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Ethical tensions in delivering Defence Engagement (Health)
  1. Martin Bricknell1 and
  2. J Kelly2
  1. 1Conflict and Health Research Group, Department of War Studies, King's College London, London WC2R 2LS, UK
  2. 2School of Nursing and Midwifery, Faculty of Health and Social Care, University of Hull HU6 7RX, Hull, UK
  1. Correspondence to Professor Martin Bricknell, Conflict and Health Research Group, King's College London–Strand Campus, London, UK; martin.bricknell{at}


This paper considers the potential ethical tensions in the conduct of Defence Engagement (Health) (DE(H)) activities. Multiple academic papers have described the ethical dimensions of topics such as ‘medical rules of eligibility’, cultural differences in clinical behaviour when providing mentoring support to military health professions, MEDCAPS (non-emergency primary care clinics by international military medical personnel direct to the indigenous civilian population) and military medical collaboration with the civilian public health system and humanitarian organisations. After a short summary of principles and perspectives in military healthcare ethics (MHE), this paper considers the ethical risks of DE(H) activities at the strategic, operational and tactical level. The paper closes by discussing how to prepare military healthcare personnel for ethical challenges during DE(H) tasks. This includes considering the wider legal, professional, societal and public health perspectives alongside clinical perspectives in the analysis of an MHE issue. In conclusion, potential MHE issues during DE(H) activities are predictable and personnel should be trained to identify and address them. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Healthcare Engagement.


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  • Twitter @MartinBricknell, @Dr Janet Zimmerman-Kelly@JanetKe33240399

  • Contributors JK and MB both conceived and shared the drafting of this 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.

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