Reference solution

Moral Questions

1. Can it be morally justifiable that the medical authority permits the patient to proceed despite the risk of another episode of uveitis?
2. Can it be morally justifiable to give the patient medical clearance for the deployment, knowing it may lead to a complicated medical evacuation, which also could put third parties at risk?

Final Actions

Prohibited

• It is never morally acceptable to issue a medical waiver based on non-medical arguments and external interference.

Maybe allowed

• If the patient and the embassy (=employer) are both informed about the medical risk but still consent to it, the medical auhority could refrain from objecting to the assignment

Permissible

• The medical authority can suggest an alternative posting to a place where adequate care could be provided in due time.
• If the patient consents to medical disclosure, it is acceptable to openly explain the medical risks to the employer and agree to issue a medical waiver for the assignment.

Further reflections

This section provides further reflections on aspects of the problem that are not discussed in the short solution provided with the game. This shall help players to think further or to understand how their own solutions fit within a larger picture.

Main ethical issues

The main ethical issues in this scenario are the questions of (1) how much paternalism may be justified to protect the individual's health, (2) how much risk is acceptable with regard to the individual not being able to do his job and as a consequence imposing risks on others, and (3) maybe a bit less important aspects regarding the risk of financial implications in case of an episode of uveitis happding during deployment.

Paternalism

Protecting the health of their patients is one of the central obligations of medical personnel. But at the same time, competent patients do have a right to decide what kinds of treatments (or preventive measures) they want to have and what kinds of risks they are ready to take. This may lead to situations in which a doctor has a different opinion than the patient concerning a treatment or preventive measure. Paternalism in such cases would mean that a doctor imposes a treatment on a patient, or only informs them about some of the medical facts and therapeutic/ preventive options. Such paternalism is ethically problematic. To avoid it, a doctor must rather fully inform a patient about facts, options, risks, etc and then help them to come to an informed consent regarding the treatment, which the informed patient prefers.

• Paternalism in the Stanford Encylopedia

Risk for others vs Medical confidentiality

Another aspect of the scenario, which complicates the question of informed consent, is that in the case the individual will not able to do his job this would probably affect others. And in the context of being deployed or working at a remote embassy such foreseeable risks should be minimized.
Generally, medical information is confidential. This means that a doctor (or HCP more generally) are not allowed to share medical information with other persons unless the patient consents to it. This is also true in military settings. A doctor may for example not share why a soldier is unfit for duty with the command, the doctor may only share the fact that the soldier is unfit for duty.
An exception to the rule of medical confidentiality is usually made if others are immediately at risk due to the health condition of a patient. A psychologist may for example warn others if a patient credibly tells the psychologist he is going to attack them. Things are however less clear with regard to sharing information about infectious diseases etc. Thus, in the present scenario the doctor should only share information about the medical condition (the uveitis) with the command if the patient consents to it.
It is important to see and take into account the difference between the risk to the individual's health (which the individual can consent to) and the risk that may emerge as a side-effect of the individual becoming sick.

• Search for confidentiality in the WMA Code of Medical Ethics

Risk of financial implications

A third aspect that may cause ethical concern is the question of foreseeable risk of high financial (or other) ressources in case of an episode of ueveitis necessitating evacuation or the like. This could be deemed relevant to the extent that the ressources are much higher than if an episode occurs at home or compared to other usually accepted spendings for deployed personnel.

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