Ethical Challenges Encountered on International Military Surgical Engagements

Military surgery has unique ethical challenges encountered in direct patient care, Department of Defense Global Health Engagement (DoD GHE). Ethical challenges have been noted in publications on individual DoD GHE; however, this study seeks to aggregate information across all types of engagements.

Qualitative analysis was conducted of responses to survey questions about experiencing an ethical challenge during a DoD GHE. Further analysis was done on reports of complications and follow-up on patients. Finally, the frequency of pre-engagement ethical or cultural training was examined.

Responses were mostly from DoD GHE in the U.S. Southern Command (23) and U.S. Indo-Pacific Command (17) areas of operation. Out of 56 surgical DoD GHE, there were 11 ethical issues noted, and 72.7% (8/11) were reported from a hospital ship mission. Qualitative analysis revealed 4 main themes: cultural challenges, ethical dilemmas, systemic issues, and relational dynamics and trust.

The study highlights the need for specific, direct patient care DoD GHE curriculum in ethics. Future research should focus on evaluating the long-term impact of pre-engagement training programs, identifying best practices for mitigating systemic and ethical challenges in different operational settings.