The purpose of this article is to describe the development of a model of moral distress in military nursing. The model evolved through an analysis of the moral distress and military nursing literature, and the analysis of interview data obtained from US Army Nurse Corps officers (n = 13). Stories of moral distress (n = 10) given by the interview participants identified the process of the moral distress experience among military nurses and the dimensions of the military nursing moral distress (...) phenomenon. Models of both the process of military nursing moral distress and the phenomenon itself are proposed. Recommendations are made for the use of the military nursing moral distress models in future research studies and in interventions to ameliorate the experience of moral distress in crisis military deployments. (shrink)

Because the goal of military medicine is salvaging the wounded who can return to duty, military medical ethics cannot easily defend devoting scarce resources to those so badly injured that they cannot return to duty. Instead, arguments turn to morale and political obligation to justify care for the seriously wounded. Neither argument is satisfactory. Care for the wounded is not necessary to maintain an army's morale. Nor is there any moral or logical connection between the right to health care (a (...) universal human right) and the duty to defend one's nation (a local political duty). Once badly wounded, soldiers enjoy the same right to medical care as any similarly ill or injured individual. National health care systems grasp this point and offer few additional health care benefits to veterans. In the United States, however, lack of universal health coverage skews the debate to focus on special entitlements for veterans without considering the health care rights that other citizens enjoy. (shrink)

This paper examines the problems that may arise, particularly for military personnel, when the requirements of doing one's duty seem to come into conflict with the demands of loyalty. This conflict is especially problematic because loyalty is often seen, especially by serving military personnel, as the highest of military virtues. The paper introduces a categorisation of ethical issues into two main types, which are referred to as ‘ethical dilemmas’ and ‘tests of integrity’ which is then used to clarify the issues (...) involved when duty and loyalty come into conflict. It is argued that a true understanding of loyalty and disloyalty means that the demands of loyalty can never legitimately override a genuine duty to follow orders. (shrink)

Since the early 1990s, an increasing number of troops have been deployed in peacekeeping missions all around the world. The mixed success and high-profile failures of several missions have provided peacekeepers and scholars with a wealth of experience from which to generate knowledge and understand key lessons. In this article I use the Rwandan case to explore the issue of the use of force to protect unarmed civilians that have become the target of violence. In particular, I focus on the (...) moral responsibilities implied in such operations. I contend that in order for peacekeepers to be effective, they need to subscribe to, and be motivated by a peacekeeper ethos. The core element of this ethos is the protection of human life. Those peacekeepers who, through experience and education, internalize this ethos will be the best prepared for the difficult task they face. This article emphasizes the importance of sharpening moral autonomy among peacekeepers, in order to provide them with the skills they need to be more effective in saving lives. To illustrate this point, I analyze the slaughter of more than 2000 refugees at the ETO school in Kigali, Rwanda; a UN site protected by Belgian peacekeepers in 1994. (shrink)

Medical ethics needs to be on its guard against those in military or political power who would seek to subvert its most basic tenets in order to serve their own endsEmergencies and warlike situations often force medical personnel to follow orders and perform actions or duties pertaining to their field of expertise in flagrant violation of their professional code of ethics. Opposing such orders may be contextually impossible, or elicit unduly high personal costs. Medical ethics, while lamenting these impositions, is (...) often reduced to passive and silent disagreement. In recent years, however, biomedical ethics has become active in accepting and supporting these estrangements from accepted standards and values of the healthcare professions, coming up with justifications of torture; suggesting non-treatment of the wounded, depending on their combatant status; prompting collaboration in the development of biological weapons, and disregarding informed consent.Physicians’ participation in torture has been unanimously condemned and, although acknowledging that such conduct “is the result of the displacement of their medical vocation by the doctrine of ‘national security’”, such an “ideological substrate” has nevertheless been deemed untenable.1 Perpetrators were found to have committed their deeds in an ethical void2; this was recognised, but in no way did it serve to excuse physicians from the duty of opposing induced suffering and assuaging its effects to the best of their abilities.Torture in its “humane” form has been defended on utilitarian grounds,3 using weak arguments that are unable to justify physicians’ active participation in torture. For the most part, professional ethics has remained adamant in its undaunted disapproval of medical non-therapeutic involvement in violent scenarios such as war, terrorism, and even torture. Nobody would have thought, in earlier times, that medical ethics could take any other position than to unrelentingly reject physicians’ participation in torture, …. (shrink)

Modern nursing evolved out of a war. Today’s nurses not only work in war zones but the profession as a whole needs to consider its responsibility in caring for victims of conflict and what its international duty is in preventing wars. This means that nurses must be informed of the devastation caused by conflict not only in countries where conflicts and war take place but also world-wide. Nurses’ responsibility is to prevent illness and alleviate suffering, which includes the long-term morbidity (...) caused by wars. They need to be more politically active in conflict resolution and prevention at local, community, national and international levels. The purpose of this article is to address these issues from an ethical perspective and to suggest implications for nursing education and practice. (shrink)

In this article, the author describes ethical decision-making in unique circumstances. A dichotomy exists between the dual roles of nurse and disaster manager in a wartime set ting. The circumstances of the situation had never been faced before and no precedents existed for the type of decisions being made. Clearly, professional codes of conduct existed along with international conventions with reference to war. The circumstances required the author to challenge the concepts of teleology and deon tology in a search for (...) the most fitting answers to a unique problem. His aim was to try to create the greatest good out of an impossible situation. The author reflects on his actions in the light of ethical thinking and considers whether his decisions were right. (shrink)

The threat of biological and chemical terrorism highlights a growing tension in research ethics between respecting the interests of individuals and safeguarding and protecting the common good. But what it actually means to protect the common good is rarely scrutinized. There are two conceptions of the common good that provide very different accounts of the limits of permissible medical research. Decisions about the limits of acceptable medical research in defense of the common good should be carried out only within the (...) latter framework. (shrink)

In a recent article, Gross argues that physicians in decent societies have a civic duty to aid in the torturing of suspected terrorists during emergency conditions. The argument presupposes a communitarian society in which considerations of common good override questions of individual rights, but it is also utilitarian. In the event that there is a ticking bomb and no other alternative available for defusing it, torture must be used, and physicians must play their part. In an earlier article, Jones also (...) argues in favour of physician participation in torture, going so far as to enthusiastically endorse the allocation of research resources as well to ensure that the ability to meet emergency situations is as efficient as scientifically possible. I argue against both these views and defend the absolute prohibition against torture generally, and against any participation by physicians in particular. I show that these arguments are incompatible with liberal or decent societies, and that the institutional requirements for making torture effective would constitute an unacceptable degradation both of medical ethics and practice, as well as of political institutions in general. (shrink)

The military's purpose centrally includes fighting its nation's wars, serving as the nation's sword. The dominant approach to military ethics today, which I will call the ?sword approach?, focuses on this purpose and builds an ethic out of the requirements the purpose imposes on soldiers. Yet recently philosophers such as Shannon French and Nancy Sherman have developed an alternative that I will call the ?shield approach?, which focuses on articulating a warrior code as a moral shield that can safeguard soldiers? (...) humanity through the stresses and losses of war. Arguably, the sword approach is, if necessary, insufficient: the claims of the shield approach must be taken into account. It may seem that a military ethicist could simply employ both approaches in parallel. I will show, however, that the real possibility of conflict between the two approaches, due to their disparity of focus, calls for a more careful reconciliation. I will argue that conceiving military service as a practice in Alasdair MacIntyre's sense makes possible the integration of the central claims of the sword and shield approaches into one coherent and comprehensive military ethic. (shrink)