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

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.

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

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.

Britain’s authoritarian turn

Looking back, in December 2020, at the year since Boris Johnson’s Conservatives were swept back into government with a huge majority, the author identifies a raft of new laws, Home Office measures and government proposals in the fields of policing, crime, and immigration and asylum which embody long-held rightwing projects. Coming on top of already discriminatory practices, these include restrictions on the fundamental right of peaceful protest and freedom from invasive and racist policing, the subjection of migrants and asylum seekers to dangerous and inhumane conditions and the removal of legal protections for asylum seekers. Simultaneously, Bills going through parliament restrict or remove altogether the legal accountability of state actors, including soldiers on overseas operations and police informants, for crimes including torture and murder. Citizens’ recourse to the courts to challenge unlawful ministerial decisions is also under threat.

Serosurveys for SARS-CoV-2: need of the hour

This letter is regarding tackling the highly infectious coronavirus disease (COVID-19).Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread across the globe, causing a worldwide pandemic. The total number of cases across the globe is about 11.6 million with over 5 lakh deaths. The number of individuals detected is always less than the actual number of infected, in nearly all respiratory viral pandemics. Rapid Point-of-Care Antigen detection test can detect SARS-CoV-2 early in the field setting. It has moderate sensitivity and high specificity yet limited availability. This test can be employed in the hospitals and containment zones and would aid in contact tracing, isolation of the affected individuals, localized containment and directing quarantine measures. IgG antibodies usually appear after one week of onset of infection and may last for several months. Serosurveys that detect these antibodies using Enzyme-linked immunosorbent assay (ELISA) help in the assessment of asymptomatic infection in close contacts, enhance the current understanding of the spread of disease, individual’s immune status and in identifying potential plasma donors. Case fatality rate is positively associated with SARS-CoV-2 seroprevalence as was demonstrated in the survey conducted in the Spanish population. Immuno-compromised patients, healthcare workers, relatively young working population comprising of bankers, media persons, individuals working at airports, overseas operations and industries, staff in municipal bodies, shopkeepers, vendors, courier services, telecommunication offices, drivers of hospital ambulances, hearse vans, buses, auto-rickshaw, taxies; bus conductors, farmers, electricity workers, migrant labourers who have travelled back from urban and peri-urban areas to rural/tribal; inhabitants of hard to reach areas, prisoners, densely populated regions of the country as well as natives after coming in contact with returned migrant; police and security personnel, those staying in institutional settings and hostels and inhabitants of containment zones should all be tested for the presence of antibodies against the virus.

Employment practices in Japan’s automobile industry: the implication for divergence of employment systems under globalization

This paper analyses recent developments in HR practice toward core white collar employees at Japan’s major automobile companies. It confirms there have been incremental but substantial changes in key HR policies such as compensation and the ranking system, but also finds that traditional long-term employment continues to be practiced at most firms. It further observes that Japan’s auto companies have introduced global HR polices earlier than have Japanese firms in comparable sectors. This, however, has not resulted in the alignment of policies toward those of overseas operations, which one often finds in other Japanese industries such as finance and pharmaceuticals. This would indicate that different trajectories of change are emerging in employment practices—that is, diversification in employment systems is expanding—according to sector (or, the products and services firms offer). This paper also analyses several background factors propelling such divergence, and suggests possible future constellations of employment systems among large elite firms in Japan. In these ways this study contributes to the debate on the effects of globalization on divergence and convergence of employment systems.

The Japanese Production System and Its International Transferability

The Japanese production system has an ethnic or national basis. There are considered to be three production components of the system-shop-floor-centred work organization, waste-free production control, and participative management in the context of cooperative labour relations. For each of these, it is possible to set up a Japanese-type'. The author is conducting research into the overseas operations of Japanese subsidiaries in automobile assembly. Japanese multinational enterprises presumably try to apply the system to their overseas operations to take advantage of its strengths; however, given that they have moved into a foreign country, presumably Japanese enterprises have to adapt to the management environment of the local area. This research investigates the following questions: (i) Does this 'application' and 'adaptation' result in a dilemma? (ii) What is actually being applied and what has not been possible to apply? (iii) How well is the balance between 'application' and 'adaptation' being achieved? According to surveys of Japanese manufacturing plants in North America, Asia, and Europe, the application of the system is possible. Of course this does not mean that it can be applied 100%. The pattern of application varies according to the management strategy of the Japanese enterprises.