Physician as Military Officer: Conflicts in Professional Duties

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