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Conflicting values - everyday ethical and leadership challenges related to care in combat zones within a military organization
Jönköping University, School of Health and Welfare, HHJ. ADULT. Högskolan i Borås.ORCID iD: 0000-0002-5521-1118
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Licensed medical personnel (henceforth LMP) experience ethical problems related to undertaking care duties in combat zones. When employed in the Armed Forces they are always under the command of tactical officers (henceforth TOs).

Aim: The overall aim was to explore everyday ethical problems experienced by military medical personnel, focusing on licensed medical personnel in combat zones from a descriptive and normative perspective. A further aim was to explore leadership challenges in leading licensed medical personnel.

Methods: For the research descriptive, explorative (inductive and abductive) and normative designs were used. Data collection was undertaken by using different methods. Altogether 12 physicians, 15 registered nurses, seven combat lifesavers and 15 tactical officers were individually interviewed. The participants were selected by strategic (I), purposive (II) and theoretical sampling (III). The interviews were analyzed by using qualitative content analysis. Study III used classic grounded theory and study IV was a normative analysis of an ethical problem based on the idea of a wide reflective equilibrium.

Results: We found that LMP experience ethical problems related to dual loyalty when serving in combat zones. They give reasons for undertaking, or not, military duties that can be seen as combat duties. Sometimes they have restricted reasons for undertaking these military duties. Furthermore, LMP are under the command of TOs who found it challenging when leading LMP, since TOs have to unify LMP in the unit. The unifying makes it difficult since LMP experience dual loyalty.

Conclusions: LMP experience dual loyalty in combat zones. The reason maybe that humanitarian law and the medical ethical codes are not clear-cut or explicit about how to be interpreted around these everyday ethical problems in internal military operations. In order to fit in todays context humanitarian law needs to be revised. Furthermore, LMP need further training in parallel with reflections on ethical problems in order to adapt to the combat zones of today.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2017. , 81 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 085
Keyword [en]
combat zones, ethical problems, everyday ethical problems, health care, licensed medical personnel, medical ethics, military ethics, military medical personnel, military personnel
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-37891ISBN: 978-91-85835-84-3 (print)OAI: oai:DiVA.org:hj-37891DiVA: diva2:1158948
Public defence
2017-12-15, Forum Humanum, School of Health and Welfare, önköping, 10:00
Opponent
Supervisors
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2017-11-21Bibliographically approved
List of papers
1. Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties
Open this publication in new window or tab >>Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties
2014 (English)In: Military medicine, ISSN 0026-4075, E-ISSN 1930-613X, Vol. 179, no 8, 821-826 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

The aim of this qualitative study is to explore the Swedish military personnel's experience of what it means to perform a caring role in a combat zone. This study assesses the challenges faced by military medical personnel in the context of a combat zone.

METHODS:

The design was descriptive with a qualitative inductive approach. Twenty military medical personnel (physicians, nurses, and combat lifesavers) were interviewed individually. They had been involved in international military operations between 2009 and 2012. This study was analyzed using qualitative content analysis.

RESULTS:

The analysis produced four categories: being in a primarily noncaring organization, caring in emotionally charged relationships, lacking an open dialog about expectations of killing and having to prioritize scarce resources.

CONCLUSIONS:

This study shows that medical personnel easily adapt to a military setting. They care but also perform other tasks when they are in a combat zone. The medical personnel want to give care to host nation but use drugs they can spare.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-25516 (URN)10.7205/MILMED-D-14-00038 (DOI)000340806700003 ()25102524 (PubMedID)2-s2.0-84986301227 (Scopus ID)
Available from: 2015-01-06 Created: 2015-01-06 Last updated: 2017-12-05Bibliographically approved
2. Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones
Open this publication in new window or tab >>Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones
2017 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background:

When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively.

Aim:

This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones.

Design:

Abductive qualitative design.Participants and research context:Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali.

Ethical considerations:

The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014).

Findings:

Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties.

Discussion/conclusion:

These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keyword
Codes of ethics; dual loyalties; empirical approaches; ethical problems; ethics education; ethics of care/care ethics; military ethics; military nursing; nursing ethics; professional ethics; qualitative research; theory/philosophical perspectives; topic areas
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-37236 (URN)10.1177/0969733017718394 (DOI)XYZ ()28766395 (PubMedID)
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2017-11-21Bibliographically approved
3. Unifying loyalty: a grounded theory about tactical officers’ (TOs) challengewhen leading licensed medical personnel (LMP) in combat zones
Open this publication in new window or tab >>Unifying loyalty: a grounded theory about tactical officers’ (TOs) challengewhen leading licensed medical personnel (LMP) in combat zones
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-37890 (URN)
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2017-11-21
4. Gathering intelligence or providing medical care on militaryoperations: an ethical problem for Swedish licensed medical personnel (LMP)in combat zones
Open this publication in new window or tab >>Gathering intelligence or providing medical care on militaryoperations: an ethical problem for Swedish licensed medical personnel (LMP)in combat zones
2017 (English)In: Journal of Military Ethics, ISSN 1502-7570, E-ISSN 1502-7589Article in journal (Refereed) Accepted
Place, publisher, year, edition, pages
Taylor & Francis, 2017
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-37889 (URN)
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2017-11-21

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