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Background reading material for Year 2 Semester 1 medical student PPSD session on Wednesday 30th August 2006 by Professor Omar Hasan Kasule, Sr.
1.0 PHYSICIANS WORKING IN UNIFORMED SERVICES
1.1 Doctors in the armed forces are uniformed members of the force with the obligation to obey all lawful commands. This makes it difficult for them to fulfill some of their ethical responsibilities to patients when there is a conflict between the orders of the force and the interests of the patient. Such doctors are advised to follow their conscience regarding duties to patients even if that would put them in jeopardy with the military command. The conflict becomes very urgent when soldiers called for service in a war zone try to get certification of unfitness from the doctor. If the soldier is a plain malingerer the matter is easy. However in actual practice the soldier may have some mental and physical maladies and the physician will have to make a value judgment whether they are sufficient for discharge from military duty. In such a case the physician should aim at making an objective assessment and report findings to the military hierarchy. He should avoid being influenced by the please of the soldiers.
1.2 Members of the armed forces are also required by military regulations to submit themselves to physical examination if instructed by higher officers. Unlike civilians they cannot invoke their right to free informed consent. They may also be ordered to undergo certain procedures like vaccination which they cannot lawfully reject.
1.3 Members of armed forces following military regulations have less confidentiality than civilians. Top commanders need to know the potential of each soldier very well before assigning military duties because the ability and judgment of a soldier on the battle-field can be crucial and lives are involves. They therefore may ask the attending physician for more details about the physical and mental health of soldiers than civilian employers. A physician in the armed forces therefore will disclose confidential information to commanders according to regulations but will also make an effort to notify the soldier of such disclosures. However disclosure without express consent should not cover members of the soldier’s family who are not members of the uniformed services unless their medical condition could affect the mental and physical health of the soldier.
2.0 SPORTS PHYSICIANS
Physicians employed by sports teams to look after players may find themselves in situations of conflict between the interests and confidentiality of their patients and the demands of the teams. The team managers want all players to be playing all the time because that translates into revenue. The physician has to certify them as fit to play and may be under management pressure to release a player who in his judgment is not fully recovered. The management may also want to find out details about a player’s health again for management and business purposes. They may want to make decisions regarding future earnings, selling the player to another club, etc. The physician must maintain his professional integrity of not disclosing information to management without player consent. Physicians may come under pressure from players or management or both to provide anabolic steroids drugs that are thought to enhance performance. This is unethical and physicians should not be imvolved. They can only prescribe drugs that are within the law.
3.0 OTHER PHYSICIANS
Issues similar to those discussed above confront physicians working with the police, physicians working with prisons, and physicians working with the media