Medical Prophylaxis in the Military: A Case for Limited Compulsion

Abstract

Current professional guidance for doctors emphasises that the ethical standards and principles that apply to the civilian practice of medicine should be applied, without modification, to military medical practice. In particular, that respect for patient autonomy is upheld. In the UK, the decision to join the military is voluntary and made in the knowledge that it means joining a chain of command that modifies certain freedoms to make decisions for oneself. One such is the wearing of personal protective equipment. Medical prophylaxis has features in common with personal protective equipment but medical personnel, unlike the nonmedical chain of command, cannot insist on compliance because to do so would contravene professional codes of conduct. In the resource-limited, high-risk, and intimately interdependent environments in which the military operate, the decisions individuals make impact on those around them. In these circumstances, the common features of prophylaxis of all kinds, including medical, may justify ordering personnel to comply. We describe how the ethical imperatives of a military unit differ from those of civilian society and how these build a case for why the right to respect for autonomy may take secondary consideration to the principles of beneficence and justice in such a setting. Medical prophylaxis is discussed as an example of a medical intervention that best describes the need for a new approach. We discuss how to overcome current limitations, either by delivering mandated prophylaxis by those without a professional registration or through a fundamental reappraisal of the ethical priorities that take precedence under different military circumstances.

This work is the personal opinion of the authors and does not represent British military doctrine or policy