{"id":13244,"date":"2019-10-02T15:28:04","date_gmt":"2019-10-02T14:28:04","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2019\/10\/Dual-Loyalty-Cecil-Wilson-.pdf"},"modified":"2019-10-02T15:28:04","modified_gmt":"2019-10-02T14:28:04","slug":"dual-loyalty-cecil-wilson-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/noticias-y-prensa\/speeches-talks-interviews\/dual-loyalty-cecil-wilson-2\/","title":{"rendered":"Dual Loyalty Cecil Wilson"},"author":17,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

Dual Loyalty Cecil Wilson<\/a><\/p>\n

August 17, 2019
\nDeclaration of Geneva
\n\u201cI will apply, for the benefit of the sick, all measures
\nwhich are required, avoiding those twin traps of
\novertreatment and therapeutic nihilism.\u201d
\nPrimum non nocere (\u201cfirst, do no harm\u201d)
\nOath of Commissioned Officers
\n\u201cI, _____, having been appointed an officer in the
\nNavy of the United States, as indicated above in the
\ngrade of ____ do solemnly swear (or affirm) that I will
\nsupport and defend the Constitution of the United
\nStates against all enemies, foreign and domestic; that
\nI will bear true faith and allegiance to the same; that I
\ntake this obligation freely, without any mental
\nreservation or purpose of evasion; and that I will well
\nand faithfully discharge the duties of the office upon
\nwhich I am about to enter; So help me God.\u201d
\n\u201cMedical ethics in times of armed conflicts is identical to
\nmedical ethics in times of peace.\u201d World Medical Association
\n\u201cRespect human life and the dignity of every individual.
\nRefrain from supporting or committing crimes against humanity
\nand condemn any such acts.
\nTreat the sick and injured with competence and compassion
\nand without prejudice.\u201d
\nAMA Declarations of Professional Responsibility
\nDual Loyalty
\nClinical role conflict between professional
\nduties to a patient and obligations, expressed
\nor implied, real or perceived, to the interest of
\na third party such as an employer, an insurer
\nor the state (military) that can violate patient\u2019s
\nrights.
\nPrimary Care Physician
\nA young female primary care physician deployed
\nin Afghanistan was directed to perform physicals
\non male detainees prior to their interrogations.
\nFemale physical exams performed on male
\nmuslims are considered highly embarrassing. She
\nrefused and was threatened with courts martial.
\nShe subsequently did the physicals, fearing the risk
\nof a court martial and serving a two-year jail term
\nthis doctor has a young daughter and did not want
\nto miss time with the daughter
\nTeam Physician
\nThe team physician for critical care transport
\n(flying ICU) stationed outside the US is directed
\nto transport four critically ill civilians to another
\nhospital. The team physician on boarding the
\nplane determines that the facilities of the
\nnewer hospital are not able to provide care and
\nthe civilians will die. He directs the aircraft pilot
\nto return the plane. The pilot refuses \u2013 he has
\ndifferent orders. There is potentially a court
\nmartial.
\nNavy Nurse
\nA Navy nurse who refused to force-feed Guant\u00e1namo
\nprisoners. he refused to manage tube feedings of prison hunger
\nstrikers. He was removed from his duties treating captive
\npatients.
\nHe was described as an 18 year active duty sailor, a one-time
\nsubmariner who, at the Navy\u2019s, urging became a nurse and
\ncommissioned officer who had only three years before retiring.
\nAt one point he was threatened with court-martial for
\ninsubordination. But the personnel board will not face a court
\nmartial and he is being returned to regular duties.
\nInstead, the nurse \u201cis going to be able to go back to work,\u201d and
\nhave every reason to believe, finish up his honorable service in
\nthe U.S. Navy.\u201d
\nJANUARY 29, 2013
\nUnder Secretary of Defense for Personnel and
\nReadiness request the Defense Health Board to
\nreview the unique challenges faced by military
\nmedical professionals in their dual-hatted
\npositions as a military officer and a medical
\nprovider
\nDefense Health Board
\nThe Defense Health Board is an appointed
\ncivilian body known as a Federal Advisory
\nCommittee to the Secretary of Defense that
\nprovides independent
\nadvice\/recommendations on matters
\npertaining to military health.
\nQuestion 1
\nHow can military professionals most
\nappropriately balance their obligations to their
\npatients against their obligations as military
\nofficers to help commanders maintain military
\nreadiness?
\nQuestion 2
\nHow much latitude should military medical
\nprofessionals be given to refuse participation in
\nmedical procedures or request excusal from
\nmilitary operations with which they have
\nethical reservations or disagreement?
\nWMA Policies
\nInternational Code of Medical Ethics
\nStatement on the Protection and Integrity of Medical Personnel
\nin Armed Conflicts and Other Situations of Violence
\nRegulations in Times of Armed Conflict
\nDeclaration of Tokyo – Guidelines for Physicians Concerning
\nTorture and other Cruel, Inhuman or Degrading Treatment or
\nPunishment in Relation to Detention and Imprisonment
\nFebruary 11, 2015
\nEthical Guidelines and Practices
\nfor United States Military
\nProfessionals
\nRecommendation 1
\nDoD should further develop and expand the infrastructure needed to
\npromote DoD-wide medical ethics knowledge and an ethical culture
\namong military health care professionals, to include: a code of ethics;
\neducation and training programs; consultative and online services;
\nethics experts; and an office dedicated to ethics leadership, policy,
\nand oversight. To achieve these goals, DoD should form a tri-Service
\nworking group with appropriate representation to formulate policy
\nrecommendations on medical ethics. This should include
\ndevelopment of a DoD Instruction to guide development of the
\ninfrastructure needed to support the ethical conduct of health care
\nprofessionals. In addition, this working group should consider the
\nbest ways to implement the recommendations in this report. .
\nRecommendation 2
\nThroughout its policies, guidance, and instructions,
\nDoD must ensure that the military health care
\nprofessional\u2019s first ethical obligation is to the patient.
\nRecommendation 3
\nDoD leadership, particularly the line commands,
\nshould excuse health care professionals from
\nperforming medical procedures that violate their
\nprofessional code of ethics, State medical board
\nstandards of conduct, or the core tenets of their
\nreligious or moral beliefs. However, to maintain
\nmorale and discipline, this excusal should not result in
\nan individual being relieved from participating in
\nhardship duty.
\nRecommendation 4
\nDoD should formulate an overarching code of military
\nmedical ethics based on accepted codes from various
\nhealth care professions to serve as a guidepost to
\npromote ethical leadership and set a standard for the
\ncultural ethos of the MHS (military health services).
\nRecommendation 5
\nTo provide formal ethics guidance, direction, and
\nsupport to the MHS and its components, DoD and the
\nMilitary Departments should:
\nPublish directions\/instructions
\nEnsure military treatment facilities have access to
\nhigh-quality ethical services
\nProvide a reach back mechanism
\nDevelop a cadre of physicians with graduate training
\nEnsure health professionals are knowledgeable
\nReview compliance with ethics directives
\nRecommendation 6
\nDoD should develop clear guidance on what
\nprivate health information can be
\ncommunicated by health care professionals to
\nleadership, and the justifications for exceptions
\nto the rule for reasons of military necessity
\nRecommendation 7
\nDoD should provide military health care
\nprofessionals with privileges similar to those of
\nChaplains and Judge Advocates regarding their
\nindependence and obligation to protect privacy
\nand confidentiality while meeting the
\nrequirements of line commanders.
\nRecommendation 8
\nDoD should provide specific education and training for
\nhealth care professionals designated to serve as
\nmedical mentors or health care providers in foreign
\nhealth care facilities or in support of humanitarian
\nassistance or disaster relief operations. Such
\neducation and training should cover cultural
\ndifferences, potential ethical issues, rules of
\nengagement, and actions that might be taken to avert,
\nreport, and address unethical, criminal, or negligent
\nbehavior or practices.
\nRecommendation 9
\nDoD should create an online medical ethics
\nportal. At a minimum, it should include links to
\nrelevant policies, guidance, laws, education,
\ntraining, professional codes, and military
\nconsultants in medical ethics.
\nRecommendation 10
\n\u2022 DoD should include in professional military
\neducation courses information on the legal
\nand ethical limitations on health care
\nprofessionals regarding patient care actions
\nthey may or may not take in supporting
\nmilitary operations and patient information
\nthey may and may not communicate to line
\nleadership.
\nRecommendation 11
\nDoD should ensure that systems and processes
\nare in place for debriefing health care
\nprofessionals to help them transition home
\nfollowing deployment. Debriefing should occur
\nas a team when possible. Not only could this
\nhelp mitigate potential moral injury in health
\ncare professionals, but it may also provide
\nlessons learned and case studies for inclusion in
\nongoing training programs.
\nRecommendation 12
\nTo create an environment that promotes ethical
\nconduct and minimizes conflicts of dual loyalty,
\nDoD leadership should emphasize that senior
\nmilitary health care professionals are full
\nmembers of the Commander\u2019s staff as an
\nadvisor on medical ethics as it relates to
\nmilitary readiness.
\nRecommendation 13
\nTo minimize isolation of health care
\nprofessionals, the Military Departments should
\nmake every effort to ensure personnel who are
\ndeploying to the same location train together
\nas a team prior to deployment. Establishing
\nrelationships prior to deployment may enable
\nbetter communication and trust among line
\ncommand and health care professionals in the
\ndeployed setting.
\nRecommendation 14
\nDoD should issue a directive or instruction
\ndesignating minimum requirements for basic
\nand continuing education and training in
\nmilitary medical ethics for all health care
\nprofessionals in all components and indicate
\nthe appropriate times in career progression
\nthat these should occur
\nRecommendation 15
\nTo enhance ethics training for military health care professionals and
\nthe line command, DoD should:
\na) Ensure pre-deployment and periodic field training includes
\nchallenging medical ethics scenarios and reminders of available
\nresources and contact information to prepare both health care
\nprofessionals and line personnel. Curricula should include
\nsimulations and case studies in addition to didactics.
\nb) Provide a mechanism to ensure scenarios and training curricula
\nare continually updated to reflect specific challenges and lessons
\nlearned through debriefing from real-world deployments and
\ngarrison operations.
\nc) Ensure key personnel returning from deployment who have faced
\nsignificant challenges provide feedback to assist personnel preparing
\nfor deployment.
\nRecommendation 16
\nTo enhance health care practices in the military operational
\nenvironment, DoD should:
\na) Update the Joint Knowledge Online Medical Ethics and
\nDetainee Health Care Operations courses to improve the
\nefficiency with which the information is communicated and
\nmaintain currency of the material.
\nb) Create a medical ethics course to cover key principles,
\nethical codes, and case studies applicable to both garrison
\nand deployed environments, in addition to providing
\nresources and appropriate steps to take when assistance is
\nneeded in resolving complex ethical issues. This course
\nshould be required for all health care professionals
\nMARCH 3, 2015
\nThe Defense Health Board submitted its report to the
\nSecretary of Defense on \u201cEthical Guidelines and
\nPractices for U.S. Miitary Medical Professionals
\nDepartment of Defense\u201d.
\nIt was considered favorably
\nDepartment of Defense Medical Ethics Center
\n(DMEC) Vision
\nEstablish the Department of Defense (DoD) Medical
\nEthics Program Office at the Uniformed Services
\nUniversity (USU), known as the DoD Medical Ethics
\nCenter (DMEC), to facilitate a common cultural ethos
\nthroughout the Military Health System (MHS), and
\nserve as a knowledge repository and consultancy
\nresource for all military health professionals
\nDoD Medical Ethics Center (1)
\n1. Health care personnel will adhere to principles of
\nmedical ethics
\n2. Baseline and periodic updates in medical ethics
\neducation and training
\n3. Systematic and integrated DoD Medical Ethics Program
\n4. Consultation by fully trained experts in medical ethics
\n5. Medical ethics leadership composed of senior medical
\nethics in military ethics will promote ethics conduct
\nand culture across the MHS and DoD
\nDoD Medical Ethics Center (2)
\n6. Health care personnel must protect their patients
\nprivacy
\n7. Medical Heath Service leaders must:
\na. Unless it could have an adverse impact on military
\nreadiness, unit cohesion, and good order and
\ndiscipline, the Armed Forces will accommodate
\nindividual expressions of belief of a member of the
\narmed forces reflecting the sincerely held conscience
\nor moral principles of the member.
\nDoD Medical Ethics Center (3)
\nb. In so far as practicable, the Armed Forces may not use
\nsuch expression of belief as the basis of any adverse
\npersonnel action, discrimination, or denial of promotion,
\nschooling, training, or assignment.
\nc. This paragraph is applicable to individual expressions of
\nbelief of a health care professional reflecting the sincerely
\nheld conscience or moral principles of the individual that
\nare grounded in an applicable professional ethics code.
\nd. Nothing in this paragraph precludes disciplinary or
\nadministrative action for conduct that is proscribed by the
\nUniform Code of Military Justice, including actions and
\nspeech that threatens good order and discipline.
\nCurrent Medical Ethics Landscape (1)
\n\u2022 Societal and media perceptions of military medical
\npractice
\n\u2022 Varying influences on ethical thought\/practices
\ndependent on age, cultural & economic
\nbackground, and religious beliefs of providers, both
\nmilitary and civilian
\n\u2022 Advances in medical technology
\n\u2022 Determining the roles of patient\u2019s providers in
\ndecision making
\nCurrent Medical Ethics Landscape (2)
\n\u2022 Potential conflicts between autonomy and
\nbeneficence
\n\u2022 Ethical practices in deployed environment
\n\u2022 Appropriate parameters of patient and heathcare
\nworkers
\n\u2022 Confidentiality and disclosure of Personnel Health
\nInformation
\n\u2022 Military mission\/chain of command influence and
\npotential conflict of interest
\nBrief to the Defense Health Board 4-23-18
\n\u2022 Initial operating capacity Fall of 2018
\n\u2022 Functional operating capacity Spring 2019
\n\u2022 Housed in the Uniformed Services University
\n\u2022 Six senior staff plus additional personnel staff and
\nethics consultants
\n\u2022 Ethics resources from within the military, and from
\noutside civilian medical ethics programs and centers
\n\u2022 Formulate medical ethics curriculum
\n\u2022 Establish medical ethics portal presence
\nPrinciples of Medical Ethics
\nMilitary Health System
\nThe MHS embraces the principles of
\nprofessional ethics of America\u2019s health care
\nprofessions whose members are represented in
\nthe Military Services. Codes of ethics
\ndeveloped by health care professional
\norganizations recognize responsibility to
\npatients first and foremost and to society. The
\nMHS views the responsibilities of health care
\npersonnel and military professionals as
\nmutually reinforcing.
\nPrinciples of Medical Ethics (1)
\nMembers of the Military Health System (MHS) will
\n\u2022 Provide competent health care
\n\u2022 Uphold the standards of professionalism
\n\u2022 Advocate for the best possible health interest of
\npatients
\n\u2022 Respect the rights of patients , colleagues and other
\nhealth care personnel
\n\u2022 Complete appropriate education and training
\nPrinciples of Medical Ethics (2)
\n\u2022 Support patient-centered decision-making
\n\u2022 Use expertise of the health professions
\n\u2022 Consider the context of local culture
\n\u2022 Uphold the responsibilities under the law In caring
\nfor enemy combatants
\n\u2022 Regard responsibility to the patient as a primary
\nresponsibility
\nFrom 2001 and the 9 Eleven
\ncatastrophe to the present
\nNelson Mandela
\nDual Loyalty
\nMilitary Medicine<\/p>\n"},"caption":{"rendered":"

Dual Loyalty Cecil Wilson August 17, 2019 Declaration of Geneva \u201cI will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.\u201d Primum non nocere (\u201cfirst, do no harm\u201d) Oath of Commissioned Officers \u201cI, _____, having been appointed an officer in the Navy of […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":13299,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2019\/10\/Dual-Loyalty-Cecil-Wilson-.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/13244"}],"collection":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/users\/17"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=13244"}]}}