Moral Dilemmas in Military Medicine: A historico-ethical analysis of the problem of dual loyalties and medical civilian assistance programs in the U.S. Army

Abstract

Practicing military medicine is a morally complicated job. While physicians are generally understood as owing moral obligation to the health and well being of their individual patients, military health professionals can face ethical tensions between responsibilities to individual patients and responsibilities to the military institution or mission. The apparently conflicting obligations of the two roles held by the physician-soldier are often referred to as the problem of dual loyalties and have long been a topic of debate. The contemporary intellectual focus on this issue has ignored larger institutional issues that contribute to the problem. The conflict is part of a larger issue: namely, the intersection between the profession of arms and the profession of medicine, as institutionalized by the modern American military. This dissertation seeks to enrich the dual-loyalties debate by grounding it in the philosophical theory of an internal professional morality and exploring an Army program that serves to highlight the problem of dual loyalties at an institutional level. This dissertation examines the embedded case of medical civilian assistance programs, exploring three periods in the history of these programs and analyzing the problem of dual loyalty in each. These programs represent the use of medicine within the military for strategic goals. Thus, a physician is expected to meet his obligation to his role as soldier, while also practicing medicine. These programs involve obligations inherent in both roles of the physician-soldier and thusly they serve as excellent exemplars for the problem of dual loyalties at an institutional level.