scholarly journals Thematic Analysis of Military Medical Ethics Publications From 2000 to 2020—A Bibliometric Approach

2021 ◽  
Author(s):  
Zachary Bailey ◽  
Peter Mahoney ◽  
Marina Miron ◽  
Martin Bricknell
Keyword(s):  
Mental Health ◽  
Medical Ethics ◽  
Health Personnel ◽  
Relative Proportion ◽  
Analysis Tool ◽  
Military Operations ◽  
Mental Health Patient ◽  
Military Health ◽  
Dual Loyalty ◽  
Military Medical Ethics

ABSTRACT Introduction There has been external criticism of the compliance of military health personnel with internationally agreed principles in military medical ethics (MME). In response, a number of authors have called for clarity on the principles and topics within the domain of MME. This complements an increased acknowledgment of the need for education in MME for military health personnel. Our paper utilizes bibliometric techniques to identify key themes in MME to inform the development of a curriculum for this subject. Materials and Methods We designed a search strategy to find publications over the period January 1, 2000-December 31, 2020 in the domain of MME from the three databases, PubMed, Web of Science, and Scopus, using the search string (ethic* OR bioethics* OR moral*) AND military AND (medic* OR health*). We obtained a total of 1,115 publications after duplication removal. After exclusion based on topic, year, and study design, we analyzed a total of 633 publications using Scopus’s embedded analysis tool and the software VOSViewer. We generated a co-occurrence word map from the abstracts of each of the publications. We deduced themes of MME based on the clusters shown in the word map, and we categorized each publication into one of these themes to analyze the change of themes over time. Results We observed a 10-fold increase in annual publications on MME between 2000 and 2020. The majority of papers were written by U.S. (72%) and UK (13%) authors, although a total of 15 countries were represented. After using VOSViewer to identify co-occurring keywords in titles and abstracts from these publications, nine themes were identified: biomedical research, care to detained populations, disaster/triage, mental health, patient-focused foundations, technology, dual loyalty, education/training, and frameworks. The relative proportion of each of these themes changed over the study period, with mental health being dominant by the end. Conclusions This study has identified key themes that might inform the development of a curriculum for teaching MME. It is noticeable that the majority of themes cover MME from the perspective of professional practice on military operations; noting, the research and technology themes also pertain to the generation of knowledge for military operations. There were a limited number of publications covering practice in the non-deployed or garrison settings, and these were codified under the themes of “framework” and “dual loyalty”. The results are skewed toward English-speaking countries and exclude non-academic publications. Further work will search for other open-source information and non-English publications. To our knowledge, this exploratory bibliometric analysis on MME in the academic literature is the first of its kind. This article has demonstrated the use of bibliometric techniques to evaluate the evolution of knowledge in MME, including the identification of key themes. These will be used to support further work to develop a curriculum for the teaching of MME to military medical audiences.

scholarly journals Medical Ethics for the Military Profession

2021 ◽  
Vol 19 (36) ◽  
pp. 851-866
Author(s):  
Martin Bricknell ◽  
Marina Miron
Keyword(s):  
Medical Ethics ◽  
Ethical Issues ◽  
Military Force ◽  
Military Leaders ◽  
Dual Loyalty ◽  
Core Concepts ◽  
Military Profession ◽  
Legal Frameworks ◽  
Military Medical Ethics ◽  
The Military

This paper summarizes medical ethics in the military profession to raise military leaders’ awareness of Military Medical Ethics (MME) and the ethical issues that may impact their medical services and personnel. First, it summarizes core concepts, including the four principles of medical ethics (autonomy, beneficence, non-maleficence, and justice), the two legal frameworks for the use of military force in war, jus ad bellum and jus in bello, and the concept of dual loyalty. It then examines MME issues during conflict, in garrison healthcare, and during the COVID-19 epidemic. Finally, it concludes by arguing that MME is an important domain of military ethics that should be taught to military leaders to complement the detailed education of MME for military medical professionals.

Teaching Military Medical Ethics: Another Look at Dual Loyalty and Triage

2010 ◽  
Vol 19 (4) ◽  
pp. 458-464 ◽  
Author(s):  
MICHAEL L. GROSS
Keyword(s):  
Medical Ethics ◽  
Assisted Suicide ◽  
Dual Loyalty ◽  
Core Subjects ◽  
Life Issues ◽  
End Of Life Issues ◽  
Military Medical Ethics ◽  
Short Courses ◽  
The Military ◽  
Military Physicians

Military medical ethics is garnering growing attention today among medical personal in the American and other armies. Short courses or workshops in “battlefield ethics” for military physicians, nurses, medics, social workers, and psychologists address the nature of patient rights in the military, care for detainees, enemy soldiers and local civilians, problems posed by limited resources, ethical questions arising in humanitarian missions, as well as end-of-life issues, ethics consultations, care for veterans, advance directives, and assisted suicide. Although many of these issues are the core subjects of any bioethics curriculum, military medical ethics presents unique challenges to bioethics educators.

scholarly journals Military Mental Health Personnel Deployment Survey: A Secondary Analysis

2019 ◽  
Vol 185 (3-4) ◽  
pp. e340-e346 ◽  
Author(s):  
Anderson B Rowan ◽  
Wendy J Travis ◽  
Cameron B Richardson ◽  
Travis R Adams
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Air Force ◽  
Health Personnel ◽  
Sleep Problems ◽  
Meaningful Work ◽  
Future Research ◽  
Military Health ◽  
Military Mental Health ◽  
Military Health Care

Abstract Introduction Military mental health personnel (MMHP) have increasingly engaged in deployment-related roles in closer proximity to combat environments. Although studies examining deployment-related outcomes among military health care personnel have found combat exposure (CE) positively related to psychological problems, no studies of MMHP have investigated CE or its association with psychological outcomes. This study seeks to provide descriptive data on CE and perceived impacts associated with deployment, as well as explore how CE, perceptions of preparedness for deployment, difficulties during deployment (DDD), and meaningful work during deployment relate to appraisal of problems after deployment (ie, sleep problems, interpersonal withdrawal, depressive symptoms, and work problems). Materials and Methods Archival postdeployment survey data from 113 U.S. Air Force MMHP previously deployed to Iraq or Afghanistan were utilized to determine descriptive statistics on CE and other factors. Additionally, hierarchical linear regression was utilized to test relationships between CE, DDD, preparation for deployment, and meaningful work with reports of sleep problems, interpersonal withdrawal, work problems, and depression symptoms. The study was approved by the Institutional Review Board of the U.S. Air Force Academy. Results MMHP reported an average of 1.58 (standard deviation = 1.03) combat-related events and DDD included: (1) being away from family/close friends (62%), (2) uncertain redeployment date (35%), (3) difficulty adapting to a new situation (35%), and (4) working long hours (31%), with 66% endorsing two or more areas of difficulty. Most MMHP reported feeling prepared for deployment both professionally (91%) and personally (87%), as well as that their family was prepared (83%). Additionally, nearly all reported at least one meaningful work experience while deployed (96%) with positive impacts on their clients, being the most frequent (89%). Furthermore, CE predicted both sleep difficulties and interpersonal withdrawal. MMHP who perceived their deployment experience as difficult also had higher rates of postdeployment difficulties. Finally, we found no relationship between perceived deployment preparation and postdeployment outcomes. Conclusions This is the first study of MMHP reporting CE rates and examining relationships between perceived outcomes and CE, deployment preparation, difficulties during deployment, and meaningful work. The vast majority of MMHP were exposed to more than one combat-related event; however, this rate of CE appears lower than what has been reported among a similar sample of military health care personnel. Although CE predicted difficulties, appraisals of difficulties during deployment experience predicted the highest rates of postdeployment difficulties, accounting for nearly a quarter or more of the outcome variance. The lack of relationship between deployment preparation and meaningful work is inconsistent with prior research and may be because of the limited response range in our sample. Additionally, other methodological limitations include: (1) cross-sectional study design, (2) lack of validated measures, and (3) the long-term retrospective nature of the assessment. Future research should incorporate more rigorous methodologies and assess constructs absent in this archival data set. Despite these limitations, this study provides important preliminary data to support future research development and funding. Additionally, the results may be used to normalize associated impacts and promote help seeking among MMHP.

scholarly journals Dual loyalty in military medical ethics: a moral dilemma or a test of integrity?

2018 ◽  
Vol 165 (4) ◽  
pp. 282-283
Author(s):  
Peter Olsthoorn
Keyword(s):  
Medical Ethics ◽  
Patient Care ◽  
Professional Ethics ◽  
Moral Dilemma ◽  
Armed Forces ◽  
Medical Personnel ◽  
Dual Loyalty ◽  
A Value ◽  
Military Medical Ethics

When militaries mention loyalty as a value they mean loyalty to colleagues and the organisation. Loyalty to principle, the type of loyalty that has a wider scope, plays hardly a role in the ethics of most armed forces. Where military codes, oaths and values are about the organisation and colleagues, medical ethics is about providing patient care impartially. Being subject to two diverging professional ethics can leave military medical personnel torn between the wish to act loyally towards colleagues, and the demands of a more outward looking ethic. This tension constitutes a test of integrity, not a moral dilemma.

scholarly journals Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel Sayko Adams ◽  
Esther L. Meerwijk ◽  
Mary Jo Larson ◽  
Alex H. S. Harris
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Chronic Pain ◽  
Veterans Health Administration ◽  
First Year ◽  
Veterans Health ◽  
Health Administration ◽  
Military Health System ◽  
Military Health ◽  
The Military

Abstract Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This study examined 1) health care utilization in VHA as an enrollee (i.e., linkage to VHA) after military separation among soldiers with postdeployment chronic pain identified in the MHS, and predictors of linkage, and 2) persistence of chronic pain among those utilizing the VHA. Methods Observational, longitudinal study of soldiers returning from a deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008–2014. The analytic sample included 138,206 active duty soldiers for whom linkage to VHA was determined through FY2019. A Cox proportional hazards model was estimated to examine the effects of demographic characteristics, military history, and MHS clinical characteristics on time to linkage to VHA after separation from the military. Among the subpopulation of soldiers who linked to VHA, we described whether they met criteria for chronic pain in the VHA and pain management treatments received during the first year in VHA. Results The majority (79%) of soldiers within the chronic pain cohort linked to VHA after military separation. Significant predictors of VHA linkage included: VHA utilization as a non-enrollee prior to military separation, separating for disability, mental health comorbidities, and being non-Hispanic Black or Hispanic. Soldiers that separated because of misconduct were less likely to link than other soldiers. Soldiers who received nonpharmacological treatments, opioids/tramadol, or mental health treatment in the MHS linked earlier to VHA than soldiers who did not receive these treatments. Among those who enrolled in VHA, during the first year after linking to the VHA, 49.7% of soldiers met criteria for persistent chronic pain in VHA. Conclusions The vast majority of soldiers identified with chronic pain in the MHS utilized care within VHA after military separation. Careful coordination of pain management approaches across the MHS and VHA is required to optimize care for soldiers with chronic pain.

scholarly journals 3191 Adolescent Substance Use: School and Community Perspectives on School-Based Interventions

2019 ◽  
Vol 3 (s1) ◽  
pp. 82-83
Author(s):  
Sycarah Fisher
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
School Counselors ◽  
School Psychologists ◽  
Early Identification ◽  
Health Personnel ◽  
Adolescent Substance Use ◽  
Adolescent Substance ◽  
School Based ◽  
School And Community

OBJECTIVES/SPECIFIC AIMS: Fifty percent of adolescents have tried an illicit drug and 70% have tried alcohol by the end of high school. Further, despite 7-9% of youth 12-17 meeting criteria for a substance use disorder only 1 in 10 actually receive it. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence based process that facilitates early identification and treatment for adults and adolescents in community (primary care) facilities. Despite the documented effectiveness of SBIRT, no research has examined the implementation of SBIRT in school settings by school-based mental health personnel. The purpose of the present study was to identify facilitators and barriers to SBIRT implementation by school-based personnel in secondary schools. METHODS/STUDY POPULATION: Participants included 30 school and community service providers including: teachers, school counselors, school psychologists, school administrators (principals and central office staff), city council members, school board members, community mental health services providers as well as state level individuals from the department of Adolescent Substance Use and the Office of Drug Control Policy. Interview guides were developed using the Consolidated Framework for Implementation Research (CFIR) to identify facilitators and barriers regarding the following: inner setting, outer setting, individuals involved, and intervention (SBIRT). The six-phase framework of Thematic Analysis (TA) was employed to analyze the data. We specifically used the deductive method to analyze the data with a pre-determined theory in mind (CFIR) to move to hypothesis building, and coding the data. RESULTS/ANTICIPATED RESULTS: Contrary to research conducted outside of the schools under the auspices that schools do not have the time or interest in providing school-based substance use interventions, several themes emerged identifying a receptivity, willingness, and eagerness to provide these services. Specifically, school-based mental health professionals (i.e., school counselors, school psychologists) being aware of adolescent substance use in their schools, but not knowing how to appropriately handle such disclosures. Further, school-based mental health personnel indicated that they would want additional training on how to identify and provide services to adolescents with substance use needs. School-based administrators also indicated a receptivity to addressing substance use with an acknowledgement that schools would need to move from a punitive model for substance use infractions to a treatment model. Some identified barriers to implementation included lack of awareness of community treatment settings for referrals and anonymity or lack thereof of substance use screening. DISCUSSION/SIGNIFICANCE OF IMPACT: While the data analyzed come from a limited sample in one school district, the present study found that schools could be potential settings for the early identification and intervention of adolescent substance use. Findings from this study contribute to our understanding of school and community receptivity to school-based interventions. Future research should identify training needs of school-based mental health personnel to assist in the early identification and prevention of substance use disorders.

Are Military and Medical Ethics Necessarily Incompatible? A Canadian Case Study

2016 ◽  
Vol 44 (4) ◽  
pp. 639-651 ◽  
Author(s):  
Christiane Rochon ◽  
Bryn Williams-Jones
Keyword(s):  
Medical Ethics ◽  
Code Of Ethics ◽  
Armed Forces ◽  
Codes Of Ethics ◽  
Core Values ◽  
Dual Loyalty ◽  
Canadian Armed Forces ◽  
Military Institution ◽  
The Military ◽  
Military Physicians

Military physicians are often perceived to be in a position of ‘dual loyalty’ because they have responsibilities towards their patients but also towards their employer, the military institution. Further, they have to ascribe to and are bound by two distinct codes of ethics (i.e., medical and military), each with its own set of values and duties, that could at first glance be considered to be very different or even incompatible. How, then, can military physicians reconcile these two codes of ethics and their distinct professional/institutional values, and assume their responsibilities towards both their patients and the military institution? To clarify this situation, and to show how such a reconciliation might be possible, we compared the history and content of two national professional codes of ethics: the Defence Ethics of the Canadian Armed Forces and the Code of Ethics of the Canadian Medical Association. Interestingly, even if the medical code is more focused on duties and responsibility while the military code is more focused on core values and is supported by a comprehensive ethical training program, they also have many elements in common. Further, both are based on the same core values of loyalty and integrity, and they are broad in scope but are relatively flexible in application. While there are still important sources of tension between and limits within these two codes of ethics, there are fewer differences than may appear at first glance because the core values and principles of military and medical ethics are not so different.

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