Journal of the Royal Army Medical Corps最新文献

The Diploma in Immediate Medical Care (DipIMC) is the entry-level interprofessional civilian qualification for prehospital emergency care (PHEC) in the UK. It is designed to test the knowledge, skills and behaviours of PHEC practitioners. Military personnel are eligible to enter, dependent on the level of PHEC experience they have. The DipIMC examination has changed in recent years; this paper aims to update aspiring candidates on the application process, recommended preparation and skill-set required to pass.

A 25-year-old infantry soldier, who was previously fit and well, had a cardiac arrest while undertaking an advanced fitness test. Despite early cardiopulmonary resuscitation by colleagues and the emergency services, he was later pronounced dead. A postmortem performed by an expert pathologist and a toxicology screen were normal and the death was attributed to sudden arrhythmic death syndrome (SADS). Screening of his family in our Inherited Cardiac Conditions clinic identified Brugada syndrome (BrS) in two first-degree relatives. This case generates discussion on sudden cardiac death, family screening in SADS, BrS and the limitations of recruit screening with an ECG.

Whether injured terrorists should receive equal consideration in medical triage as their victims is a morally and emotionally challenging issue for healthcare providers. Against the conventional approach, some commentators have argued for a 'victims-first' principle in which severely injured victims should always be prioritised over an injured terrorist even if the terrorist is worse off based on justice ideas. This paper argues that supporters of 'victims-first' fail to sufficiently justify the subversion of the equal rights of terrorists to treatment and the role and professional ethics of healthcare providers in the allocation of scarce medical resources. Accordingly, they fail to substantiate an exceptional approach for emergency medical triage during terror or terror-like attack situations.

Military physicians can experience ethical tensions and encounter important dilemmas when acting at the same time as healers, soldiers and humanitarians. In the literature, these are often presented as the result of pressures, real or perceived, from the military institution or role and obligation conflicts that can divert physicians from their primary duty towards their patients. In this article, I present the ethical experiences of 14 Canadian military physicians who participated in operational missions, particularly in Afghanistan. Interestingly, although some dilemmas discussed in the academic literature were raised by Canadian physicians, ethical tensions were less frequent and numerous than what might have been expected. Instead, what emerged were distinctions between the ethical experiences of physicians: generalists experienced more frequent and different ethical challenges than specialists, and these also varied by context, that is, garrison versus on deployment. The main dilemmas during deployment were similar to those encountered by humanitarian physicians and concerned inequalities in the provision of care between coalition soldiers and Afghans (soldiers and civilians), as well as the lack of resources. Surprisingly, participants were evenly divided with regards to how they perceived their professional identity: one group clearly prioritised the medical profession (ie, doctor first and foremost), while the other group identified themselves as military physicians, but without prioritising one profession over the other.

Using a major ethics crisis as a methodological approach to study secret science environments, part II examines the origins and organisation of the Applied Biology Committee (ABC), the first independent research ethics committee (REC) at Porton Down, Britain's biological and chemical warfare establishment since the First World War. Although working in great secrecy, the UK military, and Porton in particular, did not operate in a social, political and legal vacuum. Paradigm shifts in civilian medical ethics, or public controversy about atomic, chemical and biological weapons, could thus influence Porton's self-perception and the conduct of its research. The paper argues that the creation of the first REC at Porton in 1965, that is, the ABC, as the ' father confessor ' inside the UK's military research establishment reflected a broader paradigm shift in the field of human research ethics in the mid-1960s.

This article argues that there is a duty of care held by the State to military veterans who have been technologically enhanced as part of their military service. It suggests that enhancements may be permanent, persistent or protracted and demonstrates how enhancements generate additional moral responsibilities from the chain of command. The paper concludes by demonstrating how this institutional duty of care relates to issues such as informed consent.

Moral theory should be practically useful, but without oversight from the philosophical community, the practical application of ethics by other institutions such as the military may drift into forms that are not theoretically robust. Ethical approaches that drift in this way run the risk of becoming 'cargo cults': simulations that will never properly fulfil their intended purpose. The four quadrant approach, a systematic method of ethical analysis that applies moral principles to clinical cases, has gained popularity in the last 10 years in a variety of medical contexts, especially the military. This paper considers whether the four quadrant approach is a cargo cult or whether it has theoretical value, with particular reference to the more popular four principles approach. This analysis concludes that the four quadrant approach has theoretical advantages over the four principles approach, if used in the right way (namely, with all four quadrants being used). The principal advantage is that the four quadrant approach leaves more room for clinical judgement, and thus avoids the charge of being too algorithmic, which has been levelled at the four principles approach. I suggest that it is the fourth quadrant, which invites the user to consider wider, contextual features of the case, which gives the approach this key advantage. Finally, I make a more general proposal that theoretical ethicists should work closely with those practitioners who apply ethics in the world, and I call for a symbiotic relationship between these two camps.

Military medical ethics has been challenged by the post-11 September 2001 'War on Terror'. Two recurrent questions are whether military physicians are officers first or physicians first, and whether military physicians need a separate code of ethics. In this article, we focus on how the War on Terror has affected the way we have addressed these questions since 2001. Two examples frame this discussion: the use of military physicians to force-feed hunger strikers held in Guantanamo Bay prison camp, and the uncertain fate of the Department of Defense's report on 'Ethical Guidelines and Practices for US Military Medical Professionals'.

Biological interventions to improve performance, such as amphetamines, have a long history of military use, and in the future may include more advanced biotechnologies. This article discusses the ethics of using biomedical enhancements in the military. The article begins by describing the distinction between biomedical enhancements and interventions intended to prevent, treat or mitigate disease. It then sets forth three principles to guide the ethical use of bioenhancements-proportionality, paternalism and fairness. The article applies these principles to concerns raised by military bioenhancement: safety, fairness in access to military reward, carryover effects to civilian life, whether service members can be ordered to use bioenhancements and when they may be permitted to do so voluntarily.

Often known as ' global health diplomacy ', the provision of medical care to accomplish strategic objectives, advance public diplomacy goals and enhance soft power is increasingly emphasised in international affairs and military policies. Despite this emergent trend, there has been little critical analysis and examination of the ethics of military actors engaging in this type of work. This type of mission represents the most common form of military medical deployment within the International Security Assistance Force in Afghanistan and is now explicitly emphasised in many militaries' defence doctrine. The growth of these programmes has occurred with little analysis, examination or critique. This paper examines the history of global health diplomacy as directly related to humanitarian assistance, focusing on the difference in intention to highlight ethical dilemmas related to military involvement in the humanitarian sphere. The relationship between non-military humanitarian actors and military actors will be a focal point of discussion, as this relationship has been historically complicated and continues to shift. Relevant differences between these two groups of actors, their motivations and work will be highlighted. In order to examine the morally important differences between these groups, analysis will draw on relevant international doctrine and codes that attempt to provide ethical guidance within the humanitarian sphere.