Hooft Francesca Baukje
History and Art History, Utrecht University, Utrecht, The Netherlands
Netherlands Institute of Military History, The Hague, The Netherlands.
J R Army Med Corps. 2019 Aug;165(4):279-281. doi: 10.1136/jramc-2018-001137. Epub 2019 Mar 22.
Within military operations, military physicians and nurses experience a dual loyalty to their professional identities. The moral frameworks of the medical and military professions are not similar, and require different kinds of choices and action from its members. But above all, the legal framework in which the healthcare personnel has to operate while deployed is different from the medical moral standards. Military necessity is prioritised over medical necessity. In debates on dual loyalty, legal frameworks should be considered as a more decisive factor in ethical decision-making processes. Legal frameworks, both general and mission-specific, support this prioritisation of military necessity, complicating the work of military physicians and nurses. During the post-Cold War era, in which neutrality and moral supremacy have served as legitimising factors for military peacekeeping or humanitarian missions, this misalignment between the moral and the legal framework is problematic. What is legally correct or justifiable may not be morally acceptable to either the medical professional standards or to the general public. The legal framework should be given more prominence within the debates on dual loyalty and military medical ethics. This paper argues that the misalignment between the legal and moral framework in which deployed healthcare personnel has had to operate complicated ethical decision-making processes, impeded their agency, and created problems ranging from military operational issues to personal trauma and moral injury for the people involved, and ultimately decreasing the legitimacy of the armed forces within society.
在军事行动中，军队医生和护士对其专业身份怀有双重忠诚。医学职业和军事职业的道德框架并不相同，其成员需要做出不同类型的选择并采取不同行动。但最重要的是，医护人员在部署期间必须运作的法律框架不同于医学道德标准。军事必要性优先于医疗必要性。在关于双重忠诚的辩论中，法律框架应被视为道德决策过程中更具决定性的因素。一般的和特定任务的法律框架都支持这种军事必要性的优先地位，这使军队医生和护士的工作变得复杂。在后冷战时代，中立性和道德至上性一直是军事维和或人道主义任务的合法化因素，道德框架与法律框架之间的这种不一致是个问题。从医学专业标准或公众角度来看，法律上正确或合理的事情在道德上可能并不被接受。在关于双重忠诚和军事医学伦理的辩论中，应更突出法律框架。本文认为，部署的医护人员必须运作的法律框架与道德框架之间的不一致使道德决策过程变得复杂，阻碍了他们的行动能力，并给相关人员带来了从军事行动问题到个人创伤和道德伤害等一系列问题，最终降低了武装部队在社会中的合法性。
