military medical ethics medical ethics ethical dichotomies cultural pluralism. david a. anderson,...
TRANSCRIPT
![Page 1: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/1.jpg)
Military Medical EthicsEthical DichotomiesCultural Pluralism
David A. Anderson, DDS, MDS
![Page 2: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/2.jpg)
United States Uniformed Services Oath of Office
I do solemnly swear that I will support and defend the Constitution of the United States against all enemies, foreign or domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion, and that I will well and faithfully discharge the duties of the office on which I am about to enter. So help me God.
![Page 3: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/3.jpg)
Objectives
To honor those in uniform that tend the war-woundedTo name the uniform services:
USAF, USA, USCG, USMC, USN, USPHS and NOAA
To contrast civilian and military medical ethical premises
![Page 4: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/4.jpg)
Military Medical Ethics Short Course
Walter Reed Army Medical Center27-30 October 2009
http://www.wramc.amedd.army.mil/Support/chaplain/pages/mesc.aspx
![Page 5: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/5.jpg)
Elspeth Cameron Richie, M.D., Ph.D
Decision Making Capacity
Confidentiality, Privilege & Truth Telling
Battlefield and Detainee Ethics
Ethical Issues & Humanitarian Missions
![Page 6: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/6.jpg)
Roger A Miller, D.Min, M.Div, MABMH
History of Bioethics
Principles of Bioethics
Ethical Guidelines for End-of-Life
![Page 7: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/7.jpg)
Robert M. Veatch, M.A., M.S., Ph.D.
Medical Ethics OverviewOrgan TransplantsHuman ExperimentationFutile CareAllocation of Scarce ResourcesVirtue Ethics
![Page 8: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/8.jpg)
Carlos Gomez, Ph.D., M.D.
Palliative Care and Advanced Dementia
![Page 9: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/9.jpg)
Catherine With, J.D., L.L.M.
Legal Guidelines for End-of-Life
Advanced Medical Directives
Complimentary and Alternative Medicine
![Page 10: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/10.jpg)
Peter Weina, Ph.D., M.D.
Physician Assisted Suicide
![Page 11: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/11.jpg)
Kim S. Meyer, MSN, ACNP-BC, CNRN
Ethical Considerations in TBI
![Page 12: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/12.jpg)
Stacy Weina, FNP-BC
Ethical Concerns in Nursing
![Page 13: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/13.jpg)
Medical Ethics
Beneficence
Nonmaleficence
Autonomy
Justice
![Page 14: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/14.jpg)
Health Care EthicsHuman Dignity
Common Good
Subsidiarity
Solidarity
Justice
![Page 15: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/15.jpg)
Ethics Consultations
Four “D” Matrix Data
Deliberation
Decision
Direction
![Page 16: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/16.jpg)
Ethics Consultations
Clarify the consultation requestAssemble the relevant informationSynthesize the informationExplain the synthesisSupport the consultation process
![Page 17: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/17.jpg)
Integrated Ethics
Identify an issueStudy the issueSelect a strategyUndertake a planEvaluate and adjustSustain and spread
![Page 18: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/18.jpg)
Battlefield and Detainee Ethics
![Page 19: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/19.jpg)
Battlefield Triage Categories
MinimalCommanders want the least injured returned to duty firstThe “good”= return to duty with minimal careDelayed treatment for more urgent categories
ImmediateAmputations, airway management, lacerations, shock
The “good”= stabilize to saveFirst priority for treatment
![Page 20: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/20.jpg)
Battlefield Triage Categories
DelayedOut of danger after immediate treatment
The “good”= priority lest they get worseSecond priority for treatment
ExpectantComplicated case, prolonged condition, little hopeThe “good”= comfort onlyLast priority for treatmentShould this category exist today
![Page 21: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/21.jpg)
Law of War
Complex SubjectProportionalityRules of EngagementTorture not allowed
![Page 22: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/22.jpg)
Geneva Convention 1949
Wounded personsProtected personsReturn of medical and religious personsIdentification of medical and religious personnelTreatment of Prisoners of War
![Page 23: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/23.jpg)
More than the Geneva Convention Now Needed
Haitian refugeesSelf mutilating behavior
Somali Patients in US hospitalsStealing from the staff
The Israeli experienceCaring for suicide bombers (who failed)Pregnant women concealing bombs at checkpoints
Targeting of ambulances in Iraq
Ambulances as bombs
![Page 24: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/24.jpg)
Euthanasia on the Battlefield
Active vs. passive
Tactical vs. medicalReasons:
keep from exposing positionsavoid torture / painful deathkeep information from falling into enemy handsunit can save itselfretain medical personnel
![Page 25: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/25.jpg)
Ethics of Combat Psychiatry
“To retain the fighting strength”Proximity, Immediacy, Expectancy, Simplicity (PIES)Stated goal is return to duty (not to minimize the long term consequences)Psychiatrist as “double agent”Challenge of distinguishing harm and benefit
![Page 26: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/26.jpg)
Other Battlefield Ethical Issues
Using “experimental drugs” in battlefield setting
IND drugs, PB, anthrax
Medics in the field- does the Red Cross make them a target?
Research“go pills”
![Page 27: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/27.jpg)
DetaineesStatus: Not POWs
Medical Care
Interrogations
Feeding tubes
Release Home
![Page 28: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/28.jpg)
Ethical Issues in Humanitarian Missions
Official reasons for the mission
Do we win the minds and hearts of the people?
Medical Rules of Engagement (MROE)who and how to treatmay change with tactical situation
![Page 29: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/29.jpg)
Ethical Issues in Humanitarian Missions
Public Health IssuesParochial Capacity BuildingSustainability of protocols, relationships, technology supportAdvance exploration of unintended consequences
![Page 30: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/30.jpg)
Ethical Issues in Humanitarian Missions
Cascade of Care RecipientsUS SoldiersAlliesWounded enemyCivilians
Employed by USAcute vs. chronic careage
![Page 31: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/31.jpg)
Ethical Issues in Humanitarian Missions
Geneva ConventionArmed conflict between sovereigntiesNot applicable to ethnic conflictsRed Cross is targeted
Medical clinic target for theft
![Page 32: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/32.jpg)
Ethical Issues in Humanitarian Missions
Winners know that preparation is the key.Vigilant Security/ Egress PlanPTSD from RwandaPreparation for atrocitiesIs PIES appropriate?Stress inoculationProvider resilience training
![Page 33: Military Medical Ethics Medical Ethics Ethical Dichotomies Cultural Pluralism. David A. Anderson, DDS, MDS. United States Uniformed Services Oath of Office I do solemnly swear that](https://reader033.vdocument.in/reader033/viewer/2022042309/5ed60d0b49af592c00577077/html5/thumbnails/33.jpg)
On behalf of the President of the United States, the
Department of the Air Force, and a grateful nation, we
offer this flag for the faithful and dedicated service of……
God bless you and this family, and God bless the United
States of America.