{"id":3415,"date":"2017-01-19T13:16:36","date_gmt":"2017-01-19T13:16:36","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2017\/01\/DHB-16-recommendations.pdf"},"modified":"2017-01-19T13:16:36","modified_gmt":"2017-01-19T13:16:36","slug":"dhb-16-recommendations-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/es\/dhb-16-recommendations-2\/","title":{"rendered":"DHB-16-recommendations"},"author":2,"comment_status":"open","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

DHB-16-recommendations<\/a><\/p>\n

Defense Health Board – Federal Advisory
\nCommittee to the Secretary of Defense
\nThe Defense Health Board (DHB) is a Federal Advisory Committee to the
\nSecretary of Defense that provides independent advice \/ recommendations
\non matters relating to operational programs, health policy development, health
\nresearch programs, and requirements for the treatment and prevention of
\ndisease and injury, promotion of health and the delivery of health care to
\nDepartment of Defense (DoD) beneficiaries.
\nMission
\nThe mission of the DHB is to provide independent authoritative advice to
\nmaximize the health, safety, and effectiveness of the United States Armed Forces.
\nDefense Health Board
\nEthical Guidelines and Practices for
\nU.S. Military Medical Professionals
\nFebruary 11, 2015
\nRecommendation 1: Department of Defense (DoD) should further develop and expand
\nthe infrastructure needed to promote DoD-wide medical ethics knowledge and an ethical
\nculture among military health care professionals, to include: a code of ethics; education
\nand training programs; consultative and online services; ethics experts; and an office
\ndedicated to ethics leadership, policy, and oversight. To achieve these goals, DoD should
\nform a tri-Service working group with appropriate representation to formulate policy
\nrecommendations on medical ethics. This should include development of a DoD
\nInstruction to guide development of the infrastructure needed to support the ethical
\nconduct of health care professionals. In addition, this working group should consider
\nthe best ways to implement the recommendations in this report
\nRecommendation 2: Throughout its policies, guidance, and instructions, DoD must
\nensure that the military health care professional\u2019s first ethical obligation is to the patient
\nRecommendation 3: DoD leadership, particularly the line commands, should excuse
\nhealth care professionals from performing medical procedures that violate their
\nprofessional code of ethics, State medical board standards of conduct, or the core tenets
\nof their religious or moral beliefs. However, to maintain morale and discipline, this
\nexcusal should not result in an individual being relieved from participating in hardship
\nduty. Additionally, health care professionals should not be excused from military
\noperations for which they have ethical reservations when their primary role is to care for
\nthe military members participating in those operations.
\nRecommendation 4: DoD should formulate an overarching code of military medical
\nethics based on accepted codes from various health care professions to serve as a
\nguidepost to promote ethical leadership and set a standard for the cultural ethos of the
\nMHS. To inform this process, the ethics codes of relevant health care professional
\norganizations should be reviewed regularly and updates should be made to the military
\nmedical ethics code as appropriate.
\nRecommendation 5: To provide formal ethics guidance, direction, and support to the
\nMHS and its components, DoD and the Military Departments should:
\na) Publish directives\/instructions regarding the organization, composition,
\ntraining and operation of medical ethics committees and medical ethics
\nconsultation services within the MHS. DoD should review best practices at
\nleading civilian institutions in formulating this guidance.
\nb) Ensure military treatment facilities have access to consistent, high-quality,
\nethical consultation services, including designation of a responsible medical
\nethics expert for each location. For those facilities\/locations without onsite
\nmedical ethics support, DoD should ensure remote consultation is available.
\nc) Provide a \u201creach back\u201d mechanism for deployed health care professionals to
\ncontact an appropriately qualified individual to assist in resolving an ethical
\nconcern that has not been resolved through their chain of command.
\nd) Develop a small cadre of clinicians with graduate level training in bioethics to
\nserve as senior military medical ethics consultants.
\ne) Ensure that health care professionals are knowledgeable about their rights and
\navailable procedures for obtaining ethics consultation, expressing dissent or
\nrequesting recusal from certain objectionable procedures or activities.
\nf) Review compliance with ethics directives and instructions as part of recurring
\nhealth service inspections.
\nRecommendation 6: DoD should develop clear guidance on what private health
\ninformation can be communicated by health care professionals to leadership, and the
\njustifications for exceptions to the rule for reasons of military necessity.
\nRecommendation 7: DoD should provide military health care professionals with
\nprivileges similar to those of Chaplains and Judge Advocates regarding their
\nindependence and obligation to protect privacy and confidentiality while meeting the
\nrequirements of line commanders.
\nRecommendation 8: DoD should provide specific education and training for health care
\nprofessionals designated to serve as medical mentors or health care providers in foreign
\nhealth care facilities or in support of humanitarian assistance or disaster relief operations.
\nSuch education and training should cover cultural differences, potential ethical issues,
\nrules of engagement, and actions that might be taken to avert, report, and address
\nunethical, criminal, or negligent behavior or practices.
\nRecommendation 9: DoD should create an online medical ethics portal. At a minimum,
\nit should include links to relevant policies, guidance, laws, education, training,
\nprofessional codes, and military consultants in medical ethics.
\nRecommendation 10: DoD should include in professional military education courses
\ninformation on the legal and ethical limitations on health care professionals regarding
\npatient care actions they may or may not take in supporting military operations and
\npatient information they may and may not communicate to line leadership.
\nRecommendation 11: DoD should ensure that systems and processes are in
\nplace for debriefing health care professionals to help them transition home
\nfollowing deployment. Debriefing should occur as a team when possible. Not only could
\nthis help mitigate potential moral injury in health care professionals, but it may also
\nprovide lessons learned and case studies for inclusion in ongoing training programs.
\nRecommendation 12: To create an environment that promotes ethical conduct and
\nminimizes conflicts of dual loyalty, DoD leadership should emphasize that senior military
\nhealth care professionals are full members of the Commander\u2019s staff as an advisor on
\nmedical ethics as it relates to military readiness.
\nRecommendation 13: To minimize isolation of health care professionals, the Military
\nDepartments should make every effort to ensure personnel who are deploying to the same
\nlocation train together as a team prior to deployment. Establishing relationships prior to
\ndeployment may enable better communication and trust among line command and health
\ncare professionals in the deployed setting.
\nRecommendation 14: DoD should issue a directive or instruction designating minimum
\nrequirements for basic and continuing education and training in military medical ethics
\nfor all health care professionals in all components and indicate the appropriate times in
\ncareer progression that these should occur.
\nRecommendation 15: To enhance ethics training for military health care professionals
\nand the line command, DoD should:
\na) Ensure pre-deployment and periodic field training includes challenging
\nmedical ethics scenarios and reminders of available resources and contact
\ninformation to prepare both health care professionals and line personnel.
\nCurricula should include simulations and case studies in addition to didactics.
\nb) Provide a mechanism to ensure scenarios and training curricula are
\ncontinually updated to reflect specific challenges and lessons learned through
\ndebriefing from real-world deployments and garrison operations.
\nc) Ensure key personnel returning from deployment who have faced significant
\nchallenges provide feedback to assist personnel preparing for deployment
\nRecommendation 16: To enhance health care practices in the military operational
\nenvironment, DoD should:
\na) Update the Joint Knowledge Online Medical Ethics and Detainee Health Care
\nOperations courses to improve the efficiency with which the information is
\ncommunicated and maintain currency of the material.
\nb) Create a medical ethics course to cover key principles, ethical codes, and case
\nstudies applicable to both garrison and deployed environments, in addition to
\nproviding resources and appropriate steps to take when assistance is needed in
\nresolving complex ethical issues. This course should be required for all health
\ncare professionals.<\/p>\n"},"caption":{"rendered":"

DHB-16-recommendations Defense Health Board – Federal Advisory Committee to the Secretary of Defense The Defense Health Board (DHB) is a Federal Advisory Committee to the Secretary of Defense that provides independent advice \/ recommendations on matters relating to operational programs, health policy development, health research programs, and requirements for the treatment and prevention of disease […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":null,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2017\/01\/DHB-16-recommendations.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/media\/3415"}],"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\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/es\/wp-json\/wp\/v2\/comments?post=3415"}]}}