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UCMJ vs Hippocratic Oath

Discussion in 'Medical Students - MD' started by exHoyaFutureMilitaryMD, Feb 22, 2002.

  1. exHoyaFutureMilitaryMD

    exHoyaFutureMilitaryMD Junior Member
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    What are y'all opinions and thoughts on when the Hippocratic Oath comes in clash with Uniform Code of Military Justice?
     
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  3. johnM

    johnM Senior Member
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    Could you explain what the Uniform Code of Military Justice is? and how/when it would conflict with the Hippocratic Oath? I'm planning on starting at USUHS in the fall, but I honestly don't know a great deal about military procedures.

    Personally, I would hope that our military would not push ideals that did not allow doctors to help people the best they can, but I'm sure there are plenty of hypothetical (and maybe real) situations where military docs have to take a side. I would almost certainly take the side of the Hippocratic oath, since I feel that my first obligation is to medicine and helping otheres, a close second to the military and the country as a whole.
     
  4. hosskp1

    hosskp1 Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by exHoyaFutureMilitaryMD:
    <strong>What are y'all opinions and thoughts on the Hippocratic Oath comes in clash with Uniform Code of Military Justice?</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I think you might be getting the UCMJ mixeed up with something else (maybe the Geneva convention). But here is how I see it. EVERY member of the armed forces is subjct to the UCMJ--period. It is a set of laws that every service has to obey-- they are based on laws we already follow with a few things added for being in the military. An officer can arrest an enlisted man-- only for good cause. It is a good thing. The penalties for breaking the law will be a bit differnt-- under the UCMJ, you get a military trial, a court martial and sentance in the military justcie system. There are really no times when the Hippocratic Oath interferes with the UCMJ-- I would like to hear a particular case if you have one (if you have any specific stories, please tell me).

    Physicians in the military have a specific mission-- treat patients to the best of their ability. They usually do this without any trouble. As for choosing between the Hippocratic oath and the UCMJ-- you do not have to choose. Remember-- you are a soldier with a specific skill(medicine). You need to be good at both and by being a good soldier, it will help you be a good doctor. I do not see it any other way.

    IF you want to know about the Geneva convention-- all you have to know is that Physicians are considered non-combatants(and detainees if taken prisoner, not POWs). IF taken prisoner, you may have to treat enemy patients, but you should because that is what is expected of you being a non-combatant. When you are returned to our side--it will not be held against you for treating enemy patients. If our soldiers bring you an enemy patient to your station-- you treat them and let someone else deal with their status(again-- part of being a noncombatant).

    This is only my understanding of military matters-- any correction would be appreciated. I am an HPSP student and I am going to be an officer. I take that responsibilty seriously so I would like to know as much as possible on this.
     
  5. Teufelhunden

    Teufelhunden 1K Member
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    hosskp1 made some very good points to which I'd like to add...

    I was in the Marine Corps for 6 yrs before starting college...I'm a 1st year med student now on a Navy HPSP scholarship...anyway, during desert storm there was an argument surrounding this issue that wouldn't go away:

    Each Marine platoon had a Navy Corpsman attached to the platoon to provide combat medical support...well, according to the Geneva convention, if a firefight produces casualties on BOTH sides, the Corpsman (or physicain if there happens to be one) is supposed to triage based solely on medical need, with no regard to whether the patient is friend or foe...some Corpsman felt strongly about upholding this, and others felt that we (U.S. servicemen) would be treated first...PERIOD. Obviously, if you were a Marine, you would want your Corpsman to have the latter philosophy.

    I have to say that, having been on the front-line myself, I approach this issue from a slightly different perspective than many of my colleagues in military medicine, and is an issue I will continue to struggle with.
     
  6. LR6SO4

    LR6SO4 Senior Member
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    Wow. I'm not in the military, but I would struggle having to treat the enemy. In fact this was brought up after Sept.11 at my school in a lecture. Some liberal professor was telling us how our duty is to treat everyone regardless of race, creed, etc. (and I agree) but then he made the point that if Osama Bin Laden walked into the ER, we would have to treat him as well. Obviously a poor choice of words on his part and I among a few (yes only a few) others disagreed.

    My thinking is that since he committed such a heinous crime then the Hippocratic oath still applies, but I would take off my white coat, go to the gun check locker, and take care of business. If a court found me guilty so be it.
     
  7. Teufelhunden

    Teufelhunden 1K Member
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    LR6SO4, I completely understand where you're coming from....I'll share a foxhole with you any day.

    I wonder if your professor understands what esprit de corps is...the common spirit existing in the members of a group and inspiring enthusiasm, devotion, and strong regard for the honor of the group...more simply put, it's the reason why people jump on grenades to save their platoon, or rush an enemy machine-gun bunker even when it means certain death. Military medical personnel are included in that espirit de corps...that camaraderie....your liberal professor may be a brilliant person, but he will sadly never understand that.

    So, according to your professor, when one of your brothers-in-arms is lying on a battlefield with a sucking chest wound...you look him in the eye and say "Sorry bro, I need to go over to the other side to see if the enemy needs any bandaids."

    I'll tell you what....if I'm ever called to serve as a physician on the battefield, the brave men and women fighting will NEVER have to worry about who my first priority is.
     
  8. hosskp1

    hosskp1 Senior Member
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    I was presenting the way it was taught to me. These rules are new to me, but they do make some sense. However, If there was a time when there was a finite amount of resources and one of our soldiers had a sucking chest wound, I would use my resources to treat the US soldier first, then I will check about any enemy injuries. I do not believe that any doctor in the US armed forces would ever leave a person with a life threatening injury to check on enemey wounded. I will treat who comes to me--- I hope that it is just US military personnel or if on a humanitarian mission, civilians who need help.

    Some missions the medical personnel go on have nothing to do with war-- they are humanitarian missions after a natural disaster or famine. Then the goal might be to help the civilian population. Then there are no enemy personnel-- so there is nothing to worry about.
     
  9. BlueFalcon

    BlueFalcon curmudgeon
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    Have you read the Hippocratic Oath lately? It's an anachronistic relic. The second paragraph is my favorite. Sorry ladies, don't see any mention of you in this oath. For your reading pleasure:

    I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

    To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

    I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

    I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

    I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

    Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

    What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

    If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.
     
  10. 8744

    8744 Guest

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    As a Christian, I am not going to take the oath when I graduate. It will be a cold day in hell when I swear anything by pagan gods and false idols.

    And I don't care if it is traditional.
     
  11. exHoyaFutureMilitaryMD

    exHoyaFutureMilitaryMD Junior Member
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    Wow: great discussion so far.

    Teufelhunden:

    SEMPER FI!

    First of all, hats off to you and to the Corp. Reagan's speech writer is right. A lot of us go through life listless and in quiet desperation to search for meaning. I truly believe USMC is best at inspire a meaningful life. If I could do it all over again, I would definitely be a Marine.(folks, realize that one is NOT "in the Marine", but one IS a marine)

    BlueFalcon:

    I think if one reads carefully the Hippocratic Oath, one realizes that this Oath written so long ago still has relevance today. The cultural and social context might have changed, but the nature of the relationship between a physician and his/her patient has not. This leds me to believe that it is in fact NOT a relic of the Greco-Roman world. And if we bring your line of logic further along; would Democracy, another legacy of the Greco-Roman world, a relic?

    I am not even going to address swearing to pagan gods.

    Here is a very real scenario (and probably has happened - many times) clash between the UCMJ and the Hippocratic Oath:

    A serviceman (or woman) got their 3rd DUI. Their superior sent them to a military rehab. The attending psychiatrist, from talking with the service member, discovered a history of depression and alcohol/drug abuse. In further doctor/patient dialog, the psychiatrist found out that the servie member is gay.

    Under UCMJ, and DADTDP, the psychiatrist is required to report the service member. and henceforth a clash between UCMJ and Hippocratic Oath.

    Any thoughts on that scenario?

    SEMPER FI!
     
  12. 8744

    8744 Guest

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    Semper Fi, by the way, to all you former Marines. I was a grunt with Kilo 3/8 and was honorably discharged in 1991 after almost eight years of service.
     
  13. efs

    efs SDN Advisor
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    DADTDP? What is that?

    Under UCMJ the phsycian IS NOT required to report anything. The physiscian patient relationship is privledged, rather like a lawyer-client relationship.

    BlueFalcon brought up one of the best points. The Hippocratic oath really is outdated. In fact many schools do not use the "traditional" Hippocrtic Oath.

    I won't even bother addressing the first section.

    In the second section it says certain things are not allowed, like euthenasia, abortion, and surgery.

    While the military can provide a number of ethical conflicts for medical personnel, it is not a matter of UCMJ or the Hippocratic Oath.
     
  14. Teufelhunden

    Teufelhunden 1K Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">A serviceman (or woman) got their 3rd DUI. Their superior sent them to a military rehab. The attending psychiatrist, from talking with the service member, discovered a history of depression and alcohol/drug abuse. In further doctor/patient dialog, the psychiatrist found out that the servie member is gay.
    Under UCMJ, and DADTDP, the psychiatrist is required to report the service member. and henceforth a clash between UCMJ and Hippocratic Oath.</font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Well, this is an interesting scenerio...and there are a few issues here. First of all, I am slightly at odds with the "You're an officer first, physician second" mentality that was drilled into us at OIS. I fully intent to uphold doctor/patient confidentiality to the greatest extent possible as trust is paramount in a successful doctor/patient relationship. With that said...in this case for example, there is possible drug abuse involved. Now, if this patient is smoking a bowl before going to work as an aircraft mechanic, there are obviously greater issues at stake...I think you all know where I'm going with this...as a military physician, you are also (in a way) a public health/safety officer. In the above scenerio, safety trumps confidentiality.

    Now, how to handle the information pertaining to the patient's sexuality...I don't think there's any issue here that would make it necessary to break doctor-patient confidentiality. How can you possibly practice psychiatry if your patients feel unable to divulge things in fear that transcripts from their sessions might become "People's Exhibit A" in their Court Martial? I exaggerate here only to make a point...your patients are coming to you for help, and it is your obligation as a physician to "first do no harm" (we're back to that oath again). Again, with the exception of safety/public health issues, I believe military docs should respect doctor-patient confidentiality to the upmost.
     
  15. exHoyaFutureMilitaryMD

    exHoyaFutureMilitaryMD Junior Member
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    FYI:

    DADTDP is
    Clinton's "Don't Ask Don't Tell Don't Pursue"..
     
  16. matthew0126

    matthew0126 Anaheim Angels
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    hey guys, keep up all the good work!

    we civilians (well most of us anyways) really appreciate it <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" /> <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" /> <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />
     
  17. BlueFalcon

    BlueFalcon curmudgeon
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    My original quote: "Have you read the Hippocratic Oath lately? It's an anachronistic relic. The second paragraph is my favorite. Sorry ladies, don't see any mention of you in this oath."

    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by exHoyaFutureMilitaryMD:
    <strong>Wow: great discussion so far...

    BlueFalcon:

    I think if one reads carefully the Hippocratic Oath, one realizes that this Oath written so long ago still has relevance today. The cultural and social context might have changed, but the nature of the relationship between a physician and his/her patient has not. This leds me to believe that it is in fact NOT a relic of the Greco-Roman world. And if we bring your line of logic further along; would Democracy, another legacy of the Greco-Roman world, a relic?

    </strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">Hoya,
    Your argument falls flat for several reasons.

    While I did say that the Hippocratic Oath is a relic, I neither said nor implied that it enjoyed this status by virute of its Greek origin. I'm at a loss as to how you drew the conclusion that I think all things that originated with Greco-Roman culture should be discarded.

    I also did not dispute the fact that the Oath has relevance today; however, I think this is balanced with an equal amount of irrelevance. I believe that if one swears an oath, one ought to believe that oath to be entirely relevant and sound; rather than dressing its shortcomings with the bandage of historical/cultural context. Sweraring an Oath is not like going to a smorgasboard where you can fill your plate with what you like while avoiding that which you do not. When you swore your oath to defend the Constitutiion etc. did you examine the historical context of the oath and then use this insight to decide which portions of the oath you would follow and which you would not? I'll suggest that if you did that, then you missed the boat. Certainly any oath that is so out of step with our historical/cultural context as to not account for women physicians has no place as an active player in our historical/cultural context.

    An oath should be held to a higher standard than that it "still has relevance today." At the very least it should be entirely relevant today. There are many other oaths which draw on the Hippocratic Oath's notion of the doctor-patient relationship for inspiration. But they are greatly modified. I think their modification suggests that the original is in fact a relic.
     

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