Confidentiality is a core value in medicine and public health yet, like other core values, it is not absolute. Medical ethics has typically allowed for breaches of confidentiality when there is a credible threat of significant harm to an identifiable third party. Medical ethics has been less explicit in spelling out criteria for allowing breaches of confidentiality to protect populations, instead tending to defer these decisions to the law. But recently, issues in military detention settings have raised the profile of (...) decisions to breach medical confidentiality in efforts to protect the broader population. National and international ethics documents say little about the confidentiality of detainee medical records. But initial decisions to use detainee medical records to help craft coercive interrogations led to widespread condemnation, and might have contributed to detainee health problems, such as a large number of suicide attempts several of which have been successful. More recent military guidance seems to reflect lessons learned from these problems and does more to protect detainee records. For the public health system, this experience is a reminder of the importance of confidentiality in creating trustworthy, and effective, means to protect the public's health. (shrink)

This paper offers a brief examination of ethical health issues arising from military operations and outlines which, if any, of these ethical health issues apply to current Australian Defence Force (ADF) military operations. The transparency of military operations provided through real time global media reporting and the Internet, has raised public awareness of incidents that can be viewed broadly as ethical issues or dilemmas. While many of these issues are not new, it is the changing context of post cold war (...) military operations and scale and demand of humanitarian operations that places new requirements on how the ADF best addresses these potential issues before they become critical incidents. In identifying potential ethical issues arising from military health operations, it is recognized that military health personnel operate within a command and control organizational structure and associated culture. It is also recognized that the complexity of the issues and the environment within which military health personnel are expected to operate will raise ethical health issues not likely to be encountered to the same degree by those health practitioners operating in the average suburban practice or hospital, except when health personnel are confronted with large scale emergencies, such as those encountered with recent terrorist attacks and massacres. (shrink)

In this paper, I argue for the permissibility of torture in idealized cases by application of separation of cases: if torture is permissible given any of the dominant moral theories (and if one of those is correct), then torture is permissible simpliciter and I can discharge the tricky business of trying to adjudicate among conflicting moral views. To be sure, torture is not permissible on all the dominant moral theories as at least Kantianism will prove especially recalcitrant to granting moral (...) license of torture, even in idealized cases. Rather than let the Kantian derail my central argument, I directly argue against Kantianism (and other views with similar commitments) on the grounds that, if they cannot accommodate the intuitions in ticking time-bomb cases, they simply cannot be plausible moral views—these arguments come in both foundationalist and coherentist strains. Finally, I postulate that, even if this paper has dealt with idealized cases, it paves the way for the justification of torture in the real world by removing some candidate theories (e.g., Kantianism) and allowing others that both could and are likely to justify real-world torture. (shrink)