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Legal framework versus moral framework: military physicians and nurses coping with practical and ethical dilemmas
  1. Francesca Baukje Hooft1,2
  1. 1 History and Art History, Utrecht University, Utrecht, The Netherlands
  2. 2 Netherlands Institute of Military History, The Hague, The Netherlands
  1. Correspondence to Francesca Baukje Hooft, History and Art History, Utrecht University, Utrecht 3512 JE, The Netherlands; f.b.hooft{at}


Within military operations, military physicians and nurses experience a dual loyalty to their professional identities. The moral frameworks of the medical and military professions are not similar, and require different kinds of choices and action from its members. But above all, the legal framework in which the healthcare personnel has to operate while deployed is different from the medical moral standards. Military necessity is prioritised over medical necessity. In debates on dual loyalty, legal frameworks should be considered as a more decisive factor in ethical decision-making processes. Legal frameworks, both general and mission-specific, support this prioritisation of military necessity, complicating the work of military physicians and nurses. During the post-Cold War era, in which neutrality and moral supremacy have served as legitimising factors for military peacekeeping or humanitarian missions, this misalignment between the moral and the legal framework is problematic. What is legally correct or justifiable may not be morally acceptable to either the medical professional standards or to the general public. The legal framework should be given more prominence within the debates on dual loyalty and military medical ethics. This paper argues that the misalignment between the legal and moral framework in which deployed healthcare personnel has had to operate complicated ethical decision-making processes, impeded their agency, and created problems ranging from military operational issues to personal trauma and moral injury for the people involved, and ultimately decreasing the legitimacy of the armed forces within society.

  • military ethics
  • medical ethics
  • legal framework
  • professional identity
  • military history
  • ethical dilemmas
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  • Contributors FBH is the sole author of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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