (1989); currently, Associate Professor of Clinical Pediatrics, Department of Pediatrics and Steele Memorial
Children’s Research Center, College of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, Arizona 85724
†
Currently Associate Professor, Department of Pediatrics, Vanderbilt University, A-0126 Medical Center North, Nashville, Tennessee 37232-
2370; formerly, Lieutenant Colonel, Medical Corps, United States Army Reserve, Department of Pediatrics, Walter Reed Army Medical
Center, Washington, DC 20307
269
Military Medical Ethics, Volume 1
John Wehrle
Dustoff at Tan Son Nhut
Vietnam, 1966
Just as the wounded soldier moves along a pathway from injury, to triage, to care, to recovery, military physicians
need to travel along their own pathway of understanding themselves as both physician and soldier. Available at:
Art: Courtesy of Army Art Collection, US Army Center of Military History, Washington, DC.
270
Physician-Soldier: A Moral Profession
INTRODUCTION
The medical profession is asked by society to
prevent and treat illness and injury, and the pain
and suffering that they cause. The professional
oaths of medicine, from antiquity to modern times,
have prevented medical professionals from being
agents of death. Professional, civil, and criminal
sanctions have also been used historically to pre-
vent members of the medical profession from be-
coming involved in activities that led to the deaths
of members of their society. Conversely, the profes-
sion of arms is tasked with defending members of
that society by becoming directly involved in ac-
tivities that lead to the wounding or death of oth-
ers. How does a physician become a member of a
profession that can and will use violence to achieve
goals? How does one become a physician-soldier?
Parrish notes that,
litical ends of society by enhancing its military ca-
pability. Their actions increase their military’s abil-
ity to destroy and kill. By having physicians in the
military, societies ask, even order, physicians to be
a part of a system whose means is a direct cause of
an incomprehensible amount of injury, illness, pain,
suffering, and death.
Physicians are made a part of that military sys-
tem in a very formal way. They are sworn in as
members of the profession of arms, taking the same
oath as those who lead in combat. They wear the
same uniform, have the same rank and title system
as other soldiers, and are given the privileges
granted by society to the profession of arms. These
physician-soldiers also take at least rudimentary
training in basic military skills and are issued a
weapon when there is a threat to their well-being.
Despite being declared “noncombatants” by mod-
ern rules of war, members of the medical profes-
sion have on occasion both killed and been killed
during battle. Without question, they are in the
military. Military medical professionals cannot
separate themselves from the ends and means of
that force.
Thus military physicians are members of two
different professions that appear, at least on initial
analysis, to be in conflict. The profession of medi-
cine uses the resources of society to relieve pain and
suffering and to prevent the early death of mem-
bers of society. The profession of arms uses the col-
lective efforts of individual members of the society
to benefit society as a whole by threatening or per-
petrating violence, with resultant pain, suffering,
and death of individuals. Their relationships, obli-
gations, and responsibilities appear to be contra-
dictory, even mutually exclusive. How then can one
be both physician and soldier?
Parrish
1
believes that a physician cannot be a
soldier because the two professions have a differ-
ent set of values. We posit, however, that the val-
ues are not that different. How can this difference
of perception be resolved? It can be done by explor-
ing the essence of the professions. That part of the
discipline of philosophy that studies values, what
is right or wrong, good or bad, is called ethics. In
ethical theory one’s moral world is called
ethos.
Thus, if the question of being both physician and
soldier is to be explored then it is necessary to ex-
plore the
ethos
of the two professions and see if they
are in fundamental conflict. If the ethical relation-
ship between the two professions is to be devel-
oped, it is necessary to first understand the
ethos
of
professions themselves.
[m]aking doctors into soldiers was difficult, maybe
impossible, because of the value judgments learned
in our schooling and in our caring for the ill. Making
doctors of soldiers would probably be easier….
1(p9)
Physicians have “gone to war” for thousands of
years. This is made necessary by the nature of war.
The “end” or goal of war is to achieve control over
others, generally for political advantage. The
“means” or method of achieving this control is vio-
lence; violence that results in the wounding and
death of many. Weapon systems have been per-
fected to take maximum advantage of human vul-
nerabilities, whether those be organic (ways to kill
or maim) or psychic (ways to traumatize and ren-
der troops unable to continue the battle). The cir-
cumstances or ecology of war also increase the risk
of disease. Large numbers of people are brought
together, providing an increased risk of infectious
diseases. Inadequate and contaminated food and
water supplies, the stresses of battle, and poor hy-
giene, to name just a few, all lead to illness and
death. Travel to faraway locales results in exposure
to new types of infections, providing an increased
risk of both acquiring and dying of diseases. Changes
in sexual behavior and the opportunity for new
partners results in increases in the incidence of sexu-
ally transmitted disease. Thus, both the weaponry
and the environment of war bring suffering and
death.
When injured, ill, or overwhelmed, a soldier can
no longer contribute to military victory. By treat-
ing the wounded and other casualties, military phy-
sicians enhance their military’s ability to wage war.
Thus, military medical professionals serve the po-
271
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