scholarly journals Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study.

2021 ◽  
Author(s):  
Antoine Lamblin ◽  
Clément Derkenne ◽  
Marion Trousselard ◽  
Marie-Ange Einaudi
Keyword(s):  
Qualitative Study ◽  
Ethical Dilemmas ◽  
Armed Forces ◽  
Healthcare Personnel ◽  
Ethical Challenges ◽  
Medical Assistance ◽  
Dual Loyalty ◽  
French Military ◽  
Overseas Operations ◽  
Military Institution

Abstract Background French military doctors are currently deployed in the Sahel to support the armed forces of Operation Barkhane, in medical or surgical units. As well as supporting French soldiers, their other missions are diverse and complex: medical assistance to civilians and persons under control (PUC), advice to commanding officers. These tasks can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Little is known about the specific dilemmas experienced by French military doctors in overseas operations. We therefore conducted a qualitative study among doctors and surgeons recently deployed to the Sahel to explore and better understand this question.Method Semi-structured, face-to-face interviews were conducted with 20 French military doctors or surgeons deployed since January 2016 in medical or surgical facilities in Mali and Chad. Results All interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians (while delivering community medical assistance) or of PUC. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Questions of delivering care at the risk of their own safety or the mission’s and of treating openly hostile patients were also brought up. Most dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors’ duty of care to patients and to the military institution. Contextual factors (restricted resources and security constraints) were also associated with many of the reported dilemmas. Conclusion This is the first reported study focusing on the ethical dilemmas encountered by French military doctors in overseas operations. It provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions.

scholarly journals Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Antoine Lamblin ◽  
Clément Derkenne ◽  
Marion Trousselard ◽  
Marie-Ange Einaudi
Keyword(s):  
Qualitative Study ◽  
Ethical Dilemmas ◽  
Armed Forces ◽  
Healthcare Personnel ◽  
Ethical Challenges ◽  
Medical Assistance ◽  
Dual Loyalty ◽  
French Military ◽  
Overseas Operations ◽  
Military Institution

Abstract Background French military doctors are currently deployed in the Sahel to support the armed forces of Operation Barkhane, in medical or surgical units. As well as supporting French soldiers, their other missions are diverse and complex: medical assistance to civilians and persons under control (PUC), advice to commanding officers. These tasks can create ethical dilemmas when decisions are forced upon doctors that may be in conflict with medical values or fundamental principles. Little is known about the specific dilemmas experienced by French military doctors in overseas operations. We therefore conducted a qualitative study among doctors and surgeons recently deployed to the Sahel to explore and better understand this question. Method Semi-structured, face-to-face interviews were conducted with 20 French military doctors or surgeons deployed since January 2016 in medical or surgical facilities in Mali and Chad. Results All interviewed doctors reported having faced several ethical dilemmas during missions. All reported dilemmas involved the treatment of civilians (while delivering community medical assistance) or of PUC. The dilemmas involved choices as to which patients to treat, the use of care as a means to an end by military authorities, and the level of care attainable in the absence of any possible hospital follow-up. Questions of delivering care at the risk of their own safety or the mission’s and of treating openly hostile patients were also brought up. Several dilemmas stemmed from the dual loyalty problem, namely the conflict between military doctors’ duty of care to patients and to the military institution, but this was not the only factor involved. Contextual factors (restricted resources and security constraints) and psychological factors (especially hostility towards the enemy) were also associated with many of the reported dilemmas. Conclusion This is the first reported study focusing on the ethical dilemmas encountered by French military doctors in overseas operations. It provides unique insights into their ethical experiences and should prove useful in improving operational training for healthcare personnel deployed on overseas missions.

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.

scholarly journals COVID-19 underscores the important role of Clinical Ethics Committees in Africa

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Keymanthri Moodley ◽  
Siti Mukaumbya Kabanda ◽  
Anita Kleinsmidt ◽  
Adetayo Emmanuel Obasa
Keyword(s):  
Qualitative Study ◽  
Clinical Ethics ◽  
Ethics Education ◽  
Healthcare Professionals ◽  
Ethical Dilemmas ◽  
Ethics Committees ◽  
Ethical Challenges ◽  
Clinical Ethics Committees ◽  
Study Results

Abstract Background The COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa. Methods Twenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses. Results Kenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking. Conclusions This study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.

scholarly journals Ethical challenges of caring for burn patients: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mostafa Bijani ◽  
Fateme Mohammadi
Keyword(s):  
Qualitative Study ◽  
Personal Identity ◽  
Clinical Decision ◽  
Vulnerable Groups ◽  
Burn Patients ◽  
Ethical Challenges ◽  
Data Saturation ◽  
Field Notes ◽  
Improved Performance ◽  
Colaizzi's Method

Abstract Background Burn patients are among the most vulnerable groups of patients requiring principled ethical care. Caring for these patients often brings various ethical challenges for the members of the health care teams, especially nurses, which affect the clinical decisions made for these patients. A limited number of studies have addressed the ethical challenges of caring for burn patients for the responsible caregivers, so the present study attempted to identify these challenges. The present study aimed to explore the health professionals' experiences of the ethical challenges during caring for burn patients. Methods This was a qualitative study with a descriptive, phenomenological design. 22 health professional practiced in public burn centers in Iran who met the inclusion criteria of the study were selected via purposeful sampling to participate in the study from June to August 2019. Data were collected using semi-structured, in-depth interviews with the individuals as well as field notes. Sampling was continued up to the data saturation. Thereafter, the collected data were analyzed using Colaizzi's method. Results The findings of the study yielded 3 themes, including respect for the patient's privacy, respect for the patient's personal identity, and care challenges, as well as 9 categories. Conclusion The findings of this study showed that the burn patients’ caregivers face some challenges in the domains of maintaining the patient's privacy, respecting the patient’s personal identity, and making the best clinical decision. Thus, providing the cultural, professional, and organizational requirements of meeting the challenges of caring for burn patients can consequently result in the caregivers’ inner peace and the improved performance.

“We will never give up”: A qualitative study of ethical challenges Syrian health workers face in situations of extreme violence

Disasters ◽  
2021 ◽  
Author(s):  
Namrita S. Singh ◽  
Brittany Redman ◽  
Grant Broussard ◽  
Matthew DeCamp ◽  
Diana Rayes ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health Workers ◽  
Ethical Challenges ◽  
Extreme Violence

“With colleagues like that, who needs enemies?”:Doctors and Repression under Military and Post-Authoritarian Brazil

2019 ◽  
Vol 76 (3) ◽  
pp. 467-505
Author(s):  
Eyal Weinberg
Keyword(s):  
Medical Education ◽  
Armed Forces ◽  
Political Prisoners ◽  
State University ◽  
Medical Assistance ◽  
Military Rule ◽  
Medical Board ◽  
Military Physician ◽  
The Military ◽  
Healing Arts

As young medical students at Guanabara State University, Luiz Roberto Tenório and Ricardo Agnese Fayad received some of the best medical education offered in 1960s Brazil. For six years, the peers in the same entering class had studied the principles of the healing arts and practiced their application at the university's teaching hospital. They had also witnessed the Brazilian military oust a democratically elected president and install a dictatorship that ruled the country for 21 years (1964–85). After graduating, however, Tenório and Fayad embarked on very distinct paths. The former became a political dissident in opposition to the military regime and provided medical assistance to members of the armed left. The latter joined the armed forces and, as a military physician, participated in the brutal torture and cruel treatment of political prisoners. At the end of military rule, Brazil's medical board would find him guilty of violating the Brazilian code of medical ethics and revoke his license.

Ethical challenges when using coercion in mental healthcare: A systematic literature review

2016 ◽  
Vol 25 (1) ◽  
pp. 92-110 ◽  
Author(s):  
Marit Helene Hem ◽  
Elisabeth Gjerberg ◽  
Tonje Lossius Husum ◽  
Reidar Pedersen
Keyword(s):  
Patient Autonomy ◽  
Moral Distress ◽  
Mental Healthcare ◽  
Healthcare Personnel ◽  
Ethical Challenge ◽  
Ethical Challenges ◽  
Best Interest ◽  
Ethical Considerations ◽  
Search Terms ◽  
Healthcare It

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver Protocol. Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress.

Military Orthopedic Surgeons Are Not Just Traumatologists

2021 ◽  
Author(s):  
Camille Choufani ◽  
Olivier Barbier ◽  
Laurent Mathieu ◽  
Nicolas de L’Escalopier
Keyword(s):  
Orthopedic Surgery ◽  
Descriptive Analysis ◽  
Trauma Surgery ◽  
Armed Forces ◽  
Trauma Surgeon ◽  
Reconstruction Surgery ◽  
Orthopedic Surgeon ◽  
Orthopedic Surgeons ◽  
French Military ◽  
Military Patients

ABSTRACT Introduction Each French military orthopedic surgeon is both an orthopedic surgeon and a trauma surgeon. Their mission is to support the armed forces in France and on deployment. The aim of this study was to describe the type of orthopedic surgery performed for the armed forces in France. Our hypothesis was that scheduled surgery was more common than trauma surgery. Methods We conducted a retrospective descriptive analysis of the surgical activity for military patients in the orthopedic surgery departments of the four French military platform hospitals. All surgical procedures performed during 2020 were collected. We divided the procedures into the following categories: heavy and light trauma, posttraumatic reconstruction surgery, sports surgery, degenerative surgery, and specialized surgery. Our primary endpoint was the number of procedures performed per category. Results A total of 827 individuals underwent surgery, 91 of whom (11%) were medical returnees from deployment. The surgeries performed for the remaining 736 soldiers present in metropolitan France (89%) consisted of 181 (24.6%) trauma procedures (of which 86.7% were light trauma) and 555 (75.4%) scheduled surgery procedures (of which 60.8% were sports surgery). Among the medical returnees, there were 71 traumatology procedures (78%, of which 87.3% were light traumatology) and 20 procedures corresponding to surgery usually carried out on a scheduled basis (22%, of which 95% were sports surgery). Conclusion Military orthopedic surgeons are not just traumatologists; their activity for the armed forces is varied and mainly consists of so-called programmed interventions.

scholarly journals Psychotherapy Ethics in Twentieth-Century Literature

2020 ◽  
Author(s):  
Anna Magdalena Elsner
Keyword(s):  
Twentieth Century ◽  
Informed Consent ◽  
Therapeutic Relationship ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Literary Texts ◽  
Twentieth Century Literature ◽  
Ethical Challenges ◽  
Key Characteristics ◽  
Century Literature

Ethical issues arising in the practice of psychotherapy, such as confidentiality, boundaries in the therapeutic relationship, and informed consent, figure prominently in a range of twentieth-century literary texts that portray psychotherapy. This chapter analyzes the portrayal of these conflicts, but also stresses that they are often marginal to the overall plot structures of these narratives and that literary depictions of psychotherapy are often vague or even inaccurate concerning key characteristics of psychotherapeutic practice. Focusing on examples that either illustrate professionalism and the absence of ethical challenges in psychotherapy, or take up the ethical reservations that fueled anti-Freudianism or the anti-psychiatry movement, the chapter proposes that selected literary depictions of psychotherapy can play a key role in sensitizing therapists to the complex make-up of ethical dilemmas as well as illustrating the cultural and historical contexts of these dilemmas.

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