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Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones
Jonkoping Univ, Sweden; Univ Boras, Sweden.
Jonkoping Univ, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Univ Boras, Sweden.ORCID iD: 0000-0003-0987-7653
2019 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, no 2, p. 480-495Article in journal (Refereed) Published
Abstract [en]

Background: When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively. Aim: This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones. Design: Abductive qualitative design. Participants and research context: Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali. Ethical considerations: The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014). Findings: Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties. Discussion/conclusion: These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2019. Vol. 26, no 2, p. 480-495
Keywords [en]
Codes of ethics; dual loyalties; empirical approaches; ethical problems; ethics education; ethics of care/care ethics; military ethics; military nursing; nursing ethics; professional ethics; qualitative research; theory/philosophical perspectives; topic areas
National Category
Medical Ethics
Identifiers
URN: urn:nbn:se:liu:diva-155904DOI: 10.1177/0969733017718394ISI: 000461439900015PubMedID: 28766395OAI: oai:DiVA.org:liu-155904DiVA, id: diva2:1301577
Note

Funding Agencies|Faculty of Caring Science, Work Life and Social Welfare, University of Boras, Boras, Sweden

Available from: 2019-04-02 Created: 2019-04-02 Last updated: 2019-06-27

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