Content area
Full Text
Point:
Wars must be won if our country ... is to be protected from unthinkable outcomes, as the events on September 11th most recently illustrated.... This best protection unequivocally requires armed forces having military physicians committed to doing what is required to secure victory.... As opposed to needing neutral physicians, we need military physicians who can and do identify as closely as possible with the military so that they, too, can carry out the vital part they play in meeting the needs of the mission.
Counterpoint:
We believe the role of the "physician-soldier" to be an inherent moral impossibility because the military physician, in an environment of military control, is faced with the difficult problems of mixed agency that include obligations to the "fighting strength" and ... "national security."
These two quotes typify the competing worldviews brought to bear on the ethical and human rights obligations of health professionals in the armed forces. Attention has focused increasingly on the role of health professionals in abuses of detainees in military custody following revelations of gross human rights violations at the Abu Ghraib detention center in Iraq. It is important to note, however, that detainee abuse illustrates but one example, albeit particularly egregious, of a deeper problem of dual loyalty (alternatively called mixed agency) in the military. As health personnel are torn between duties to heal on the one hand and to support military objectives on the other, these tensions result in inevitable ethical and human rights consequences for both soldiers and civilians.
Historically, ethical obligations of health professionals have privileged the need for loyalty to patients. In the modern world, however, health professionals are frequently placed in settings where they are asked to weigh their devotion to patients against service to the objectives of government or other third parties. Dual loyalty poses particular challenges for health professionals when the subordination of the patient's interests risks violating that patient's human rights. Thus it is critical that the problem of dual loyalty be addressed through recasting the dilemma not as health professional neutrality versus identification with military objectives, but rather as imposing a mandate to engage with the human rights laws and principles at stake. In other words, the inescapable "mixed agency" of health professionals serving in the...