A service evaluation of the use of the four-quadrant approach to assess the ethical dimensions of clinical decision-making during deployment.
The ethical issues that arise for Armed Forces medical personnel on deployment can be extremely complex. The range of factors that medical personnel may need to take into account can be greater than in civilian medicine (such as complying with the Geneva Convention, the care of Captured Persons, adhering to the Chain of Command and the need to support the integrity of the local health service even where it is less able to offer specialist care). The Royal Centre for Defence Medicine (RCDM) (Research and Academia Medical Directorate) - with help with funding from the Red Cross - has held three ‘annual’ day-long symposia on medical ethics. These aimed to harness the experience of those returning from operations to explore ethical concerns that have arisen in unusual (in the context of medical ethics, though sadly not of military medicine) and intense context encountered during operations. An adapted ‘four quadrant approach’ has been adopted in pre-deployment training prior to departure for Afghanistan. This approach is, however, a limited tool. It does not provide the user with the means of balancing the information within each area to arrive at a conclusion. This requires individual judgement in consultation with the team involved.
MESH is working with RCDM to determine if and how medical personal are using the tool, and how useful it is proving to be in the Field Hospital in Camp Bastion, Afghanistan. We will also be looking at whether the tool needs to be developed to better assist ethical decision-making and if so, how. A secondary aim of the work is to develop ways of improving pre-deployment training in ethics based on the findings.
Professor Heather Draper – MESH, University of Birmingham
Major Lizzy Bernthal – Research Fellow, RCDM
Colonel Rob Russell - Deployed Medical Director, Defence Professor EM, RCDM.
For more information contact Heather Draper (PI) email: firstname.lastname@example.org