Physicians often face conflicts between their professional duty of loyalty to patients and their concomitant responsibilities to third parties. These latter responsibilities may be to family members or to other parties interested in a patient's welfare. Or they may take an economic form, as is increasingly reflected by the influence of health plans and other third-party payers in clinical decision-making. A physician may have a responsibility to perform a court's request for a forensic evaluation or to perform actions on behalf of state institutions like prisons, which require specific duties of physicians that conflict with their traditional commitments. Or the responsibility may be to the military, whose ultimate goal is to protect the security of a population. In each case, a physician's additional or peripheral responsibilities may divide her initial duty to patient care.
Military duties are often particularly difficult to reconcile with other personal, professional, or even legal duties. The history of judicial deference to the military in this country, embedded in the Constitution and known as the separate community doctrine, reflects our willingness to cabin military duties as both separate from other duties and, for the most part, unconditional. Perhaps it should not be surprising that when a service member believes a given order to be in conflict with his or her own moral value or ethical code, an available justification for otherwise unethical behavior is employed: The imposed military duty constitutes a separate responsibility, apart from those normally attaching to an individual in his or her "personal" life. If duties can be thus compartmentalized, one may consider himself free from personal responsibility for actions performed while operating in a specific and sanctioned role such as soldier, attorney, or physician. One may only be held professionally responsible and thus judged on the basis of shared professional ethical guidelines. It remains an open question how individuals ought to honor their personal values when professional duties require conflicting action, and much of the literature on role morality has focused on this question. The implications that follow from sacrificing one's personal moral values for professional obligations can be disturbing, even if they are ultimately justifiable from a utilitarian perspective.
More disturbing, however, should be the apparent ease with which robust professional norms and duties in one profession can be suppressed in favor of those in another. Such has been the case with the medical profession and the military. The strong evidence that doctors ignored, justified, or even helped in the humiliation, degradation, and physical abuse of Iraqi detainees at Abu Ghraib has shocked many in both the medical and non-medical communities. Mounting evidence suggests that physicians falsified and delayed death certificates, shared detainees' medical information with military interrogators, ignored abuse, and covered up homicides -- all activities in contravention of international law and medical ethics. This Note argues that, while these activities were arguably outside the realm of military duties, they would not have been committed had medical professional norms been obeyed.
Michael K. Gottlieb,
Executions and Torture: The Consequences of Overriding Professional Ethics,
Yale J. Health Pol'y L. & Ethics
Available at: https://digitalcommons.law.yale.edu/yjhple/vol6/iss2/3