China
Africa
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The ethics of healthcare in prison and dementia
Published in Joanne Brooke, Dementia in Prison, 2020
The concept of professional independence for the healthcare professionals working in a prison setting can be challenging, as there is a need to balance their independence whilst working in and sometimes for a non-medical organisation, which is referred to as Dual Loyalty (Pont et al., 2012). This requires two layers of professional competence in possessing the medical skills and knowledge to be part of the healthcare team whilst also holding the specialist knowledge necessary to apply that within a prison setting. This is exemplified by the challenge of providing confidential care to patients whilst recognising the possible implications for the safety of the prison. The challenges faced by healthcare professionals in the prison setting are often underestimated, especially when consent is a requirement. A healthcare professional may note injuries from violence on a prisoner, which should be reported to the prison authorities, but this can only occur with the consent of the prisoner. If the prisoner refuses, the doctor faces a difficult decision as to support the best interests of the prisoner, as well as other inmates.
Ethics, legal and humanitarian issues
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
These conflicting priorities are perhaps most clearly seen on the intensive care unit.12 At the best of times, the intensive care unit (ICU) is a scarce resource and requires gatekeeping decisions. These are normally based mainly on a patient’s need (triage) and their likelihood of responding to treatment (prognosis). However, with a limited number of beds in a deployed setting, a new pressure is added – military necessity and responsibility to the CoC, the need to keep resources available for future troops who are yet to be wounded, for example. The need for resolution of this dual loyalty has been recognised, and the International Dual Loyalty Working Group13 has published guidelines that confirm that the military medical officer is a doctor first, that civilian ethics apply to military clinicians and that military clinicians should triage and treat the sick and wounded according to their need.
The future
Published in Tony White, John Black, The Doctor's Handbook, Part 2, 2018
They defined what the training is for values and ethics as well as science. On the subject of ethics there was an interesting study in the International Journal of Health Services in 2007 that suggested that in addition to doctors being taught military medical ethics the broader problem of dual loyalty needs to be addressed when doctors’ advocacy for the patient conflicts with other institutional or societal objectives. In other words, as medical students they should be taught how they can and should stand up to health plans, the military, HMOs, drug makers, the government or any other entity that asks doctors to violate medical ethics. Indeed the American Medical Association supported comprehensive medical education that keeps pace with the ethical challenges facing doctors. It was felt that medical students should graduate with enough ethical education to stiffen their resolve when institutions ask them to do the wrong thing.
Codes of Ethics, Human Rights and Forced Migration
Published in The American Journal of Bioethics, 2021
While each of the above examples is somewhat different, each raises a similar ethical issue for healthcare professionals working in close proximity, namely how to reconcile the obligation to act in the best interests of their patients while being co-opted to act as a de-facto border guard (as is the case in the UK) or facilitate policies that clearly harm health. There are no straightforward answers for such dilemmas in codes of ethics. Often labeled “dual loyalty” conflicts, the advice often given is to reconcile such dilemmas by placing the interests of the patients first, but it simply isn’t clear how this can be accomplished or how this should be negotiated day to day (Essex 2019). Detention centers raise further questions about the rights and dignity of patients and the standard of healthcare provided within detention. What is ethical care for a child when they are separated from their parents? What does autonomy mean for people who are detained? Is beneficence a matter of healthcare as usual or advocating for a patient’s release? How do we square this with generally accepted norms to uphold human rights and dignity? We could say that given the circumstances, healthcare professionals should still do their best to promote the health of their patients and minimize their contribution to any wrongdoing. If faced with two bad options, healthcare professionals should obviously take the one which will do the least harm. Such statements, however, often overlook the potential for broader reform and, for those who remain detained (or in a liminal state), are woefully inadequate (Essex 2018).
Rationing Crisis: Bogus Standards of Care Unmasked by COVID-19
Published in The American Journal of Bioethics, 2020
Third, virtually all commentary on resource allocation in crises, like COVID-19, assume without analysis that utilitarianism rules in a pandemic. But a pandemic, as horrific as it is, does not automatically alter the ethics of the medical profession by adopting utilitarianism as its code. (Baker and Strosberg 1992) And “To the extent that bad protocols… entrench harmful practices, perhaps no protocol would be better…” (Fink 2003, 714). The governor of the hardest hit state, Andrew Cuomo, for example, rejected protocols that would abandon specific categories of patients in favor of others. Dual loyalty (to the patient and the publics’ health) is a problem for medicine (and the public and elected leaders), not a solution. Even in combat (the metaphor most often used for the pandemic), and even with military physicians who are also military officers, “medical ethics is identical in peacetime and wartime.” (Annas and Crosby 2019).