Complexities of autonomy in military medical ethics: A brief report

The first Fallen Surgeons Military Educational Symposium was convened in conjunction with the the American Association for the Surgery of Trauma (AAST) 23 meeting, under the guidance of the AAST Military Liaison Committee. The daylong session included a 1.5-hour segment on military medical ethics in combat and its unique challenges. Medical ethical issues arise frequently within the military across a range of varied circumstances, from the day-to-day operations of stateside forces to the complexities of deployed troops in theaters of conflict. Given the scope of these circumstances, preparation and advanced planning are the key to addressing and resolving the ethical issues that occur. The goal of this session was to present illustrative cases, not to prescribe solutions, and to make the attendees aware of some of the challenges they may encounter when deployed. Military surgeons may, at times, may be forced to balance a patient's autonomy against other competing needs. Decisions a physician may be faced with in order to support successful completion of the mission may not always align with their duty to the respect the autonomy of the patient they are treating. This concept of dual loyalties is a known ethical conflict experienced by military medical providers. This case discusses a grievously injured soldier who declines potentially lifesaving surgery and the ethical challenges posed to the care team.