My research focuses on the analysis of ethical issues in military medicine. The institution of the military and the context of deployment represent unique considerations in ethical analysis that have often gone under discussed or undervalued in both the fields of professional ethics and traditional medical ethics. These considerations include extreme environments, reduced autonomy, and conflicting professional or institutional obligations, among others. My research shows that within this context moral agents often face complicated moral dilemmas. While I have examined many issues within the broad field of military medical ethics, the majority of this work specifically looks at matters related to the problem of dual-loyalty. The problem of dual loyalty recognizes the fact that military physicians encounter situations in which ethical tensions arise between their responsibilities as physicians (to their patients) and those responsibilities as soldiers (to the military mission).
My doctoral dissertation, “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,” analyzed the ethical dilemmas incumbent in military humanitarian assistance missions, where military medical service-members provide medical care to civilian populations in order to achieve strategic goals. This research employed an interdisciplinary methodology to provide historico-ethical analysis of the largest formalized programs of this category; the Medical Civic Action Program (MEDCAP) and the Medical Readiness Training Exercise (MEDRETE), focusing primarily on the MEDCAPs of the Vietnam War and MEDRETEs of the 1980-90’s. A significant focus of my dissertation involved qualitative interviews with military physicians who had participated in these programs. These interviews compared various first-person experiences with MEDCAPs and MEDRETEs to analyze recurring themes and prove that these missions created a variety of ethical dilemmas. Throughout these interviews, military medical professionals described ethical issues ranging from the devaluing or subordination of medical goals, and the instrumentalization of medicine, to the exploitation of patients, among others. My project concretely examined these missions and their use of medicine as a tool of strategy within the U.S. Army, demonstrating that they present many ethical dilemmas to the physician-soldiers who participate in them and arguing that these missions represent a programmatic example of the problem of dual loyalty.
Previously, the voices of program participants had not been heard, and the military had failed to recognize the ethical realities of these missions. My research has addressed this gap in knowledge, and challenged the military to recognize these dilemmas. To date, this research has been published in a number of journals including a 2015 article in Ethics and Armed Forces (EAF) and a 2014 article in Medical Corps International Forum (MCIF). My doctoral research has also been presented at both national and international meetings such as the annual conference for the National Meeting of the Association for Practical and Professional Ethics (APPE), the NATO Centre of Excellence for Military Medicine (MILMED COE), and the UNESCO World Conference on Bioethics, Medical Ethics & Health Law. Additionally, this research has formed the foundation for invited talks at the National University of Singapore, the Center for the Study of Bioethics at the University of Belgrade in Serbia and the International Committee of Military Medicine’s (ICMM) Workshop on Military Medical Ethics. Drawing on my research and resulting publications, I have given talks, presentations and initiated dialogue with key stakeholders (such as NATO representatives, Surgeon Generals, commanders, and military physicians) in order to emphasize the need for increased ethics education within the armed forces.
My next research project will examine Medical Civic Action Programs (and similar missions) as employed by the U.S. military during the contemporary conflicts in Afghanistan and Iraq. According to U.S. Department of Defense (DOD), Instruction 3000.05 Military Stability Operations (MSOs) are a “core U.S. military mission,” that “shall be given priority comparable to combat operations.” This instruction has been in place since 2010 and specifically emphasizes stability operations that include humanitarian and civic assistance programs, of which medical missions (such as MEDCAPs) are among the most utilized. The emphasis now placed on these missions warrant their examination. My research will examine this category of programs as used by U.S. military during contemporary conflicts from 2001-present. Recognizing the role of American allies’ participation in these programs, I will also examine the application of the MEDCAP model within the NATO-led International Security Assistance Force (ISAF) mission in Afghanistan. This next project will identify and analyze the ethical dilemmas present in contemporary medical civilian assistance (humanitarian) missions, discussing recurring themes throughout history as well as any new or novel ethical dilemmas arising in modern conflicts. A qualitative interdisciplinary methodology will be employed to provide both ethical discussion and analysis, as well as case studies of the military medical environment. Specifically, this methodology will focus on policy analysis, primary and secondary source reviews, and semi-structured interviews with military medical professionals who have directly participated in these missions. Ultimately, the goal of this work is to both fill an identified gap in the literature and provide concrete solutions in the form of advocating increased training and education, as well as specific models for program improvement.
Throughout all of my work, I use my research to promote change within the military community. The analysis produces useful information for physician-soldiers, other military medical professionals and personnel, non-medical commanders, policy-makers, government leaders and interested academics or laypeople. Many members of the military medical community struggle in dealing with the moral dilemmas inherent within the complex context of the military institution. This work represents a distinctive and interesting example of the instrumentalization of medicine, and the moral dilemmas to the intersection of the profession of arms and the profession of medicine.