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Report on the Joint Workshop with MILMED COE on Military Medical Ethics


Report on the Joint Workshop with MILMED COE
on Military Medical Ethics

Munich, Germany

14-16 September, 2015



In cooperation with the NATO Centre of Excellence for Military Medicine (MILMED COE), the ICMM and its Centre of Reference for Education on International Humanitarian Law and Ethics organized a Workshop on Military Medical Ethics. The objective of the workshop was to elaborate an analysis of the ethical challenges faced by military medical services in the complex environment of contemporary conflict scenarios.

The ICMM was represented by Major General Prof. (ret.) Marc MORILLON, Chairman of the Scientific Council, Colonel (ret.) Johan CROUSE, Chief of the LOAC International Teachers and Major Hiam ESMEIRAN, Chairperson of the Nurses and Paramedics’ Technical Commission.

The workshop was co-chaired by BG Dr Stefan KOWITZ (Director of the NATO Centre of Excellence for Military Medicine, Budapest), Major Dr David WINKLER (Chairman of ICMM Centre of Reference for Education of IHL and Ethics), and Dr Daniel MESSELKEN (Zurich Centre for Military Medical Ethics). The event was hosted by the Bundeswehr Medical Academy in Munich and was held from 14 to 16 September 2015. The workshop was attended by 24 participants from 14 nations and the audience included officers, commanders, legal advisors, medical advisors and planners, but also academic researchers.

During the first session of the workshop, several presenters reported on recent field experiences and illustrated the current ethical issues encountered by military health care personnel during recent missions. The variety and complexity of these challenges was highlighted by a number of exemplary case studies.

The second session was dedicated to an «inventory» of the existing legal and ethical rules, regulations, and principles that should guide the work of military health care personnel. Presentations of this session introduced the international legal framework and its general principles (IHL) as well as existing NATO regulations on military medicine. It was emphasized that military health care personnel are bound, by the Geneva Conventions and Additional Protocols, to act according to medical ethics. The latter were the subject of a presentation on Military Medical Ethics and on current declarations of professional ethics for military health care personnel.

Based on this rich input, the participant then worked during the remainder of the workshop on a common analysis of the most relevant ethical issues for military health care personnel and the question of how to react to them.

Analyzing the presented cases and adding from their own rich experience, the participants drafted a list of the typical situations, causes and triggers of ethical dilemmas for military health care personnel. As a result, scarce resources and mixed obligations were identified as the main sources of conflict together with a lack of knowledge about the ethical duties and obligations of medical personnel. Other issues include the misuse of medical knowledge, the ill-treatment of detainees, and questions of the use of the protective emblem. The whole range of issues related to disaster relief operation constitute another challenge often encountered in military support missions.

The participants agreed that the ethical challenges related to modern missions during which the medical services are often in close contact to civil population and infrastructure, require specific education and training of military health care providers on ethics. Ethical misbehavior of military health care personnel not only endangers their professional integrity but also puts the success of missions in times of globalized communication tools at risk.

Unprepared exposure of health care personnel to stressful situations and ethical dilemmas can in addition be associated with post-traumatic stress. It was thus commonly acknowledged that the training or at least information of all military personnel about the duties and obligations of (military) health care personnel is a decisive factor. As raising awareness and education both need to rely on knowledge about the real-world challenges, it was stipulated to build up a database with cases and case studies in military medical ethics similar to the lessons learned approach in other disciplines.

It was commonly agreed that the recent document on «Ethical principles of health care in times of armed conflict and other emergencies», which was developed under the auspices of the ICRC, ICMM, and other institutions would constitute an ideal basis for future guidelines applicable in NATO.

The recommendations of the workshop, which include to extend the training on military medical ethics and to update the current doctrine, will be presented to the next COMEDS plenary meeting.