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‘A band of brothers’—an exploration of the range of medical ethical issues faced by British senior military clinicians on deployment to Afghanistan: a qualitative study
  1. Elizabeth M Bernthal1,
  2. H J A Draper2,
  3. J Henning3 and
  4. J C Kelly4
  1. 1Academic Department of Military Nursing, Royal Centre for Defence Medicine (Academia and Research) Medical Directorate, Birmingham, UK
  2. 2Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  3. 3The Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine (Academia and Research), Defence Medical Group North, Northallerton, UK
  4. 4Faculty of Health and Social Care, University of Hull, Hull, UK
  1. Correspondence to Lt Col Elizabeth M Bernthal, Academic Department of Military Nursing, Medical Directorate, Royal Centre for Defence Medicine (Research and Academic), ICT Centre, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham, B15 2SQ, UK; SenResFellow.ADMN{at}


Aims To identify and explore features of ethical issues that senior clinicians faced as deployed medical directors (DMDs) to the British Field Hospital in Afghanistan as well as to determine the ethical training requirements for future deployments.

Method A qualitative study in two phases conducted from November 2014 to June 2015. Phase 1 analysed 60 vignettes of cases that had generated ethical dilemmas for DMDs. Phase 2 included focus groups and an interview with 13 DMDs.

Findings Phase 1 identified working with limited resources, dual conflict of meeting both clinical and military obligations and consent of children as the most prevalent ethical challenges. Themes found in Phase 2 included sharing clinical responsibilities with clinicians from other countries and not knowing team members' ways of working, in addition to the themes from Phase 1.

Discussion This study has drawn together examples of scenarios to form a repository that will aid future training. Recommendations included undertaking ethics training together as a team before, during and after deployment which must include all nationalities who are assigned to the same operational tour, so that different ethical views can be explored beforehand.


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  • Contributors EMB was responsible for the study conception and design, obtaining funding, drafting of the manuscript; EMB, HJAD, JH and JCK were involved in the data collection; EMB, HJAD, JH and JCK were all involved in the analysis of Phase 1; EMB and JCK were involved in the analysis of Phase 2; JCK obtained ethical clearance; HJAD, JH and JCK critically reviewed the manuscript.

  • Competing interests None declared.

  • Ethics approval University of Hull Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.