Dual Professional Loyalty and Medical Ethics Outside Armed Conflict: The Physician-Soldier Dilemma

The foundational challenge of dual professional loyalty can create tensions for ethical medical practice. The apparent ultimate goal, exclusivism between medical and the military profession, creates conflicts of dual loyalty in the physiciansoldier that could impact negatively both the physician and the patient. The physician-soldier under the strict military command and control with the ultimate goal of dishing lethal harm on the enemies of the state for political objectives, ought solemnly to ‘do no harm’ and uphold other ethical demands (autonomy, justice and confidentiality) of medical profession which occasionally clashes with the military objectives. Furthermore, the physician part of the physician-soldier is regulated by a non-military authority which can sanction him without consideration to his peculiar situation if he breaches the ethics of the practice, hence placing him in a dilemma. In this paper, the authors tried to situate the intricate relationship between morality, ethics and the law, making a background for the topic hinged on the conflicts of medical ethics with the military demands in the physician-soldier, especially in garrison practice, which seems to have been neglected in preference to such debates during armed conflicts. The differing concepts of loyalty to superiors and organization in the military, and loyalty to principles and patients in the medical profession is highlighted. Drawing largely from years of experience as a physician-soldier in practice the authors point to the conflicts that threaten the ethical demands of patient autonomy, abuse of justice and neutrality, scientific validity, freedom of conscience and professionalism. Possible solutions include more education of the top military superiors through focused workshops and conferences and careful consideration of a “rankless” status for very ethical and more consciencebound professionals in the military. The erroneous but strongly held ideas by some military superiors that the physician part of the physician-soldier should be subsumed in the military as a mere tool at their disposal for achieving military goals, in total disregard to the ethics and humanitarian laws, should be more seriously and universally condemned.