Op GRITROCK ethics; the way of things to come?

Abstract

The Defence Medical Services (DMS) deployed on Op GRITROCK to Sierra Leone in support of the Ebola outbreak. This operation was the first large-scale DMS deployment since operations in Afghanistan ceased at the end of 2014. This type of operation revealed a number of ethical issues and challenges that the DMS had not faced for a long time. The ethical issues identified during the deployment are discussed in this article using the principalism approach of Beauchamp and Childress. Many of these issues were not identified prior to deployment, and troops were not adequately prepared. The article will outline the difficulties of using the principles of autonomy, beneficence, non-maleficence and justice during a public health emergency, and conclude with recommendations for ethical considerations that should be identified and mitigated against for future deployments to a public health emergency.

Civil–military cooperation in the management of infectious disease outbreaks: a scoping review

“…When it comes to regulations in civil–military response collaboration, UNOCHA Oslo guidelines and Military and Civil Defence Assets guidelines,68 69 as well as the military rules of engagement, play an important role. However, civilian and military actors remain unaware, which may cause frustration and reputational damage 1 56 57 62 64 66 70. Gibson-Fall19 argues that the COVID-19 pandemic demonstrates the need for new civil and military domestic legal and ethical frameworks and instruments.…”

‘A band of brothers’—an exploration of the range of medical ethical issues faced by British senior military clinicians on deployment to Afghanistan: a qualitative study

“…There is always a limit to the capacity and resources of medical assets, whatever the mission 17. The execution of the MRoE has to be carefully balanced to ensure the military medical system follows internationally agreed ethical principles and supports capacity building without undermining the development of the indigenous health economy 15 17. Working with limited resources also raised a challenge when deployed with other nations if there was a difference of opinion among the clinical team who should be prioritised for treatment; that some nationalities wished to prioritise their own nation's personnel before the host nation is documented in the literature 31…”

“…However, military clinicians may not be able to rely on previous experience in future contingency operations where the characteristics, environment, circumstances and type of deployment are less likely to have been previously experienced. For example, the ethical issues that clinicians faced in treating Ebola virus disease in Sierra Leone were very different to those encountered during an international conflict 15. An increased knowledge about the factors that make decision-making difficult should facilitate appropriate training programmes to be developed in ethical issues, regardless of the environment, type and context of the military mission.…”

“…The Medical Rules of Eligibility (MRoE) state clearly which patient groups can access the military medical system in order to protect medical capacity for the primary mission while adhering to international and humanitarian law 15 17. The need to comply with the MRoE within the culture of the indigenous population may create a greater range of ethical issues that Defence Medical Services (DMS) personnel need to address on deployment than that their civilian colleagues need to face in UK 12.…”

“…The need to comply with the MRoE within the culture of the indigenous population may create a greater range of ethical issues that Defence Medical Services (DMS) personnel need to address on deployment than that their civilian colleagues need to face in UK 12. Medical advances in Afghanistan have made previously unsurvivable injuries survivable which has created ethical challenges not experienced in previous conflicts15 (T Hodgetts, ‘DMS ethics: research campaign framework’—PowerPoint presentation, Medical Directorate, Joint Medical Command, Birmingham, unpublished presentation for Stakeholders’ meeting, 25 May 2014).…”