Essay Sample on Military Healthcare Practitioners' Dual Loyalty Dilemma: Confidentiality & Ethics

Introduction

Confidentiality in the military is an issue that is associated with many dilemmas concerning ethics, moral conduct and conflict with the law (Remley & Herlihy, 2014). Healthcare practitioners in the military are often faced with dual loyalty dilemmas which occur when their clinical duties and roles are in outright or indirect conflict with the personal interests of their patients and their sworn duty to the employing party (Johnson, Grasso & Maslowski, 2010). Moral and ethical obligations that are expected of military healthcare professionals are far higher than those of their colleagues in private healthcare service. Hence, these expectations lead to more ethical and moral dilemmas among MHCPs related to the confidentiality of the patients (soldiers). More often than not, cases of professional and ethical conflicts arise. For instance, the British armed forces follow the guidelines outlined in the Ministry of Defense policy paper, which stipulate that all medical needs of their soldiers are subject to the military and professional constraints (Johnson et al., 2010). Therefore, the MHCPs must consider the medical needs of their patients and balance them with their duties in the force. This essay presents a vignette that is based on the ethical and moral dilemmas that military healthcare providers are faced with about following orders and following the general health code of conduct.

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Conflict of loyalty about the patient refusing treatment in a non-operational scenario can be best managed through a discretional approach (Prosek & Holm, 2014). For instance, a situation where a soldier refuses treatment within the confines of the military can help reduce ethical dilemmas among MHCPs by allowing them to seek medical care in civilian healthcare providers.

A critical analysis of the case of sergeant green provided in the journal article by Kelly (2011), who is an army officer for over 20years presents us with a perfect example of an ethical dilemma in the military concerning the professional, moral code of conduct and military law. The sergeant also has gone on several tours of duty in Northern Ireland, the Balkans, Afghanistan, and Iraq. Eighteen months ago, while on tour in Afghanistan, he witnessed some of his platoon comrades being killed while insurgents maimed some of them during battle. The psychologist in charge, Major Smith, diagnosed him with Post-traumatic stress disorder (PTSD), a mental disorder that occurs after an individual is exposed to traumatic experiences of a severe nature. The major recommends that sergeant green starts his psychological treatment procedure with the military psychologist immediately. Apart from the PTSD, sergeant green is a competent and physically fit soldier.

Sergeant Green is set to go back to Afghanistan for a deployment tour that will last for six months. Additionally, the sergeant is set to be promoted to the next rank after his deployment to Afghanistan. This worries him because if he accepts major Smith's recommendation to start treatment for the PTSD, he will not be deployed, and his life and career in the military will change. Sergeant Green refuses to give consent to major to disclose the diagnosis to the commanding officer or his lieutenant (Kelly, 2011). The conflict arises because Major Smith is obligated by military law to tell Sergeant Green's commanding officer that he is not fit to go to Afghanistan. Since green is a highly qualified and experienced soldier, his CO will want to know the reason he is not fit for duty.

Major Smith knows that the sergeant is unfit for deployment, but cannot disclose his illness to the CO and his refusal to accept treatment without his consent, and he is not sure of what exactly is his next course of action. The ACA professional code of conduct section B.1.c stipulates that counsellors should only disclose information with the consent of the patient (Ponton & Duba, 2009). However, Major Smith is obliged to follow military orders and should not allow soldiers to go on duty if he deems them medically unfit. Allowing soldiers who are not medically fit for duty is exposing them and the lives of their comrades to the risk of harm or dangers that can cause fatalities. That what is confusing Major Smith, should he breach the confidentiality of Sergeant Smith and give the CO a full description of his diagnosis of the sergeant's PTSD?

Conclusion

To sum up, although the duty to safeguard the confidentiality of patients in the military is not absolute, it goes back to the whole issue of ethics among MHCPs. Soldier's freedom of speech and expression is curtailed in a way; this raises the question of whether the soldier's rights should also be reduced. It also raises the question of whether the professionalism of MHCPs should be subjected to laws that limit their professional autonomy (Remley & Herlihy, 2014). The military should consider the fact that sergeant green is a grown adult and therefore has the right to decide what to do with his body. The UK law under the mental health act and the general medical council (GMC) are in agreement that an individual has the right to accept or refuse treatment even though he has a mental health disorder (Johnson et al., 2010). Therefore, sergeant green's refusal to start treatment should not be used as a basis of ruining his career. The commanding officer should also not put Major Smith in a position where he should breach his confidentiality with sergeant green. Additionally, he should agree with the major and not press him for additional information.

References

Johnson, W. B., Grasso, I., & Maslowski, K. (2010). Conflicts between ethics and law for military mental health providers. Military medicine, 175(8), 548-553.

Kelly, R. G. N. (2011). Using an Ethical Model to Manage Patient-Soldier Confidentiality When Medical Treatment for Post Traumatic Stress Disorder is Refused. Online Journal of Health Ethics, 7(2), 8.

Ponton, R. F., & Duba, J. D. (2009). The ACA Code of Ethics: Articulating counseling's professional covenant. Journal of Counseling & Development, 87(1), 117-121.

Prosek, E. A., & Holm, J. M. (2014). Counselors and the Military: When Protocol and Ethics Conflict. Professional Counselor, 4(2).

Remley, T. P., & Herlihy, B. (2014). Ethical, legal, and professional issues in counseling. Upper Saddle River, NJ: Pearson.