Dual loyalty issues confront health and welfare professionals in immigration detention centres in Australia. There are four apparent ways they deal with the ethical tensions. One group provides services as required by their employing body with little questioning of moral dilemmas. A second group is more overtly aware of the conflicts and works in a mildly subversive manner to provide the best possible care available within a harsh environment. A third group retreats by relinquishing employment in the detention (...) setting. A fourth group is activist in intent and actions. Derived from research and ethnography conducted in Australia, the article explores the moral dilemmas confronting those who are duty-bound by professional codes of ethics while also bound by loyalty to their employers and silenced by confidentiality statements. It provides particular focus on psychiatry, nursing and social work. We conclude by speculating whether a politics of compassion and acts of solidarity can forge a pathway through the ethical terrain. In doing so we draw upon human rights considerations as well as on the works of Joan Tronto and Elisabeth Porter. (shrink)

Military doctors and nurses, working neither as pure soldiers nor as merely doctors or nurses, may face a ‘role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command’. This conflict is commonly called dual loyalty. This chapter gives an overview of the military and the medical ethic and of the (...) resulting dual loyalty problem for medical personnel working in the military. It considers how dual loyalties relate to being a professional, something medical personnel are the paradigmatic examples of, but also something military personnel claim to be. Against that background, the chapter elaborates on the medical rules of eligibility used in Afghanistan, and on the policies concerning military involvement in local healthcare, to see what the existing rules and policies are, and whose interests they serve. (shrink)

Dual loyalty refers to the common emotional experience of being pulled in two different directions. It consists of a collective state of mind such that diasporas feel they owe allegiance to both host country and homeland. The study explored the theme of dual loyalties in an Arab American novel, Scattered Like Seeds , by Shaw J. Dallal. The paper used the qualitative research design involving literary criticism. The results showed that dual loyalties can be usual in (...) terms of their occurrence as a diagnostic phenomenon, but they are unusual and melodic in terms of their effects on the psychology and the social portion of the people affected. The study concludes that dual loyalty as exemplified by Thafer, reaches a point where one belongs to both and none; unable to entirely side with one, Thafer is not accepted by either he is viewed as an American by the Arabs and an Arab by the Americans. Dual loyalty is like a hyphen, a portion that enables one to impartially see the deformities of each culture. KEYWORDS: Literature, dual loyalties, Arab American novel, literary criticism, USA. (shrink)

Wars must be won if our country … is to be protected from unthinkable outcomes, as the events on September 11th most recently illustrated…. This best protection unequivocally requires armed forces having military physicians committed to doing what is required to secure victory…. As opposed to needing neutral physicians, we need military physicians who can and do identify as closely as possible with the military so that they, too, can carry out the vital part they play in meeting the needs (...) of the mission.Counterpoint:We believe the role of the “physician–soldier” to be an inherent moral impossibility because the military physician, in an environment of military control, is faced with the difficult problems of mixed agency that include obligations to the “fighting strength” and … “national security.”. (shrink)

When militaries mention loyalty as a value they mean loyalty to colleagues and the organisation. Loyalty to principle, the type of loyalty that has a wider scope, plays hardly a role in the ethics of most armed forces. Where military codes, oaths and values are about the organisation and colleagues, medical ethics is about providing patient care impartially. Being subject to two diverging professional ethics can leave military medical personnel torn between the wish to act loyally (...) towards colleagues, and the demands of a more outward looking ethic. This tension constitutes a test of integrity, not a moral dilemma. (shrink)

Although Australia has comparatively few individuals seeking asylum, it has had a mandatory detention policy in place since 1992. This policy has been maintained by successive governments despite the overwhelmingly negative impact mandatory detention has on mental health. For mental health professionals working in this environment, a number of moral, ethical, and human rights issues are raised. These issues are discussed here, with a focus on dual loyalty conflicts and drawing on personal experience, the bioethics and human rights (...) literature, and recent parliamentary inquiries. For those who continue to work in this environment, future directions are also discussed. (shrink)

There are a range of ethical issues that confront physicians in times of war, as well as some of the uses of physicians during wars. This book presents a theoretical apparatus which undergirds those debates, namely by casting physicians as being confronted with dual-loyalties during times of war. While this theoretical apparatus has already been developed in other contexts, it has not been specifically brought to bear on the ethical conflicts that attain in wars. Arguably, wars thrust physicians into (...) ethical conflicts insofar as these wars create a tension between a physician's obligation to heal and an obligation to serve some other good (e.g., military chain of command, national security, the greater good, etc.). Alternatively, we can debate whether this conception is appropriate. For example, one could argue that that non-medical duties cannot attach to physicians (e.g., due to nonoverlapping spheres of justice), thus abrogating the dual-loyalty challenge. Or else one could argue that these medically-trained personnel do not act qua physicians at all (but rather partisan advocates) and therefore duties that would otherwise attach to physicians do not attach here. In the first part of this book, these issues are debated. In the second part of the book, the dual-loyalities frame is used to explore various substantive debates that obtain when the military makes use of physicians. Physician involvement in torture is a heated topic, and certainly the most visible element of the debate. Also, however, we could use the dual-loyalties framework to explore issues in other arenas, such as: development of chemical and biological weapons, medical neutrality/battlefield triage, and so on. In each of these cases, the same tensions arguably exist: physicians have duties both to their patients and elsewhere (which, depending on the details of the view, could be any of the above-mentioned ends). (shrink)

Background Post-September 11, 2001, the U.S. government has labeled thousands of Afghan war detainees "unlawful combatants". This label effectively deprives these detainees of the protection they would receive as "prisoners of war" under international humanitarian law. Reports have emerged that indicate that thousands of detainees being held in secret military facilities outside the United States are being subjected to questionable "stress and duress" interrogation tactics by U.S. authorities. If true, American military physicians could be inadvertently becoming complicit in detainee abuse. (...) Moreover, the American government's openly negative views towards such detainees could result in military physicians not wanting to provide reasonable care to detainees, despite it being their ethical duty to do so. Discussion This paper assesses the physician's obligations to treat war detainees in the light of relevant instruments of international humanitarian law and medical ethics. It briefly outlines how detainee abuse flourished in apartheid South Africa when state physicians became morally detached from the interests of their detainee patients. I caution U.S physicians not to let the same mindset befall them. I urge the U.S. medical community to advocate for detainee rights in the U.S, regardless of the political culture the detainee emerged from. I offer recommendations to U.S physicians facing dual loyalty conflicts of interest in the "war on terror". Summary If U.S. physicians are faced with a conflict of interest between following national policies or international principles of humanitarian law and medical ethics, they should opt to adhere to the latter when treating war detainees. It is important for the U.S. medical community to speak out against possible detainee abuse by the U.S. government. (shrink)

Background Post-September 11, 2001, the U.S. government has labeled thousands of Afghan war detainees "unlawful combatants". This label effectively deprives these detainees of the protection they would receive as "prisoners of war" under international humanitarian law. Reports have emerged that indicate that thousands of detainees being held in secret military facilities outside the United States are being subjected to questionable "stress and duress" interrogation tactics by U.S. authorities. If true, American military physicians could be inadvertently becoming complicit in detainee abuse. (...) Moreover, the American government's openly negative views towards such detainees could result in military physicians not wanting to provide reasonable care to detainees, despite it being their ethical duty to do so. Discussion This paper assesses the physician's obligations to treat war detainees in the light of relevant instruments of international humanitarian law and medical ethics. It briefly outlines how detainee abuse flourished in apartheid South Africa when state physicians became morally detached from the interests of their detainee patients. I caution U.S physicians not to let the same mindset befall them. I urge the U.S. medical community to advocate for detainee rights in the U.S, regardless of the political culture the detainee emerged from. I offer recommendations to U.S physicians facing dual loyalty conflicts of interest in the "war on terror". Summary If U.S. physicians are faced with a conflict of interest between following national policies or international principles of humanitarian law and medical ethics, they should opt to adhere to the latter when treating war detainees. It is important for the U.S. medical community to speak out against possible detainee abuse by the U.S. government. (shrink)

This survey set out to explore occupational health professionals' courses of action with respect to privacy in a situation of dual loyalty between employees and employers. A postal questionnaire was sent to randomly selected potential respondents. The overall response rate was 64%: 140 nurses and 94 physicians returned the questionnaire. Eight imaginary cases involving an ethical dilemma of privacy were presented to the respondents. Six different courses of action were constructed within the set alternatives proposed. The study indicated (...) that privacy as an absolute value is not in the interest of either employees or employers. It also showed that, where dual loyalty is concerned, the most valid course of action in dealing with sensitive subjects such as drug and work community problems, sexual harassment and sick leave is to rely on tripartite co-operation. If they maintain their professional independence and impartiality, health professionals are well placed to succeed in this challenging task; if not, there are bound to be severe violations of privacy. (shrink)

Most professionals have the arduous task of managing their own dual loyalty: in one contextual relationship, they are members of a profession while simultaneously they are employed as members of a locally established organisation. This sense of a dual loyalty has to be taken into account when professional bureaucracies develop ethics programmes. This article focuses on universities. Accounting for the dual loyalty of academic professionals, it is the objective of the study to contribute to (...) the most appropriate ethics programmes in such an academic context. Based on a review of the literature, we identify which ethical issues commonly emerge in educational and research activities. Then we offer a conceptual analysis of the conditions required for each different strategy of ethics management. We argue that none of the four theoretically derived strategies is applicable solely on its own. For universities it is most promising to design ethics programmes based on the guiding values of the academic community, including integrity measures for universities and corrective measures for students. The argument developed in this article is assumed to be widely applicable in assessing the appropriateness of ethics management strategies in other professional settings. (shrink)

The present article focuses on the case of the 2012 hunger-strike of Palestinian prisoners in Israeli jails. We analyze the ethical dilemma involved in the way the Israeli medical community reacted to these hunger-strikes and the question of force feeding within the context of the fundamental dual-loyalty structure inherent in the Israeli Prison Services—system. We argue that the liberal perspective that focuses the discussion on the dilemma between the principle of individual autonomy and the sanctity of life tends (...) to be oblivious to the asymmetrical relation of power that characterizes the prison system and to the socio-political context in which hunger-strikes take place. Emphasizing hunger-strikes as political acts implies that health practitioners’ conducts cannot be analyzed only through the prism of clinical medical ethics. It requires a public health ethics’ approach, an approach that understands health in the context of the complex relationship between society, state, organizations, communities and individuals. The authors are both academics and volunteers in Physicians for Human Rights—Israel thus our analysis is based both on sociological and public health ethics principles and on the continuous work and advocacy for the right to health of prisoners. (shrink)

ABSTRACTTeam physicians have a complicated job that involves potentially conflicting obligations to multiple entities. Though responsible for the medical care of the athletes as individuals, they also have obligations to the team that employs them which can include returning athletes to play who are at heightened risk of re-injury. The fact that the athletes and owners have some overlapping interests only complicates this issue. Further, there are strong financial incentives to do what is necessary to obtain and keep a position (...) as a team physician. This article examines dual loyalty and conflict of interest in sports medicine, and argues that there is not now a widely accepted or adequate solution to either. Moving toward a solution will require fairly serious changes in the role of the team physician.Abbreviations: FIMS International Federation of Sports Medicine; NFL National Football League; MVP Most Valuable Player; RGIII Robert Griffin, III. (shrink)

Background: Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. Methods: This qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated (...) persons using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. Results: We first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: respecting the patient’s pace and perceived coercion; patient health needs to be first priority; clarity in roles and responsibilities; and the art of communication – between transparency and unchecked information sharing. Discussion: Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings. (shrink)

BackgroundMental health professionals (MHP) working in court-mandated treatment settings face ethical dilemmas due to their dual role in assuring their patient’s well-being while guaranteeing the security of the population. Clear practical guidelines to support these MHPs’ decision-making are lacking, amongst others, due to the ethical conflicts within this field. This qualitative interview study contributes to the much-needed empirical research on how MHPs resolve these ethical conflicts in daily clinical practice. Methods31 MHPs working in court-mandated treatment settings were interviewed. The (...) interviews were semi-structured and our in-depth analysis followed the thematic analysis approach.ResultsWe first outline how mental health professionals perceive their dual loyalty conflict and how they describe their affiliations with the medical and the justice system. Our findings indicate that this positioning was influenced by situational factors, drawing the MHPs at times closer to the caring or controlling poles. Second, our results illustrate how participating MHPs solve their dual loyalty conflict. Participants considered central to motivate the patient, to see the benefits of treatment and its goals. Further, transparent communication with patients and representatives of the justice system was highlighted as key to develop a trustful relationship with the patient and to manage the influences from the different players involved. ConclusionsEven though individual positioning and opinions towards dealing with the influences of the justice system varied, the results of our research show that, in spite of varying positions, the underlying practice is not very different across participating MHPs. Several techniques that allow developing a high-quality therapeutic alliance with the patient are key elements of general psychotherapy. Transparency appears as the crucial factor when communicating with the patient and with representatives of the justice system. More specifically, patients need to be informed since the beginning of therapy about the limits of medical confidentiality. It is also recommended to develop guidelines that define the level of detailed information that should be disclosed when communicating with the authorities of the justice system. (shrink)

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation, or signs of torture. Mounting information from many sources, including Pentagon documents, the International Committee of the Red Cross, Amnesty International, Human Rights Watch, etc., indicate that medical personnel failed to maintain medical records, (...) conduct routine medical examinations, provide proper care of disabled and injured detainees, accurately report illnesses and injuries, and falsified medical records and death certificates. Medical personnel and medical information was also used to design and implement psychologically and physically coercive interrogations. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism. (shrink)

Military medical ethics is garnering growing attention today among medical personal in the American and other armies. Short courses or workshops in “battlefield ethics” for military physicians, nurses, medics, social workers, and psychologists address the nature of patient rights in the military, care for detainees, enemy soldiers and local civilians, problems posed by limited resources, ethical questions arising in humanitarian missions, as well as end-of-life issues, ethics consultations, care for veterans, advance directives, and assisted suicide. Although many of these issues (...) are the core subjects of any bioethics curriculum, military medical ethics presents unique challenges to bioethics educators. (shrink)

This essay explores the challenges of dual loyalty in the emergency setting. The author, an emergency room psychiatrist, finds himself caring for a patient who has been detained by U.S. Immigration and Customs Enforcement for potential deportation under circumstances that the author finds unjust. He also recognizes that the patient's reported psychiatric symptoms are likely not of the nature or severity to justify a psychiatric admission that might forestall deportation. While the author has taught the subject of (...) class='Hi'>dual loyalty in medicine for many years, he struggles with the question of how to balance his duties to further his patient's welfare with his legal obligations to the state and the rule of law. (shrink)

This study explorers whether the relative impacts of brand identification and identification with other users of brand pages on brand loyalty vary according to consumers’ regulatory focus. By integrating social identification theory with regulatory focus theory, this study adopts a dual identification framework to compare the differential impacts of promotion regulatory fit and prevention regulatory fit on brand loyalty. Besides, the moderating effects of product type on the relationship between promotion/prevention regulatory fit and brand loyalty are (...) further investigated. Finally, this study uses different combinations of information technology affordances in order to examine their influences on each identification target. The current study adopts a qualitative methodology and involved conducting semi-structured interviews with 27 brand page users in regard to IT affordances and their subdimensions. The research model was empirically tested using a cross-country comparison of data collected from surveys conducted in China and the United States. The results support our hypotheses and confirm the differential effects of promotion and prevention regulatory fit on brand loyalty. Theoretically, our study enhances our understanding of the relative effect of dual identification on brand loyalty on social media. Practically, our study delivers insights for companies into how social media brand pages can be used as a strategic tool to achieve brand values. (shrink)

In Loyalty to Loyalty: Josiah Royce and the Genuine Moral Life, Matthew Foust richly examines the nature of a controversial virtue: loyalty. It is well known that for Royce loyalty was not only a fundamental moral concept but an anthropological one since, in his view, loyalty to a cause allows individuals to become selves, creatures with unity of purpose in life. However, this ground level of loyalty is not the only one existing for him. (...) Simultaneously to a particular cause one must adhere to loyalty to loyalty, a universal cause that is a moral obligation for each human being. Foust attempts to recover this dual aspect of the Roycean conception of loyalty with the purpose of defending his contemporary relevance.. (shrink)

The corporate social responsibility literature has emphasized the importance of both economic and ethical domains of corporate behavior. Analyzing unprecedented survey data from investors in a socially responsible mutual fund, this article considers how economic and ethical concerns shape shareholder investment behavior. In particular, this article analyzes levels of investor fund loyalty, defined as the continued investment in a mutual fund despite the belief that one is earning a lower return on investment. Building upon existing research that shows SR (...) fund assets are more stable than conventional fund assets, this article leverages within respondent comparisons to clarify that dual investors are more loyal to their SR fund than to their conventional fund. This suggests that a corporation’s ethical behavior attracts more patient investment capital, an important consideration for any corporation that is deciding to what degree it should engage in corporate social responsibility. In addition, this article empirically demonstrates that economic motivations reduce SR fund loyalty and that ethical motivations induce SR fund loyalty. This evidence that ethical motivation is associated with fund loyalty advances research on morality in the market by yielding empirical evidence to a largely theoretical debate. (shrink)

A study of the life and works of Denis Diderot in reference to English influences in the eighteenth century. Specifically examines Diderot's life and general relationship to England, his English friends, and his professions as a moralist, philosopher, scientist, encyclopedist, dramatist, novelist, and critic.

Professional Ethics, viewed as a managerial challenge and opportunity in this study, deals with the often overlooked conceptions, actions and behavior of individuals who see themselves both as members of a profession and as members of an organization. Managers have to deal with this dual loyalty and inherent potential for conflict. This is of particular importance for new types of organizations when wanting to develop and sustain an ethical platform for the ultimate goal - assuring that future business (...) decisions of individuals are in "ethical balance" with the organization's own values and goals. (shrink)

: Undoubtedly, in the formation of history, relations between religious structures and political powers, which are shaped within certain principles, have an important place. The course of these relations determines the strength and domain of both sides. This form of relationship, in some cases, evolves in favor of political power, and sometimes manifests itself as a political direction of religious interests. It is possible to see politics as a direction of religion or to use it in the direction of its (...) own interests in the politics that the Soviet Union has implemented since the Second World War. As a matter of fact, the Soviet Union, which has embraced the ideology of official atheism and struggled against religious beliefs, did not stop using religion/church for conjuration in its own interests. In this context, The Soviet leader Stalin has almost reconstructed the Russian Orthodox Church, which he had been trying to destroy since the early years of the Second World War. Even, Moscow has made serious attempts to make Patriarchate the pioneer of the Orthodox world. In this article, we aim to emphasize Stalin’s church politics and reasons. We will also stress the reasons behind the Council of the Orthodox Churches, which Stalin sought to achieve through the Moscow Patriarchate in 1947. Finally, we will touch on the policy of the Fener Greek Patriarch against these developments. Summary: Throughout history, politics of states have been under the influence of religion. Likewise, religions have directed political authority in the direction of their own interests. Sometimes a religion takes the state under its influence; sometimes under a state takes a religion under the influence and they try to use the other one in the interests of itself. Concepts that define religion-state relations have emerged under the influence of experiences experienced over time. Secularism is at the head of the concepts that determine religion-state relations today. What secularism is and how it is practiced is much debated in the scientific circles. Despite all these struggles, however, no binding definition has been reached for all political issues. Certainly, the subjective structure of states plays an important role in regulating religion-state relations. The political ideology adopted by this political structure and the world view varies. Sometimes political structures with official atheist ideology can break the principle of secularism. While these ideologies are ungodly in their nature, they benefit from political interests. As an example, it is possible to show the Soviet Union with an atheist ideology. Because the Soviet regime used religion in the direction of political interests between 1943-1948. The Russian Orthodox Church, which was very active and competent during the reign of Tsarist Russia, lost its power with the Bolshevik Revolution in 1917. The Soviet regime has made the Russian Orthodox Church an illegal institution. The struggle against the church by the regime continued until the Second World War. With the Second World War, Stalin's church politics changed. There is no doubt that this political change has become more than one reason. The first is that the state has entered into a war. Stalin did not want to continue the struggle with religion while the war was going on. Another reason for pushing Stalin for a policy change towards the Church is the anti-Soviet propaganda carried out by the Germans. As a matter of fact, the Germans defined themselves as the savior of the Russian people. It was also alleged that Germany was waging a war against the Soviets in order to free Russian people from communism. Even brochures were taken from the airplanes in this frame. The Germans aimed to break the resistance of the Russian people with this method. Stalin acted to ward off this propaganda of the Germans. Stalin therefore had to keep an eye on church politics and stopped the oppression against the church. In this framework, opportunities were provided for the Russian Orthodox Church. For example, have been approved to organize rites in churches. The priests are encouraged to strengthen hand the people. Also closed churches have been reopened by Stalin. In this way the German propaganda has been wasted. The Second World War ended with the victory of the Soviet Union. Stalin, however, continued to use the church after the war was over. So why did Stalin continue to support the church as an atheist? What were the reasons for pushing Stalin into this policy? Stalin's post-war church policy has multiple causes. The most important of these is spreading the Soviet influence over the entire Balkans and Middle East geography through the Russian Orthodox Church. Undoubtedly this is related to the long-term policies of the Soviets. Because the war has changed all the balances in the world. This has given new opportunities to the Soviets. At the beginning of these, the Orthodox world comes to the Soviet influence. It seems that the steps towards this have been started to be started from 1945. In this context, the Russian Orthodox Church found important activities. For example, the Moscow Patriarch has established relations with other Orthodox Churches. Jerusalem, Athens, Cyprus, Antakya churches were visited. In the end, an attempt was made to collect the Orthodox Council. The struggle of the Western and Eastern bloc emerged after the Second World War divided the Orthodox world into two camps. In this process, the Greek, Cyprus and Jerusalem Orthodox churches under the leadership of the Fener Patriarchate were under American influence. The Serbian, Bulgarian and Antiochian Orthodox Churches under the leadership of the Moscow Patriarchate were under Soviet influence. For these reasons, the Soviet regime, which has been fighting for the Church since the Bolshevik Revolution in 1917, has given up its position. It is understood from this historical fact that a regime adopting irreligion as an official ideology uses religion in its own interests as needed. This indicates that secularism is relative. This study will try to show how the Soviet Union uses the Russian Orthodox Church in its own interests despite the atheism ideology. (shrink)

This article begins with three problems of “dual loyalties” in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics—for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved (...) using a theory of professional ethics absent from medical ethics until now though common outside. Employing a physician—rather than an ordinary officer, some other kind of healer, or scientist—is to enter a sort of “Ulysses contract” requiring the physician’s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing on other fields of practical ethics. (shrink)

Since the mid-1800s, clergy, doctors, other clinicians, and military personnel who specifically facilitate their work have been designated “non-combatants”, protected from being targeted in return for providing care on the basis of clinical need alone. While permitted to use weapons to protect themselves and their patients, they may not attempt to gain military advantage over an adversary. The rationale for these regulations is based on sound arguments aimed both at reducing human suffering, but also the ultimate advantage of the nation-state (...) fielding non-combatant staff. However, this is sometimes not immediately apparent to combatant colleagues. Clinicians in the armed force are also military officers, owing a “dual loyalty” that can create conflict if their non-combatant status is not well understood. Historical examples of doctors breaching their responsibilities include prioritisation of combat capability over the rights of individual soldiers (as occurred when scarce medical resources were allocated to soldiers more likely to return to battle in preference to those most likely to die without them), use of physicians to facilitate prisoner interrogation, medical research or treatment to enhance physical performance at the expense of health, application of Medical Rules of Eligibility according to factors other than clinical need, provision of treatment contingent upon support for military objectives, and use of medical knowledge to enhance weapons. However, not being a combatant party to a conflict does not imply that the non-combatant clinician cannot act in the national interest. Indeed, by adhering to the same universal ethics as their civilian colleagues, military clinicians provide optimal care to their own troops, facilitate freedom of action in host nations, and build positive international relationships during the conflict and in the post-conflict state. (shrink)

Australia has one of the harshest regimes for the processing of asylum seekers, people who have applied for refugee status but are still awaiting an answer. It has received sharp rebuke for its policies from international human rights bodies but continues to exercise its resolve to protect its borders from those seeking protection. One means of doing so is the detention of asylum seekers who arrive in Australia by boat. Health care providers who care for asylum seekers in these conditions (...) experience a conflict of “dual loyalty,” whereby their role in preserving and maintaining the health of patients can run counter to their employment in detention facilities. Many psychiatrists who have worked in the detention setting engage in forms of political activism in order to change the process of seeking refuge. (shrink)

This paper explores ethical questions arising from the work of health practitioners in immigration detention centres in Australia. It raises questions about the roles of professional disciplines and the ways in which they confront dual loyalty issues. The exploration is guided by interviews conducted with health professionals who have worked in asylum seeker detention and an examination of the outsider advocacy role undertaken by the social work profession. The paper discusses the stance taken by individuals and professional associations (...) on participation in controlled settings, including as participant, bystander and advocate, and asks when the provision of care becomes collusion with oppression. (shrink)

BackgroundInternational codes of ethics play an important role in guiding professional practice in developing countries. In the occupational health setting, codes developed by international agencies have substantial import on protecting working populations from harm. This is particularly so under globalisation which has transformed processes of production in fundamental ways across the globe. As part of the process of revising the Ethical Code of the International Commission on Occupational Health, an Africa Working Group addressed key challenges for the relevance and cogency (...) of an ethical code in occupational health for an African context through an iterative consultative process.DiscussionFirstly, even in the absence of strong legal systems of enforcement, and notwithstanding the value of legal institutionalisation of ethical codes, guidelines alone may offer advantageous routes to enhancing ethical practice in occupational health. Secondly, globalisation has particularly impacted on health and safety at workplaces in Africa, challenging occupational health professionals to be sensitive to, and actively redress imbalance of power. Thirdly, the different ways in which vulnerability is exemplified in the workplace in Africa often places the occupational health professional in invidious positions of Dual Loyalty. Fourth, the particular cultural emphasis in traditional African societies on collective responsibilities within the community impacts directly on how consent should be sought in occupational health practice, and how stigma should be dealt with, balancing individual autonomy with ideas of personhood that are more collective as in the African philosophy of ubuntu. To address stigma, practitioners need to be additionally sensitive to how power imbalances at the workplace intersect with traditional cultural norms related to solidarity. Lastly, particularly in the African context, the inseparability of workplace and community means that efforts to address workplace hazards demand that actions for occupational health extend beyond just the workplace.SummaryA stronger articulation of occupational health practice with advocacy for prevention should be an ethical norm. Ethical codes should ideally harmonize and balance individual and community needs so as to provide stronger moral authority guidelines. There is a need to consider an African Charter on Bioethics as complementary and strengthening of existing codes for the region. (shrink)

How can we ensure that players in the National Football League receive excellent health care they can trust from providers who are as free from conflicts of interest as realistically possible? NFL players typically receive care from the club's own medical staff. Club doctors are clearly important stakeholders in player health. They diagnose and treat players for a variety of ailments, physical and mental, while making recommendations to the player concerning those ailments. At the same time, club doctors have obligations (...) to the club, namely to inform and advise clubs about the health status of players. While players and clubs share an interest in player health—both of them want players to be healthy so they can play at peak performance—there are several areas where their interests can diverge, and the divergence presents legal and ethical challenges. The current structure forces club doctors to have obligations to two parties—the club and the player—and to make difficult judgments about when one party's interests must yield to another's. None of the three parties involved should prefer this conflicted approach. We propose to resolve the problem of dual loyalty by largely severing the club doctor's ties with the club and refashioning that role into one of singular loyalty to the player-patient. The main idea is to separate the roles of serving the player and serving the club and replace them with two distinct sets of medical professionals: the Players' Medical Staff and the Club Evaluation Doctor. We begin by explaining the broad ethical principles that guide us and that help shape our recommendation. We then provide a description of the role of the club doctor in the current system. After explaining the concern about the current NFL player health care structure, we provide a recommendation for improving this structure. We then discuss how the club medical staff fits into the broader microenvironment affecting player health. (shrink)

This essay takes a historical view on “citizen science” by exploring its socialist version via the case of a Soviet amateur seismologist Vladimir Mannar. In the wake of the 1948 Ashgabat earthquake, which coincided with Lysenko’s victory in his campaign against genetics, Mannar launched an aborted campaign for a participatory “socialist seismology.” Mannar co-opted Lysenkoist language of science for the people and gained professional status within professional seismology but was shut out by the experts capitalizing on a “big science” imperative (...) of cold war. Mannar’s personal experiences of navigating competing pulls of cold war seismology and his vision of “people’s seismology,” marginalized within increasingly technical and instrumental cold war science, shed light on oxymoronic nature of citizen science, and the clash between participatory vision of science and an increasing reliance on high-level technical expertise. This case provides a vantage point from which to examine the dual nature of citizen science with its dual loyalties, ambiguities, and the constantly renegotiated status of data—the raison d’être and the most tangible outcome of the initiatives unfolded on the outer fringes of academic science. (shrink)

Using an interpretative research approach to ethical and legal literature, it is argued that nursing in the battlefield is distinctly different to civilian nursing, even in an emergency, and that the environment is so different that a duty of care owed by military nurses to wounded soldiers should not apply. Such distinct differences in wartime can override normal peacetime professional ethics to the extent that the duty of care owed by military nurses to their patients on the battlefield should not (...) exist. It is also argued that as military nurses have legal and professional obligations to care for wounded soldiers on the battlefield, this obligation conflicts with following military orders, causing a dual loyalty conflict. This is because soldiers are part of the ‘fighting force’ and must be fit to fight and win the battle. This makes them more of a commodity rather than individual persons with distinct health care needs. (shrink)

Force-feeding of detainees at Guantánamo BayIn April, the US Department of Defense reportedly sent 40 additional military medical personnel, including doctors and nurses, to the Guantánamo Bay Naval Base to carry out the force-feeding of detainees on hunger strike.1 By the end of June, up to 104 of the remaining 166 individuals held in US military detention at Guantánamo were refusing food. The protest against conditions at the base, and the fate of those being held there—including those already cleared for (...) transfer or release—began in February 2013. In June, it was reported that as many as 44 of the hunger strikers were being force-fed by military medical teams.2The response by the US authorities to the hunger strike prompted expressions of outrage from the international medical community.3,4 In April, the American Medical Association wrote to the US secretary of defense, insisting that ‘forced feeding of [competent] detainees violates core ethical values of the medical profession.’5 Adding the voice of the profession in the UK to these calls, at its annual conference in June, the British Medical Association condemned the participation of doctors and nurses in the force-feeding, calling on governments worldwide to ensure that all prisoners have access to confidential, independent medical treatment, and supporting any clinician who challenged cruel, inhuman or degrading treatment. Also in June, the BMA Chairman wrote to President Obama and US secretary of defense, Hagel, urging them to immediately suspend medical involvement in force-feeding at Guantánamo, and to institute an urgent inquiry into how the current situation was allowed to develop.Force-feeding mentally competent adults who are refusing food is a clear violation of medical ethics and is unjustifiable, as articulated by the World Medical Association's Declaration of Malta.6 Doctors with dual loyalties, including military doctors, are bound by the same …. (shrink)

Professional Ethics, viewed as a managerial challenge and opportunity in this study, deals with the often overlooked conceptions, actions and behavior of individuals who see themselves both as members of a profession and as members of an organization. Managers have to deal with this dual loyalty and inherent potential for conflict. This is of particular importance for new types of organizations when wanting to develop and sustain an ethical platform for the ultimate goal – assuring that future business (...) decisions of individuals are in "ethical balance" with the organization's own values and goals. (shrink)

Privacy is a key ethical principle in occupational health services. Its importance is emphasised in several laws, in ethical codes of conduct as well as in the literature, yet there is only very limited empirical research on privacy in the occupational health context. Conceptual questions on privacy in the occupational health context are discussed. The baseline assumption is that, in this context, privacy cannot be approached and examined only from the employee’s vantage point but the employer’s point of view must (...) also be taken into account, and that the concept has several dimensions . Even though privacy is a basic human need, there is no universally accepted definition of the concept and no consensus on whether an organisation can have privacy in the same way as people do. Many of the challenges surrounding privacy in the context of occupational health seem to be associated with the dual loyalties of occupational health professionals towards the employee and employer and with their simultaneous duties of disseminating and protecting information . Privacy is thus not an absolute value, but more research is needed to understand its multidimensional nature in the context of occupational health. (shrink)

Military doctors and nurses, employees with a compound professional identity as they are neither purely soldiers nor simply doctors or nurses, face a role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command (London et al. 2006). In the context of military medical ethics this is commonly called dual loyalty (...) (or, less commonly, mixed agency). Although other professionals in the military, for instance counsellors or lawyers, might experience similar problems of dual loyalties, it seems that the dual loyalties experienced by military medical personnel are particularly testing. (shrink)

This book challenges the World Medical Associationâ (TM)s (WMA) International Code of Ethics statement in 2004, which declared that â ~medical ethics in armed conflict is identical to medical ethics in times of peaceâ (TM). This is achieved by examining the professional, ethical, and legal conflicts in British Military healthcare practice that occur in three distinct military environments. These are (i) the battlefield, (ii) the operational environment and (iii) the non-operational environment. As this conflict is exacerbated by the need to (...) achieve Operational Effectiveness, this book also explores the dual loyalty conflict that Military Health Care Professionals (MHCPs) encounter between following military orders and professional codes of practice. The method used to challenge the WMAâ (TM)s statement and explore these conflicts is the use of real-life problem-solving vignettes, which mirror actual ethical and professional conflicts and dilemmas that may occur in the three environments. The areas of law analysed similarly reflect the difficulties that MHCPs face when caring for the sick and wounded in violent locations when under attack. In particular, the book questions whether it is right for a MHCP to owe their patients a duty of care in hostile environments. This leads on to questioning if any MHCP could be protected by combat immunity where no duty of care is owed to fellow soldiers in the battlefield. The book also questions whether the standard of care should be variable in hostile environments. It also explores the dual loyalty conflict of a wounded senior officer refusing treatment from a junior officer. In addition, it examines the difficulties of a doctor maintaining patient confidentiality when a soldier refuses treatment for a psychological injury but wishes to redeploy to the battlefield. The book successfully challenges the WMAâ (TM)s statement. It also concludes by suggesting that neither a military-focused approach nor a professional healthcare-focused approach towards military healthcare is the best way to solve the dual loyalty conflict. (shrink)

Military physicians are often perceived to be in a position of ‘dual loyalty’ because they have responsibilities towards their patients but also towards their employer, the military institution. Further, they have to ascribe to and are bound by two distinct codes of ethics, each with its own set of values and duties, that could at first glance be considered to be very different or even incompatible. How, then, can military physicians reconcile these two codes of ethics and their (...) distinct professional/institutional values, and assume their responsibilities towards both their patients and the military institution? To clarify this situation, and to show how such a reconciliation might be possible, we compared the history and content of two national professional codes of ethics: the Defence Ethics of the Canadian Armed Forces and the Code of Ethics of the Canadian Medical Association. Interestingly, even if the medical code is more focused on duties and responsibility while the military code is more focused on core values and is supported by a comprehensive ethical training program, they also have many elements in common. Further, both are based on the same core values of loyalty and integrity, and they are broad in scope but are relatively flexible in application. While there are still important sources of tension between and limits within these two codes of ethics, there are fewer differences than may appear at first glance because the core values and principles of military and medical ethics are not so different. (shrink)

Global debates in approaches to HIV/AIDS control have recently moved away from a uniformly strong human rights-based focus. Public health utilitarianism has become increasingly important in shaping national and international policies. However, potentially contradictory imperatives may require reconciliation of individual reproductive and other human rights with public health objectives. Current reproductive health guidelines remain largely nonprescriptive on the advisability of pregnancy amongst HIV-positive couples, mainly relying on effective counselling to enable autonomous decision-making by clients. Yet, health care provider values and (...) attitudes may substantially impact on the effectiveness of nonprescriptive guidelines, particularly where social norms and stereotypes regarding childbearing are powerful, and where providers are subjected to dual loyalty pressures, with potentially adverse impacts on rights of service users. Data from a study of user experiences and perceptions of reproductive and HIV/AIDS services are used to illustrate a rights analysis of how reproductive health policy should integrate a rights perspective into the way services engage with HIV-positive persons and their reproductive choices. The analysis draws on recognised tools developed to evaluate health policies for their human rights impacts and on a model developed for health equity research in South Africa to argue for greater recognition of agency on the part of persons affected by HIV/AIDS in the development and content of policies on reproductive choices. We conclude by proposing strategies that are based upon a synergy between human rights and public health approaches to policy on reproductive health choices for persons with HIV/AIDS. (shrink)

Professional Ethics, viewed as a managerial challenge and opportunity in this study, deals with the often overlooked conceptions, actions and behavior of individuals who see themselves both as members of a profession and as members of an organization. Managers have to deal with this dual loyalty and inherent potential for conflict. This is of particular importance for new types of organizations when wanting to develop and sustain an ethical platform for the ultimate goal – assuring that future business (...) decisions of individuals are in "ethical balance" with the organization's own values and goals. (shrink)

This commentary examines the incursion on the neutrality of medical personnel now taking place as part of the human rights crises in Bahrain and Syria, and the ethical dilemmas which these incursions place not only in front of physicians practicing in those nations, but in front of the international community as a whole.In Bahrain, physicians have recently received harsh prison terms, apparently for treating demonstrators who clashed with government forces. In Syria, physicians are under the same political pressure to avoid (...) treating political demonstrators or to act as informants against their own patients, turning them in to government authorities. This pressure has been severe, to the point that some physicians have become complicit in the abuse of patients who were also political demonstrators.This paper posits that physicians in certain countries in the Middle East during the “Arab Spring,” specifically Syria and Bahrain, are being used as both political pawns and political weapons in clear violation of Geneva Convention and World Medical Association guidelines, and that this puts them into the most extreme sort of “dual loyalty” dilemma. They are being forced to choose between their own safety and well-being and that of their patients – a negative sum scenario wherein there is no optimal choice. As such, an international call for a United Nations inquiry must be made in order to protect the neutrality of medical care and personnel during times of armed conflict. (shrink)