Health Care in Contexts of Risk, Uncertainty, and Hybridity

Description

This book sheds light on various ethical challenges military and humanitarian health care personnel (HCP) face while working in adverse conditions. Contexts of armed conflict, hybrid wars or other forms of violence short of war, as well as natural disasters, all have in common that ordinary circumstances can no longer be taken for granted. Hence, the provision of health care has to adapt, for example, to a different level of risk, to scarce resources, or uncommon approaches due to external incentives or requirements. This affects the practice of health care as well as its ethics. This book offers a panoramic overview on various challenges healthcare faces in extraordinary situations and provides new insights from practitioners’ as well as from academic scholars’ perspectives. Contents About the Editors Chapter 1: Health Care in Contexts of Risk, Uncertainty, and Hybridity – Introduction to the Volume 1.1 The Changing Nature of Warfare – Where Are We and What Are We Talking About? 1.1.1 Asymmetrical Warfare 1.1.2 Hybrid Warfare – Everything New, Again? 1.1.3 Intermediate Conclusion: The Changing Nature of War 1.2 How Changes in Warfare Impact the Work of Military HCP 1.2.1 Complex Emergencies: A (Public) Health Perspective on Modern Conflicts 1.2.2 Some Specific Challenges and Exemplary Situations 1.3 Synopsis – A Brief Outlook on the Volume References Part I: Doctrinal and Legal Aspects Chapter 2: Military Medical Ethics & the United States: An Overview of Recent Developments in the Operationalized Landscape 2.1 Introduction 2.1.1 Background 2.2 International Organizations 2.2.1 International Committee of the Red Cross: Geneva Conventions 2.2.2 International Committee on Military Medicine (ICMM) 2.2.3 NATO: The NATO Centre of Excellence for Military Medicine (MILMED COE) 2.2.4 World Medical Association 2.3 The United States Department of Defense (DOD) 2.3.1 Recent Developments in Military Medical Ethics: The DHB Report 2.3.2 DoDi 6025.27: Medical Ethics in the Military Health System 2.3.3 Military Health System (MHS) Principles of Medical Ethics 2.3.4 Defense Medical Ethics Center (DMEC) 2.4 Conclusion Works Cited Chapter 3: Attacks on Hospitals: An Alarming Problem for Military Medicine as Well as for Humanitarian Medicine 3.1 Introduction 3.1.1 Common Grounds Between Military and Humanitarian Medicine 3.1.2 The Kunduz Bombings and Their Aftermaths 3.2 Discussion 3.2.1 Historical Perspective: A New Epoch? 3.2.2 Moral Perspective: Does Proportionality Count? 3.2.3 Traditional and Revisionist Just War Theories 3.2.4 An Ideological Threat to Humanitarian Medicine and Impartiality 3.3 Conclusion Appendices Appendix 1: Protocol Additional to the Geneva Conventions of 12 August 1949, and Relating to the Protection of Victims of International Armed Conflicts (Protocol I), 8 June 1977 Appendix 2: Protocol Additional to the Geneva Conventions of 12 August 1949, and Relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), 8 June 1977 References Chapter 4: Impact of US Anti-Terrorism Legislation on the Obligation of Non-state Armed Groups to Provide Medical Care to the Wounded and Sick Under IHL 4.1 Introduction: International Legal Framework and US Anti-Terrorist Legislation Related to the Provision of and Access to Medical Care in NIACs 4.2 Implementation of US Counter-Terrorism Legislation: Inconsistencies with IHL and Remedies 4.2.1 Implementation of US Anti-Terrorism Legislation 4.2.1.1 Access to Qualified Medical Personnel 4.2.1.2 Access to Medical Supplies and Equipment 4.2.1.3 Resort to Relief Organisations 4.2.2 Inconsistencies of the Implementation of US Anti-Terrorism Legislation with IHL and Remedies 4.2.2.1 Inconsistencies of the Implementation of US Anti-Terrorism Legislation with IHL 4.2.2.2 Potential Challenges to Finding the US Accountable for Domestic Practices That Are Inconsistent with Its International Obligations 4.2.2.3 Potential Remedies 4.3 Conclusion Annexes Bibliography Treaties United Nations Geneva Conventions and Additional Protocols United Nations’ Resolutions International Case Law International Court of Justice International Criminal Tribunal for the Former Yugoslavia Others US’ Legislation US’ Court Cases Books Publications/Reports Articles Conferences and Statements Press Articles and Videos Websites Chapter 5: Military Medical Staff in Hybrid Wars 5.1 Introduction 5.2 New and Old Wars 5.3 Combatant Claims to Medical Assistance 5.4 The Basis for a Claim to Medical Aid 5.5 The Dilemma of Military Medics 5.6 Military Medics and Just Conduct in War References Part II: Treating Soldiers Chapter 6: Morituri Soldiers on Operation Theatres: The French Approach and a Case Analysis 6.1 Introduction 6.2 Morituri Soldiers on Operation Theatres: The French Approach 6.2.1 The French Military Health-Care Providers Are Subject to the French Legislation on End of Life, Whatever the Place They Operate, Whatever the Patient’s Nationality 6.2.1.1 End of Life: A Legal Vacuum, a Gap Which Was Bridged in France in 2005 6.2.1.2 What Does This Law Say? 6.2.1.3 This Law Applies to the French Medical Corps 6.2.2 While Respecting the French Legislation, the Medical Corps Still Have to Adapt to the Particular Situation the Operation Theatre Represents (Doctrine of the medical support for the operations, DIA-4.0.10_SOUTMED-OPS 2014) 6.2.2.1 When the Clock Is Ticking: Only Emergency Care Matters 6.2.2.2 In Mass Casualties Situations: The Need for Triage 6.2.2.3 In Situations of Insecurity: The Need for Simple Protocols 6.2.3 The Educational Framework: The “Val-de-Grâce” School 6.3 Practical Implementation, Drawn from the Afghan Experience 6.3.1 Circumstances of the Attack 6.3.2 Reaction of the French Military Convoy to the Attack 6.3.3 Injury Assessment and Medical Care for the Victims of the Attack 6.3.4 The Future of Wounded Soldiers and the Analysis of the Event 6.4 Conclusion References Chapter 7: Patient Preference Predictors and Paternalism in Military Medicine 7.1 Introduction: Patient Preference Predictors 7.2 PPPs and the Problem of Naked Statistical Evidence 7.3 Paternalistic Prediction 7.4 Paternalism in the Military 7.5 Paternalistic Prediction in Military Medicine 7.6 Concluding Remarks References Chapter 8: Battlefield Euthanasia: Ethics and the Law 8.1 Background: Western Ethical Views on Suicide and Euthanasia 8.2 Euthanasia on the Battlefield 8.3 The Ethics of Euthanasia Today 8.4 Euthanasia and the Laws of Armed Conflict References Part III: Treating Civilians and Humanitarian Missions Chapter 9: The Ethical Challenges of Providing Medical Care to Civilians During Armed Conflict 9.1 The Duty to Provide Medical Care to Civilians During Armed Conflict 9.2 Civilian Medical Care and Medical Rules of Eligibility 9.3 Provincial Reconstruction Teams (PRTs): Medical Care or Medical Diplomacy? References Chapter 10: Bridging the Gap Between Intentions and Outcomes in Military Humanitarian Assistance and Disaster Relief Missions 10.1 Preamble 10.2 Introduction 10.2.1 Military Forces and HADR 10.2.2 The Accountability Obligations 10.2.3 HADR in Haiti 10.2.3.1 Local Participation 10.2.3.2 No-Cost, Non-earthquake Related Healthcare 10.2.3.3 The Haitian Perspective 10.3 Conclusion References Chapter 11: Rescuing Relief in Remote Management and Programming: Using a Duty of Care Transfer Review to Assess the Accountability of Humanitarian Interventions 11.1 Remote Management and the Challenge of Accountability 11.2 Accountability: Definitions and Drivers 11.2.1 Definitions of Accountability and the Humanitarian Accountability Partnership 11.2.2 Drivers of Accountability in the Humanitarian Sphere 11.2.3 To Whom Are Humanitarian Organizations Accountable? 11.3 Improving Accountability to Affected Populations 11.3.1 Enabling and Incentivizing Accountability through Standards 11.3.2 Duty of Care and the Transfer of Trust 11.4 The Duty of Care Transfer Review 11.4.1 A Case of Challenged Trust 11.4.2 Focusing on Principles and Commitments 11.4.3 Duty of Care Transfer Review 11.5 Conclusions References Chapter 12: Unpacking the “Oughtness” of Palliative Care in Humanitarian Crises: Moral Logics and What Is at Stake? 12.1 Introduction 12.1.1 Background 12.1.2 Methods 12.1.3 Ethics 12.2 Findings 12.2.1 All Humans Deserve to Die with Dignity 12.2.2 Letting a Person Die in Pain Is Inhumane 12.2.3 Dying Alone Is Wrong 12.2.4 Those Ethically Committed to Take Care of the Most Fragile / Vulnerable Cannot Ignore Those with Palliative Care Needs 12.2.5 Providing the Same Care in Resource-Limited Settings as in High-Resource Settings Is a Question of Justice 12.3 Discussion 12.3.1 Caveats and Cautions 12.3.2 Palliative Care – What Is at Stake? 12.4 Conclusion References Chapter 13: Risk and Infectious Disease Outbreaks: Should Military Medical Personnel Be Willing to Accept Greater Risks Than Civilian Medical Workers? 13.1 Introduction 13.2 The Obligation of Healthcare Professionals to Treat Patients Even at Risk to Themselves 13.3 Does the Obligation to Treat Patients Even at Risk to Themselves Extend to Military Personnel? 13.4 Other Civilian and Other Military: Should the Military Be Expected to Bear Greater Risks Because They Are Military? 13.5 Trust and Reciprocity 13.6 Conclusion References Part IV: Doing Research Chapter 14: When to Suspend Bioethical Principles in Military Medicine for Operational Purposes: A Framework Approach 14.1 Introduction 14.2 Bioethical Principles 14.2.1 Suspension of Bioethical Principles 14.2.2 Suspension of Bioethical Principles in the Military Setting 14.2.3 The Role of the Human Research Ethics Committee/Research Ethics Committee/Institutional Review Board 14.3 Framework 14.4 Case Study Discussion 14.4.1 Operation Desert Storm – Anthrax Vaccine 14.4.2 H1N1 Outbreak on a Warship 14.5 Other Potential Uses of the Framework 14.6 Conclusion Appendix A: Coleman Supreme Emergency in Military Medical Settings Framework Flowchart References Chapter 15: The Ethics of Biomedical Military Research: Therapy, Prevention, Enhancement, and Risk 15.1 Introduction: Human Enhancement in the Military 15.2 The Issue of Risk in Enhancement Research 15.3 A Tripartite Distinction Between Enhancements 15.4 Re-thinking Risks and Benefits in the Context of Enhancement Research 15.5 Possible Objections 15.5.1 Therapeutic Enhancements Need Not all Have a More Advantageous RBR 15.5.2 Coercing/Targeting Vulnerable Subjects 15.5.3 Therapeutic Enhancements Are Less Reversible than Pure Ones 15.5.4 Incentivizing Risky or Deceitful Behavior 15.5.5 Military Enhancement and Risk Beyond Research Subjects 15.6 Conclusions References Chapter 16: Military Medicine Research: Incorporation of High Risk of Irreversible Harms into a Stratified Risk Framework for Clinical Trials 16.1 Introduction 16.1.1 Military Medicine Research: How Much Risk Should Patients Accept? 16.2 Traditional Trial Model and Its Issues 16.3 Reversible Versus Irreversible Treatments 16.4 Previous Related Clinical Trials 16.5 Degenerative, Progressive Terminal or Life Threatening Versus Chronic/Stable Disease Trials 16.6 Target Disease Population Size 16.7 A Potential New Stratified Risk Framework for Minimising Risk-Benefit Ratio 16.7.1 Examples 16.8 Conclusion References Index