The complicated life of a physician-soldier: Medical readiness training exercises & the problem of dual loyalties

Sheena M. Eagan Chamberlin

Institute for the Medical Humanities, University of Texas Medical Branch, Galveston, USA.

DOI: 10.4236/jbise.2013.610A1002                

Abstract

While physicians are generally understood as owing moral obligation to the health and well being of their individual patients, military health professionals can face ethical tensions between responsibilities to individual patients and responsibilities to the military mission. The conflicting obligations of the two roles held by the physician-soldier are often referred to as the problem of dual loyalties and have long been a topic of debate. This paper seeks to enrich the dualloyalties debate by examining the embedded case study of medical civilian assistance programs. These programs represent the use of medicine within the military for strategic goals. Thus, a physician is expected to meet his obligation to his role as a soldier while also practicing medicine. These programs involve obligations inherent in both roles of the physician-soldier and thusly they serve as excellent exemplars for the problem of dual loyalties at an institutional level. This paper focuses on Medical Readiness Training Exercises (MEDRETEs). These programs are short-term, generally taking place in low-income nations in order to accomplish strategic goals including training opportunities for military medical professionals that are not possible on the home front. This form of temporary program raises ethical concerns regarding the exploitation of vulnerable populations and the value of what is termed “parachute medicine”. The short-term nature of these interventions makes long-term treatment and follow-up impossible, begging the question as to whether this peak and trough approach to foreign civilian aid is of any use. Physicians are generally understood as having obligations towards the well being of the patient, which these programs do not necessarily prioritize. Rather, the programmatic intent is military, with political and strategic aims of furthering international relations, increasing US military global presence and providing austere and tropical training opportunities for military healthcare providers. This can be morally problematic for the physician-soldier.

Keywords

Military Medicine; Dual Loyalty; Medical Ethics; History of Medicine; Military History; Military Ethics; MEDRETEs; Civic Action

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Stanley (2010) Number 6000.16 military health support for stability operations.
[2]	Gillett, M.C. (1981) The army medical department, 1775-1818. Center for Military History, Washington DC.
[3]	Taylor, J.F. (1984) Health care as an instrument of foreign policy (a proposed expanded role for the army medical department). Master’s Thesis, US Army War College, Carlisle Barracks, 15-16.
[4]	Standage, S. (1993) A role for the army medical specialist corps in nation assistance. Master’s Thesis, US Army War College, Carlisle Barracks.
[5]	González, J. (2000) Harvest of empire: A history of Latinos in America. Viking, New York.
[6]	González, J. (2000) Harvest of empire: A history of Latinos in America. Viking, New York, 13.
[7]	Taylor, J.F. (1984) Health care as an instrument of foreign policy (a proposed expanded role for the army medical department). Master’s Thesis, US Army War College, Carlisle Barracks, 4.
[8]	Cobian, A.R. (1996) The US army: A partner for development. Master’s Thesis, US Army War College, Carlisle Barracks.
[9]	Taylor, J.F. (1984) Health care as an instrument of foreign policy (a proposed exapnded role for the army medical department). Master’s Thesis, US Army War College, Carlisle Barracks, 16.
[10]	Natkins, I.L. (1989) The role of health services in support of the theatre campaign plan. Master’s Thesis, US Army War College, Carlisle Barracks, 4.
[11]	Gonzalez, L.C. (1988) United States Military medicine’s role in low-intensity conflict in Latin America. Master’s Thesis, US Army War College, Carlisle Barracks, 12.
[12]	Agency for Internal Development (1982) Congressional presentation, fiscal year. 430.
[13]	Jenkins, E. (1988) Medical civic action programs (medcaps) and medical readiness training exercises (medretes) as instruments of foreign policy. Master’s Thesis, US Army War College, Carlisle Barracks.
[14]	Jenkins, E. (1988) Medical civic action programs (medcaps) and medical readiness training exercises (medretes) as instruments of foreign policy. Master’s Thesis, US Army War College, Carlisle Barracks, 17.
[15]	Jenkins, E. (1988) Medical civic action programs (medcaps) and medical readiness training exercises (medretes) as instruments of foreign policy. Master’s Thesis, US Army War College, Carlisle Barracks, 21.
[16]	Jenkins, E. (1988) Medical civic action programs (medcaps) and medical readiness training exercises (medretes) as instruments of foreign policy. Master’s Thesis, US Army War College, Carlisle Barracks, 27.
[17]	JTF-B (2012) Medical readiness training exercises (medrete). Joint Task Force Bravo. http://www.jtfb.southcom.mil/library/factsheets/factsheet.asp?id=10291
[18]	Department of the Army (1985) Field manual No 41-10: civil affairs operations. Department of the Army, Washington DC, 10-20.
[19]	Department of Defense (2008) Instruction 2205.02: Humanitarian and civic assistance (Hca) activities.
[20]	Department of Defense (1995) Instruction 2205.3: Implementing procedures for the humanitarian and civic assistance (Hca) program.
[21]	Aller, L.F. (1994) Letters to the editor: Medretes. Military Medicine, 159, A4.
[22]	Hood, C.H. (1991) The United States army medical department in low-intensity conflict. Military Medicine, 156, 64-67.
[23]	Jenkins, E. (1988) Medical civic action programs (medcaps) and medical readiness training exercises (medretes) as instruments of foreign policy. Master’s Thesis, US Army War College, Carlisle Barracks, 7.
[24]	Hood, C.H. (1991) Humanitarian civic action in honduras. Military Medicine, 156, 292-296.
[25]	Wittich, A.C. (1989) The medical care system and medical readiness training exercises (medretes) in Honduras. Military Medicine, 154, 20-21.
[26]	DeKoning, B.L. Soto Cano air force base, Honduras. Life on the Line.
[27]	Claypool, R.G. (1989) Military medicine as an instrument of power: An overview and assessment. Master’s Thesis, US Army War College, Carlisle Barracks, 16.
[28]	Mitchell IV, C.H. (1991) The medic as an instrument of national policy or what in the world is the department of defense doing in medical humanitarian assistance? Master’s Thesis, US Army War College, Carlisle Barracks.
[29]	Eagan Chamberlin, S.M., Interviewed (2012) Participant 5, transcript.
[30]	Eagan Chamberlin, S.M., Interviewed (2012) Participant 2, interview notes.
[31]	Crutcher, J.M. and Beecham, H.J. (1995) Short-team medical field missions in developing countries: A practical approach. Military Medicine, 160, 339.
[32]	Eagan Chamberlin, S.M., Interviewed (2012) Participant 6, transcript.
[33]	Cramblet, P.B. (1991) US medical imperatives for low intensity conflict. Master’s These, US Army War College, Carlisle Barracks.
[34]	Lesho, E.P., Jawad, N.K. and Hameed, H.M. (2011) Towards a better approach to medical humanitarian assistance in Iraq and future counterinsurgency operations. Military Medicine, 176, 1-3.
[35]	Weisser, R.J. (1993) The Maturing of medretes. Military Medicine, 158, 573.
[36]	Eagan Chamberlin, S.M., Interviewed (2013) Participant 9, transcript.
[37]	Eagan Chamberlin, S.M., Interviewed (2012) Participant 3, transcript.
[38]	Taylor, J.A. (1985) Military medicine’s expanding role in low-intensity conflict. US Army.
[39]	Eagan Chamberlin, S.M., Interviewed (2013) Participant 10, interview notes.
[40]	Gaillard, R. (1990) Civic action versus counterinsurgency and low intensity conflict in Latin American: The case for delinkage. Master’s Thesis, US Army War College, Carlisle Barracks.
[41]	Eagan Chamberlin, S.M., Interviewed (2013) Participant 8, interview notes and transcript.
[42]	Cramblet, P.B. (1991) US medical imperatives for low intensity conflict, 1
[43]	Cramblet, P.B. (1991) US medical imperatives for low intensity conflict, 15-16.
[44]	Taylor, J.F. (1984) Health care as an instrument of foreign policy (a proposed exapnded role for the army medical department). Master’s Thesis, US Army War College, Carlisle Barracks.
[45]	Gonzalez, W.E. (1988) United States military medicine’s role in low-intensity conflict in Latin America.
[46]	War Department (1947) Field manual 27-5: United States army and navy manual of civil affairs military government. Washington DC.
[47]	Department of the Army and the Air Force (1990) Field manual 100-20: Military operation in low intensity conflict. Washington DC.
[48]	Department of Defense (1995) Joint doctrine for military operations other than war. Joint Chiefs of Staff, Washington DC.
[49]	Department of Defense, Chiefs of Staff (1995) Joint publication 4-02: Doctrine for health services support in joint operations. Washington DC.
[50]	Eagan Chamberlin, S.M., Interviewed (2012) Participant 4, transcript.
[51]	Eagan Chamberlin, S.M., Interviewed (2013) Participant 7, transcript.
[52]	Sadlon, G.L. (2000) Army medical department leaders in military operations other than war. Master’s Thesis, U.S. Army War College, Carlisle Barracks.
[53]	Cramblet, P.B. (1991) US medical imperatives for low intensity conflict. Master’s Thesis, US Army War College, Carlisle Barracks.
[54]	Driftmeyer, J.E., Llewellyn, C.H. and US Participants Perspectives on Military Medical Humanitarian Assistance, Eds. (2002) Special operations and low intensity conflict office of the assistance secretary of defence, measures of effectiveness. Center for Disaster and Humanitarian Assistance Medicine, Bethesda.
[55]	Malsby III, R. (2008) Into which end does the thermometer go? Application of military medicine in counterinsurgency: Does direct patient care by American service members work? Master’s Thesis, US Army Command and General Staff College, Fort Leavenworth.
[56]	Wilensky, R.J. (2004) Military medicine to win hearts and minds: Aid to civilians in the Vietnam War. Texas Tech University Press, Lubbock, 3.
[57]	Driftmeyer, J.E. and Llewellyn, C.H. (2002) Humanitarian service: Recruitment & retention effects among uniformed services medical personnel. Measures of Effectiveness Center for Disaster and Humanitarian Assistance Medicine, Bethesda.
[58]	Driftmeyer, J.E. and Llewellyn, C.H. (2002) Humanitarian service: Recruitment & retention effects among uniformed services medical personnel. Measures of Effectiveness Center for Disaster and Humanitarian Assistance Medicine, Bethesda, 3.
[59]	Malsby III, R. (2008) Into which end does the thermometer go? Application of military medicine in counterinsurgency: Does direct patient care by American service members work? Master’s Thesis, US Army Command and General Staff College, Fort Leavenworth, 66-67.
[60]	Wilensky, R.J. (2004) Military medicine to win hearts and minds: Aid to civilians in the Vietnam War. Texas Tech University Press, Lubbock, 86-87.