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Physician As Military Officer: Conflicts Inof Pr Essional Duties

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Physician As Military Officer: Conflicts Inof Pr Essional Duties University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Doctoral Dissertations Graduate School 8-2009 Physician as Military Officer: Conflicts inof Pr essional Duties Kevin Michael Bond University of Tennessee - Knoxville Follow this and additional works at: https://trace.tennessee.edu/utk_graddiss Part of the Philosophy Commons Recommended Citation Bond, Kevin Michael, "Physician as Military Officer: Conflicts inof Pr essional Duties. " PhD diss., University of Tennessee, 2009. https://trace.tennessee.edu/utk_graddiss/12 This Dissertation is brought to you for free and open access by the Graduate School at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a dissertation written by Kevin Michael Bond entitled "Physician as Military Officer: Conflicts inof Pr essional Duties." I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, with a major in Philosophy. John Hardwig, Major Professor We have read this dissertation and recommend its acceptance: Glenn Graber, Alfred Beasley, Janice Harper Accepted for the Council: Carolyn R. Hodges Vice Provost and Dean of the Graduate School (Original signatures are on file with official studentecor r ds.) To the Graduate Council: I am submitting herewith a dissertation written by Kevin Michael Bond entitled “Physician as Military Officer: Conflicts in Professional Duties.” I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, with a major in Philosophy. John Hardwig, Major Professor We have read this dissertation and recommend its acceptance: Glenn Graber Alfred Beasley Janice Harper Accepted for the Council: ___________________________ Carolyn R. Hodges, Vice Provost and Dean of the Graduate School (Original Signatures on file with official student records.) Physician as Military Officer: Conflicts in Professional Duties A Dissertation Presented for the Doctor of Philosophy Degree The University of Tennessee, Knoxville Kevin M. Bond August 2009 Copyright © 2009 by Kevin M. Bond All rights reserved. ii Dedication This dissertation is dedicated to my mentors Staff Sergeant Harry Gilstrap, Professor Larry Magrath, and to my parents Howard and Kaye Bond. Friends all, without whom this would not be possible. iii ACKNOWLEDGEMENTS I would like to thank John Davis for starting me on this project and John Hardwig for seeing that I successfully completed it. The other members of my committee – Glenn Graber, Alfred Beasley, and Janice Harper – have all contributed to my development as a scholar, educator, and philosopher. I would like to thank the people I work with at West Point. My interactions with them – especially COL Hannah, LTC Doty, and LTC Julum – have been invaluable to my understanding of military culture, moral psychology, and character development. I have been fortunate for the support of my family and friends. My parents have been patient in reading my papers and helping me to clarify my views. My friends have provided me with a sounding board for my ideas. Although we collectively hold many diverse views, we can still discuss varying perspectives and continue to respect each other at the end of the day. Learning to agree to disagree, and to gracefully accept divergent views, has been a valuable lesson. Members of Nisora Dojo deserve special thanks – Sensei England, Sempei Leh, Sempei McNeil, Kohei Henderson, and Kohei Gardner. The study of Eastern Martial Arts has opened my eyes to new ways of understanding philosophy and living “the good life.” Jim, Judi, Tom, William, and April all deserve thanks for their support. Thanks! Finally, appreciatively and respectfully, thanks to the physicians and military personnel who shared parts of their lives with me. Thank you all, and I hope our paths cross again in the future. iv Disclaimer: The views expressed herein are those of the author and do not purport to reflect the position of the Army Center of Excellence for the Professional Military Ethic (ACPME), the United States Military Academy (USMA), the Department of Army (DA), the Department of Defense (DoD), or the Government of the United States of America. v Abstract A “moral dilemma” is a situation in which there is more than one obligatory course of action, but to act on one choice means to not act upon the others. Moral dilemma arises when an action, or inaction, results in “wrongness” because other morally correct obligations are rendered unattainable. Sometimes prolonged exposure to moral dilemma leads to a phenomenon known as “moral distress.” Moral distress is a negative feeling or state that is experienced when a person makes moral judgments about a situation in which he or she is involved, but, due to one or more constraints, does not act upon those judgments. This inability to resolve conflicting moral judgments may be caused by a conflict of duty. The United States Military acknowledges situations of moral dilemma when soldiers experience difficulty in determining a correct course of action because of “right versus right” conflict in duty or in values. This happens, for example, when physicians who join the military assume a dual role – that of physician and military officer. The military physician must sometimes act without being provided a satisfactory professional conceptual model of a moral working-self for adjudicating potential conflicts in duties. A comparison of professional duties and ethics of the medical and military professions, a critique of methods of conflict resolution, and a review of issues of conflict may provide insights into instances of perceived moral dilemma. After examining these topics, I propose a moral topology of decision-making that allows military physicians the conceptual space to preserve professional and personal integrity while upholding professional standards of competence and ethical behavior embraced by both professions. vi Table of Contents Chapter Page I. Moral Dilemmas of Military Physicians …………………………….... 1 §1: Moral Dilemma: Reactions and Phenomenology 3 §2: Moral Dilemma and the Military Physician 7 §3: Thesis 17 II. Perceived Conflict …………………………………………….... 22 §1: Different Roles 26 §2: Codes of Ethics & the Hidden Curricula 30 §3: Conflicting Values, Conflicting Identities 40 III. The “Either-Or” Solution ……………………………………… 45 §1: The Needs of the Many & Military Necessity 47 §2: The Patient Comes First 71 IV. Challenges to the “Either-Or” Solution ……………………………… 92 §1: Challenges to Military Proponents 94 §2: Challenges to Medical Proponents 110 §3: Summary of “Either-Or” Analysis 129 §4: Towards a Common Ground 134 V. A Moral Topology for Military Physician Decision-Making …….... 143 §1: Topology-AMC 146 §2: Advantages of Topology-AMC 167 §3: Applying Topology-AMC – Cases Revisited 175 §4: Final Thoughts 194 Works Consulted ……………………………………………………… 197 Appendices ………………………………………………………….…... 211 Appendix 1: Terms and List of Abbreviations 212 Appendix 2: A Primer on Moral Psychology 222 Appendix 3: The “Either-Or” Solution: Nazi Case Study 237 Appendix 4: Nuremburg Charges 277 Appendix 5: Just War Theory—Conditions 284 Appendix 6: A Primer on Professionalism 285 Vita ……………………………………………………………………… 294 vii Chapter 1: Moral Dilemmas of Military Physicians I don’t know a soul who doesn’t maintain two separate lists of doctrines—the ones that they believe that they believe; and the ones that they actually try to live by. Orson Scott Card Ender’s Game Light and matter are both single entities, and the apparent duality arises in the limitations of our language. Werner Heisenberg “A moral dilemma is a situation in which an agent S morally ought to do A and morally ought to do B but cannot do both, either because B is just not-doing-A or because some contingent feature of the world prevents doing both.”1 Moral dilemma most frequently arises when principles, values, or duties come into conflict. Prolonged exposure to moral dilemma sometimes results in a phenomenon known as “moral distress.” Moral distress is a negative feeling or state that is experienced when a person makes moral judgments about a situation in which he or she is involved, but cannot act upon those judgments because of constraints. Constraints may be internal, such as those of conflicting values, or external, such as institutional policy or procedure that interferes with professional responsibility. Soldiers in the United States military experience moral dilemma in what the Army calls “right versus right” conflicts. These conflicts are typically described as existing due to conflicts in duty or in values.2 Examples of this include conflict between loyalties to squad members versus loyalty to “The Big Army” or respect to a foreigner versus loyalty to 1 Christopher W. Gowans, Moral Dilemmas. New York: Oxford University Press, 1987. 3. 2 Personal conversation with LTC Joe Doty, 10 March 09. The seven Army Values are loyalty, duty, respect, selfless service, honor, integrity, and personal courage. 1 soldiers in a leader’s care.3 This dissertation investigates moral dilemma as it applies to the military physician who finds a conflict
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