Dual Loyalty among Military Health Professionals: Human Rights and Ethics in Times of Armed Conflict

Abstract

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. 1 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." 2 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 3 following revelations of gross human rights violations at the Abu Ghraib detention center in Iraq. 4 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) 5 in the military. 6 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 This paper is based on the Dual Loyalty Project (1998-2000), which was funded by the Greenwall Foundation to develop guidelines that protect the human rights of patients in situations where health professionals face dual loyalty conflicts. The intellectual contributions of the International Dual Loyalty Working Group, as well as the assistance of Ms. Kathy Mallinson and Dr. Joanne Stevens in preparing this manuscript are gratefully acknowledged.

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